The role of epidemiology in developing nutritional recommendations: past, present, and future.
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Observations of the relations between food choices and health have been made since ancient times, but epidemiology, which can be regarded as the science of systematically studying these relations, has played a key role in official nutritional guidance only in recent years. In the past 20 y the principal goal of nutritional guidance has changed from the prevention of nutritional deficiencies to the prevention of chronic diseases. This evolving purpose of nutritional guidance has demanded that nutritional epidemiology play an increasingly important role. Although no other type of nutritional science can equal epidemiology in the relevance of either the dietary exposures or the health outcomes, substantial problems limit the ability of nutritional epidemiology to convincingly prove causal associations. The classic criteria for causation are often not met by nutritional epidemiologic studies, in large part because many dietary factors are weak and do not show linear dose-response relations with disease risk within the range of exposures common in the population. The most important problem in nutritional epidemiology in the past has been the inaccuracy of dietary assessment. In the future, an additional problem will be the proliferation of hypotheses that can be tested in multiple ways among the many subgroups of the population that can be defined by factors such as age, sex, and genotype. Future progress in our understanding of the relations between diet and health will necessitate improved methods in nutritional epidemiology and a better integration of epidemiologic methods with those used in the clinical nutritional sciences. (+info)
Child mortality in Stockholm during 1885-1910: the impact of household size and number of children in the family on the risk of death from measles.
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Previous studies have associated overcrowding at the household level with increased mortality, especially from airborne diseases. This association may be confounded by associations with adverse socioeconomic conditions or low age at infection. This study investigated the effect of crowding on the risk of measles death. Individual entries in a population-based register and on death certificates for children aged 0-15 years living in one parish in Stockholm in 1885, 1891, and 1910 (n = 36,718) were used to analyze cause-specific and overall death rates in relation to household size and the number of children in the household, using Cox regression analysis. Bivariate analysis identified significant relations between crowding and the cause-specific risk of death, which were subsequently tested while controlling for other known risk factors for childhood death. Significant negative associations between crowding and the risk of death from pneumonia and bronchitis disappeared when controlling for other risk factors. A negative association between the risk of overall death and large household size became significantly positive when controlling for other risk factors. The increased risk of death from measles associated with proxies for crowding remained after controlling for other risk factors. In conclusion, crowding may have a statistically independent effect on the risk of death from measles. (+info)
Handguns as a pediatric problem. 1986.
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Handgun injury is a major cause of morbidity and mortality in American society, particularly for young people. Large numbers of children are affected by handgun violence through the loss of fathers, brothers, and other relatives. Young children are injured and sometimes killed in handgun accidents. Some children and many adolescents are murdered with handguns. Because of their great lethality and very limited ability to provide personal protection, the great burden of handgun injury can best be reduced by making handguns less available. Handgun control cannot reduce rates of crime or interpersonal assault, but it can be expected to reduce the frequency and severity of injury which grows out of these situations, to levels closer to the much lower ones found in other countries. Pediatricians can contribute to this effort, as they have to the efforts to reduce the morbidity and mortality from poisonings and motor vehicle passenger injury. (+info)
The Vineberg legacy: internal mammary artery implantation from inception to obsolescence.
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At a time when cardiac surgery was still approached with hesitation, Arthur M. Vineberg developed the procedure of direct implantation of the internal mammary artery into the left ventricle for the relief of myocardial ischemia. The Vineberg operation, as it became known, had merit but never received broad endorsement from the medical and surgical communities. Its physiologic benefits were inconsistent and for years were documented by little more than anecdotal evidence, until coronary angiography (newly developed by Mason Sones) was able to demonstrate that the procedure did in fact increase perfusion in the diseased heart. This supporting evidence came rather late, for within the next decade direct aortocoronary artery bypass grafting overtook the Vineberg operation as a more efficient means of revascularizing the myocardium. Thousands of patients, however, had benefited from internal mammary artery implantation at a time when options were few; and the procedure was an aggressive move towards current (and similarly aggressive) treatments for myocardial ischemia. Moreover, the characteristics of the myocardium that Vineberg sought to exploit may form the basis for future therapy. A reappraisal of the implant is warranted, as today's physicians and surgeons inherit the last remaining recipients of Vineberg implants. (+info)
Equipment standards: history, litigation, and advice.
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The authors present a concise history of the development of national and international standards for surgical equipment. Standards-writing organizations, surgical and other specialty societies, universities, test houses, and the U.S. government have influenced this process, which is now manifested in complex interactions between national and international standards-writing organizations, and in CE (Conformite Europeene) marks being placed on surgical equipment in the United States and elsewhere. The history of litigation in standards development is also reviewed. Recommendations to maximize patient safety and to help ensure successful, cost-effective defense in litigation for surgeons who use equipment and may suffer its malfunctions are given. Overall, the complicated oversight of surgical equipment standards and the approval process appears to be contributing to the improving and outstanding results of U.S. surgery reported by the U.S. government. (+info)
Improvements in workplace safety--United States, 1900-1999.
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At the beginning of this century, workers in the United States faced remarkably high health and safety risks on the job. Through efforts by individual workers, unions, employers, government agencies, scientists such as Dr. Alice Hamilton, and others, considerable progress has been made in improving these conditions. Despite these successes, much work remains, with the goal for all workers being a productive and safe working life and a retirement free from long-term consequences of occupational disease and injury. Using the limited data available, this report documents large declines in fatal occupational injuries during the 1900s, highlights the mining industry as an example of improvements in worker safety, and discusses new challenges in occupational safety and health. (+info)
Paradigms in epidemiology textbooks: in the footsteps of Thomas Kuhn.
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This article attempts to contribute to the debate on the future of epidemiology by combining Thomas Kuhn's ideas on scientific paradigms with the author's observations on some epidemiology textbooks. The author's interpretations were based on his readings of Kuhn's The Structure of Scientific Revolutions, epidemiology textbooks, and papers on the future of epidemiology. Thomas Kuhn's view is that sciences mostly work with a single paradigm driven by exemplars of successful work, and that proposals for paradigm change are resisted. Sciences that are maturing or changing do not have a dominant paradigm. Epidemiology textbooks showed diversity in their concepts, content, and approach. Most exemplars related to etiologic research rather than public health practice. One key focus of the recent controversy regarding the role of epidemiology has been the increasing inability of epidemiology to solve socially based public health problems. Kuhn's views help explain the polarization of views expressed. Kuhn's philosophy of science offers insights into controversies such as whether a paradigm shift is needed or imminent and the gap between epidemiology and public health practice. Interaction between science philosophers, epidemiologists, and public health practitioners may be valuable. (+info)