Skip to content

eCohorts and the future of epidemiology

March 29, 2013

mobile smartphoneReporter Ron Winslow posted an article in the March 18, 2013 issue of The Wall Street Journal about a privately-funded University of California, San Francisco (UCSF) effort to track heart disease risk in over 1 million adults using mobile technology.

The project, called “Health eHeart”  is described by Dr. Jeffrey Olgin, UCSF’s chief of cardiology, as “a large-scale digital version of the Framingham Heart Study.”  The researchers plan to engage participants by encouraging them to enter their own data (e.g., brief surveys), be available for digital follow-up, and to use digital apps and sensors to record certain biological measures like blood pressure.

Questions for consideration:

  1. Are “eCohorts” the wave of the future for epidemiology? For what types of research questions are they best suited?
  2. What steps are needed to enable the widespread use of mobile technology for data collection in research studies?
  3. What are the new challenges that arise with the use of “eCohorts”?

We look forward to an engaging discussion on these issues.

Posted by the Epidemiology Branch, NHLBI

Guest contributor Dr. David C. Goff offers perspective on the future of epidemiology

March 13, 2013

The Future image -20034177A year ago, the NHLBI launched this forum in an effort to open an active discussion with the larger epidemiology research community about the future of epidemiology as it relates to cardiovascular disease. We want to thank everyone for their thoughtful contributions to the forum and look forward to further engaging with the research community on this important topic.

We are pleased to welcome guest contributor, David C. Goff, Jr., M.D., Ph.D., chair of the American Heart Association (AHA) Council on Epidemiology and Prevention, and dean of the Colorado School of Public Health, who will help us mark the one-year anniversary by sharing his perspective on the future of epidemiology:

Strong epidemiology has been a critical component of advances in public health over at least the past half-century and will remain important in the future.  The potential contributions of strong epidemiology include further elucidation of the social determinants of health, the molecular determinants of health, and the comparative effectiveness of various interventions, whether based on changes in policies, systems, environments, behaviors, or the use of pharmacologic, biologic, or device-based therapies. 

We need better science regarding the social influences that constrain healthy behaviors and the policy changes that can redress those constraints. The best science will likely come from strong collaboration between epidemiologists and social scientists. We need better science regarding the molecular basis of health, including how environmental exposures and behavioral patterns interact with the genome and microbiome to influence biologic systems, that can be examined with increasingly complex methods, such as epigenomics, proteomics, and metabolomics.  The best science will likely come from strong collaboration between epidemiologists and systems biologists.

We need better science regarding the impact of various interventions on population health.  In some instances, randomized trials will be the best approach, but for many policy-based interventions, other approaches may be needed.  For example, cross-sectional observational studies have shown associations between density of public food advertisements (e.g., billboards) and obesity prevalence, but association is not necessarily causation.  Evaluation of natural experiments in public food advertising could clarify this issue.

Strong epidemiology has contributed greatly to advances in cardiovascular health over the past half-century, and will be critical to efforts to advance global cardiovascular health for decades to come.

David C. Goff, Jr., MD, PhD
Chair, AHA Council on Epidemiology and Prevention
Dean, Colorado School of Public Health

Epidemiology: looking back on 2012 and looking forward to 2013

January 16, 2013

Wave erasing 2012 written on the sand with 2013 on foreground2012 was a gratifying year, filled with discussions on future directions in epidemiology that were open, productive, and creative.  The NHLBI Digital Forum has been one avenue of discussion and we appreciate all of the contributions that we received.  Several of the discussions led to specific actions within the NHLBI’s Epidemiology Branch.  A workshop is being planned for 2013 that will focus on the value, strengths, and weaknesses of embedding clinical trials within observational studies.  A second workshop is being planned for 2013 assessing the role of existing medical data collection systems in surveillance of cardiovascular diseases.  There will be additional emphasis on developing methods to obtain higher quality data at lower costs. 

In this post, we now ask an open question to our readers:  for 2013, what do you think should be a high priority Funding Opportunity Announcement for observational studies that could be proposed by the NHLBI?

Posted by the Epidemiology Branch, NHLBI

Embedding clinical interventions in observational cohort studies

November 6, 2012

Jigsaw PiecesAn observational cohort study, with well-characterized participants, comprehensive event identification, and extensive infrastructure, may offer a platform to conduct clinical trials or community interventions.  At the same time, an intervention could impact the data collection, analysis, and interpretation of longitudinal studies.

What are the advantages and disadvantages of this hybrid design? What types of clinical or community interventions would be best in this scenario?  How can epidemiology and clinical trial expertise be successfully integrated?  Are there budgetary benefits to embedding interventions? How would participants and communities react to this model?

We are seeking input on these questions as we consider new research directions.  We welcome your comments.

Posted by the Epidemiology Branch, NHLBI

Epidemiology and Comparative Effectiveness – How can epidemiology best contribute?

September 20, 2012

light bulb and stethoscopeTwo seminal reports, the first by the Institute of Medicine and the second by the Patient-Centered Outcomes Research Institute, focus on the priorities for comparative effectiveness research (CER). An important question is the role that observational, rather than interventional, studies can play in addressing the priorities raised in these two reports.  It is likely that both financial and feasibility issues will limit the number of trials that can be conducted.  Some questions that we’d like to address include: 

 · What areas of CER can be addressed by observational studies, particularly where trials may not be feasible? 

· Can there be better analytical methods to control for indication bias in evaluating treatments? 

· What can be contributed by existing cohorts, registries, medical data bases, and surveillance populations?

We welcome your comments and other questions that you would like to discuss.

Posted by the Epidemiology Branch, NHLBI

Training and career development in epidemiology – planning for the future

August 1, 2012

As “on-thLearning (words) Imagee-job” training is replaced by structured approaches [Luepker RV], it becomes increasingly challenging to identify and train heart, lung, blood, and sleep epidemiologists in core competencies [Brownson RC, Samet JM, Thacker SB], while also providing learning opportunities that will foster multidisciplinary research in emerging scientific areas. Planning for the future entails preparing a new generation of highly skilled epidemiologists.  We welcome your comments on how to make this happen.

 Core questions for the Epidemiology Training Community include: 

  • How can NIH-supported research training and career development programs [Sumandea CA, Balke CW.] meet future heart, lung, blood, and sleep epidemiology needs?
  • How can we increase demographic diversity across the epidemiology workforce?
  • What is the optimal mix of instructional training vs. hands-on training for epidemiology, and do the criteria for NIH training and career development awards allow a mix of both?
  • How can we inspire careers in epidemiology given the current, and hopefully temporary, reduction in research awards?

 We are looking forward to an engaged conversation on these issues.

 Posted by the Epidemiology Branch, NHLBI

Results-based accountability – beyond counting widgets

June 25, 2012

success (words) and ruler

There is increasing demand to justify investments made in biomedical research (as discussed in these papers: Macilwain, Van Noorden, Ioannidis, Lauer).  Some metrics that have been applied to individuals for performance evaluation and promotion, such as numbers of publications and citations, are now being applied to research projects.

Investigator-initiated and NIH-initiated studies are both facing increased pressure to show that they are worth the investment, but do we know how to define and create metrics to measure the value of these research investments?  What are the appropriate metrics for productivity and impact of general biomedical research, and in particular epidemiology studies?  What are the potential benefits and pitfalls?  Since results-based accountability is increasingly being applied to biomedical research, what is the best approach?

Posted by Epidemiology Branch, NHLBI