American journal of public health
-
Randomized controlled trials of public health interventions are often complex: practitioners may not deliver interventions as researchers intended, participants may not initiate interventions and may not behave as expected, and interventions and their effects may vary with environmental and social context. Reports of randomized controlled trials can be misleading when they omit information about the implementation of interventions, yet such data are frequently absent in trial reports, even in journals that endorse current reporting guidelines. Particularly for complex interventions, the Consolidated Standards of Reporting Trials (CONSORT) statement does not include all types of information needed to understand the results of randomized controlled trials. CONSORT should be expanded to include more information about the implementation of interventions in all trial arms.
-
Electronic medical record keeping has led to increased interest in analyzing historical patient data to improve care delivery. Such research use of patient data, however, raises concerns about confidentiality and institutional liability. ⋯ We also explored current regulations on patient confidentiality, the need for identifying information in research, and the effectiveness of deidentification and data security. We will present an algorithm for researchers to use to think about the data security needs of their research, and we will introduce a vocabulary for documenting these techniques in proposals and publications.
-
A pandemic of highly pathogenic influenza would threaten the lives of hundreds of thousands in the United States and confront governments and organizations, with ethical issues having wide-ranging implications. The Department of Health and Human Services and all states have published pandemic influenza plans. ⋯ Although some states acknowledged the need for ethical decisionmaking, very few prescribed how it should happen. If faced by a pandemic in the near future, we stand the risk of making many unjust and regrettable decisions.
-
Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices). ⋯ Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society's current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.
-
There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world. The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.