Annals of epidemiology
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Annals of epidemiology · Jun 2018
Addressing refugee health through evidence-based policies: a case study.
The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. ⋯ Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams.
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Annals of epidemiology · Jun 2018
Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi and 2009 Tennessee Pregnancy Risk Assessment Monitoring System.
One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations. ⋯ Although all women should be counseled on postpartum contraceptive use, findings suggest that important subpopulations of women may benefit from more targeted counseling during prenatal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies.
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Annals of epidemiology · May 2018
Historical ArticleExcess mortality patterns during 1918-1921 influenza pandemic in the state of Arizona, USA.
Our understanding of the temporal dynamics and age-specific mortality patterns of the 1918-1921 influenza pandemic remains scarce due to lack of detailed respiratory mortality datasets in the United States and abroad. ⋯ The 1918-1921 influenza pandemic killed an estimated 0.8% of the Arizona population in three closely spaced consecutive waves. The mortality impact of the fall 1918 wave in Arizona lies in the upper range of previous estimates reported for other US settings and Europe, with a telltale age distribution of deaths concentrated among young adults. We identified a significant rise in tuberculosis-related mortality during the pandemic, lending support to the hypothesis that tuberculosis was a risk factor for severe pandemic infection. Our findings add to our current understanding of the mortality impact of this pandemic in the US and globally.
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It is estimated that there are 370 million indigenous peoples in 90 countries globally. Indigenous peoples generally face substantial disadvantage and poorer health status compared with nonindigenous peoples. Population-level cancer surveillance provides data to set priorities, inform policies, and monitor progress over time. ⋯ This commentary describes key issues relating to cancer surveillance among indigenous populations including 1) suboptimal identification of indigenous populations, 2) numerator-denominator bias, 3) problems with data linkage in survival analysis, and 4) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world. These include acknowledgment of the central importance of full engagement of indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets and mitigation and/or careful assessment of biases inherent in cancer surveillance methods for indigenous peoples.
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Annals of epidemiology · Jan 2018
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics.
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA) was designed to answer the question of whether a novel continuous breast arterial calcification (BAC) mass score improves cardiovascular risk stratification among asymptomatic postmenopausal women. This article describes recruitment and baseline characteristics. ⋯ MINERVA is the first cohort with a continuous measure of BAC. The cohort is large, ethnically diverse, and deeply phenotyped in terms of socioeconomic, behavioral, and clinical factors, and blood biomarkers.