Cost-effective Screening in International Adoptees

描述（由申请人提供）：候选人是一个初级学者 临床医生，受过儿科和流行病学培训，其长期职业生涯 目标是进行以患者为导向的研究，以改善医疗保健 为美国和发展中国家的弱势儿童提供服务。的 拟议的培训计划旨在使候选人能够过渡到 从新手到独立的流行病学研究者， 国际儿童健康具体目标是获得maundered 在以患者为导向的研究和严格的方法的实践经验 与经验丰富的导师团队一起进行决策分析方法的培训， 国家专家。培训计划描述了活动（高级学位 课程，独立学习和以病人为导向的研究），重点是 进一步发展流行病学方面的技能， 在国际收养（IA）儿童中进行有效筛查。两 建议进行补充研究，以解决临床和成本问题， IA中B型肝炎病毒（HBV）和结核病（TB）筛查的有效性 孩子这些研究都是基于这样一个假设， 筛查可以提供一种具有成本效益的方法， 移民儿童的健康结果，并符合公共卫生 必要条件每项研究都涉及主要收集新数据， 在传染病流行率和风险因素方面存在的重大差距 IA儿童的疾病，以及标记物（皮肤试验和 免疫史）来预测感染、疾病或保护性免疫。 这将提供有关传染病负担的新信息， 它的表达，在美国越来越多的IA儿童群体中。这些新数据 还将提供成本效益分析所需的估计数， 将制定评估替代方法的效用， 免疫接种和结核病筛查。该提案涉及重要的知识差距 关于从资源匮乏的国家移民到美国的儿童的健康问题， 环境，并可能提供重要的新数据，为合理和成本- 对IA儿童进行有效筛查。这群孩子是在这个 建议可以在未来的研究中遵循，旨在回答具有挑战性的 关于早期筛查的长期影响的问题， 预防性结核病治疗。最后，该建议将提供一个关键的培训 有机会促进候选人作为流行病学家的职业发展 致力于病人导向的研究

DESCRIPTION (provided by applicant): The candidate is a junior academic clinician, trained in pediatrics and epidemiology, whose long-term career goals are to conduct patient oriented research that will improve health care delivery to vulnerable children in the US and in the developing world. The proposed training program was designed to enable the candidate to transition from novice to independent researcher in epidemiology with expertise in international child heath. The specific objectives are to obtain maundered practical experience in patient oriented research and rigorous methodological training in decision analytic methods with an experienced team of mentors and national experts. The training plan describes activities (advanced degree coursework, independent study and patient oriented research) focused on further developing skills in epidemiology with immediate applications to cost- effective screening in internationally adopted (IA) children. Two complementary studies are proposed that address the clinical and cost- effectiveness of hepatitis B virus (HBV) and tuberculosis (TB) screening in IA children. These studies are based on the hypothesis that focused, rational screening can provide a cost-effective means for improving the long-term health outcomes of immigrant children and is consonant with public health imperatives. Each study involves primary collection of new data that address important gaps regarding the prevalence and risk factors for infectious diseases in IA children, and the utility of markers (skin tests and immunization history) to predict infection, disease or protective immunity. This will provide new information regarding the infectious disease burden, and its expression, in the growing group of IA children in the US. These new data also will provide estimates necessary for cost-effectiveness analyses that will be developed to assess the utility of alternative approaches for immunization and TB screening. The proposal addresses important knowledge gaps about the health of children immigrating to the US from resource-poor environments and may provide important new data for rational and cost- effective screening in IA children. The cohort of children developed in this proposal may be followed in future research designed to answer challenging questions with respect to the long-term impact of early screening and preventive TB therapy. Finally, the proposal will provide a key training opportunity to foster the candidate s career development as an epidemiologist with a commitment to patient oriented research.