Epidemiology

This book presents a systematic analysis of how BSE policy was made in the UK and EU, 1986%#x2013;2004. The main focus is on the role of scientific expertise, advice, and evidence in policy-making processes, and its use by officials and ministers as a political resource. The central argument is that highly political and highly problematic policy decisions were often misrepresented as based on, and only on, sound science. Those tactics required the selective highlighting of scientific uncertainties. Since many of the most crucial policy-sensitive uncertainties were concealed or discounted, research to diminish those uncertainties was not undertaken. Since the claim had been that it was impossible for BSE-contaminated food to cause a human spongiform encephalopathy, when such cases emerged in 1996, the policy-making regime was comprehensively undermined and a crisis ensued. The BSE policy saga is used to develop and refine a general analytical framework with which science-based policy governance can be analysed, providing resources with which the book specifies the conditions under which such policy-making may achieve and reconcile scientific and democratic legitimacy.

The third edition of this book reviews the global burden of cancer, causes of cancer, and current priorities and future directions in cancer epidemiology and prevention research. The book maintains the structure of previous editions with seventy-two chapters organized into five major sections: Basic Concepts; The Magnitude of Cancer; The Causes of Cancer; Cancer by Tissue of Origin, and Cancer Prevention and Control. The introductory chapters under Basic Concepts highlight the advances in genomic and molecular biology that have applications in morphologic classification of malignant tumors, and in the elucidation of critical genetic events that result in malignant transformation and tumor invasion. The section on the Magnitude of Cancer reviews global patterns of cancer incidence and mortality in relation to country of residence, age, gender, race and ethnicity, and socioeconomic status. The section on The Causes of Cancer reviews the spectrum of environmental, lifestyle and genetic risk factors that are associated with the origin of human cancers. Chapters on Cancer by Tissue of Origin review systematically the demographic, environmental, and host factors that impact the origin and progression of cell-and organ-specific neoplasms. The concluding section, Cancer Prevention and Control, addresses methods and applications for translating epidemiologic, laboratory, and clinical research observations into preventive interventions. Special emphasis is provided on measuring the impact of behavioral interventions on health-promoting practices, as well as governmental policies that regulate environmental carcinogens.

Cancer causes a quarter of all deaths in England and Wales. There is great professional and public interest in cancer trends, but no satisfactory source to which to turn to find information about these trends and explanation of them. It is even more difficult to know where to turn for information on trends in factors causing cancer. This book presents new analyses that bring together data on cancer trends in England and Wales since 1868. Detailed consideration is given to the reasons for changes in rates of cancer, in relation to a wide range of risk factors and preventive factors. Data are presented with figures and tables describing long-term trends in more than fifty factors that may affect the risk of cancer, including AIDS, asbestos exposure, cancer screening, childbearing, diet, smoking, and ultraviolet radiation. Particular attention is given to trends in recent decades, but historical trends are also considered.

The case-control method, and to a lesser extent its case-based variants, have become a most important tool in the armamentarium of today's investigator of health problems. This book addresses a number of general and specific questions dealing with the case-control and other case-based methods, including how to design and implement a case-control study that minimizes biases; how to analyze the data to deal appropriately with confounding and to help identify interactions; how to interpret data from a case-control study; and how to use the method in a variety of problem solving situations. The book provides an exposition of the uses of a study of individual cases as well as case series in epidemiology. It describes the development of the comparative method as a basis for decision making in the health professions. The first part of the book deals with issues of design of the case control and other case based methods such as the case-crossover and case-cohort studies. In this section of the book several issues of design and analysis of case-control studies are presented within a framework for developing an information base for decision making in research and in health care. The second part of the book has a focus on the applications of the method. These include the use of case-control studies in outbreak investigations as well as other acute events such as disasters, the use of the method in health care and health services evaluation, and its use in genetic epidemiology as well as other applications.

This book is concerned with the research and policy analysis of the Global Health Equity Initiative (GHEI). It gives a truly global perspective on health equity, with contributors from each country. Reflecting the purpose of the GHEI itself, this book aims to contribute to the building of global capacity to measure, monitor, and interpret developments in health equity at national and international levels to underpin action. A conscious effort is made to focus analysis on inequities in health status, rather than access to health services, and on health inequities within countries, rather than the more often discussed inequities between countries. Insights about health equity from fields of epidemiology, demography, economics, and social science are brought to life in country studies from Bangladesh, Chile, China, Japan, Kenya, Mexico, Russia, South Africa, Sweden, Tanzania, the United Kingdom, the United States, and Vietnam. The book is organized around four key elements that structure a systematic response to inequities in health: establishing and strengthening share values, describing the health divide and analyzing causes, tackling the root causes of inequities in health, and reducing the negative consequences of ill health and building more equitable health care systems. The last part offers insights into developing the policy response to inequities in health from a global perspective.

Cancer is diagnosed in about 140 per million children in Britain each year. There is a 1 in 500 chance that a child will be affected in the first 15 years of life, the most frequently occurring types of cancer being leukaemia and brain tumours. This book covers the descriptive epidemiology of childhood cancer in Britain through a series of analyses based on data from the National Registry of Childhood Tumours, the largest population-based specialist children's cancer registry in the world. The central four chapters are devoted to detailed analyses of the data. Throughout these chapters, the diagnoses are classified according to the International Classification of Childhood Cancer, Third Edition. First, there is a comprehensive account of national incidence during 1991–2000, with tables of rates and age-incidence graphs for all the major types of childhood cancer. This is followed by an analysis of incidence trends during 1966–2000. The chapter on survival includes a detailed account of survival rates for 1991–2000, analyses of trends during 1966–2000 with a discussion of how they are related to clinical progress, and information on long-term survival. The chapter on mortality gives an account of childhood cancer mortality during 1965–2004. These chapters are preceded by accounts of the history and methodology of the registry, and of the methods used for analyzing the data. The book concludes with a review of past, current and future functions of the registry and uses of its data.

Chronic pain is a major cause of distress, disability, and work loss, and it is becoming increasingly prevalent through the general move towards an ageing population, which impacts dramatically upon society and health care systems worldwide. Due to improvements in health care, it is becoming more common for patients to continue living with long-term illness or disease (rather than these being terminal). Yet little attention has been paid to chronic pain as a public health problem or to the potential for its prevention, even though it can be studied and assessed using concepts and ideas from classical epidemiology. This book takes an unusual approach in making a symptom the focus of public health research and policy. Written by leaders in the field of pain, it fills a gap in current literature by presenting chronic pain in terms of cause, impact, consequence, and prevention. It presents individual conditions as examples of chronic pain, together with chapters that provide overviews on the assessment of pain and methodological issues behind population assessment.

Epidemiology is the science that underpins health and health care, and is concerned with the pattern, frequency, and causes of disease. This book describes and illustrates epidemiology and its applications to policy making, health service planning, and health promotion. This book's first edition developed a conceptual approach to epidemiology, which involves a systematic focus on underlying concepts and fundamental principles, and this edition expands upon this popular method. It emphasizes theories and principles, as the bedrock of methodology, countering the mounting criticism that epidemiology is an atheoretical discipline. The interdependence of epidemiological studies and their essential unit within a theoretical, technical, and ethical framework is an important theme of this book. The emphasis is on interactive learning throughout, with each chapter including learning objectives, both theoretical and numerical exercises, recent examination questions from relevant courses, and a summary. The text is illustrated, with material summarised in tables.

Coronary heart disease is the leading cause of death worldwide affecting millions of people in both developed and developing countries. The dual aims of this book are to review the well-established and emerging risk factors in coronary heart disease (CHD) and to apply this knowledge to public health approaches to disease prevention. The book includes authoritative accounts of studies within a single population and international studies, important areas of methodological development, trials to test preventive strategies, and the application of epidemiological and other knowledge to the development of public health policy for the prevention of widespread disease. It is an all-encompassing work containing contributions from the world authorities in the field. The book is divided into four sections. The introduction reviews advances in the understanding of, and the current status, of risk factors for CHD. Section Two looks at recent global trends and emerging patterns of CHD morbidity and mortality in several countries, and includes chapters on work done under the auspices of the World Health Organisation (WHO) on the global burden of disease in relation to smoking and blood pressure. Section Three focuses on advances in understanding the aetiology of CHD with each chapter focused on a particular risk factor. Section Four explores measures of prevention and intervention in terms of public health policy with specific examples from around the world.