Cost-effective Screening in International Adoptees

职位描述(申请人提供)：应聘者为初级教师 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中心的研究，以改善医疗保健 向美国和发展中国家的弱势儿童提供服务。这个 拟议的培训计划旨在使候选人能够过渡 从流行病学新手到具有以下专业知识的独立研究员 国际儿童健康协会。具体目标是获得精益求精 以病人为中心的研究实践经验和严谨的方法 与经验丰富的导师和团队一起培训决策分析方法 国家专家。培训计划描述活动(高级学位 课程作业、独立学习和以患者为中心的研究)侧重于 进一步发展流行病学技能，立即应用于成本- 国际收养(IA)儿童的有效筛查。二 建议进行补充研究，以解决临床和成本- 乙肝病毒和结核病筛查在IA中的效果 孩子们。这些研究是基于这样一种假设，即聚焦、理性 筛查可以提供一种经济有效的手段来改善长期 移民儿童的健康结果，并与公共卫生相一致 当务之急。每项研究都涉及对新数据的初步收集，这些数据涉及 关于传染性疾病流行率和危险因素的重要差距 IA儿童的疾病，以及标志物的使用(皮肤测试和 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，以及 它的表达，在美国日益增长的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， 将被开发来评估替代方法的有效性 免疫接种和结核病筛查。该提案解决了重要的知识差距问题 关于从资源贫乏移民到美国的儿童的健康问题 并可能提供重要的新数据，以合理和成本- 对IA儿童进行有效的筛查。在这种情况下发展起来的儿童队列 在未来旨在回答挑战的研究中可能会遵循这一建议 关于早期筛查的长期影响的问题和 预防性结核病治疗。最后，该提案将提供关键的培训 培养S候选人成为流行病学家的机会 致力于以病人为中心的研究。

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.