Richard A. Goodman’s research while affiliated with Emory University and other places

Context: The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. Program or policy: We sought to identify and consolidate a practical and annotated listing of those data sets. Implementation and/or dissemination: Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. Evaluation: We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. Discussion: The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.

Interventions are control and prevention measures that public health officials select and implement at one or more points in time after initiating a field investigation in response to an acute public health problem. Regardless of the nature of the problem, an immediate need exists to understand what is happening and to recommend and implement control and prevention measures that are scientifically justified and acceptable to the community. Public health officials must recommend these actions often without incontrovertible epidemiologic proof of a causal association between the putative source or cause of the problem and occurrence of exposure and disease or injury. Under such circumstances, the key question for the field epidemiologist and decision-makers is: “How much epidemiologic certainty is required before initiating action?” This chapter discusses the decision-making process regarding interventions during the course of epidemiologic field investigations and concludes with a summary of actions relating to interventions that should be considered at each progressive stage of the field investigation.

In response to an outbreak of disease of public health importance, a city, county, or state health department can request field epidemiologic assistance from the next higher level public health agency. In the United States, the highest level public health agency is the Centers for Disease Control and Prevention. To ensure smooth communications, planning, and execution of an epidemiologic field investigation, as well as to maintain good relationships from the initiation of the investigation to the final report, several operational aspects should be addressed. Key elements of operationalizing an epidemiologic field investigation include the following: 1) initial request and communications between inviters and invitees and a formal invitation for assistance from an authorized official; 2) clarification of the investigation’s main objectives and roles and responsibilities of those involved; 3) preparation of the field team for departure; 4) initial in-person meeting of the field team with local health officials and collaborators to review and update the situation, review local resources and primary points of contact, and identify a local public information officer; 5) management of field team activities with lists of necessary tasks for team members and frequent communications within the team, between team leader and senior supervisor, and between team and local officials; 6) in-person debriefing meeting with preliminary findings and recommendations by field team before departure; and 7) drafting of the final report with full findings and recommendations. Field investigations will proceed more smoothly and productively if both inviters and invitees adequately address key operational aspects before, during, and after the investigation.

Cancer is the second leading cause of morbidity and mortality in the U.S. Although reducing the number of new cancer cases is a national health goal, the continuing growth of the older adult population ensures that the burden of cancer will increase. Despite documentation of the shortage of oncologists to meet the growing need, relatively limited attention has been focused on increasing the physician workforce trained in the prevention and control of cancer. The existing physician workforce with such specialized training in cancer prevention and control is small, aging, increasing at a low rate, and likely to decrease because of an imbalance between retiring physicians and new entrants. This commentary addresses the imperative for increasing the number of physicians trained in preventive medicine with a specialization in cancer prevention and control by first providing a brief overview of U.S. cancer morbidity and mortality, then describing the status of, and trends in, physician training in cancer prevention and control, and concluding by suggesting opportunities for bolstering physician training in cancer prevention and control.

Introduction: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk U.S. Population: Methods: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). Results: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. Discussion: This study is the first to document concurrent prevalence of primary dementia subtypes among this U.S. Population: The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.

Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework.

Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice.