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PubMed1998

Epidemiologic support to state and local sexually transmitted disease control programs. Perceived need and availability. The Field Epidemiology Network for STDs (FENS).

BACKGROUND AND OBJECTIVES: Sexually transmitted diseases (STDs) comprise the majority of national infectious disease morbidity reported, yet the number of epidemiologists working in state and local STD programs is estimated to be small. Even less is known about the training and activities of those epidemiologists. GOALS: To determine the number, training, and affiliation of epidemiologists working with STD programs and the level of satisfaction with epidemiologic support available. STUDY DESIGN: Survey of 65 program managers in state and local health departments. RESULTS: Program managers named 146 people working on epidemiologic activities, and 84 of those people were classified as "epidemiologist" by the criteria we applied. The median number of full-time equivalent (FTE) epidemiologists working in or with STD programs was 0.5; one quarter of all STD program had no epidemiologists. There was a significant association between number of FTE epidemiologist and population, with most programs with more than 0.5 epidemiologists located in areas with at least 1,000,000 population. State Epidemiologists do not provide technical support to most state STD programs. Almost half (45%) of all program managers indicated that they have inadequate epidemiologic support for routine program activities. CONCLUSIONS: The current level of epidemiologic support available to most STD programs is inadequate to perform surveillance and data analyses, interpret data to develop program objectives, and perform program evaluation. An essential next step is the delineation of a set of critical, analytic STD field epidemiology functions to define appropriate standards against which epidemiologic capacity can be more precisely measured.

Epidemiology↗
PubMedDate not supplied

[Field epidemiology and social epidemiology].

Comparing field epidemiology and social epidemiology, we pretend to think about the no explicit images and meanings operating in both necessary convergent fields, about the obstacles present in epidemiological practice to fulfil its social function and about the necessity of changing epistemological, methodological and practice grounds, beginning with field epidemiologists teaching programmes. Field epidemiology would tend to act in an absent theoretical frame. On the other hand, social epidemiology would tend to prioritize theoretical developments (thinking and research about social determinants) without correspondent action, because of the limits to change public policies. Other differences are found at intervention level (micro-macrospace), its aim (outbreak control vs. inequalities control) and the way to communicate with society. They are similar in the methodological concern, the predominance of orientation based on positivism and framed through statistic methods, but in process of epistemological opening, the stress experienced between the alternative relationship to a virtual world of data bases or to the real society, their peripherical situation in relation of the political, social, institutional and professional system and the tendency to professional frustration. Finally, we ask ten questions to the field epidemiologists related with their present practice, in order to consider if they are developing social epidemiology, and propose some changes in epidemiologist teaching and practice.

Epidemiology↗
PubMed1993

The Society for Epidemiologic Research and the future of epidemiology.

This paper describes the development of noninfectious disease epidemiology and the subsequent organization of the Society for Epidemiologic Research. It defines epidemiology as "the study of the health of human populations," and outlines its four basic functions. Certain negative trends in epidemiologic research are indicated. The current tasks of epidemiology are reviewed, as well as the objective and subjective factors which will determine the future of epidemiology.

Epidemiology↗
PubMed1999

Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies. The DECODE-study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis of Diagnostic Criteria in Europe.

AIMS/HYPOTHESIS: The World Health Organisation Consultation recommended new diagnostic criteria for diabetes mellitus including: lowering of the diagnostic fasting plasma glucose to 7.0 mmol/l and introduction of a new category: impaired fasting glycaemia. The diagnostic 2-h glucose concentrations for diabetes and for impaired glucose tolerance were unchanged. This study identifies fasting plasma glucose concentrations predicting a diabetic 2-h plasma glucose of 11.1 mmol/l or more, analyses the sensitivity and specificity of different screening strategies for diabetes and describes the cardiovascular risk profile in people with impaired fasting glycaemia. METHODS: European population based studies (n = 17) or large, representative samples of employees (n = 3) with both fasting and 2-h post load glucose concentrations following 75-g oral glucose tolerance tests were included (18,918 men and 10,190 women). The Iceland study (8881 men and 9407 women) is presented separately as a 50-g glucose load was used. RESULTS: The fasting plasma glucose predicting a 2-h plasma glucose of 11.1 mmol/l or more with optimal sensitivity and specificity was a) 5.8 mmol/l in women and 6.4 mmol/l in men; b) independent of age; c) increased with obesity. Fasting plasma glucose of 7.0/7.8 mmol/l or more predicted a diabetic 2-h plasma glucose with sensitivities of 49.0/29.8% and specificities of 98.2/99.7%, respectively. CONCLUSION/INTERPRETATION: If fasting glucose is used alone, the 31% of diabetic subjects with a non-diabetic fasting glucose but a diabetic 2-h glucose, will not be diagnosed; impaired fasting glycaemia and impaired glucose tolerance do not identify the same people; the risk profile of people with impaired fasting glycaemia depends on 2-h glucose concentrations. Obesity is the main confounder in the association between fasting and 2-h glucose.

Adult↗
PubMed2005

The epidemiology of pertussis: a comparison of the epidemiology of the disease pertussis with the epidemiology of Bordetella pertussis infection.

In the prevaccine era pertussis epidemics followed a cyclic pattern, with peaks every 2 to 5 years. With the marked reduction of pertussis by vaccination, the same cyclic pattern still occurs. Studies relating to reported pertussis and Bordetella pertussis infection have been reviewed and analyzed. The increase in reported pertussis over the last 2 decades is mainly due to a greater awareness of pertussis and perhaps to the use of several less efficacious vaccines. Studies of prolonged cough illnesses in adolescents and adults reveal that 13% to 20% are a result of B pertussis infection. Serologic studies suggest that the rate of B pertussis infection in adolescents and adults is approximately 2.0% per year. The rate of cough illnesses (pertussis) caused by B pertussis infection in adolescents and adults is between 370 and 1500 per 100,000 population. These data suggest that there are between approximately 800,000 and 3.3 million cases per year in the United States. The coming availability of adolescent- and adult-formulated diphtheria and tetanus toxoids and acellular pertussis vaccines for adolescents and adults and their widespread use should reduce the reservoir of B pertussis disease. It is suggested that a universal program of adolescent and adult boosters would decrease the circulation of B pertussis in these age groups and possibly could lead to the elimination of the organism from the population.

Adolescent↗
PubMed1983

A comparison between the sciences of epidemiology and statistics based on an examination of epidemiological or statistical studies on diabetes in Japan.

The authors selected 24 original papers which were regarded them as the epidemiological study and the statistical study from their titles, from the end of World War II to 1981. And these papers were selected from 3 medical journals of internal medicine, other medical journals and proceedings of 2 International Conferences (see Table 1), and also were the object of study, namely, theoretical considerations. Besides we classified these 24 papers into 2 sorts; papers for an epidemiological study and a statistical study, and made a comparative study of details of these papers theoretically. As the result we were able to clarify what the authors of 24 papers had considered about the natures of epidemiology and statistics as the science. It was clarified that two sciences, epidemiology and statistics, had been in the general trend without any recognition of the differences between two. And as the conclusion we pointed out that the field of activity of statistics was broader than that of epidemiology, and the nature of statistics as the science might be changeable according to the object, moreover, statistical theory might be a branch of mathematics and so on.

Diabetes Mellitus↗
PubMed1996

Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology.

Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization--molecular and societal as well as individual--this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline.

Epidemiologic Methods↗
PubMed1982

Epidemiology and epidemiologic methods: an introduction for respiratory care practitioners.

Epidemiology is the study of the distribution of disease in a population and of the factors that determine that distribution. Respiratory care practitioners encounter many aspects of epidemiology in training and practice and should become aware that most initial epidemiologic observations are made by clinicians. The determinations that excessive oxygen administration caused retrolental fibroplasia and that exposure to cotton bracts in the textile industry caused byssinosis resulted from the collaborative efforts of epidemiologists, laboratory workers, and clinicians. The three types of study designs in observational epidemiology are: (1) the cohort (incidence) study, in which a study factor is observed at the onset of the study and the study population is followed over time for the development of new cases of a disease; (2) the cross-sectional (prevalence) study, in which the presence or absence of risk factors is measured at one point in time in a study population and prevalence rates of disease among those with and without the risk factors are compared; and (3) the case-control study, in which the numbers of persons with and without a given disease who share certain background characteristics or exposure levels to risk factors are determined and compared. The epidemiologist's continued collaboration with the clinician and the laboratory scientist is important because epidemiology alone can rarely provide conclusive solutions to every aspect of a problem.

Epidemiologic Methods↗
PubMed2002

[What is epidemiology and what is cancer epidemiology?].

We have the world's oldest cancer registry in Denmark. We also have a cancer society that has invested substantial funds in epidemiology, which have been well used by highly skilled cancer epidemiologists. This is the formula for success. Cancer epidemiology, which is now conducted at the highest international level in Denmark, is a subdiscipline within epidemiology, and most of its activities are related to public health problems. Clinical cancer epidemiology is, however, a field which will grow in the next decades. Cancer epidemiology requires data of good quality and access to data for use in research. New important results will emerge if trajectories of cancer occurrence can be studied in a lifelong perspective. Research involving genetic factors will also open up new avenues for studies, but it will not replace research, whose starting point is the population's social conditions, their lifestyle, and environmental influences.

Denmark↗
PubMed1993

Scope and strategies of genetic epidemiology: analysis of articles published in Genetic Epidemiology, 1984-1991.

Genetic epidemiology is a relatively new discipline that seeks to unravel the role of genetic factors and their interactions with environmental factors in the etiology of diseases, using population and family study approaches. To characterize the overall direction and emphasis of research strategies used in this field, we reviewed original research articles published in the journal Genetic Epidemiology since its inception in 1984 until the end of 1991. Of 259 published original articles, 92 (35%) focused primarily on methodologic/statistical developments, most commonly in the area of linkage analysis/gene mapping, and 167 (65%) articles were applied or data-derived. Only 42 articles (16%) were population studies, and 217 (84%) were family studies. Most family studies dealt with genetic analysis of pedigree data using segregation and linkage analyses. Of the 137 applied family studies, 73 (53%) were drawn from well-defined populations, and only 40 (29%) considered specific environmental factors in their analyses. These findings clearly indicate a rapid growth in the methodologic and statistical aspects of genetic epidemiology, and in the emphasis on family-based studies and genetic analysis methods. Further developments in genetic epidemiology will require greater integration of epidemiologic approaches of study design and analyses into population and family studies of disease etiology.

Epidemiology↗
PubMed1992

Epidemiology and Health for All. The role of epidemiology in a health policy.

World Health Organization's goal Health for All is the starting point for a most ambitious health policy ever. The paper analyzes the role of epidemiology in the Organization's work, particularly in the Health for All development. During WHO's early years, epidemiology helped to design and carry out major public health campaigns against such scourges of the humanity as yaws, tuberculosis, malaria and small pox. When the Organization during the 1960s began to emphasize the need to develop the infrastructure of health care, health services research partly replaced epidemiology as WHO's main scientific allay. After the Health for All policy was launched in 1987, epidemiology has again played a major role in establishing the scientific background of the policy. The European experiences show how the epidemiologists can help WHO to identify the most important health problems and set achievable and measurable targets for them. The paper concludes that epidemiology serves to identify problems, show ways to solve them, monitor the changes in the situation and evaluate the achievements.

Epidemiology↗
PubMed2001

Feminism meets the "new" epidemiologies: toward an appraisal of antifeminist biases in epidemiological research on women's health.

This essay explores an alternative paradigm for epidemiology, one which is explicitly informed by a feminist perspective. We intend to expand upon recent critiques and debates within the emergent fields of "critical", "popular", and "alternative" epidemiology to examine how epidemiology's conceptual models--which are meant to contribute to the prevention of social inequalities in health, but may instead reinforce social hierarchies based on gender, race, and class--constrain our understanding of health and disease. Specifically, we examine persistent antifeminist biases in contemporary epidemiological research on women's health. Issues highlighted include: problem definition and knowledge production in women's health: biological essentialization of women as reproducers; and decontextualization and depoliticization of women's health risks. As part of this critique, we include suggestions for an emancipatory epidemiology that incorporates an alternative feminist framework.

Epidemiologic Studies↗
PubMed1994

[Role of population-based cancer registry in cancer epidemiology--epidemiological studies in the Cancer Registration Scheme in Osaka, Japan].

A population-based cancer registration scheme started in three areas in Japan in the 1950s solely for studying cancer incidence in their respective areas. Soon thereafter, several prefectural governments started their own schemes as part of their cancer control programs, effectively expanding the aims of cancer registration: to clarify cancer facts, to elevate the medical care for cancer patients, and to plan and evaluate cancer control programs. The Osaka Cancer Registry (OCR) started in 1962, and has been using epidemiological methods as a tool in constructing its registration scheme, as well as analyzing and utilizing registry data. This report deals with the results obtained in the OCR, classifying these results into four activities of epidemiology. 1. Clarifying cancer facts (descriptive epidemiology): The OCR has been observing incidence, medical care for cancer patients, distribution of cases by clinical stage, and the 5-year relative survival rate, and has estimated the prevalence rate, cured-case rate, and future incidence into the 21st century. Population-based data on histology and multiple cancers collected at the OCR have also contributed to the new approaches in cancer epidemiology. 2. Research on risk factors (analytical epidemiology): The OCR developed a computerized record-linkage system in 1970. This not only made registry work more effective and reliable, but many cohort studies were able to be conducted with relatively little effort and highly reliable results. The cancer case file in the OCR has been linked with the newly prepared data file of the study group, and cancer incidence among the study group has been observed. Finally, cancer risks of possible causal factors in that group have been estimated quantitatively. 3. Evaluation of control programs: Secondary prevention programs (early detection) have been conducted in Japan as major cancer control programs, because effective risk factors were not previously defined. OCR data have been used for estimating sensitivity and specificity of screening tests for various cancers, as well as for evaluating the effect of clinical work on improving survival and on decreasing cancer deaths. 4. Planning future cancer control programs: The OCR has reported on the probable rapid increase of cancer incidence in the 21st century, especially of elderly cancer cases, and cancer cases with poor survival. To control these difficult problems, new cancer programs should be urgently designed and implemented. The authors have recommended that programs be prepared by cancer site, and have already presented a detailed program for lung cancer control.

Cohort Studies↗
PubMed1997

[Molecular epidemiology in the epidemiological transition].

The epidemiological transition describes the changes in the health profile of populations where infectious diseases are substituted by chronic or non-communicable diseases. Even in industrialized countries, infectious diseases emerge as important public health problems and with a very important association with several type of neoplasm. Molecular epidemiology brings in new tools for the study of the epidemiological transition by discovering infectious agents as etiology of diseases, neither of both new. Much has been advanced in the understanding of the virulence and resistance mechanism of different strains, or improving the knowledge on transmission dynamics and dissemination pathways of infectious diseases. As to the non-communicable diseases, molecular epidemiology has enhanced the identification of endogenous risk factors link to alterations, molecular changes in genetic material, that will allow a more detail definition of risk and the identification of individual and groups at risk of several diseases. The potential impact of molecular epidemiology in other areas as environmental, lifestyles and nutritional areas are illustrated with several examples.

Chronic Disease↗
PubMed2000

Genetic epidemiologic studies on age-specified traits. NIA Aging and Genetic Epidemiology Working Group.

This commentary calls attention to the value of combining genetic and epidemiologic methods in studies to understand the determinants of two crucial aspects of aging: ages at which certain outcomes (e.g., disease, mortality) occur and rates of change with age of individual's characteristics (e.g., physiologic functions, disease risk factors). Inclusion of age in the specification of traits in genetic epidemiologic studies could lead to improved strategies to increase healthy life expectancy and evaluate individuals' risk for age-related morbidity. Special issues that make genetic epidemiologic approaches important for studies of age-specified phenomena as well as opportunities and challenges for such studies are discussed, including study designs, sampling frames, databases, analytic tools, and related methodological issues. This commentary is based on a report prepared by the Aging and Genetic Epidemiology Working Group, convened by the National Institute on Aging to review opportunities for research on the genetic epidemiology of aging-related outcomes. The report, which contains more extensive discussion, literature review, and references, is available on the World Wide Web at http://www.nih.gov/nia/conferences/GeneticReport111199.htm.

Age Factors↗
PubMed2006

Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA.

OBJECTIVE: To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study. DESIGN AND SETTING: In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor. PARTICIPANTS: Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination. MAIN RESULTS: Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks. CONCLUSIONS: The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.

Accidents, Aviation↗