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PubMed2005

Challenges of epidemiology in the 21st century: comments from the leaders of several epidemiology associations.

At the 2002 American Public Health Association Meeting, leaders of 12 epidemiology associations discussed the future challenges and epidemiology in the 21st century. A summary of the identified research-related, ethics, advocacy, training, and professional organization challenges is presented. Increased communication between all epidemiologists--regardless of specialty--is an excellent first step toward developing strategies to meet these challenges.

Epidemiology↗
PubMed2005

[Methods of infectious disease epidemiology for public health services: case control studies as bridge between practical work, surveillance and epidemiology].

Routine surveillance of infectious diseases is one important task of national public health services. Due to globalization the impact of international disease monitoring rises. The volume of traffic and trade is constantly increasing, which makes a spread of infectious diseases to distant places more likely then ever. This are challenges international infectious disease networks have to deal with. Thus, the role of investigation of disease outbreaks is not only relevant for local level; it furthermore prevents broader spread. To eliminate outbreak sources good epidemiological analyses have to be conducted. However, this often leads to extra time and personal resources. In addition classical studies, like case-control studies, underlay methodical limitations. Case-control studies, especially if conducted on the basis of notified cases from surveillance data, are susceptible to bias (like selection- and recall bias). Another study design, the case-case study (case-case comparison), provides an alternative, which is less affected by such limitations. In this approach a number of cases related within an outbreak, is compared with a group of infected individuals of the same disease, not belonging to the outbreak. Results from recently published studies lead to the assumption that this study design is adequate for the investigation of infectious disease outbreaks, captured by surveillance systems. The practical application of this study design makes it especially useful for local public health services and thus provides a bridge between surveillance, epidemiology and practical work in Public Health.

Case-Control Studies↗
PubMed2000

Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

OBJECTIVE: Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. PARTICIPANTS: Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. EVIDENCE: We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. CONSENSUS PROCESS: From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. CONCLUSIONS: The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.

Epidemiology↗
PubMed2003

Epidemiology and risk factors of eating disorders: a two-stage epidemiologic study in a Spanish population aged 12-18 years.

OBJECTIVE: The authors studied the prevalence rates of eating disorders (ED) and their risk factors in a Spanish population aged 12-18 years. METHOD: A two-stage epidemiologic study was conducted in the province of Valencia. Educational centers, classrooms, and individuals were selected randomly. The initial sample comprised 544 subjects. During Stage 1, subjects were screened with the 40-item Eating Attitude Test and a sociodemographic questionnaire that evaluates risk factors. During Stage 2, a semistandardized clinical interview was conducted with each participant. A random control group was paired by class, age, and sex. Comorbid psychiatric disorders and partial and subclinical forms were detected using criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). RESULTS: Using DSM-IV criteria, the morbidity rate was 2.91%, women comprised 5.17% of the sample, men comprised 0.77% of the sample, and the sex ratio was 6.71. Using DSM-IV criteria, including subclinical forms, the morbidity rate was 5.56%, women comprised 10.3% of the sample, men comprised 1.07% of the sample, and the sex ratio was 9.63. Six risk factors were isolated: psychiatric comorbidity, friend on a diet in the last year, desire to lose weight, desire to be less corpulent, sentimental problems, and diet in the last year. DISCUSSION: This is the first Spanish two-stage epidemiologic study to include a control group and to investigate risk factors.

Adolescent↗
PubMed1996

Epidemiologic research in an integrated regional medical care system: the Marshfield Epidemiologic Study Area.

To capitalize on Marshfield Clinic's advantages for population-based health research, we developed the Marshfield Epidemiologic Study Area (MESA). Marshfield Clinic is an integrated system consisting of a large multispecialty clinic and 23 affiliated clinics. Clinic physicians provide virtually all of the medical care, both inpatient and outpatient, for residents of the area. MESA consists of 14 ZIP codes in which over 95% of the 50,000 residents and most significant health events are captured in Marshfield Clinic databases, including all deaths, 94% of hospital discharges, and 92% of medical outpatient visits. MESA exemplifies the research potential of integrated medical care systems and the efforts required to realize that potential. Because it is representative of a defined population and provides an unselected sample of patients, MESA is well suited for epidemiologic research and research elucidating the clinical spectrum and natural history of diseases and the effectiveness of treatment.

Adolescent↗
PubMed2001

Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients.

BACKGROUND: Carcinoid tumours are rare malignant neuroendocrine tumours. In 1992 octreotide was introduced in the Netherlands as a palliative treatment for the carcinoid syndrome in metastatic carcinoid disease. The aims of this epidemiological study were to evaluate epidemiological data and the impact of octreotide on survival in metastatic carcinoid disease. PATIENTS AND METHODS: Between 1989 and 1996, 2391 patients with carcinoid disease were diagnosed in the Netherlands. Survival data from two Registries were available in 619 patients, diagnosed between 1980 and 1997. RESULTS: Between 1989 1996, incidence was 1.95/100,000. Under the age of 50 years a significant female predominance was observed. Under the age of 35 years, appendiceal carcinoid was the most frequently diagnosed primary site. Incidence of distant metastases at diagnosis for appendix and lung primary sites was 1.6% and 5.5%, compared to 40%, in the other primary sites. Multivariate analysis of 619 patients revealed that age, stage and appendix localisation predicted survival. In metastatic disease, however, only year of diagnosis after 1992 independently predicted survival (P = 0.012). CONCLUSIONS: The female predominance found under the age of 50 years suggests hormonal influence. Improved survival in metastatic carcinoid disease might relate to the use of octreotide.

Adolescent↗
PubMed1995

The use of epidemiological techniques to assess risk: the epidemiology of microbial keratitis.

The role of the three principal epidemiological study designs-- descriptive, cohort and case-control studies--for the evaluation of risk, is illustrated by describing their use for the investigation of microbial keratitis. Descriptive studies have identified potential risk factors and causes of microbial keratitis by both case reports and case series; trauma, ocular surface diseases and, latterly, contact lenses have been identified as potential risk factors. These studies have also shown that Pseudomonas aeruginosa and Acanthamoeba are particularly associated with contact lens wear. However, these studies are limited because they cannot be used to quantify risk. Cohort studies, in which the number of cases of a disease developing in a defined and initially unaffected population are identified, are usually inappropriate for assessing rare conditions because the size of the study often has to be too large, and follow-up too long, to generate sufficient numbers of cases. Some of the disadvantages of this study type can be overcome by sampling techniques and have been successfully carried out to obtain incidence figures for microbial keratitis. Case-control studies use multivariable analyses to examine the risk of microbial keratitis associated with various factors. This is an economical study design for investigating rare diseases because a group of subjects with the disease is compared with a control group from the same population who are unaffected. The selection of an appropriate control group is a difficult problem in epidemiology but this study design has been crucial in identifying risk factors and potential causes of microbial keratitis.

Acanthamoeba Keratitis↗
PubMed2007

GI Epidemiology: databases for epidemiological studies.

BACKGROUND: Large databases are being increasingly used for examining the epidemiology and outcomes of digestive and liver disorders. The complexity and rigor of the methods used to conduct these studies are often underestimated. AIMS: For the most commonly used databases, we provide a brief description of the contents, highlight strengths and weakness, and provide links for more detailed information. We also present a systematic approach to utilizing large databases for addressing research questions, highlighting commonly encountered study design issues, as well as strategies for resolving these issues. CONCLUSIONS: 1. Research using large databases requires the same essential skills needed to conduct research studies using other data sources. These include a rigorous study design, expertise in analytic methods, and relevant research questions. 2. The completeness and accuracy of information contained in the database must be assessed. Methods for improving the quality and completeness of this information should be considered. 3. Despite similarities among large databases, gaining insight and experience into the structure and content of each database is essential. Key points *Large databases can be a powerful source of information to examine the clinical epidemiology and outcomes of digestive and liver disorders. * Research using large databases requires the same essential skills needed to conduct research studies using other data sources. These include a rigorous study design, expertise in analytic methods, and relevant research questions. * The completeness and accuracy of information contained in the database must be assessed. Methods for improving the quality and completeness of this information should be considered. * Despite similarities among large databases, gaining insight and experience into the structure and content of each database is essential. * Examples of commonly used large databases are presented with a synopsis of information contained in the database, as well as strengths and limitations of using the database for research.

Databases as Topic↗
PubMed2004

Molecular epidemiology of tuberculosis and recent developments in understanding the epidemiology of tuberculosis.

The development of molecular typing techniques during the last decade has led to remarkable improvements in epidemiological studies of tuberculosis (TB) and other infectious disease. In this paper, the burden of TB disease, current issues about disease control in developed countries including Australia and the contribution of molecular typing to improved understanding of TB epidemiology are reviewed.

Cluster Analysis↗
PubMed1977

Epidemiology abuse: epidemiologic and Psychosocial perspectives on heroin maintenance.

Two perspectives on drug abuse have evolved. Epidemiologic approaches treat drug abuse as if it were an infectious disease and deal with it within the framework of host, agent, and environment. Epidemiologists, approaching drug abuse from a public health standpoint, tend to think in terms of supply reduction. Psychosocial approaches focus on the demand aspect of drug abuse. Interest centers on psychological/sociological explanations of drug-taking behavior, such as psychopathology and alienation, and on unintended consequences of supply-reduction strategies. The author proposes that the two models eomplement each other and need to be integrated. A policy of strict supply reduction for nonaddicts coupled with heroin maintenance for addicts is suggested. Such a policy combines epidemiologic emphasis on supply reduction with psychosocial stress on the impractible nature of addiction and the futility of prohibitionlike approaches.

Attitude to Health↗
PubMed2002

Epilepsy and epileptic disorders, an epidemiological marker? Contribution of descriptive epidemiology.

Numerous epidemiological studies concerning the incidence and prevalence of epilepsy and epileptic seizures have been performed in different geographical areas throughout the world. The results of these studies show some disparities in the evaluation of incidence and prevalence rates. Higher incidence rates have been reported in a few studies performed in developing countries. Many prevalence studies seem to corroborate this figure although more recent surveys report similar rates to those observed in the developed world. These controversial results are discussed because there is no scientific reason that the clinical aspects and natural evolution of the disease should be different between developed and developing countries. However, some epidemic or endemic diseases might explain, in part, these figures. On the other hand, the age and sex distribution of the disease seems to be specific to epilepsy and could be related to particular risk factors and some demographic considerations. Apart from obvious methodological biases, the results of these studies lead us to recognize that epilepsy is universal it can occur in any people and is ubiquitous i.e. it is observed in every country but is not an equally distributed disease. Epileptic seizures and epilepsy might be considered as an epidemiological marker of some endemo-epidemic diseases or the results of certain preventive measures.

Age Distribution↗
PubMed1992

Epidemiology and aging: how gerontology has changed noncommunicable disease epidemiology in the United States of America.

Epidemiology is a continuously evolving discipline that has been greatly enriched by addressing the health problems of the elderly. In the United States of America, this has resulted in a large national data resource of functional and health measures on older populations, heretofore not available. In this article, suggestions are made for research priorities in the next 10 years in the epidemiological study of the elderly. They include: (i) a special emphasis on enhancing analytical methods, particularly for complex longitudinal data; (ii) an effort to understand the impact of the physiochemical environment on older persons, both in the household and workplace setting; (iii) the identification of new ways to determine early life exposures among older persons, so that hypotheses about early influences on aging processes can be tested; and (iv) a general effort to include function status and other geriatric measures as a routine part of the clinical record, so that secondary research on such records can be more conveniently performed.

Aged↗
PubMed1989

[Clinical epidemiology: a new epidemiology?].

The concept of "clinical epidemiology" is well established in the New World; indeed most of the quotations and works cited in this paper come from the United States and Canada. On the other hand, the concept seems to remain controversial in most countries in the Old World. From an exploration of the interface between the approaches used by epidemiologists on the one hand, and clinicians (including psychiatrists) on the other, this paper discusses aspects of the relationship between "conventional" and "clinical" epidemiology; in particular questions are raised as to whether these are part of the same continuum or whether they are separated by a gulf. At present, answers to such questions depend on subjective positions as well as on objective criteria. In order to reach a consensus on these questions, further concertation especially among epidemiologists, will be needed.

Canada↗
PubMedDate not supplied

[Use of a combined epidemiological, virological and morphological analysis of rubella infection for an epidemiological survey of congenital rubella].

The results of composite epidemiological, virological and morphological studies of intrauterine rubella infection performed in 1979, in the period of maximum increase of rubella incidence in Moscow for 11 years (1969-1979) are presented. Investigations of 125 foci of rubella established a relatively high frequency of contacts of pregnant women with the source of infection in families of rubella patients. Twenty-nine cases of clinically manifest and inapparent rubella among pregnant women were detected and confirmed in the laboratory; intrauterine infection at 3-17 weeks was established in 16 out of 18 virologically examined women. The ratio of the disease forms was 3.5 : 1. Using laboratory methods of investigations, rubella of pregnant women was confirmed in 100% cases. From the aborted and fetal materials collected in the disease or inapparent infections of pregnant women rubella virus was isolated in 88.9%, marked pathomorphological lesions were found in organs of 61% of the fetuses examined. The organotropism of rubella virus was confirmed by a high rate (87%) of virus isolation from placenta and umbilical cords as well as by localization of morphological lesions in these organs and in the eye lens tissues. These characteristics of marked teratogenic potentials of the circulating virus strains indicate the necessity of organization of regular epidemiological surveys of rubella in pregnant women for prevention of congenital rubella in the USSR.

Animals↗
PubMed1995

Epidemiology in action. Participants of the Liverpool Epidemiology Programme.

An outline is given of some international schemes aimed at strengthening epidemiological capabilities. Particular reference is made to the Liverpool Epidemiology Programme, dedicated to the exchange of ideas between trainers and health workers. Its activities have resulted in an expanding worldwide network of support for the development of training programmes and materials.

Computer-Assisted Instruction↗
PubMedDate not supplied

[Assessing the effectiveness and quality of state epidemiologic surveillance and the activities of the first level sanitary epidemiologic institutions].

Validates a complex of methodological approaches to assessing the efficiency of sanitary epidemiological institutions today. Shows the specificities of such assessment for the institutions of the first-level management. Validates a demonstration model for computer processing of data on the efficiency of departments of environmental hygiene and of specialists in this field and recommends this model for regional centers of State Sanitary and Epidemiological Surveillance.

Epidemiologic Methods↗
PubMed2003

The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.

Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.

Adolescent↗
PubMed1979

The epidemiology of fascioliasis in Malawi: I. The epidemiology in the intermediate host.

Fasciola gigantica Cobbold was studied in the intermediate host snail. On snail survey Lymnaea natalensis Krauss was the species found responsible for the transmission of Fasciola gigantica in Malawi. The ecology of this snail was studied at 5 different habitats spread throughout Malawi. The snail population was recorded high from April to October. The epidemiological cycle of Fasciola gigantica in the snail was determined and it was shown that snail infection was high in April and May and thus more metacercariae are released in August to October following such an infection. To complete the epidemiological picture studies reported separately were done involving the definitive host.

Animals↗