RESEARCH TRAINING AND EDUCATION CORE

虽然夏威夷在种族、民族和社会经济地位方面的差距很大，但 接受过分析这些差异的培训的调查人员的数量并不是这样。研究性培训的目标和目标 教育的核心是培养一支多样化的科学队伍来研究健康差距并促进健康 公平，这是中心赠款续期的中心目标之一。 上述结果预计将产生重要的积极影响，因为增加 对健康差距研究感兴趣的研究人员数量，提高他们的技能，并使他们暴露 采用跨学科的方法将增强我们进行创新、全面、精心设计的能力 在夏威夷和其他地区开展研究以缩小差距和改善弱势群体的健康 太平洋地区和全球的类似高危人群。 除非我们现在投资于建设人力资本，以了解差距的本质和原因 在护理质量和结果方面，我们将削弱解决这些差距和改善结果的能力。 针对弱势群体。 虽然夏威夷的总体健康状况，无论是以预期寿命还是生活质量衡量，都非常高， 夏威夷在与种族、民族和性别有关的健康结果方面背负着相当大的不平等 社会经济地位。在这些差距中，突出的是预期寿命较低和较长 土著夏威夷人和其他太平洋岛民中的疾病流行率[Bitton等人；Mau等人；Graninetti 等人；Maskarinec等人；Aluli等人；Harris和Jones]。认识到这一点，许多调查人员对 进行研究，以更好地了解这些差异的性质和根源，并遵循以下原则 具有针对性干预的探索性研究。 然而，存在着严重的障碍，限制了调查人员发展必要的健康技能的能力。 差异研究。提供指导和统计支持是另外两个重要问题(具体 目标1)。夏威夷大学开设的侧重于应用生物统计学的课程很少。 在全国范围内，有一股衡量差距的可用技术和方法的热潮 超越了临床试验。这些方法侧重于现实世界的有效性，而不是有效性，并具有 更短的时间范围，提高将其转化为可操作干预措施的能力。研究报告 培训和教育核心将通过提供基于案例的研究方法课程来填补这一空白 以及另一门针对博士生的比较效果分析和健康差距研究课程 和初级教员。我们向硕士和博士生讲授这些方法的课程将 希望在关键时刻激发人们对这一领域的兴趣，因为他们开始专注于特定的研究主题。 收集数据也可能既昂贵又耗时，但也存在规模经济。如果我们的房子很大 数据集和开发专业知识，我们可以支持许多学生和初级教职员工。核心将容纳和 向学生和教职员工提供用于健康差距研究的数据(具体目标2)。 这些数据集的内容将取决于参与者的兴趣，但可能包括糖尿病登记 由该中心创建的联邦医疗保险公共使用文件(http://www.cms.gov/BSAPUFS)与SEER癌症有关 数据(http://seer.cancer.gov)，和地方和国家行为风险因素监测系统数据 (http://www.cdc.aov/BRFSS：http://hawaii.gov/health/neighbor/statistics/brfss/brfss/index.html).) 另一个障碍是通常为缩小差距而采取的“竖井”方法[Marmot等人]。为 例如，公共卫生有基于社区倡议的方法，医生和护士往往 采取个案咨询的方法，药剂师讨论药物，替代护理提供者 重点放在他们选择的治疗方式上。然而，肥胖和心脏代谢的其他组成部分的问题 综合症，太复杂了，不能从单一的角度解决。通过培训学生和调查人员从 在同一门学科中，我们希望鼓励跨学科研究的发展 促进青年中跨学科团队的发展(具体目标3) 调查人员。跨学科的方法已被证明在以下方面取得了重大进展 了解和减少健康差距[Emmons等人]。 如果这项研究的拟议目标得以实现，更多的研究人员在健康方面得到激励和培训 差异研究，我们相信该领域可以取得重大进展，可以用来指导 开发治疗、服务和预防性干预措施，以实现预期的结果 夏威夷的弱势群体。

While the extent of disparities related to race, ethnicity, and socioeconomic status in Hawai'i is large, the number of investigators trained to analyze these disparities is not. The goal of the Research Training and Education Core is to develop a diverse scientific workforce to study health disparities and promote health equity, which is one of the central goals of the Center grant renewal. The outcomes described above are expected to have an important positive impact because increasing the number of investigators interested in health disparities research, improving their skill sets, and exposing them to trans-disciplinary approaches will enhance our ability to conduct innovative, comprehensive, well-designed research studies to reduce disparities and improve the health of vulnerable populations in Hawai'i and other similar at-risk populations in the Pacific and globally. Unless we invest now in building the human capital essential to understanding the nature and reasons for gaps in quality and outcomes of care, we will lessen our ability to address these disparities and improve outcomes for vulnerable populations. While overall health status in Hawai'i, whether measured by life expectancy or quality of life, is very high, Hawai'i is burdened with considerable inequities in health outcomes related to race, ethnicity, and socioeconomic status. Prominent among these disparities is the lower life expectancy and increased prevalence of disease among Native Hawaiians and other Pacific Islanders [Bitton et al.; Mau et al.; Grandinetti et al.; Maskarinec et al; Aluli et al; Harris and Jones]. Recognizing this, many investigators are interested in conducting research studies to better understand the nature and origins of these disparities, and to follow this exploratory research with targeted interventions. There are critical barriers, however, limiting investigator ability to develop the skills necessary to conduct health disparities research. Availability of instruction and statistical support are two other important issues (Specific Aims 1). There are very few courses offered at the University of Hawai'i focused on applied biostatistics. Nationally, there is an upsurge of available techniques and approaches to measuring disparities that go beyond clinical trials. These approaches focus on real world effectiveness rather than efficacy and have shorter time horizons, increasing their ability to be translated into actionable interventions. The Research Training and Education Core would fill this gap by providing a course on case-based research methodology and another course on comparative effectiveness analysis and health disparities research to doctoral students and junior faculty. Our lectures to master- and doctoral-level students regarding these methodologies will hopefully spark interest in the field at a critical point as they begin to focus on specific research topics. Assembling data can also be costly and time consuming but there are economies of scale. If we house large data sets and develop expertise, we can support many students and junior faculty. The Core would house and make available to students and faculty data for health disparities research (Specific Aim 2). The content of these datasets will depend on the interest of participants, but might include a diabetes registry created by the Center, Medicare Public Use Files (http://www.cms.gov/BSAPUFS) linked with SEER cancer data (http://seer.cancer.gov), and local and national Behavioral Risk Factor Surveillance System Data (http://www.cdc.aov/BRFSS: http://hawaii.gov/health/neighbor/statistics/brfss/brfss/index.html). An additional barrier is the "silo" approach that is often taken to reduce disparities [Marmot et al.]. For example, public health has approaches based on community-based initiatives, physicians and nurses tend to take a case by case counseling approach, pharmacists discuss medications, and alternative care providers focus on their treatment of choice. However, the problem of obesity, and other components of Cardiometabolic Syndrome, is too complex to tackle from a single perspective. By training students and investigators from various disciplines in the same course, we hope to encourage the development of a trans-disciplinary research perspective and to foster the development of interdisciplinary teams (Specific Aim 3) among young investigators. Trans-disciplinary approaches have been shown to lead to significant advances in understanding and reducing health disparities [Emmons et al]. If the proposed aims of this study are achieved and more researchers are inspired and trained in health disparities research, we believe significant advances can be made in the field that can be used to guide the development of treatments, services, and preventative interventions to achieve desired outcomes for vulnerable populations in Hawai'i.