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4.
Artigo em Inglês | MEDLINE | ID: mdl-31527415

RESUMO

Despite the high-demand work environment for field epidemiologists in field epidemiology training programs, little is known about their occupational stress. To identify occupational stress and its related factors, the occupational stress among trainees in field epidemiology training programs in Southeast Asia and Western Pacific regions from 2016 to 2018 was examined using six subscales: Role Overload, Role Insufficiency, Role Ambiguity, Role Boundary, Responsibility, and Physical Environment. Furthermore, the data on the year of training and type of training program as well as the level of burnout, which affects stress-coping strategies, were collected. Fisher's exact tests and logistic regression models were used to examine associations between occupational stress, burnout, the number of years of training, and the type of training program. Sixty-two trainees participated, and there were no significant associations between burnout, the year of training, and type of training program. A burden of occupational stress in Role Overload and Physical Environment was reported by 56% and 53% of respondents, respectively. The trainees affiliated with a university program were less likely to have a burden of occupational stress in Responsibility and Physical Environment. It is concerning that more than half of trainees in the programs experienced occupational stress in Role Overload and Physical Environment. Additional efforts to design improved training programs to reduce occupational stress are warranted.


Assuntos
Epidemiologistas/psicologia , Estresse Ocupacional , Adaptação Psicológica , Ásia , Austrália , Epidemiologistas/educação , Humanos , Saúde Pública , Local de Trabalho
5.
Eur J Epidemiol ; 34(8): 725-730, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161279

RESUMO

A review of epidemiological papers conducted in 2009 concluded that several studies employed variable selection methods susceptible to introduce bias and yield inadequate inferences. Many new confounder selection methods have been developed since then. The goal of the study was to provide an updated descriptive portrait of which variable selection methods are used by epidemiologists for analyzing observational data. Studies published in four major epidemiological journals in 2015 were reviewed. Only articles concerned with a predictive or explicative objective and reporting on the analysis of individual data were included. Method(s) employed for selecting variables were extracted from retained articles. A total of 975 articles were retrieved and 299 met eligibility criteria, 292 of which pursued an explicative objective. Among those, 146 studies (50%) reported using prior knowledge or causal graphs for selecting variables, 34 (12%) used change in effect estimate methods, 26 (9%) used stepwise approaches, 16 (5%) employed univariate analyses, 5 (2%) used various other methods and 107 (37%) did not provide sufficient details to allow classification (more than one method could be employed in a single article). Despite being less frequent than in the previous review, stepwise and univariable analyses, which are susceptible to introduce bias and produce inadequate inferences, were still prevalent. Moreover, 37% studies did not provide sufficient details to assess how variables were selected. We thus believe there is still room for improvement in variable selection methods used by epidemiologists and in their reporting.


Assuntos
Estudos Epidemiológicos , Epidemiologistas , Publicações Periódicas como Assunto , Viés , Humanos , Projetos de Pesquisa
6.
Public Health Rep ; 134(4): 379-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31161923

RESUMO

OBJECTIVES: To better understand the current status and challenges of the state public health department workforce, the Council of State and Territorial Epidemiologists (CSTE) assessed the number and functions of applied public health epidemiologists at state health departments in the United States. METHODS: In 2017, CSTE emailed unique online assessment links to state epidemiologists in the 50 states and the District of Columbia (N = 51). The response rate was 100%. CSTE analyzed quantitative data (27 questions) on funding, the number of current and needed epidemiologists, recruitment, retention, perceived capacity, and training. CSTE coded qualitative data in response to an open-ended question that asked about the most important problems state epidemiologists face. RESULTS: Most funding for epidemiologic activities came from the federal government (mean, 77%). State epidemiologists reported needing 1199 additional epidemiologists to achieve ideal capacity but noted challenges in recruiting qualified staff members. Respondents cited opportunities for promotion (n = 45, 88%), salary (n = 41, 80%), restrictions on merit raises (n = 36, 70%), and losses to the private or government sector (n = 33, 65%) as problems for retention. Of 4 Essential Public Health Services measured, most state epidemiologists reported substantial-to-full capacity to monitor health status (n = 43, 84%) and diagnose and investigate community health problems (n = 47, 92%); fewer respondents reported substantial-to-full capacity to conduct evaluations (n = 20, 39%) and research (n = 11, 22%). CONCLUSIONS: Reliance on federal funding negatively affects employee retention, core capacity, and readiness at state health departments. Creative solutions for providing stable funding, developing greater flexibility to respond to emerging threats, and enhancing capacity in evaluation and applied research are needed.


Assuntos
Fortalecimento Institucional/estatística & dados numéricos , Epidemiologistas/provisão & distribução , Epidemiologistas/estatística & dados numéricos , Epidemiologia/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Adulto , District of Columbia , Humanos , Masculino , Pessoa de Meia-Idade , Governo Estadual , Estados Unidos
7.
Public Health Rep ; 134(4): 386-394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211646

RESUMO

OBJECTIVES: The Council of State and Territorial Epidemiologists (CSTE) has periodically assessed the epidemiological capacity of states since 2001, but the data do not reflect the total US epidemiology capacity. CSTE partnered with the Big Cities Health Coalition (BCHC) in 2017 to assess epidemiology capacity in large urban health departments. We described the epidemiology workforce capacity of large urban health departments in the United States and determined gaps in capacity among BCHC health departments. METHODS: BCHC, in partnership with CSTE, modified the 2017 State Epidemiology Capacity Assessment for its 30 member departments. Topics in the assessment included epidemiology leadership, staffing, funding, capacity to perform 4 epidemiology-related Essential Public Health Services, salary ranges, hiring requirements, use of competencies, training needs, and job vacancies. RESULTS: The 27 (90%) BCHC-member health departments that completed the assessment employed 1091 full-time equivalent epidemiologists. All or nearly all health departments provided epidemiology services for programs in infectious disease (n = 27), maternal and child health (n = 27), preparedness (n = 27), chronic diseases (n = 25), vital statistics (n = 25), and environmental health (n = 23). On average, funding for epidemiology activities came from local (47%), state (24%), and federal (27%) sources. Health departments reported needing a 40% increase from the current number of epidemiologists to achieve ideal epidemiology capacity. Twenty-five health departments reported substantial-to-full capacity to monitor health problems, 21 to diagnose health problems, 11 to conduct evaluations, and 9 to perform applied research. CONCLUSIONS: Strategies to meet 21st century challenges and increase substantial-to-full epidemiological capacity include seeking funds from nongovernmental sources, partnering with schools and programs of public health, and identifying creative solutions to hiring and retaining epidemiologists.


Assuntos
Fortalecimento Institucional/estatística & dados numéricos , Epidemiologistas/provisão & distribução , Epidemiologistas/estatística & dados numéricos , Epidemiologia/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
Am J Epidemiol ; 188(5): 818-824, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30877296

RESUMO

This commentary addresses being an epidemiologist at a time when the field of epidemiology again faces a paradigm shift as the tools for research on human health draw increasingly on emerging technologies-various omics and new methods for collecting individual data at high intensity-and on new methods for carrying out research through administrative and health care data bases linked to biobanks. At the same time, epidemiologists in public health practice continue to face the usual array of challenges, but with the threat of global issues as well. The profession of epidemiologist is not monolithic; it embraces a broad range of activities and professional venues, reflecting the many contexts where epidemiologists do their work, the nature of the problems addressed, and the span and application of their findings. Obtaining data from people and populations comes with serious ethical obligations related to privacy and confidentiality of individuals and respect for the populations studied. Beyond generating and analyzing data, epidemiologists engage in guiding action through the evidence they have created with the ultimate goal of advancing health. This commentary addresses "mega-trends" that will affect the profession in the decades to come.


Assuntos
Epidemiologistas/organização & administração , Epidemiologistas/tendências , Epidemiologia/organização & administração , Epidemiologia/tendências , Prática de Saúde Pública , Confidencialidade , Coleta de Dados/métodos , Epidemiologistas/normas , Epidemiologia/normas , Humanos , Competência Profissional/normas , Papel Profissional
10.
Curr Environ Health Rep ; 6(1): 8-15, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30671781

RESUMO

PURPOSE OF REVIEW: In recent years, investigators in a variety of fields have reported that most published findings can not be replicated. This review evaluates the factors contributing to lack of reproducibility, implications for environmental epidemiology, and strategies for mitigation. RECENT FINDINGS: Although publication bias and other types of selective reporting may contribute substantially to irreproducible results, underpowered analyses and low prevalence of true associations likely explain most failures to replicate novel scientific results. Epidemiologists can counter these risks by ensuring that analyses are well-powered or precise, focusing on scientifically justified hypotheses, strictly controlling type I error rates, emphasizing estimation over statistical significance, avoiding practices that introduce bias, or employing bias analysis and triangulation. Avoidance of p values has no effect on reproducibility if confidence intervals excluding the null are emphasized in a similar manner. Increased attention to exposure mixtures and susceptible subpopulations, and wider use of omics technologies, will likely decrease the proportion of investigated associations that are true associations, requiring greater caution in study design, analysis, and interpretation. Though well intentioned, these recent trends in environmental epidemiology will likely decrease reproducibility if no effective actions are taken to mitigate the risk of spurious findings.


Assuntos
Saúde Ambiental , Epidemiologistas , Epidemiologia , Reprodutibilidade dos Testes , Projetos de Pesquisa , Feminino , Humanos
11.
Genet Epidemiol ; 43(3): 242-249, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30659680

RESUMO

Given the rapid pace with which genomics and other -omics disciplines are evolving, it is sometimes necessary to shift down a gear to consider more general scientific questions. In this line, in my presidential address I formulate six questions for genetic epidemiologists to ponder on. These cover the areas of reproducibility, statistical significance, chance findings, precision medicine and related fields such as bioinformatics and data science. Possible hints at responses are presented to foster our further discussion of these topics.


Assuntos
Epidemiologistas , Genômica , Biologia Computacional , Humanos , Medicina de Precisão , Reprodutibilidade dos Testes
14.
Trials ; 19(1): 440, 2018 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107812

RESUMO

BACKGROUND: Institutional review boards must guarantee the ethical acceptability of a randomized controlled trial before it is conducted. However, some may regard an unbalanced randomization ratio as reflecting an absence of uncertainty between the groups being compared. The objective was to assess institutional review board members' perceptions of whether unbalanced randomization in randomized controlled trials is justified and ethically acceptable. METHODS: Institutional review board members worldwide completed a survey involving clinical vignettes modeling situations classically advocated to explain the use of unbalanced randomization. Institutional review board members were asked whether unbalanced randomization was justified and ethically sound. Answers were collected by using visual analog scales. Data were analyzed by principal component analysis, and a hierarchical ascending classification was created. Verbatim answers were assessed by qualitative content analysis. RESULTS: We analyzed responses from 148 institutional review board members. Three classes of respondents were identified: class 1 (n = 58; 39.2%), mostly skeptics who disagreed with unbalanced randomization, whatever the justification; class 2 (n = 46; 31.1%), believers who considered that unbalanced randomization was acceptable whatever the justification, except cost; and class 3 (n = 44; 29.7%), circumstantial believers for whom unbalanced randomization may be justified for methodological and safety issues but not cost or ethical issues. When institutional review board members were asked whether unbalanced randomization respected the equipoise principle, the mean quotation was low (4.5 ± 3.3 out of 10), especially for class 1 members. CONCLUSIONS: Institutional review board members perceive unbalanced randomization heterogeneously in terms of its justification and its ethical validity.


Assuntos
Atitude do Pessoal de Saúde , Comitês de Ética em Pesquisa/ética , Conhecimentos, Atitudes e Prática em Saúde , Distribuição Aleatória , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Equipolência Terapêutica , Adulto , Epidemiologistas/ética , Epidemiologistas/psicologia , Eticistas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Filosofia Médica , Cirurgiões/ética , Cirurgiões/psicologia , Incerteza
15.
Cancer Epidemiol ; 56: 46-52, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30032027

RESUMO

BACKGROUND: There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics. METHODS: "InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (http://interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites; Breast, Colon, Rectum, Stomach, Melanoma and Lung. RESULTS: Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, individualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of individual risk and differences between various measures. CONCLUSIONS: "InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.


Assuntos
Métodos Epidemiológicos , Epidemiologistas/educação , Neoplasias/mortalidade , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade
19.
Health Policy Plan ; 33(5): 702-706, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29596614

RESUMO

The randomized controlled trial is commonly used by both epidemiologists and economists to test the effectiveness of public health interventions. Yet we have noticed differences in practice between the two disciplines. In this article, we propose that there are some underlying differences between the disciplines in the way trials are used, how they are conducted and how results from trials are reported and disseminated. We hypothesize that evidence-based public health could be strengthened by understanding these differences, harvesting best-practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions.


Assuntos
Economia , Epidemiologistas , Saúde Pública , Ensaios Clínicos Controlados Aleatórios como Assunto , Prática Clínica Baseada em Evidências , Humanos
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