Anyone who attempts to read genetics or epidemiology research literature needs to understand the essentials of biostatistics. This book, a revised new edition of the successful "Essentials of Biostatistics" has been written to provide such an understanding to those who have little or no statistical background and who need to keep abreast of new findings in this fast moving field. Unlike many other elementary books on biostatistics, the main focus of this book is to explain basic concepts needed to understand statistical procedures.

This Book: Surveys basic statistical methods used in the genetics and epidemiology literature, including maximum likelihood and least squares.Introduces methods, such as permutation testing and bootstrapping, that are becoming more widely used in both genetic and epidemiological research.Is illustrated throughout with simple examples to clarify the statistical methodology.Explains Bayes' theorem pictorially.Features exercises, with answers to alternate questions, enabling use as a course text.

Written at an elementary mathematical level so that readers with high school mathematics will find the content accessible. Graduate students studying genetic epidemiology, researchers and practitioners from genetics, epidemiology, biology, medical research and statistics will find this an invaluable introduction to statistics.

Susan M. De Vos uses comparative and life course perspectives to provide an in-depth demographic study of the household. Based on data gathered by the World Fertility Survey, this illuminating reference explores household composition in six Latin American countries and compares the situation with that in the United States and western Europe as well as with each other. The study examines the complex household; non-family household living; and the living arrangements of children, young adults, middle-aged people, and elderly people.

Prevention of disease and injury, including early identification of risks and disease and optimal control of potentially debilitating or fatal complications of chronic conditions, is the area of clinical medicine that holds the greatest promise for improving human health. Each year a long list of major, but potentially preventable health problems exacts a terrible human and financial toll. These problems urgently need our attention, especially as major advances in curative medicine become more complex and costly. Prevention of disease and injury may well be the central health issue of our time, an issue of vital concern to every quarter of our society. Now is a very good time to promote prevention. Citizens and some social groups are increasingly aware of and interested in health and fitness issues. There is great enthusiasm about-even obsession with-health, and we are seeing an astonishing proliferation of health publications and media presentations for laymen, fitness and weight control cen ters, exercise programs, health food stores, disease support groups, health education programs, and do-it-yourself diagnostic kits. All of this betokens an increased health consciousness on the part of public and perhaps signals greater individual accountability for health."

This Companion Textbook supplements the ActivEpi CD-ROM, sold separately. The ActivEpi CD-ROM provides a multimedia presentation of concepts, commonly taught in an introductory epidemiology course. ActivEpi mixes a full array of media to motivate, explain, visualize and apply epidemiological concepts. Virtually all of the material on the ActivEpi CD-ROM is included in the Companion Textbook. Because individuals differ in their learning skills, the ActivEpi CD-ROM and the ActivEpi Companion Textbook offer readers different but related options on how to learn epidemiology. The Textbook can be used as a hardcopy reference of the textual materials contained on the CD-ROM, as a resource for the practice exercises, as a general reference, or even a self-contained textbook. ActivEpi includes 15 lessons and over 50 hours of content via more than 250 launchable activities and homework exercises. It can be used in a variety of teaching formats: distance learning, self-paced learning, on-campus courses, and short courses. For the latest additions to ActivEpi, visit David Kleinbaum's website.

Handbook of Survival Analysis presents modern techniques and research problems in lifetime data analysis. This area of statistics deals with time-to-event data that is complicated by censoring and the dynamic nature of events occurring in time. With chapters written by leading researchers in the field, the handbook focuses on advances in survival analysis techniques, covering classical and Bayesian approaches. It gives a complete overview of the current status of survival analysis and should inspire further research in the field. Accessible to a wide range of readers, the book provides: An introduction to various areas in survival analysis for graduate students and novices A reference to modern investigations into survival analysis for more established researchers A text or supplement for a second or advanced course in survival analysis A useful guide to statistical methods for analyzing survival data experiments for practicing statisticians

This book has several objectives. Most basically it presents an approach to assessing interorganizational innovation diffusion. To do this we have tried to link contempo rary organizational theory with more person-centered diffusion theory. We have also combined contingency theory with the resource dependence perspective to explain why organizations might choose to initially consider an innovation, re define it to suit their particular environmental context, and then implement it. Another objective has been to examine how environmental constraints can limit the ways in which diffusion channels form, and can determine when diffusion can be truly organizational and when it will depend upon individuals. In doing so, we have tried to indicate how organizational structures emerge to manage re sources in ways that are consistent with those environmental constraints. We have borrowed the notion of boundary management from resource dependence, and we have used it to examine how organizations use various boundary management strategies to preserve their autonomy in exchange relationships with other organi zations. We have done this both at the network level and at the level of individual organizations."

Immunizationisoneofthegreatadvancesinpublichealth. Figure0. 1showsacamel with a solar-powered refrigerator on his back carrying vaccines across a hot desert to the far reaches of civilization. Many vaccines contain live viruses that need to be kept cold, or the vaccine viruses will die, and the vaccines will lose their ability to produce an immune response. Thus a continuous chain of refrigeration, the cold chain, from the origin to delivery of some vaccines needs to be maintained. The inspiration of the camel image is that it represents the dedication of the world to bring vaccines to everyone. The ?rst major success, and the origin of the word vaccination (vacca for cow), was Jenner's introducing cowpox-based vaccine against smallpox in the late 18th century. After nearly a century hiatus, at the end of the 19th century, inoculations against cholera, typhoid, plague (caused by bacteria) and rabies (caused by a virus) were developed. By the early 20th century, statisticians of the stature of Karl Pe- son, Major Greenwood, and Udny Yule were heartily involved in discussions of evaluating these vaccines in the ?eld. In the 1920s, new vaccines included pert- sis, diptheria, tetanus, and bacille Calmette-Guerin ' against tuberculosis. The 1930s saw development of yellow fever, in?uenza, and rickettsia vaccines. After World War II, the advent of cell cultures in which viruses could grow enabled production of polio vaccine and vaccines against measles, mumps, rubella, varicella, and a- novirus, among others (Plotkin et al 2008).

This Handbook provides a comprehensive overview of the theories, methods and approaches for reducing HIV-associated risk behaviors. It represents the first single source of information about HIV prevention research in developed and developing countries. It will be an important resource for students, researchers and clinicians in the field.

nd This book stems from the 2 Parkinson's Disease Symposium on "Neurotoxic Factors in Parkinsons disease and related disorders", held on August 6-7,1999 at the University ofUlm Medical School in Ulm at the Danube, Germany. The symposium wasalso asatellite ofthejointmeetingofthe InternationalSocietyfor Neurochemistry (ISN) and the European Society for Neurochemistry (ESN) that followed immediately afterwards in Berlin. The specific topic, neurotoxic factors in Parkinson's disease (PD), was chosen in light of accumulating neurobiological and epidemiological evidence indicating that the causes of this second most common neurodegenerative disorder, and possibly of related conditions such as multiple systems atrophy, in some manner involve environ- mental (xenobiotic) and even endogenous toxic agents. This volume brings together much of that neurobiological evidence; and in epidemiology, several recent major studies ofPD - for example, a study of20,000 twins published in the Journal of the American Medical Association in 1999 - conclude that environmental and life style than genetics, appear to be critical in the idiopathic disease. However, factors, rather the precise roles of neurotoxic factors in the pathogenesis of PD and related basal ganglia disorders remain uncertain, despite the cascade of research resulting from the discovery of the prototype MPTP in the early 1980's, and frankly, we have been surprised by the paucity of concentrated attention on specific environmental agents other than MPTP.

During the last few centuries, and particularly in recent decades, problems result ing from the excessive use of drugs and alcohol have spread virtually as an epidemic to every country in the world and to almost every community. Abuse of alcohol and drugs is related to numerous other health problems, such as the spread of acquired immune deficiency syndrome (AIDS) on all continents. Health and social services today cannot afford to ignore this crisis since it affects all levels of society and manifests itself in diverse health and social problems. In recent years, the World Health Organization has received numerous requests for training material for physicians in this field. This manual therefore meets an urgent need. The availability of new data and the dearth of suitable textbooks have made its preparation mandatory. The influence of sociocultural factors on drug dependence and alcohol related problems-on their cause, development, and consequences as well as on their treatment and prevention-has been taken into account in the preparation of this manual in order to ensure that its usefulness is not limited to one country or region. It has been prepared primarily for the teaching of physicians and medical students, although much of it is relevant to the training of nurses, midwives, health educators, primary-care workers, medical social workers, counselors, and psychologists. In fact, suggestions have been included for adapting the manual for use in the training of such varied groups of students."

This volume of Documenta Ophthalmologica Proceedings Series collects the scientific papers presented at the 2nd International Symposium on Retinal Pigment Epithelium and the 4th Meeting of the European Macula Group held in Genoa, May 29-June 1, 1996. The Symposium on Retinal Pigment Epithelium was promoted by the University Eye Clinic of Genoa as the natural continuation of the first Symposium held with great success in Genoa in 1988. The previous Meetings of the European Macula Group were held in Coimbra (1988), Crete (1989) and Athens (1994). I was greatly pleased and honoured to host the fourth congress of this distinguished Society and I am grateful to Gabriel Coscas, Jose Cunha-Vaz and George Theodossiadis, found ers of the Society, for selecting Genoa on this occasion. The two meetings integrated well in an unicuum and brought together an exceptional number of outstanding retinal specialists coming from all over the world. All the aspects of the current research concerning retinal pigment epithelial and macular diseases were covered. Several interesting presentations regarded new techniques of retinal and choroidal imaging. A full session was dedicated to the latest advances in culture and transplantation of retinal pigment epithelial cells. Age-related macular degeneration was a major subject for discussion, including new approaches to treatment. This topic was high lighted by a mini-symposium on drusen, including a series of superb lectures on classification, clinicopathological studies, indocyanine green imaging, and laser treatment for prevention of choroidal neovascularization.

Proceedings of the Second International Workshop on Epidemiology and Prevention of Gallstone Disease, held in Rome, December 4-5, 1989

Root disease epidemics, because much of the activity takes place in soil and out of sight, pose special challenges to growers who seek to manage them and to scientists who study them. All relevant topics of root disease epidemics and their management are presented: The critical aspects of specific disease components including inoculum, host roots, mycorrhiza and the soil environment are explored. Challenges of disease assessment and the temporal and spatial aspects of epidemic development are considered, and approaches to root disease management including host resistance, chemical, biological and cultural management are discussed in detail. The book fulfills the needs of researchers, teachers, and practitioners of plant pathology.

Incidence and mortality of atherosclerosis and coronary heart disease (CHD) vary considerably among races, populations and ethnic groups. Some individuals with low levels of risk factors succumb early to disease while many others with a high risk profile do not. CHD clusters in families and is manyfold increased in first degree relatives of persons with an early onset of the disease. Such studies provide compelling evidence of the high degree of heritability of CHD and its risk factors. This book consolidates the available evidence for the roles of genetics in atherosclerosis, its correlates and its sequelae. It presents and discusses the methodology currently used to elucidate the role of genetics. Separate parts focus on evidence of familial aggregation and ethnic variability of the disease and on monogenic and polygenic inheritance modes including all the recent findings and innovation. The book also contains chapters on the genetic aspects of vessel wall processes, such as early structural findings in histological studies and the variability of coronary anatomic patterns. Polymorphisms at the DNA level (RFLP) are detailed and reviewed. Directions for future research in the exciting and fast developing realm of genetic epidemiology are outlined and the major preventive and public health implications are discussed. Genetic Factors in Coronary Heart Disease provides a systematic review of findings, integrated to offer a comprehensive summary and stepping stone for future research. It will be of interest to investigators in atherosclerosis, genetics, epidemiology, biostatistics, cardiology and public health.

The terrorist use of diseases as bioweapons has been one of the major security concerns in recent years, particularly after the anthrax letter attacks in the USA in 2001. This uncertain threat of intentional outbreaks of diseases exists side by side with the constantly changing very real threat from diseases, epidemics and pandemics as recently illustrated by the H1N1 influenza pandemic, SARS, and H5N1 bird influenza events. This publication contains case studies on the public health planning for (un)usual disease outbreaks for 11 large and small countries with a focus on South Eastern Europe. In many countries, military entities traditionally play an important role in emergency response to disease outbreaks. In smaller countries, very little exists, however, in terms of specific biopreparedness efforts (in both the military and civilian area), which is at least partly due to a relatively low bioterrorism threat perception, and serious resource constraints. The uncertainty associated with the bioterrorism threat makes public health preparedness planning for such events politically and financially very difficult. The similarity of responding to bioterrorism events and natural disease outbreaks from a public health point of view suggests the merit of looking at biopreparedness as a part of overall health emergency planning, not as a separate effort.

Blastomycosis remains the most enigmatic of human mycotic infections. The enigmas encompass the natural habitat of the etiologic agent, extent of exposure and subclinical infections in endemic areas, distribution of en demic foci throughout the world, inconsistency of serologic evaluation of infected patients, and varying response of such patients to standard treat ment regimens. In spite of diligent investigations by many competent investigators, we still do not know the ecological niche inhabited by the etiologic agent. We have many tantalizing clues but no definite answers. Nor do we know the extent of the endemic areas in the world for this disease. Skin testing, so useful in defining the distribution of histoplasmosis and coccidioidomycosis, has been of no value in mapping endemic areas for blastomycosis. Even the serologic evaluation of known cases of the disease has been too erratic in results to be useful as a diagnostic or prognostic procedure. The enigmas of blastomycosis go straight to the disease itself. There is an extensive literature on the debate concerning the presence and extent of subclinical infections. Case report series demonstrate that such transient infections do occur but, unlike other mycoses, the extent to which this phe nomenon is common in the general population still cannot be assessed. Even the diagnosis of established disease is a major clinical problem.

The biology of solid tumor metastasis has been the subject of significant scientific and clinical interest for years and while experimental evidence reveals that metastasis is not solely a random event, very little is known about the biology of metastasis originating from prostate cancer. This is in spite of the fact that the majority of prostate cancer patients die with metastatic lesions to the bone. Progress in understanding this most important aspect of prostate cancer has been hampered by the lack of suitable animal models and an inability to accurately quantify bone metastases and their responses to therapy. Over the past decade, scientists in Japan and the United States have steadily advanced our understanding of the cellular, molecular and immunologic biology of primary and disseminated prostate cancer. It is this body of new information, combined with advances in imaging techniques and prostate cancer tumor markers, that prompted the need for an in-depth assessment of bone metastasis of prostate cancer. Accordingly, on December 12, 1990, a group of basic and clinical investigators from Japan and the United States convened in Gotenba, Japan, to hold the first conference devoted solely to the basic biology and clinical aspects of bone metastases originating from prostate cancer. The cross-fertilization of ideas that was fostered through in-depth discussion of technological advances among various basic and clinical disciplines not only further advanced our understanding of prostate metastases to the bone, but suggested approaches for precise quantitative assessment of these lesions and their treatment.

Hypertension is a major health problem and contrary to ischemic heart disease, which occurs only in Western countries, its distribution is almost universal. It is this universality that has prompted us to gather, in this book, data on arterial blood pressure obtained in different parts of the world. Moreover, cerebrovascular mortality, which is the commonest cause of death from hypertension, is decreasing in most Western countries and in Japan, and the reasons for this are still far from clear. A major problem in comparing blood pressure values from different centers is the standardization of the measurement. Complete standardization will never be achieved if one takes into account the numerous factors that may influence blood pressure in epidemiological studies. Whether blood pressures are measured by doctors or by technicians, are recorded at home, in the working place or in a hospital, in sitting, standing or supine position, and is taken during the same examination-all of these whether a blood sample factors can influence blood pressure measurement. But meals, time of day (blood pressure being higher in the evening), heart rate, cuff size, stethoscope used, digit preference, month of year, temperature, etc., can equally influence the measurement. Home reading of arterial blood pressure at standardized times is probably the best answer to all of these problems and has been used with gratifying results in a comparative study between Belgium and Korea.

Drs. Franco and Rohan bring together a timely and comprehensive set of reviews describing the biologic basis of carcinogenesis, issues related to measurement and interpretation of cancer precursors, site specific precancerous conditions, and control of cancer precursors The book has several important strengths, most notably the wealth of current information on cancer precursors and related topics provided by an impressive cast of cancer researchers. it effectively provides specific and compelling reasons for studying cancer precursors, the most up-to-date and comprehensive collection of reviews on the topic, and a realistic picture of the complexities facing research of cancer precursors. American Journal of Epidemiology "In this book, Drs. Franco and Rohan have succeeded in preparing a comprehensive, timely, and critical review of the substantial progress that has been made in our understanding of cancer precursors. They have enlisted experts in the field who have contributed authoritative chapters to a wide variety of cancers with emphasis on the etiology and natural history, including the role of environmental and heritable factor that provoke normal cells to undergo malignant transformation. Epidemiologic data are linked whenever possible to molecular as well as clasical cellular pathology, providing a fuller understanding of the casual events and mechanisms that initiate the carcinogenic process." -From the Foreward by Joseph F. Fraumeni, Jr., M.D., M.S. Director, Division of Cancer Epidemiology and Genetics National Cancer Institute National Institutes of Health Rockville, MD This book provides an overview of the progress made in the last few years on the epidemiology, detection methods, and preventive stategies for cancer precursors. Contributors to the 25 chapters are among the world's most knowledgeable scientists in the areas of molecular pathology, epidemiology, and control of cancer precursors. Their reviews of the topic are accessible to a large professional base that includes basic cancer researchers, clinical oncologists, pathologists, molecular biologists, epidemiologists, nurses, health professionals working on policy implications, and graduate students in cancer-related fields. Divided into five sections, the book begins with brief overviews of the molecular basis of carcinogenesis and of the histological aspects of cancer precursors. Issues related to the measurement, interpretation, and the study of precursor lesions are addressed in Part II, including timely chapters on epidemiologic approaches to studying intermediate endpoints, the impact of measurement error, and methods of processing biological specimens for molecular epidemiology studies. The main section of the text is found in Part III, with chapters on cancer precursors at the most important anatomical sites at which solid tumors occur, including the lung, breast, colon, esophagus, and prostate. The site-specific reviews include discussions of the epidemiology of those lesions, and, where appropriate, aspects of their detection and prevention. The final sections of the book feature valuable overviews on screening and prevention strategies and the role of evidence-based medicine in judging the value of such strategies for national and international policy guidelines on cancer control.

Acquired immune deficiency syndrome (AIDS) poses a health threat unparalleled in modem times. Identified just a few years ago, AIDS and the human inunlmodeficiency virus (IDV) responsible for it affect millions of persons worldwide. AIDS has already become the leading cause of death among persons under 40 in some large American cities. From the beginning. it has been evident that AIDS carries unique psychological and social ramifications. In spite of its lethality, new cases of HIV infection are preventable if individuals can be assisted to make behavior changes to lessen or eliminate viral transmission. To the extent that we can develop effective primary prevention interventions, it will be possible to keep larger numbers of people from becoming infected with the mv virus. Psychological and social risk behavior change interventions, whether at the level of individual clients, groups, or entire communities, can playa key role-in fact, the only available role-in disease prevention. Patients with any life-threatening illness have psychological, social, and support needs. However, these needs are more pronounced and, often, less easily addressed for persons affected by AIDS. People in good clinical health but with HIV infection face years of worry concerning whether they will develop AIDS. Nearly 2 million Americans are currently in this precarious position; by 1991, 50 to 100 million persons worldwide are expected to share the same uncertainty."

Even a brief scan of the table of contents of the present volume is enough to disclose the diversity of research interests and opinions in the field of lipidology. It is precisely this diversity that is the strength of our field and that was showcased by the XII International Symposium of DRUGS AFFECTING LIPID METABOLISM (DALM). The papers published here from these proceedings may be divided into three categories: those that define-and refine---our understanding ofthe clinical benefit of aggressive lipid management, those that develop our knowledge of ris!. assessment, and those that discuss the genetic, bio~hemical, and biophysical mechanisms underlying the pathology of coronary heart disease. On the clinical front, further analysis of the results of the Scandinavian Simvastatin Survival Study (4S) has indicated the cost-effectiveness of therapy in patients with established coronary heart disease. The West of Scotland Coronary Prevention Study (WOSCOPS), whose methodology was described at the DALM XII symposium, has demonstrated in a mostly primary-prevention population what 4S demonstrated for secondary prevention the year before: aggressive lipid-regulating therapy reduces coronary heart disease morbidity and mortality rates without concurrently increasing mortality from noncardiovascular causes. In the future, important considerations will be to develop protocols that maximize benefit in groups underrepresented in traditional clinical research for example, women and the elderly-and to improve compliance to existing treatment regimens. Furthermore, antioxidant, omega-3 fatty acid, and gene therapies warrant further investigation.

Here is a book for clinicians, clinical investigators, trainees, and graduates who wish to develop their proficiency in the planning, execution, and interpretation of clinical and epidemiological research. Emphasis is placed on the design and analysis of research studies involving human subjects where the primary interest concerns principles of analytic (cause-and- effect) inference. The topic is presented from the standpoint of the clinician and assumes no previous knowledge of epidemiology, research design or statistics. Extensive use is made of illustrative examples from a variety of clinical specialties and subspecialties. The book is divided into three parts. Part I deals with epidemiological research design and analytic inference, including such issues as measurement, rates, analytic bias, and the main forms of observational and experimental epidemiological studies. Part II presents the principles and applications of biostatistics, with emphasis on statistical inference. Part III comprises four chapters covering such topics as diagnostic tests, decision analysis, survival (life-table) analysis, and causality.

Hardly a day goes by without news headlines concerning infectious disease threats. Currently the spectre of a pandemic of influenza A-H1N1 is raising its head, and heated debates are taking place about the pro s and con s of vaccinating young girls against human papilloma virus. For an evidence-based and responsible communication of infectious disease topics to avoid misunderstandings and overreaction of the public, we need solid scientific knowledge and an understanding of all aspects of infectious diseases and their control.

The aim of our book is to present the reader with the general picture and the main ideas of the subject. The book introduces the reader to methodological aspects of epidemiology that are specific for infectious diseases and provides insight into the epidemiology of some classes of infectious diseases characterized by their main modes of transmission. This choice of topics bridges the gap between scientific research on the clinical, biological, mathematical, social and economic aspects of infectious diseases and their applications in public health.

The book will help the reader to understand the impact of infectious diseases on modern society and the instruments that policy makers have at their disposal to deal with these challenges. It is written for students of the health sciences, both of curative medicine and public health, and for experts that are active in these and related domains, and it may be of interest for the educated layman since the technical level is kept relatively low."

The management of Alzheimer's Disease and the related dementias is one of the major challenges to health care professionals and American society-at-large for the coming decade and the coming millennium. The rapid growth of the over-eighty-five population, the group which, as recent studies have confirmed and as many of us clinicians have long suspected, has an even higher prevalence than previously quoted of dementing disorders, is the major cause of this. We are thus challenged by, as Bernard Issacs used to call it, "the survival of the unfittest," as well as the oPtimistic approach of "bringing life to years," as John F. Kennedy said. The fact is that we, as a society, tend to confuse "treatment" and "cure" (and "prevention"). As the proceedings of the conference which this book represents emphasize, there is considerable work going on about the potential prevention of, or at least the reduction of, symptomatology in these illnesses by interventions genetically, chemIcally, and so forth. However, the more we find out, the more complicated it becomes, and the more heterogeneous Alzheimer's and the related disorders appear to be, not only in their manifestations (as clinicians have long recognized) but also in the individual initiating and underlying processes. For these reasons, absolute preventive techniques or the likelihood of an intervention which will reverse the process in a high proportion of patients, do not appear to be just around the corner.