RESUMEN
Computational models support environmental regulatory activities by providing the regulator an ability to evaluate available knowledge, assess alternative regulations, and provide a framework to assess compliance. But all models face inherent uncertainties because human and natural systems are always more complex and heterogeneous than can be captured in a model. Here, we provide a summary discussion of the activities, findings, and recommendations of the National Research Council's Committee on Regulatory Environmental Models, a committee funded by the U.S. Environmental Protection Agency to provide guidance on the use of computational models in the regulatory process. Modeling is a difficult enterprise even outside the potentially adversarial regulatory environment. The demands grow when the regulatory requirements for accountability, transparency, public accessibility, and technical rigor are added to the challenges. Moreover, models cannot be validated (declared true) but instead should be evaluated with regard to their suitability as tools to address a specific question. The committee concluded that these characteristics make evaluation of a regulatory model more complex than simply comparing measurement data with model results. The evaluation also must balance the need for a model to be accurate with the need for a model to be reproducible, transparent, and useful for the regulatory decision at hand. Meeting these needs requires model evaluation to be applied over the "life cycle" of a regulatory model with an approach that includes different forms of peer review, uncertainty analysis, and extrapolation methods than those for nonregulatory models.
Asunto(s)
Medición de Riesgo , Conservación de los Recursos Naturales , Toma de Decisiones , Exposición a Riesgos Ambientales , Humanos , Modelos Teóricos , Formulación de Políticas , Probabilidad , Reproducibilidad de los Resultados , Programas Informáticos , Estados Unidos , United States Environmental Protection AgencyRESUMEN
PURPOSE: To examine the impact of various breastfeeding outcomes of three cohorts receiving different methods of prenatal breastfeeding education. METHODS: Retrospective cohort design with patients attending a breastfeeding education class at an Army medical center. Controls were matched for sponsor rank, marital status, and smoking status. One hundred ninety-four mothers who expressed intent to breastfeed received breastfeeding education as follows: (a) a class that used video demonstration and group teaching by a lactation consultant, (b) a new mothers' support group with one-on-one teaching prenatally and weekly meetings postpartum, taught by a lactation consultant and a pediatrician, and (c) a control group educated at prenatal visits only. Descriptive statistics, chi-square, ANOVA, unpaired t test, and logistic regression were used to analyze the data. RESULTS: Women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls (p = .01). There was no significant difference in rates between types of classes offered (p = .45). CLINICAL IMPLICATIONS: Prenatal breastfeeding education can influence the amount of time women breastfeed. All providers of prenatal care should consider offering such classes in order to improve breastfeeding rates.
Asunto(s)
Lactancia Materna/estadística & datos numéricos , Madres/educación , Educación del Paciente como Asunto/organización & administración , Atención Prenatal/organización & administración , Análisis de Varianza , Lactancia Materna/psicología , Distribución de Chi-Cuadrado , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/organización & administración , Humanos , Intención , Modelos Logísticos , Madres/psicología , Madres/estadística & datos numéricos , Enfermeras Clínicas/organización & administración , Investigación en Evaluación de Enfermería , Evaluación de Resultado en la Atención de Salud , Atención Posnatal/organización & administración , Embarazo , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Grupos de Autoayuda/organización & administración , Apoyo Social , Factores de Tiempo , Grabación de Cinta de VideoRESUMEN
In December 2006, the U.S. Environmental Protection Agency (EPA) sponsored a 2-day workshop on "Interpretation of Epidemiologic Studies of Multipollutant Exposure and Health Effects" in Chapel Hill, NC. The final session at this workshop was devoted to assessing the biological plausibility of epidemiological findings with regard to criteria air pollutants. The presentations and the panel contributions of this last session primarily focused on controlled exposure studies and led to wide-ranging discussions, some of which were provocative. The panel summary provides some guidance to future evaluations of the biological plausibility of the epidemiological reports on criteria pollutants and is intended to stimulate thinking, without drawing any definitive conclusions. This paper does not approach, nor was it intended to approach, the more formal analytical approach such as that used in EPA's development of its Science Assessment Document for the criteria pollutants.