Medical certification of workers for respirator use is an important activity of occupational medicine health professionals. Spirometry is a diagnostic tool to evaluate respiratory distress/insufficiency that may affect respirator use. In this study, we analyzed the pulmonary function data of 337 workers from different occupations which required medical evaluation to wear a respirator. The American Thoracic Society and National Fire Protection Association criteria were used to evaluate employees. Of 337 workers who were cleared for respiratory use on the basis of medical questionnaires for respirator compliance, 14 (4.15%) failed to pass respirator compliance on the basis of NFPA criteria and 5 (1.48%) failed to pass respirator compliance criteria on the basis of ATS criteria. We compared the use of different Spirometric equations to evaluate these criteria and we found the Crapo equation cleared more workers for respirator use as compared to the Knudson and NHANES III equations. We also measured repeated Forced Expiratory Volume in 1st Second (FEV1) and Forced Vital Capacity (FVC) and compared the results longitudinally over time. Age was the only significant factor affecting the reduction in the lung function in longitudinal analysis. Longitudinal spirometry results suggested that workers were protected while using a respirator in the workplace, but age is the significant factor in reducing their lung function. As some workers were able to qualify for respirator use based on questionnaire alone but failed respirator clearance subsequent to pulmonary function testing, it is recommended that spirometry be used to evaluate clearance for all workers who will use a respirator in the workplace. As well, using different Spirometric equations can affect the outcome on passing or failing clearance for respirator use, and this should be considered in a respiratory medical certification program.

With widespread use of the Internet, data is often shared between organizations in B2B health care networks. Integrating data across all sources in a health care network would be useful to public health surveillance and provide a complete view of how the overall network is performing. Because of the lack of standardization for a common data model across organizations, matching identities between different locations in order to link and aggregate records is difficult. Moreover, privacy legislation controls the use of personal information, and health care data is very sensitive in nature so the protection of data privacy and prevention of personal health information leaks is more important than ever. Throughout the process of integrating data sets from different organizations, consent (explicitly or implicitly) and/or permission to use must be in place, data sets must be de-identified, and identity must be protected. Furthermore, one must ensure that combining data sets from different data sources into a single consolidated data set does not create data that may be potentially re-identified even when only summary data records are created. In this thesis, we propose new privacy preserving data integration protocols for public health surveillance, identify a set of privacy preserving data integration patterns, and propose a supporting framework that combines a methodology and architecture with which to implement these protocols in practice. Our work is validated with two real world case studies that were developed in partnership with two different public health surveillance organizations.

Current syndromic surveillance systems utilize centralized databases that are neither scalable in storage space nor in computing power. Such systems are limited in the amount of syndromic data that may be collected and analyzed for the early detection of infectious disease outbreaks. However, with the increased prevalence of international travel, public health monitoring must extend beyond the borders of municipalities or states which will require the ability to store vasts amount of data and significant computing power for analyzing the data. Intelligent mobile agents may be used to create a distributed surveillance system that will utilize the hard drives and computer processing unit (CPU) power of the hosts on the agent network where the syndromic information is located. This thesis proposes the design of a mobile agent-based syndromic surveillance system and an agent decision model for outbreak detection. Simulation results indicate that mobile agents are capable of detecting an outbreak that occurs at all hosts the agent is monitoring. Further study of agent decision models is required to account for localized epidemics and variable agent movement rates.

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T05:47:57Z (GMT). No. of bitstreams: 1 Garcia_RosanaAparecida_D.pdf: 5581875 bytes, checksum: 00e9d86de7ff28079b760ab5c21a818d (MD5) Previous issue date: 2015 / Resumo: A Vigilância em Saúde é entendida aqui, como uma instituição - conceito base para a Análise Institucional (AI). Seu processo de institucionalização nos remete à história da Saúde Pública, impactando no atual modelo de gestão e nas ferramentas de trabalho utilizadas em sua contemporaneidade. Considerando que a Vigilância em Saúde tem raízes e processos a partir deste modelo conceitual, há um impacto na prática e estratégias utilizadas pelos sujeitos que dela fazem parte, marcada, muitas vezes, por modelos verticalizados e pouco participativos. O objetivo deste estudo foi estudar a trajetória da Vigilância em Saúde de Campinas (SP) na perspectiva da Análise Institucional sócio-histórica, buscando uma compreensão de sua gênese histórica, social e teórica e seu processo de institucionalização (duração, temporalidade e historicidade). Neste sentido, a proposta da análise institucional na vertente sócio-histórica fundamenta-se na necessidade de ampliação do conhecimento acerca de fatos no passado, mas que ainda possuem repercussão no presente. Foram utilizados alguns conceitos chave da Análise Institucional, como analisador, implicação e instituição ¿ desdobrando em seus momentos instituído, instituinte e institucionalização. Esse estudo teve natureza qualitativa, teórico e empírico, com base em entrevistas semiestruturadas e pesquisa documental. As entrevistas iniciais ¿ chamados de "entrevistas disparadoras" ¿ foram realizadas com os sujeitos que participaram dos processos iniciais de municipalização, descentralização e regionalização da Vigilância em Campinas. Em seguida foram entrevistados outros gestores e trabalhadores dos serviços de saúde que vivenciaram a história mais recente da Vigilância. A maioria das entrevistas foram gravadas e posteriormente transcritas e enviadas aos entrevistados para que acrescentassem ou retirassem o que julgassem importantes. Após a análise dos das entrevistas e de alguns documentos que trouxeram alguns eventos realizados pela Vigilância de Campinas, o grupo entrevistado foi convidado para duas oficinas de restituição para debate sobre os achados e construção do texto. O trabalho demonstrou que o modelo atual de Vigilância não insere o sujeito dentro de suas ações e nem considera seu contexto social. Tendo esse pressuposto como modelo, as estratégias utilizadas pela Vigilância são predominantemente normativas e administrativas, mais ligadas à tecnologia dura e dura-leve, ou seja, pouco se trabalha com as relações intersubjetivas que estão diretamente relacionadas com a missão da Vigilância. O modelo de Vigilância de Campinas, apesar do protagonismo dos sujeitos, mantem pouca articulação com a sociedade e controle social. Os desafios percebidos são relacionados a investir nas tecnologias leves (relacionais) no sentido de incluir os diferentes sujeitos no processo de Vigilância. A possibilidade de intercessão entre suas práticas e a sociedade, deve ser motivada por um desejo de dar autonomia aos sujeitos que protagonizarão mudanças dentro da instituição / Abstract: The Health Surveillance is understood in this thesis as an institution ¿ base concept for the Institutional Analysis. Its process of institutionalization refers to the history of Public Health, presenting an impact in the present model of management and in the work settings utilized in its contemporaneity. Since Health Surveillance has its roots and processes departing from this theoretical model, there is an impact in the practices and strategies used by the subjects who are part of it; this impact is marked very often by verticalized and non-participative models. The objective of this project was to study the journey of the Health Surveillance in Campinas (SP) in the perspective of the socio-historic Institutional Analysis, aiming at a comprehension of its historic, social and theoretical genesis and its process of institutionalization (duration, temporality and historicity). Thus, the institutional analysis purpose in the social-historical field is based in the need of spreading the knowledge about past facts but which still have repercussion until the present. Some key-concepts of the Institutional Analysis were used as analyzer, implication and institution ¿ reshaping its moments as instituted, instituter and institutionalization. This study has a qualitative, theoretical and empirical nature and it is based on semi-structured interviews and document research. The early interviews ¿ so called "triggering interviews" ¿ were made with the subjects who participated in the early processes of municipalization, decentralization and regionalization of the Health Surveillance in Campinas. Following this part other managers and health workers who lived the recent history were interviewed. Most of the interviews was recorded and then transcripted and sent to the interviewees for them to add or erase any information they could judge important. After the analysis of the interviews and some documents which brought up events made by the Health Surveillance, the interviewed group was invited for two restitution workshops for a debate about the discovers and the construction of the text. The work showed that the present model of Health Surveillance is not inclusive in its actions nor considers peoples social contexts. Having this assumption model, the strategies used by the Health Surveillance are mainly based on rules and administration and are more connected to the hard and hard-soft technology, that means that very few works are done about the inter-subjetive relations that are directly related to the mission of the Health Surveillance. The model of Health Surveillance, although its subjects are protagonists, keeps few articulation with the society and its control. The challenges observed are relational to investing in soft technologies (related) in a way that it includes different subject in the process. The possibility of interception between its practices and society must be motived by a desire of giving independence to the subjects who were protagonists in the changes inside of the institution / Doutorado / Ciências Sociais em Saúde / Doutora em Saúde Coletiva

É imprescindível a produção de alimentos em maior quantidade, segurança e qualidade, sob processos que equilibram o máximo possível interesses econômicos, sociais, culturais, políticos e ambientais, com motivação não apenas no aspecto técnico, mas em uma abordagem mais humanizada. Assim, atenuando os problemas de produção não só com instrução, mas mostrando a importância do produtor de alimentos como agente promotor de Saúde Pública. O Brasil possui uma legislação sanitária rigorosa que orienta, regula e normatiza os procedimentos e cuidados a serem adotados na produção de alimentos. Entretanto há questões culturais que frequentemente entram em conflito com as leis. O abate informal de aves e o contexto sanitário no município de São Paulo é assunto riquíssimo de se discutir, pois há toda uma legislação de esferas diferentes que regula o assunto em questão; ações e crenças populares que influenciam a prática; a questão étnica dos atores desse cenário. Em paralelo, o consumidor (ou mercados externos) torna-se mais exigente a cada dia quanto a segurança e qualidade. Na primeira parte deste trabalho há a apresentação do conceito de Segurança Alimentar; a contextualização e desenvolvimento da Avicultura Brasileira; a situação do abate informal no Brasil e impactos na Saúde Pública; o papel do Médico Veterinário em relação às avícolas. Considerando a escassez de trabalhos direcionados especificamente a este tema objetivou-se fazer uma análise crítica sobre a existência e funcionamento das “Avícolas” na cidade de São Paulo, identificar os fatores facilitadores do funcionamento deste tipo de estabelecimento e discutir ações para mitigar os riscos sanitários envolvidos nesta atividade, com enfoque na hipótese de que são informais, ilegais e clandestino, oferecendo risco à Saúde Pública, que não é viável sua existência nos moldes atuais, porém são possíveis modificações para viabiliza-los. Na segunda parte é apresentado o cenário das avícolas no município em uma estimativa de cerca de 3900 estabelecimentos, porém não existem dados oficiais exatos sobre o assunto. Através de vistorias foi possível constatar que os locais não ofereciam condições para alojamento dos animais pensando na segurança pública e bem estar animal, tampouco de executar a atividade que se propõe. O ambiente de trabalho é promíscuo, não há cuidados com o colaborador, dejetos, tampouco implantação de programas de autocontrole e/ou boas práticas de fabricação. Confrontando a legislação vigente com essa realidade são estabelecimentos informais e ilegais, infringindo diversas leis sanitárias, ambientais, trabalhistas e fiscais. Impacta em potencial as finanças públicas pelo potencial zoonótico desta prática. A comercialização de aves em Avícolas se mantém, predominantemente pela falsa crença de que são animais saudáveis, igual aos frangos criados no sítio, remetendo a uma memória emocional das pessoas, que compram um produto mais caro sem condições mínimas necessárias. Em 2006 houve um projeto de lei municipal na tentativa de legalizar a prática por integrar a cultura de etnias específicas, como os orientais. Como perspectivas para regularização das Avícolas e otimização da fiscalização é possível a criação de um banco de dados integrado entre os órgãos estatais diretamente envolvidos possibilitando cruzar, relacionar e complementar informações pertinentes a esta questão, levando a um olhar mais amplo do setor produtivo, do delineamento estratégico de controle e vigilância sanitária, análise de dados e resultados ao longo das ações. Também, fortalecer o sistema de fiscalização, sendo mais efetiva e presente, implantar categoria “Avícolas” no sistema de cadastro da vigilância sanitária municipal e projetos de leis pertinentes à área contarem com participação e discussão de profissionais e acadêmicos da área de interesse. Ainda, a organização em cooperativa de criação e/ou produção, possibilitando a implantação de SUASA e/ou SIM, organizando e regulamentando a prática. O investimento em informação e educação para comerciantes e população é uma arma eficaz de longo prazo para o combate à prática / It is essential food production in greater quantity, safety and quality in processes that balance as much as possible economic, social, cultural, political and environmental interests, with motivation not only in technical aspects, but in a more humane approach. Thus, reducing production problems not only with education, but showing food producer’s importance as public health promoter. Brazil has strict health legislation that directs, regulates and standardizes the procedures and precautions to be adopted in food production. However there are cultural issues that often conflict with the law. The informal slaughter of poultry and sanitary context in São Paulo is rich topic to discuss because there is a whole different spheres of legislation regulating the issue; actions and popular beliefs that influence the practice; ethnicity of the actors in this scenario. In parallel, the consumer (or foreign markets) becomes more rigorous every day for safety and quality. The first part of this study presents the concept of Food Safety; Brazilian Poultry’s context and development; the situation of informal slaughter in Brazil and impacts on Public Health; the role of the veterinarian in relation to poultry. Considering the lack of work specifically on this topic aimed to make a critical analysis of the existence and operation of "Poultry" in São Paulo, identify factors that facilitate the operation of this type of establishment and discuss actions to mitigate health risks involved in this activity, focusing on the hypothesis that are informal, illegal and clandestine, offering a risk to public health, it is not feasible its existence in the current form, but modifications are possible for enables them. The second part presents the scenario of poultry in the city on an estimate of about 3900 establishments, but there are no accurate official data on the subject. Through inspections it was found that the sites did not offer conditions for housing the animals thinking about public safety and animal welfare, either running the activity it proposes. The workplace is promiscuous, there is no employee’s care, waste, either implementation of self-control programs and/or good manufacturing practices. Confronting the current legislation with that reality are informal and illegal settlements, violating various health, environmental, labor and tax laws. Potential impact on public finances by the zoonotic potential of this practice. The sale of chicken in Poultry remains predominantly by the false belief that they are healthy animals, like the chickens raised on the grange, referring to an emotional memory of people who buy a more expensive product without minimum required conditions. In 2006 there was a municipal bill in an attempt to legalize the practice to integrate the culture of specific ethnic groups such as Asians. As prospects for settlement of Poultry and supervision of optimization is possible to create an integrated database between state agencies directly involved in allowing cross, relate and additional information relevant to this issue, leading to a broader vision of the productive sector, the design strategic control and health monitoring, data analysis and results over the shares. Also, strengthen the inspection system, more effective and present, deploy category "Poultry" in the registration system of municipal health surveillance and projects of relevant laws to the area count on participation and discussion of professional and academic area of interest. The organization in cooperative breeding and/or production, enabling the deployment of Suasa and/or SIM, organizing and regulating the practice. Investment in information and education for traders and population is an effective weapon of long-term to combat the practice

L’approche médico-économique dans les évaluations des systèmes de surveillance en santé publiqueMots clés : évaluation des systèmes de surveillance, évaluation médico-économique, méthode des choix discretsLa surveillance en santé publique et la veille sanitaire sont en lien direct avec l’action et la décision publique en fournissant des informations précises et validées aux autorités sanitaires afin que ces dernières mettent en œuvre les mesures de contrôle et de prévention appropriées. Dans un contexte d’émergences infectieuses et d’apparition de nouvelles menaces pour la santé des populations, la surveillance en santé publique doit disposer d’une capacité d’adaptation et de priorisation. Ce besoin d’adaptation dynamique est confronté au réalisme des ressources disponibles de plus en plus limitées et à la demande sociale en matière de santé publique et de protection contre les risques sanitaires croissants. L’évaluation des systèmes de surveillance en santé publique au regard de leur utilité et de leur performance technique est préconisée depuis plusieurs décennies. La question de l’efficience de ces systèmes de surveillance est plus récente et prend une dimension particulière au regard du contexte budgétaire contraint qui touchent tous les opérateurs de l’état.Ce travail s’est attaché, à montrer l’intérêt et la valeur ajoutée d’une démarche standardisée d’évaluation des systèmes de surveillance en maladies infectieuses au sein d’une agence nationale de santé publique. Fondée sur un protocole développé selon la méthodologie préconisée par les recommandations internationales, cette démarche a enrichi la stratégie de surveillance de l’institution et a permis d’initier de nouveaux travaux portant sur la valorisation des bénéfices engendrés par la surveillance et leur prise en considération pour la priorisation des ressources. Une revue systématique de la littérature scientifique a permis de dresser un état des lieux et des connaissances sur l’évaluation des bénéfices de la surveillance en santé publique. Outre le faible nombre d’études dans le domaine, cette revue montre que les bénéfices engendrés par la surveillance sont le plus souvent estimés par le coût des cas épargnés ou des vies sauvées grâce aux actions de contrôle et de réponse. Cette approche présente plusieurs limites. Elle est difficilement applicable pour les systèmes de surveillance ne nécessitant pas des mesures de contrôle immédiates. Elle ne prend pas en compte les valeurs d’existence en lien avec les effets non monétaires induits par la surveillance en santé publique et la veille sanitaire. Afin de prendre en compte toutes les dimensions de la surveillance, nous avons mené une étude exploratoire faisant appel à la méthode des choix discrets appliquée à des systèmes de surveillance de maladies infectieuses émergentes. Cette étude inédite dans le champ de la surveillance en santé publique réalisée sur un échantillon de convenance, montre l’importance de certains critères comme la prévalence ou la létalité. Des consentements à payer marginaux pour ces critères sont estimés pour la première fois et constituent une première indication. Les résultats de cette étude apportent quelques éléments de réponse à la question des bénéfices induits par un système de surveillance ou de veille sanitaire.L’approche médico-économique dans les évaluations des systèmes de surveillance reste un domaine peu exploré. L’actualisation des recommandations internationales sur l’évaluation des systèmes de surveillance serait utile et devrait intégrer une approche médico-économique. L’intérêt potentiel de la méthode des choix discrets pour la valorisation des bénéfices induits par les systèmes de surveillance et de veille sanitaire appliquée dans une étude exploratoire dans ce travail devrait être évalué sur une plus grande échelle. / Economic evaluations approach in the public health surveillance systems evaluationsKey word: public health surveillance system evaluation, economic evaluation, discrete choice experimentsPublic health surveillance is closely linked to action as it provides accurate and validated information to health authorities in order that these same authorities can implement appropriate prevention measures and control strategies. In a context of emerging infectious diseases and of new health threats occurring, priorities for public health surveillance need to be reviewed and adapted regularly. This need of constant adaptation is facing limited resources and an increasing social demand of health security and protection against all health risks. Assessing the usefulness and the technical performance of surveillance systems are the main objectives of public health surveillance system evaluations and this has been recognized for many years through international guidelines. The efficiency of a surveillance system is a more recent question and takes a particular dimension in the context of budgetary constraints that all national agencies are facing.This work aimed to underline the interest and the added value of an external and formal evaluation process of surveillance systems in a national public health agency. Based on a generic evaluation protocol drawn up in accordance with international recommendations, this evaluation process has improved the surveillance strategy of the institution and has brought new questions up about the estimations of benefits of surveillance systems and their impact in the surveillances prioritizing process. A systematic literature review has drawn a clear picture of the state of the art and the knowledges in the field of public health surveillance system benefits estimation and evaluation this systematic review indicates that, to date, very few economic evaluations of public health surveillance systems have been performed worldwide. It also shows that the benefits of surveillance are mainly assessed by the costs of the number of cases or deaths prevented by the response and control measures. This approach has certain limits. It cannot be applied when the primary objective of the surveillance activities is not linked to immediate response. It does not take into account the existence value of a Public health surveillance system. In order to take the dimensions of a public health surveillance system, we have conducted a pilot study using discrete choice experiments applied to different emerging infectious diseases surveillance systems. This study, novel in the field of public health surveillance, was performed among a convenient sample and shows the importance of certain criteria such as the prevalence and the case fatality ratio. For the first time, marginal willingness to pay for these criteria have been estimated and these results give some insights into the question of the benefits, a public health surveillance system can bring.Economic evaluations of public health surveillance system remain an area where little has been carried out to date. Updating international recommendations for public health surveillance systems would be useful and should include an economic approach. The potential interest of the discrete choice experiments for valuing benefits of a public health system used in this pilot study need to be confirmed in a larger scale.

Understanding spatial perspectives on the spread and incidence of a disease is invaluable for public health planning and intervention. Choropleth maps are commonly used to provide an abstraction of disease risk across geographic space. These maps are derived from aggregated population counts that are known to be affected by the small numbers problem. Kernel density estimation methods account for this problem by producing risk estimates that are based on aggregations of approximately equal population sizes. However, the process of aggregation often combines data from areas with non-uniform spatial and population characteristics. This thesis presents a new method to aggregate space in ways that are sensitive to their underlying risk factors. Such maps will enable better public health practice and intervention by enhancing our ability to understand the spatial processes that result in disparate health outcomes.

Background: Distortion product otoacoustic emissions (DPOAEs) are a promising screening technique for the early detection of subtle noise induced cochlear function changes. Objectives: To determine the applicability of DPOAEs as a health surveillance technique for the early detection of noise induced hearing loss (NIHL) in workers at a steel manufacturing industry. Methods: DPOAEs were recorded in 20 participants with no history of occupational noise exposure and 20 participants exposed to noise in the steel manufacturing industry. Participants were not exposed to noise for at least 48 hours prior to testing. All participants were male with normal audiometric thresholds of ?15 dB HL. The DPOAE presence and response amplitude levels for different frequencies were compared between the two groups. The study further evaluated the short-term test-retest repeatability of DPOAE measurements, and also compared the total test duration of performing DPOAEs to the duration of screening audiometry. Results: The noise exposed group had statistically significantly lower DPOAE response amplitudes than the control group for all the tested frequencies; (p&#0600.001) at 2002 to 4004 Hz, and (p=0.01, p=0.001) at 6348 and 7996 Hz respectively, suggesting more cochlear damage in the noise exposed group due to early outer hair cell damage. DPOAEs showed very good reproducibility, and the average duration of performing a set of DPOAEs was significantly shorter (461 ± 68.2 seconds) than the duration of performing audiometry (591 ± 76.9 seconds), p&#0600.001. Conclusion: DPOAEs appeared to be a sensitive technique in detecting noise induced subtle cochlear function changes. DPOAEs could be used as a health surveillance technique for the early detection of NIHL in the steel manufacturing industry. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / M Communication Pathology / Unrestricted

Indiana University-Purdue University Indianapolis (IUPUI) / Between 3.2 and 5.3 million U.S. civilians live with traumatic brain injury (TBI)-related disabilities. Although the post-acute phase of TBI has been recognized as both a discrete disease process and risk factor for chronic conditions, TBI is not recognized as a chronic disease. TBI epidemiology draws upon untimely, incomplete, cross-sectional, administrative datasets. The adoption of electronic health records (EHR) may supplement traditional datasets for public health surveillance and research. Methods Indiana constructed a state-wide clinical TBI registry from longitudinal (2004-2018) EHRs. This dissertation includes three distinct studies to enhance, evaluate, and apply the registry: 1) development and evaluation of a natural language processing algorithm for identification of TBI severity within free-text notes; 2) evaluation and comparison of the performance of the ICD-9-CM and ICD-10-CM surveillance definitions; and 3) estimating the effect of mild TBI (mTBI) on the risk of post-acute chronic conditions compared to individuals without mTBI. Results Automated extraction of Glasgow Coma Scale from clinical notes was feasible and demonstrated balanced recall and precision (F-scores) for classification of mild (99.8%), moderate (100%), and severe (99.9%) TBI. We observed poor sensitivity for ICD-10-CM TBI surveillance compared to ICD-9-CM (0.212 and 0.601, respectively), resulting in potentially 5-fold underreporting. ICD-10-CM was not statistically equivalent to ICD-9-CM for sensitivity (𝑑𝑑𝑑𝑑̂=0.389, 95% CI [0.388,0.405]) or positive predictive value (𝑑𝑑𝑑𝑑̂=-0.353, 95% CI [-0.362,-0.344]). Compared to a matched cohort, individuals with mTBI were more likely to be diagnosed with mental health, substance use, neurological, cardiovascular, and endocrine conditions. Conclusion ICD-9-CM and ICD-10-CM surveillance definitions were not equivalent, and the transition resulted in a underreporting incidence for mTBI. This has direct implications on existing and future TBI registries and the Report to Congress on Traumatic Brain Injury in the United States. The supplementation of state-based trauma registries with structured and unstructured EHR data is effective for studying TBI outcomes. Our findings support the classification of TBI as a chronic disease by funding bodies, which may improve public funding to replace legacy systems to improve standardization, timeliness, and completeness of the epidemiology and post-acute outcomes of TBI.

Several substantive observations formed the basis for this research. First, the observation of stagnating life expectancy in the United States over the first two decades of the 21st century, representing a dubious form of American exceptionalism. Second, evidence suggesting that novel measures of biological aging might provide allow for early evaluation of population-level health trajectories, based on direct observation of health status in still-living people. Third, the opportunity to apply these measures for study of population-level phenomena, using methods routinely used in the fields of sociology, demography, and economics. This dissertation represents a proof-of-concept work to support the application of biological aging measures to population health surveillance. In Chapter 2, I conduct a systematic literature review of novel measures and approaches to the quantification of population aging published since 2000, and identify 3 major classes of novel population aging measures. Biological-aging measures can be understood as a specific application of Sanderson and Scherbov’s α-ages approach, which indexes “true age” to the distribution of some aging-related characteristic in a reference sample. Relative to other novel measures and approaches, however, biological-aging algorithms hold particular promise in their ability to provide direct measures of pre-clinical, aging-related health risk across the entire adult age range of a population. In chapters 3 and 4, I apply published biological aging algorithms to blood-chemistry and organ-test data collected by the National Health and Nutrition Examination Surveys (NHANES) to test whether the U.S. population has grown biologically older over the past two decades, as some interpretations of life expectancy data would suggest, and to evaluate the extent to which selected social and environmental exposures might explain these trends. Formal age-period-cohort analysis revealed consistent period increases in biological aging from 1999-2018; while population aging slowed after the training cohort was measured in NHANES III (1988-1994), aging trajectories have reverted towards early-1990s levels since the turn of the century. Limited evidence of cohort effects was observed, with findings consistent regardless of age, race, and sex – although racial disparities in biological aging persisted over the entire study period. Kitagawa-Blinder-Oaxaca decomposition analysis of four candidate exposures (i.e., BMI, smoking status, blood lead, and urinary polycyclic aromatic hydrocarbon levels) suggested that changes in the distribution of behavioral and environmental risk factors accounted for a substantial proportion of observed period trends and/or racial disparities in biological aging over the first two decades of the 21st century. Broadly, these results suggest that measures of biological aging can provide earlier and more precise readouts of population health trajectories and their drivers, ultimately informing next-generation public health efforts to promote healthy aging and aging health equity.