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At least 37 records · Page 2Linked to original sources
PubMed2002

Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods.

OBJECTIVES: To investigate why some women prefer caesarean sections and how decisions to medicalise birthing are influenced by patients, doctors, and the sociomedical environment. DESIGN: Population based birth cohort study, using ethnographic and epidemiological methods. SETTING: Epidemiological study: women living in the urban area of Pelotas, Brazil who gave birth in hospital during the study. Ethnographic study: subsample of 80 women selected at random from the birth cohort. Nineteen medical staff were interviewed. PARTICIPANTS: 5304 women who gave birth in any of the city's hospitals in 1993. MAIN OUTCOME MEASURES: Birth by caesarean section or vaginal delivery. RESULTS: In both samples women from families with higher incomes and higher levels of education had caesarean sections more often than other women. Many lower to middle class women sought caesarean sections to avoid what they considered poor quality care and medical neglect, resulting from social prejudice. These women used medicalised prenatal and birthing health care to increase their chance of acquiring a caesarean section, particularly if they had social power in the home. Both social power and women's behaviour towards seeking medicalised health care remained significantly associated with type of birth after controlling for family income and maternal education. CONCLUSIONS: Fear of substandard care is behind many poor women's preferences for a caesarean section. Variables pertaining to women's role in the process of redefining and negotiating medical risks were much stronger correlates of caesarean section rates than income or education. The unequal distribution of medical technology has altered concepts of good and normal birthing. Arguments supporting interventionist birthing for all on the basis of equal access to health care must be reviewed.

Adult↗
PubMed1983

[Possibilities of the epidemiologic method and various results of a population study of schizophrenia].

Some results of the epidemiological studies on schizophrenia conducted recently by the Epidemiology Department of the Psychiatry Institute, the USSR Academy of Medical Sciences, are summed up. The principal demographic data on schizophrenia, such as its prevalence and forms as well as the pathogenetic role of the sex and age are presented. Taking the paroxysmal forms as a model, the application of the epidemiological method in investigating the course and probable prognosis of schizophrenia is reviewed in greater detail. On the basis of the material from a representative group of patients with paroxysmal schizophrenia of the 15-year duration or over (1461 patients), the basic regularities of the time course of negative and positive disturbances during remission, as well as the specific features of the shift in the clinical forms of paroxysms are demonstrated. Statistical distribution shows that in most patients, the distinctive signs of a given form of the disease course tend to remain unaltered during the whole period of the illness. Apart from reflecting the stability of patterns of the disease course, these findings support the validity of the current schizophrenia differentiation.

Age Factors↗
PubMed1993

An epidemiologic method for assessing the effectiveness of hearing conservation programs using audiometric data.

A hearing conservation program (HCP) must include audiometric monitoring. In keeping with this requirement, enormous bodies of audiometric data have been accumulated. However, only a limited number of methods are available for using audiometric data to assess HCP effectiveness. This study illustrates an epidemiologic method. The risk of developing hearing loss (measured by the standard threshold shift) was compared between study and reference populations using the risk ratio. The study population had an increased risk of nearly 3-fold. Epidemiologic risk comparison methods, using reference populations, offer an alternative to current methods for HCP evaluation using audiometric data.

Adult↗
PubMed2001

Epidemiological methods to assess the correlation between industrial contaminants and rates of congenital anomalies.

The present knowledge of epidemiological methods, applied to assess the correlation between industrial contaminants and rates of congenital anomalies is reviewed. The concept of congenital anomalies may be extended to include other adverse reproductive outcomes, such as malformations, infant mortality, stillbirths, spontaneous abortions, intrauterine growth retardation, ectopic pregnancies, multiple births, altered secondary sex ratio, and parental sub-fertility. The review of occupational exposures associated with congenital anomalies indicated: (1) inconsistency of the reported associations; (2) more positive than negative associations; (3) solvents are the best studied, and the most frequently reported teratogenic chemicals; (4) common congenital anomalies are the most frequently studied diagnostic categories, while other defects are grouped into larger categories, with little biological meaning. The review of environmental exposures indicated that: (1) single-site studies outnumber multi-site ones; (2) results are heterogeneous; (3) congenital anomalies are, in general, unspecific, and grouped into large categories, such as those defined by anatomic systems. Recent developments in molecular biology anticipate the possibility to measure exposures directly, instead of by different "proxies", as well as to analyze the genetic predisposition for the teratogenic response to given environmental agents. The strategy of building up large banks of biological materials has already started in several birth defects registries. The following procedural guidelines to assess the teratogenicity of a pollutant are recommended: (1) strength of the association; (2) consistency of findings in different studies; (3) specificity of the association; (4) time-exposure relationship; (5) existence of a dose-response gradient between exposure and disease occurrence; (6) biological plausibility; (7) coherence of the evidence with natural history of the disease; (8) experimental (or quasi-experimental) evidence and (9) reasoning by analogy.

Congenital Abnormalities↗
PubMedDate not supplied

[Contributions of the epidemiologic method to the rational study of juvenile delinquency].

In this study we analyze some of the contributions of the epidemiological method to the study of juvenile delinquency. We used 68,583 complaints to the Police during 1983-1986 to do so; furthermore, we asked the opinion of the citizens by means of an opinion poll of a representative sample of the population on the subject of public safety. The application of the techniques of Multivariant Analysis (Analysis of the Principal Components) allowed us to reduce the dimensions of the study and fix our attention on 8 specific crimes. We have attempted to design a system, using Predictive Epidemiology, for the evaluation of preventive measures applied to the rational fight against delinquency. Special emphasis is made on the presentation of a system of analysis for the calculation of the real rate of delinquency in a given community.

Epidemiologic Methods↗
PubMedDate not supplied

Hazard identification in occupational injury: reflections on standard epidemiologic methods.

To prevent workplace injuries, epidemiologic research must continue to progress beyond methods originally used for acute or chronic diseases. For injury research, exposure assessment requires increased sophistication because exposures comprise multiple, transient factors and complex work activities. Frequently reported risk factors such as age, gender, seniority, or prior injury are often confounders or effect-modifiers of unknown exposures. Injury rate calculations across nominal categories, e.g., department or job classification, identify where hazards are concentrated but provide little insight into their nature; injury counts often perform almost as well. Calculation of rates in relation to time actually spent in plausible etiologic exposure conditions usually is not feasible. Generalization of the Haddon approach for individual injury events to systematically analyze injury case series can identify both the mechanism of injury and the relative occurrences of high-risk conditions. In some contexts, case-crossover designs may elucidate injury causation. National databases and information systems of employers, insurers, and equipment suppliers could contribute case series for injury hazard identification. By enhancing exposure assessment through a focus on case series, epidemiologic research can expand its contribution to preventing workplace injuries.

Accidents, Occupational↗
PubMed1995

Measurement of skeletal muscle: laboratory and epidemiological methods.

Despite skeletal muscle's central role in the pathogenesis of sarcopenia, measurement methods remain underinvestigated and inadequately validated. Our review indicates that skeletal muscle (SM) measurement methods quantify different components and properties of muscle, ranging from the atomic to whole-body levels of body composition. Laboratory methods tend to measure whole body SM (e.g., total muscle protein, muscle cell mass, and adipose tissue-free SM components) while epidemiological methods tend to measure regional muscle (e.g., anatomic SM of an extremity). Advances in computerized axial tomography and magnetic resonance imaging methods now allow accurate estimates of whole body and regional SM and promise to finally permit comprehensive in vivo studies of SM biology and methodology. These imaging methods may help to resolve many of the confusing issues that surround the investigation of this major body composition component.

Adipose Tissue↗
PubMed1997

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

Clinical Competence↗
PubMed1989

[Epidemiologic methods and their application].

The first part of the paper pertains to the concept of the approach to investigations of health in relation to the living environment. It is based on the fact that man is exposed to the action of basic groups of factors: physical, chemical, biological and psychosocial. Attention is devoted not only to the specific action of individual factors or their groups to the health of man but also to certain general trends, i.e. the influence on the immunobiological status of the organism, the influence on the cardiovascular system and the influence on the genetic apparatus with all sequelae, in particular in the sphere of diseases of civilization. As these factors only rarely act isolated, a comprehensive approach to the problem is essential. In the main part of the paper the principles of the application of epidemiological methods in the sphere of investigations of the health status and living environment are analyzed. The following pattern is used: 1. Descriptive epidemiology (using mortality and morbidity statistics); 2. Analytical epidemiology (prospective and retrospective approach); 3. Experimental epidemiology. The key problem remains assessment of exposure and subsequent effect on health. In conjunction with it certain principles of assessment and monitoring are mentioned as well as advantages and limitation of the basic methods of approach.

Epidemiologic Methods↗