Springer Series on Epidemiology and Public Health – serie

Therearemanygoodepidemiologytextbooksonthemarket,butmostoftheseare addressedtostudentsofpublichealthorpeoplewhodoclinicalresearchwithe- demiologicmethods. Thereisaneedforashortintroductiononhowepidemiologic methodsareusedinpublichealth,geneticandclinicalepidemiology,becausehealth professionalsneedtoknowbasicepidemiologicmethodscoveringetiologicaswell asprognosticfactorsofdiseases. Theyneedtoknowmoreaboutmethodologythan introductorytextsonpublichealthhavetooffer. Insomehealthfaculties,epidemiologyisnotevenpartoftheteachingcurri- lum. Webelievethistobeaseriousmistake. Medicalstudentsarestudentsofall aspectsofdiseasesandhealth. Withoutknowingsomethingaboutepidemiologythe cliniciansandotherhealthprofessionalscannotreadagrowingpartofthesci- ti cliteratureinanyreasonablycriticalwayandcannotnavigateintheworldof "evidence-basedmedicineandevidence-basedprevention. "Withoutskillsine- demiologicmethodologytheyareinthehandsofexpertsthatmaynotonlyhavean interestinhealth.Some health professionals may believe that only common sense is needed to conductepidemiologicalstudies,butthescienti cliteratureandthepublicdebate onhealthissuesindicatethatcommonsenseisofteninshortsupplyandmaynot thrivewithoutsomeformaltraining. Epidemiologic methods play a key role in identifying environmental, social, and genetic determinants of diseases. Clinical epidemiology addresses the tr- sitionfromdiseasetohealthortowardmortalityorsocialormedicalhandicaps. Publichealthepidemiologyaddressesthetransitionfrombeinghealthytobeingnot healthy. Descriptiveepidemiologyprovidesthediseasepatternthatisneededtolook athealthinabroadperspectiveandtosettheprioritiesright. Epidemiologyisabasic scienceofmedicinewhichaddresseskeyquestionssuchas"Whobecomesill?"and "Whatareimportantprognosticfactors?"Answerstosuchquestionsprovidethe basisforbetterpreventionandtreatmentofdiseases. Many people contributed to the writing of this book: medical students in Denmark,studentsofepidemiologyattheIEAEEPEsummercourseinFlorence, Italy,andstudentsofpublichealthinLosAngeles. Withouttechnicalassistance v vi Preface fromGitteNielsen,JenadeShelley,NinaHoheandPamMasangkaythebookwould neverhavematerialized.LosAngeles,California JornOlsen Odense,Denmark KaareChristensen IowaCity,Iowa JeffMurray Stockholm,Sweden AndersEkbom Contents Part I Descriptive Epidemiology 1 Measures of Disease Occurrence ...3 IncidenceandPrevalence ...4 Incidence...6 RatesandDynamicPopulations ...7 CalculatingObservationTime...9 Prevalence,Incidence,Duration ...10 MortalityandLifeExpectancy ...11 LifeExpectancy ...12 References...13 2 Estimates of Associations ...15 3 Age Standardization...19 4 Causes of Diseases ...23 References...28 5 Descriptive Epidemiology in Public Health...29 GraphicalModelsofCausalLinks ...33 References...35 6 Descriptive Epidemiology in Genetic Epidemiology...37 OccurrenceDatainGeneticEpidemiology ...37 ClusteringofTraitsandDiseasesinFamilies ...38 TheOccurrenceofGeneticDiseases ...40 References...41 7 Descriptive Epidemiology in Clinical Epidemiology...43 SuddenInfantDeathSyndrome(SIDS)...44 CytologicalScreeningforCervixCancer ...45 ChangesinTreatmentofJuvenileDiabetes ...46 References...47 vii viii Contents Part II Analytical Epidemiology 8 Design Options...51 CommonDesignsUsedtoEstimateAssociations...51 EcologicalStudy ...52 Case-ControlStudy...54 CohortStudy ...55 ExperimentalStudy ...56 Reference ...57 9 Follow-Up Studies ...59 TheNon-experimentalFollow-Up(Cohort)Study ...59 StudyingRiskasaFunctionofBMI ...60 LongitudinalExposureData...62 DifferentTypesofCohortorFollow-UpStudies...63 10 Case-Control Studies...67 Case-CohortSampling ...69 DensitySamplingofControls...69 Case-Non-caseStudy...71 PatientControls ...72 SecondaryIdenti cationoftheSourcePopulation ...74 Case-ControlStudiesUsingPrevalentCases...74 WhentoDoaCase-ControlStudy? ...77 References...78 11 The Cross-Sectional Study...79 12 The Randomized Controlled Trial (RCT) ...81 Reference ...

Despite adults’ best preventive efforts, childhood obesity is on the rise in most areas of the world, and with it the prevalence of Type 2 diabetes, hypertension, cardiovascular disease, and other formerly adult-onset conditions. Epidemiology of Obesity in Children and Adolescents takes the global ecological approach that is needed to understand the scope of the problem and its multiple causes and mechanisms, and to aid in developing more effective prevention and intervention programs. In the book’s first half, experts present a descriptive summary of youth obesity trends in ten world regions, broken down by age group, gender, socioeconomic status, and risk factors. Complementing these findings, part two reviews the evidence base regarding the variables, separately and in combination, having the most significant impact on young people’s development of obesity, including:• Genetic and nutrigenomic factors.• Environmental and psychosocial factors, such as family shopping and eating habits and access to healthful foods.• Neuroendocrine regulation.• Prenatal and neonatal factors (e.g., gestational diabetes of the mother).• Dietary factors, from nutrient content to young people’s food preferences.• Physical activity versus sedentary behavior.Epidemiology of Obesity in Children and Adolescents is necessary reading for the range of professionals involved in curtailing this epidemic, including public health specialists, epidemiologists, pediatricians, nurses, nutritionists, psychologists, health educators, and policymakers.

Therearemanygoodepidemiologytextbooksonthemarket,butmostoftheseare addressedtostudentsofpublichealthorpeoplewhodoclinicalresearchwithe- demiologicmethods. Thereisaneedforashortintroductiononhowepidemiologic methodsareusedinpublichealth,geneticandclinicalepidemiology,becausehealth professionalsneedtoknowbasicepidemiologicmethodscoveringetiologicaswell asprognosticfactorsofdiseases. Theyneedtoknowmoreaboutmethodologythan introductorytextsonpublichealthhavetooffer. Insomehealthfaculties,epidemiologyisnotevenpartoftheteachingcurri- lum. Webelievethistobeaseriousmistake. Medicalstudentsarestudentsofall aspectsofdiseasesandhealth. Withoutknowingsomethingaboutepidemiologythe cliniciansandotherhealthprofessionalscannotreadagrowingpartofthesci- ti cliteratureinanyreasonablycriticalwayandcannotnavigateintheworldof "evidence-basedmedicineandevidence-basedprevention. "Withoutskillsine- demiologicmethodologytheyareinthehandsofexpertsthatmaynotonlyhavean interestinhealth.Some health professionals may believe that only common sense is needed to conductepidemiologicalstudies,butthescienti cliteratureandthepublicdebate onhealthissuesindicatethatcommonsenseisofteninshortsupplyandmaynot thrivewithoutsomeformaltraining. Epidemiologic methods play a key role in identifying environmental, social, and genetic determinants of diseases. Clinical epidemiology addresses the tr- sitionfromdiseasetohealthortowardmortalityorsocialormedicalhandicaps. Publichealthepidemiologyaddressesthetransitionfrombeinghealthytobeingnot healthy. Descriptiveepidemiologyprovidesthediseasepatternthatisneededtolook athealthinabroadperspectiveandtosettheprioritiesright. Epidemiologyisabasic scienceofmedicinewhichaddresseskeyquestionssuchas"Whobecomesill?"and "Whatareimportantprognosticfactors?"Answerstosuchquestionsprovidethe basisforbetterpreventionandtreatmentofdiseases. Many people contributed to the writing of this book: medical students in Denmark,studentsofepidemiologyattheIEAEEPEsummercourseinFlorence, Italy,andstudentsofpublichealthinLosAngeles. Withouttechnicalassistance v vi Preface fromGitteNielsen,JenadeShelley,NinaHoheandPamMasangkaythebookwould neverhavematerialized.LosAngeles,California JornOlsen Odense,Denmark KaareChristensen IowaCity,Iowa JeffMurray Stockholm,Sweden AndersEkbom Contents Part I Descriptive Epidemiology 1 Measures of Disease Occurrence ...3 IncidenceandPrevalence ...4 Incidence...6 RatesandDynamicPopulations ...7 CalculatingObservationTime...9 Prevalence,Incidence,Duration ...10 MortalityandLifeExpectancy ...11 LifeExpectancy ...12 References...13 2 Estimates of Associations ...15 3 Age Standardization...19 4 Causes of Diseases ...23 References...28 5 Descriptive Epidemiology in Public Health...29 GraphicalModelsofCausalLinks ...33 References...35 6 Descriptive Epidemiology in Genetic Epidemiology...37 OccurrenceDatainGeneticEpidemiology ...37 ClusteringofTraitsandDiseasesinFamilies ...38 TheOccurrenceofGeneticDiseases ...40 References...41 7 Descriptive Epidemiology in Clinical Epidemiology...43 SuddenInfantDeathSyndrome(SIDS)...44 CytologicalScreeningforCervixCancer ...45 ChangesinTreatmentofJuvenileDiabetes ...46 References...47 vii viii Contents Part II Analytical Epidemiology 8 Design Options...51 CommonDesignsUsedtoEstimateAssociations...51 EcologicalStudy ...52 Case-ControlStudy...54 CohortStudy ...55 ExperimentalStudy ...56 Reference ...57 9 Follow-Up Studies ...59 TheNon-experimentalFollow-Up(Cohort)Study ...59 StudyingRiskasaFunctionofBMI ...60 LongitudinalExposureData...62 DifferentTypesofCohortorFollow-UpStudies...63 10 Case-Control Studies...67 Case-CohortSampling ...69 DensitySamplingofControls...69 Case-Non-caseStudy...71 PatientControls ...72 SecondaryIdenti cationoftheSourcePopulation ...74 Case-ControlStudiesUsingPrevalentCases...74 WhentoDoaCase-ControlStudy? ...77 References...78 11 The Cross-Sectional Study...79 12 The Randomized Controlled Trial (RCT) ...81 Reference ...

Despite adults’ best preventive efforts, childhood obesity is on the rise in most areas of the world, and with it the prevalence of Type 2 diabetes, hypertension, cardiovascular disease, and other formerly adult-onset conditions. Epidemiology of Obesity in Children and Adolescents takes the global ecological approach that is needed to understand the scope of the problem and its multiple causes and mechanisms, and to aid in developing more effective prevention and intervention programs. In the book’s first half, experts present a descriptive summary of youth obesity trends in ten world regions, broken down by age group, gender, socioeconomic status, and risk factors. Complementing these findings, part two reviews the evidence base regarding the variables, separately and in combination, having the most significant impact on young people’s development of obesity, including:• Genetic and nutrigenomic factors.• Environmental and psychosocial factors, such as family shopping and eating habits and access to healthful foods.• Neuroendocrine regulation.• Prenatal and neonatal factors (e.g., gestational diabetes of the mother).• Dietary factors, from nutrient content to young people’s food preferences.• Physical activity versus sedentary behavior.Epidemiology of Obesity in Children and Adolescents is necessary reading for the range of professionals involved in curtailing this epidemic, including public health specialists, epidemiologists, pediatricians, nurses, nutritionists, psychologists, health educators, and policymakers.

This book describes key methods and instruments for assessing diet-related factors, physical activity, social and environmental factors, physical characteristics and health-related outcomes in children and adolescents. These tools were developed and deployed within the framework of the pan-European IDEFICS and I.Family cohort studies. These population-based field studies were funded within the 6th and 7th European Framework Programme, respectively, and were intended to assess the prevalence and aetiology of lifestyle-related diseases in children, focusing on overweight and obesity, and to develop effective strategies for primary prevention. In the course of a decade we undertook a major research endeavour, collecting standardised data from children, families, neighbourhoods, kindergartens, pre-schools and schools in eight European countries, employing a uniform cross-cultural methodology. This resulted in a rich picture of the daily lives and living contexts of children and their families.Studies encompassing childhood and adolescence face the particular challenge of the transitions from pre-school to primary school and from childhood to adolescence; accordingly, the instruments used need to be adapted to different developmental stages while maintaining their comparability across the age range. In young children, questionnaires have to be completed by proxies, usually their parents, while older children, particularly adolescents, can provide a major part of the requested information themselves.This book presents suitable designs, methods and instruments for data collection in studies of children and adolescents. Each chapter explains the development and background of the instruments applied in the surveys and summarises the current state of knowledge. All chapters were written by key experts in their respective research fields. We are grateful for their valuable contributions and their enthusiastic support in producing this book, which also presents survey experiences in which practice does not always follow theory. Participants’ responses can on occasion be unexpected and unpredictable, but meeting these challenges can also enrich epidemiological surveys and yield methodological refinements. We sincerely hope that the book and the online material will be of considerable value to other research teams.

This book allows readers to gain an in-depth understanding of the role of real-world data in pharmacoepidemiology, and highlights the strengths and limitations of the respective databases with regard to pharmacoepidemiological research.Over the past decade, the increasing use of real-world data in pharmacoepidemiological research has been accompanied by a growing recognition of the value of real-world evidence in clinical and regulatory decision-making. Electronic healthcare databases allow analyses of drug and vaccine utilization in routine care after approval, as well as investigations of their comparative effectiveness and safety. They are especially useful for the identification of rare risks and rare drug exposures over long periods of time, and as such sustainably extend the basis for drug safety research.This book provides an introduction to the role of real-world data in pharmacoepidemiological research and the main developments in the last 15years. It also offers a comprehensive overview of the general classification characteristics of databases, together with their strengths and limitations, and a detailed description of 21 individual databases, written by professionals who work with or maintain them.

This book allows readers to gain an in-depth understanding of the role of real-world data in pharmacoepidemiology, and highlights the strengths and limitations of the respective databases with regard to pharmacoepidemiological research.Over the past decade, the increasing use of real-world data in pharmacoepidemiological research has been accompanied by a growing recognition of the value of real-world evidence in clinical and regulatory decision-making. Electronic healthcare databases allow analyses of drug and vaccine utilization in routine care after approval, as well as investigations of their comparative effectiveness and safety. They are especially useful for the identification of rare risks and rare drug exposures over long periods of time, and as such sustainably extend the basis for drug safety research.This book provides an introduction to the role of real-world data in pharmacoepidemiological research and the main developments in the last 15years. It also offers a comprehensive overview of the general classification characteristics of databases, together with their strengths and limitations, and a detailed description of 21 individual databases, written by professionals who work with or maintain them.

This book addresses the origins, determinants and magnitude of the global problem of sedentary behaviour, along with concise yet in-depth solutions for tackling it.As a consequence of major technological advances in modern society, many people find themselves in environments characterized by prolonged sedentary behaviour. Building on the contributions of leading experts in the field, the new edition of this book presents updated knowledge about sedentary behaviour, its medical and public health significance, its correlates and determinants, measurement techniques, and recommendations for addressing this behaviour at the individual, community, environmental, and policy level. The book encompasses current research linking the COVID-19 pandemic to increased levels of sedentary behavior, and it covers global and planetary health aspects of sedentary behavior, highlighting sustainable development goals such as health and well-being for all.Applying a cross-disciplinarymethodology, the book avoids considering physical activity and sedentary behavior as a single continuum, which potentially hampers progress in confronting widespread levels of sedentariness. Rather, the book helps readers better understand how sedentary and physically active behavior co-occur and how the two behaviours have distinct contributing factors. Building on the contributions of distinguished international experts in the field, this thorough resource is a valuable asset and challenges professionals, researchers, students, and practitioners alike to adopt new strategies and expand their reach.

This book addresses the origins, determinants and magnitude of the global problem of sedentary behaviour, along with concise yet in-depth solutions for tackling it.As a consequence of major technological advances in modern society, many people find themselves in environments characterized by prolonged sedentary behaviour. Building on the contributions of leading experts in the field, the new edition of this book presents updated knowledge about sedentary behaviour, its medical and public health significance, its correlates and determinants, measurement techniques, and recommendations for addressing this behaviour at the individual, community, environmental, and policy level. The book encompasses current research linking the COVID-19 pandemic to increased levels of sedentary behavior, and it covers global and planetary health aspects of sedentary behavior, highlighting sustainable development goals such as health and well-being for all.Applying a cross-disciplinarymethodology, the book avoids considering physical activity and sedentary behavior as a single continuum, which potentially hampers progress in confronting widespread levels of sedentariness. Rather, the book helps readers better understand how sedentary and physically active behavior co-occur and how the two behaviours have distinct contributing factors. Building on the contributions of distinguished international experts in the field, this thorough resource is a valuable asset and challenges professionals, researchers, students, and practitioners alike to adopt new strategies and expand their reach.

This comprehensive open access book gives an overview of the core issues in digital public health, with a strong emphasis on prevention, population health, and health systems. It covers a broad spectrum of topics, ranging from theoretical frameworks to legal and ethical issues related to digital public health applications and interventions. With chapters on user-centered technology development, evaluation, participatory approaches in digital public health, and global digital public perspectives, it also presents examples taken from ten essential public health operations. Targeted at researchers in academia, industry, and government, this unique text offers a broad insight into digitalization, a central topic in the current development of public health worldwide.

This book examines the new knowledge that has been gained from the objective monitoring of habitual physical activity by means of pedometers and accelerometers. It reviews current advances in the technology of activity monitoring and details advantages of objective monitors relative to physical activity questionnaires. It points to continuing gaps in knowledge, and explores the potential for further advances in the design of objective monitoring devices.Epidemiologists have studied relationships between questionnaire assessments of habitual physical activity and various medical conditions for some seventy years. In general, they have observed positive associations between regular exercise and good health, but because of inherent limitations in the reliability and accuracy of physical activity questionnaires, optimal exercise recommendations for the prevention and treatment of disease have remained unclear. Inexpensive pedometers and accelerometers now offer the epidemiologist the potential to collect relatively precisely graded and objective information on the volume, intensity and patterns of effort that people are undertaking, to relate this data to past and future health experience, and to establish dose/response relationships between physical activity and the various components of health. Such information is important both in assessing the causal nature of the observed associations and in establishing evidence-based recommendations concerning the minimal levels of daily physical activity needed to maintain good health.

This book provides an introduction to the common research methodology specific to clinical epidemiology for both students and researchers. The goal of the book is to fill the gap left by texts that concentrate on public health epidemiology and focuses on what is not covered well in such publications. The four sections of the book cover methods that have not previously been brought together in one volume and serve as a second level textbook of clinical epidemiology methods. Some of the most important topics included in this volume are: clinical agreement in quantitative measurements, interpretation of diagnostic tests, sample size considerations, modelling time-to-event data and meta-analysis. The book will be useful for clinical researchers as well as for postgraduate students in clinical epidemiology. In this second edition, sections related to modeling of binary outcomes and research synthesis methods have been extensively updated.

This book examines the new knowledge that has been gained from the objective monitoring of habitual physical activity by means of pedometers and accelerometers. It reviews current advances in the technology of activity monitoring and details advantages of objective monitors relative to physical activity questionnaires. It points to continuing gaps in knowledge, and explores the potential for further advances in the design of objective monitoring devices.Epidemiologists have studied relationships between questionnaire assessments of habitual physical activity and various medical conditions for some seventy years. In general, they have observed positive associations between regular exercise and good health, but because of inherent limitations in the reliability and accuracy of physical activity questionnaires, optimal exercise recommendations for the prevention and treatment of disease have remained unclear. Inexpensive pedometers and accelerometers now offer the epidemiologist the potential to collect relatively precisely graded and objective information on the volume, intensity and patterns of effort that people are undertaking, to relate this data to past and future health experience, and to establish dose/response relationships between physical activity and the various components of health. Such information is important both in assessing the causal nature of the observed associations and in establishing evidence-based recommendations concerning the minimal levels of daily physical activity needed to maintain good health.

This book addresses the origins, determinants and magnitude of the global problem of sedentary behaviour, along with concise yet in-depth solutions for tackling it. As a consequence of major technological advances in modern society, many people find themselves in environments characterized by prolonged sedentary behaviour. Although inadequate exercise has long been known to cause adverse health consequences, sedentary behaviour has recently emerged as a risk factor for the development of numerous chronic diseases and health conditions. Building on the contributions of leading experts in the field, this book presents current knowledge about sedentary behaviour, its medical and public health significance, its correlates and determinants, measurement techniques, and recommendations for addressing this behaviour at the individual, community, environmental, and policy level. Applying a cross-disciplinary methodology, the book avoids considering physical activity and sedentary behavior as a single continuum, which potentially hampers progress in confronting widespread levels of sedentariness. Rather, the book helps readers better understand how sedentary and physically active behavior co-occur and how the two behaviours have distinct contributing factors. Building on the contributions of distinguished international experts in the field, this thorough resource is a valuable asset and challenges professionals, researchers, students, and practitioners alike to adopt new strategies and expand their reach.

This book describes key methods and instruments for assessing diet-related factors, physical activity, social and environmental factors, physical characteristics and health-related outcomes in children and adolescents. These tools were developed and deployed within the framework of the pan-European IDEFICS and I.Family cohort studies. These population-based field studies were funded within the 6th and 7th European Framework Programme, respectively, and were intended to assess the prevalence and aetiology of lifestyle-related diseases in children, focusing on overweight and obesity, and to develop effective strategies for primary prevention. In the course of a decade we undertook a major research endeavour, collecting standardised data from children, families, neighbourhoods, kindergartens, pre-schools and schools in eight European countries, employing a uniform cross-cultural methodology. This resulted in a rich picture of the daily lives and living contexts of children and their families.Studies encompassing childhood and adolescence face the particular challenge of the transitions from pre-school to primary school and from childhood to adolescence; accordingly, the instruments used need to be adapted to different developmental stages while maintaining their comparability across the age range. In young children, questionnaires have to be completed by proxies, usually their parents, while older children, particularly adolescents, can provide a major part of the requested information themselves.This book presents suitable designs, methods and instruments for data collection in studies of children and adolescents. Each chapter explains the development and background of the instruments applied in the surveys and summarises the current state of knowledge. All chapters were written by key experts in their respective research fields. We are grateful for their valuable contributions and their enthusiastic support in producing this book, which also presents survey experiences in which practice does not always follow theory. Participants’ responses can on occasion be unexpected and unpredictable, but meeting these challenges can also enrich epidemiological surveys and yield methodological refinements. We sincerely hope that the book and the online material will be of considerable value to other research teams.

“Methods of Clinical Epidemiology” serves as a text on methods useful to clinical researchers. It provides a clear introduction to the common research methodology specific to clinical research for both students and researchers. This book sets out to fill the gap left by texts that concentrate on public health epidemiology and focuses on what is not covered well in such texts. The four sections cover methods that have not previously been brought together in one text and serves as a second level textbook of clinical epidemiology methodology. This book will be of use to postgraduate students in clinical epidemiology as well as clinical researchers at the start of their careers.

“Methods of Clinical Epidemiology” serves as a text on methods useful to clinical researchers. It provides a clear introduction to the common research methodology specific to clinical research for both students and researchers. This book sets out to fill the gap left by texts that concentrate on public health epidemiology and focuses on what is not covered well in such texts. The four sections cover methods that have not previously been brought together in one text and serves as a second level textbook of clinical epidemiology methodology. This book will be of use to postgraduate students in clinical epidemiology as well as clinical researchers at the start of their careers.

This book is open access under a CC BY-NC-ND 4.0 license.This open access book is the first compilation that reviews a wide range of social determinants of health (SDHs) for non-communicable diseases (NCDs) and healthy ageing in Japan. With the highest life expectancy and the largest elderly population in the world, Japan has witnessed health inequality by region and social class becoming more prevalent since the 2000s. The first half of this volume describes in detail major NCDs, such as cancers, heart and kidney diseases, diabetes, stroke, and metabolic syndrome. The second half, on the other hand, explores various SDHs relating to healthy ageing. All chapters review and focus on SDHs, particularly health inequality associated with socio-economic status and social capital, which are widely addressed in the field of social epidemiology. The book makes the argument that “Health for All” advocated by the WHO should be implemented based on social justice and benefits for the greater society. Public health researchers and policymakers, both in Japan and other nations, will gain scientific evidence from this book to prepare for the coming era as ageing becomes a global issue.