Analytical Epidemiological Studies Research Articles

"The assessment of odontophobia among Syrian refugees at the Moroccan military medical and surgical hospital in the Zaatari camp in Jordan and its influence by post-traumatic stress disorder : about an epidemiological investigation".

Introduction : 
 Odontophobia is a complex anxiety disorder related to excessive fear of dental care. Of multifactorial origin, it affects more females than males at all ages. Odontophobia can also be associated with other disorders, namely post-traumatic stress disorder (PTSD), which is recognized in refugees from civil wars.
 Materials and methods : 
 Descriptive and analytical cross-sectional epidemiological study, carried out during February 2020 at the Syrian refugee camp in Zaatari, Jordan, involving 200 consultants at the dental office to assess their degree of odontophobia and to determine the risk factors associated with this disorder, particularly post-traumatic stress disorder (PTSD).
 Results : 
 The authors collated 200 subjects of which 125 (62.5%) were phobic with a corah score (> or = to 13) and 75 (37.5%) were non-phobic with a corah score (< to 13). The sex ratio was statistically different between the two populations with a predominance of female sex (p=0.025). odontophobia is also related to the length of time spent in Syria during the civil war, it is observed more in 96 (48%) patients who spent between (13 and 24 months) (p=0.017). Similarly, odontophobia is influenced by post-traumatic stress disorder in its severe form (p=0.011).
 Conclusion: 
 Descriptive and analytical observational epidemiological study showing the high prevalence of odontophobia among Syrian refugees consulting at the dental office of the Moroccan military medical-surgical hospital in Zaatari camp in Jordan and its influence by post-traumatic stress disorder (PTSD).

Health effects of air pollution: a Southern European perspective.

ObjectiveTo summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe.Data sourcesLiterature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.Study selectionRecent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.ResultsAir pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardio-respiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas.ConclusionsBased on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.

Factors associated with elder abuse: a systematic review of the literature.

Elder abuse is a complex public health problem. It is of fundamental importance to ascertain which factors are associated with each specific type of abuse, as a way of enabling the creation of evidence-based public policies. The aim of the present study was to systematically review the literature regarding analytical epidemiological studies of factors associated with elder abuse. Four databases were used for the bibliographic search: Pubmed, Scopus, Web of Science and Lilacs, with no limitations regarding year of publication. Articles were selected by pairs of researchers in two stages: reading of abstracts (3.121) and reading of complete articles (64). The total number of articles selected was 27. The risk of bias was evaluated. The factors associated with general violence were age, sex, marital status, educational level, income, family arrangement, social support, solitude, mental disorder, depression, suicide attempt, dependence on others in daily activities, cognitive function, chronic diseases, alcohol or drug abuse, among others. Elder abuse was found to be a multifactorial and complex phenomenon that should not therefore be viewed in a partial one-dimensional manner, but in such a way as to take into account all dimensions and the interdependence of these.

Comparing Randomized Controlled Trials and Real-World Studies in Chronic Obstructive Pulmonary Disease Pharmacotherapy.

Analytic epidemiological studies cover a large spectrum of study methodologies, ranging from noninterventional observational studies (population-based, case–control, or cohort studies) to interventional studies (clinical trials). Herein, we review the different research methodologies or study designs and discuss their advantages and disadvantages in the context of chronic obstructive pulmonary disease (COPD) pharmacotherapy. Although randomized controlled trials (RCTs) are considered the “gold standard” for evaluating the efficacy and safety of an intervention, observational studies conducted in a real-world scenario are useful in providing evidence on the effectiveness of the intervention in clinical practice; understanding both efficacy and effectiveness is important from the clinician’s perspective. Pragmatic clinical trials that use real-world data while retaining randomization bridge the gap between explanatory RCTs and noninterventional observational studies. Overall, different study designs have their associated advantages and disadvantages; together, findings from all types of studies bring about progress in clinical research as elucidated through examples from COPD research in this paper.

Evolução epidemiológica da COVID-19 no Brasil e no mundo

Objetivo: analisar a evolução epidemiológica da COVID-19 no Brasil correlacionando ao cenário mundial atual. Metodologia: trata-se de um estudo epidemiológico analítico e documental com abordagem quantitativa e descritiva de dados secundários da COVID-19 do Boletim Epidemiológico Especial número 15 do Ministério da Saúde do Brasil sobre a situação epidemiológica até o dia 08 de maio de 2020. Resultados: os Estados Unidos lideram em número de casos confirmados 1.318.787 (33%) e óbitos 78.503 (28%) no mundo. O Brasil, ocupa o 8º lugar com 145.328 (4%) dos casos confirmados de COVID-19, a sua letalidade está em 6,8% e a mortalidade é de 46,6 por 1.000.000 de habitantes. Em 2020, registrou-se 107.895 hospitalizações por Síndrome Respiratória Aguda Grave no Brasil, desse total, 27.086 (25%) eram casos confirmados de COVID-19 e 7.514 (28%) evoluíram para óbito, sendo as pessoas com 60 anos ou mais 5.697 (69%) dos casos e as cardiopatias e o diabetes os grupos de risco que destacaram-se consideravelmente nos óbitos dos idosos. Conclusão: a doença ainda não está sob controle, o distanciamento social e o uso de máscaras são a melhor forma de evitar a progressão de casos e mortes por COVID-19.

Estimating Case Fatality Rate of Symptomatic Patients with COVID-19: Is This the Right Thing to Do?

Background: Case fatality rates (CFRs) and case recovery rates (CRRs) are frequently used to define health consequences related to a certain disease epidemics, as well as for COVID-19 outbreak. Objectives: This study aimed to compare various introduced methods and models for the calculation of CFR and CRR related to COVID-19 over a present period of time based on the recent global and national data. Methods: This analytical epidemiological study was conducted on the detail data from 210 countries and territories around the world on 17 April 2020. We used three different formulas to measure CFR and CRR, considering all possible scenarios. Results: We committed to show only 72 countries with more than 1000 cases of COVID-19. Overall, using first, second and third estimation models, the CFR were 6.22%, 21.20%, and 8.67%, respectively; similarly, the CRR were estimated as 23.21%, 78.86%, 32.23%, respectively. We have shown CFR vary so much from spatially depend on the methods of estimation which have been implemented and timing of cases reports, that is a lowest CFR of 0.31 in the Singapore, and a CFR of 98.82 in UK. Overall, European region witnessing the highest CFR (9.38 to 24.88). Conclusion: Even with the more precise method of CFRs estimation, the value is overestimated. Case fatality and recovery rate is not only measure of severity of disease and the better estimation would be the more reliable indicator of country performance fighting against COVID-19.

A descriptive study of racial inequalities in mortality from hepatocellular cancer before and after licensure of lifesaving drugs for hepatitis C virus in the United States

BackgroundSince 1979, mortality from hepatocellular cancer (HCC) has doubled in the United States (US). Lifesaving drugs, prohibitively expensive for some, were approved and marketed to treat hepatitis C virus (HCV), a major risk factor for HCC, beginning in 1997. After the prior introduction of other lifesaving innovations, including active retroviral drug therapy for human immunodeficiency virus and surfactant for respiratory distress syndrome of the newborn, racial inequalities in their mortalities increased in the US. In this descriptive study, we explored racial inequalities in mortality from HCC before and after licensure of HCV drugs in the US. MethodsThe US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) were used to describe HCC mortality rates from 1979 to 2016 in those 55 years of age and older, because they suffer the largest disease burden. Joinpoint regression was used to analyze trends. To estimate excess deaths, we applied White age-sex-specific rates to corresponding Black populations. FindingsFrom 1979 to 1998, racial inequalities in mortality from HCC in the US were declining but from 1998 to 2016 racial inequalities steadily increased. From 1998 to 2016, of the 16,770 deaths from HCC among Blacks, the excess relative to Whites increased from 27.8% to 45.4%, and the trends were more prominent in men. Concurrently, racial inequalities in mortality decreased for major risk factors for HCC, including alcohol, obesity and diabetes. InterpretationThese descriptive data, useful to formulate but not test hypotheses, demonstrate decreasing racial inequalities in mortality from HCC which were followed by increases after introduction of lifesaving drugs for HCV in the US. Among many plausible hypotheses generated are social side effects, including unequal accessibility, acceptability and/or utilization. Analytic epidemiological studies designed a priori to do so are necessary to test these and other hypotheses.

Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature

BackgroundInadequate translation from theoretical to statistical models of the greenspace – health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses. MethodsWe conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics. ResultsWe found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing. ConclusionsWe found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.

ANALISIS SIKAP REMAJA DALAM MENGHADAPI SINDROM PREMENSTRUASI DI SMPN 1 MAUK TANGERANG TAHUN 2019

Background: Based on World Health Organization reports, premenstrual syndrome has a higher prevalence in Asian countries compared to Western countries. Research results in Indonesia on 260 women of reproductive age, found there was 95 percent have at least one symptom of premenstrual syndrome, with moderate to severe levels of 3.9 percent. The impact of premenstrual syndrome on academic activities is a decrease in concentration of learning, and an increase in class attendance. This study aims to analyze the attitudes of adolescents on premenstrual syndrome at Junior High School 1 Mauk Tangerang in 2019. Methodology: This research is an analytic epidemiological study with a cross-sectional study design. The sample in this study were 151 people. The sampling technique uses purposive sampling. The research instrument consisted of a questionnaire about attitudes, knowledge, physical activity recall, psychology based on the Hamilton Rating Scale for Anxiety (HRS-A) questionnaire which was a standard questionnaire, while the health education questionnaire had been tested for validity and reliability with a cronbach's alpha coefficient value of 0.66. Data were analyzed using univariate and bivariate analysis, the Chi-Square test to prove whether there was a relationship between variables. Results: The majority of adolescents had a positive attitude (50.3%) on premenstrual syndrome, high knowledge (74.2%), heavy physical activity (53.6%), psychology in the category of mild anxiety (54.3%) and high health education (53.0%). The results showed that there was a relationship between knowledge, physical activity, psychology, and health education on premenstrual syndrome. Conclusions and Recommendations: There is a relationship between knowledge, physical activity, psychology, and health education with adolescent attitudes on premenstrual syndrome. It is expected to increase knowledge about reproductive health especially about menstruation, getting used to exercising and maintaining a good lifestyle.

Effects of Particulate Matter on the Incidence of Respiratory Diseases in the Pisan Longitudinal Study.

The current study aimed at assessing the effects of exposure to Particulate Matter (PM) on the incidence of respiratory diseases in a sub-sample of participants in the longitudinal analytical epidemiological study in Pisa, Italy. Three hundred and five subjects living at the same address from 1991 to 2011 were included. Individual risk factors recorded during the 1991 survey were considered, and new cases of respiratory diseases were ascertained until 2011. Average PM10 and PM2.5 exposures (µg/m3, year 2011) were estimated at the residential address (1-km2 resolution) through a random forest machine learning approach, using a combination of satellite data and land use variables. Multivariable logistic regression with Firth’s correction was applied. The median (25th–75th percentile) exposure levels were 30.1 µg/m3 (29.9–30.7 µg/m3) for PM10 and 19.3 µg/m3 (18.9–19.4 µg/m3) for PM2.5. Incidences of rhinitis and chronic phlegm were associated with increasing PM2.5: OR = 2.25 (95% CI: 1.07, 4.98) per unit increase (p.u.i.) and OR = 4.17 (1.12, 18.71) p.u.i., respectively. Incidence of chronic obstructive pulmonary disease was associated with PM10: OR = 2.96 (1.50, 7.15) p.u.i. These results provide new insights into the long-term respiratory health effects of PM air pollution.

FREKUENSI DAN FAKTOR RISIKO KUNJUNGAN ANTENATAL CARE

Antenatal care is a program that can reduce maternal and infant mortality. Antenatal care program is able to detect complications early in pregnancy followed by health education and prevention of pregnancy complications. The standard frequency of antenatal care visits based on WHO recommendations in 2016 is 8 times. The study aims to analyze the risk factors that influence the frequency of antenatal care visits. The research used was an analytic epidemiological study with a cross sectional approach. The dependent variable was pregnant women at the puskesmas and the independent variables were age, education, occupation, family income, parity, perception, family support, husband support, knowledge. The number of samples obtained from the calculation of the simple random sampling formula is 140. After the data was collected, it was processed and then analyzed univariate, biavariate, multivariate. Statistical test results show that risk factors that influence the frequency of antenatal care visits are parity (PR = 2,453; 95% CI = 1,129-5,331; Pvalue = 0.023) and knowledge (PR = 5,114; 95% CI = 1,878-13,922; Pvalue = 0.001). Good knowledge of pregnant women about antenatal care checks then antenatal care pregnancy visits with the number of visits ? 6 times. The higher the mother's understanding of the importance of antenatal care for maternal and infant health, the better behavior to get health services for pregnancy. Health workers are expected to apply the ANC visit frequency standard in accordance with WHO 2016 standards and increase maternal knowledge about pregnancy to family planning through pregnant mother classes.
 
 Keywords : risk factor, frekuency, visits, antenatal care

Enquête de pratiques : que proposent en premier les médecins généralistes devant une artériopathie asymptomatique des membres inférieurs ?

IntroductionPeripheral artery disease of lower limbs (PAD) can be discovered at an asymptomatic stage by the realization of systolic pressure indices. The 2006 recommendations of the French National Authority for Health on AOMI encourage the systematic prescription of antiplatelet agents; the 2012 recommendations on the proper use of antiplatelet agents no longer encourage it in the case of asymptomatic PAD. These two recommendations still coexist. Our objective was to determine the management of an asymptomatic PAD by general practitioners. MethodsDescriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 GPs practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017. The question was: “if an asymptomatic PAD is discovered in a 50-year-old patient who is otherwise in good general condition, what do you generally do?” ResultsOur sample was 92 general practitioners (42% participation). Of these, only 6 were practicing HPIs. Before an asymptomatic PAD, management included an opinion from an angiologist (84%) and/or a cardiologist (75%) before the drug was prescribed (antiplatelet agent for 57%, statin for 33% and ACE inhibitor for 14%). ConclusionThe extension assessment was carried out in more than 8 out of 10 cases. The use of antiplatelet antiaggregants was significant, which can be explained by the coexistence of divergent recommendations. The rapid clarification of recommendations is essential with the evolution of scientific data.

Socioeconomic Factors and Cultural Practices Influencing the Resurgence of Bedbugs (Cimex hemipterus): A Case of Nakuru Town, Kenya

Bedbugs are parasitic insects that feed mostly on blood (human). Cimex hemipterus commonly known as the Tropical bedbug resurge in warmer climates like Africa, Asia and America. Over the years bedbug infestation has remained a major public health concern among the residents of Nakuru Town Kenya. The purpose of this study was to determine socioeconomic factors and cultural practices that influence the resurgence of bedbugs in Nakuru Town, Kenya.
 This study adopted analytic epidemiological study design and used cross sectional descriptive survey for data collection. It was conducted in seven estates in Nakuru Town, Kenya with an estimated population of 32,856 in a period of seven months. Cluster sampling was used to sample the households in the estates with the study surveillance being done in four hundred and twenty two (422) households whereas 57% and 43% of the participants were male and female respectively.
 The main source of income among the respondents was self-employment with only 27% of the participants being employed. According to the findings of this study 31% of the residents were earning between 5000 and 10000 with only 4% of their monthly income been allocated to healthcare. The current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. Cultural beliefs like witchcraft are limiting the eradication of bedbugs and leads to the resurgence in some of the households.
 In conclusion, the current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. The findings of this study will be used to inform the policy makers in the Nakuru County government on measures to be taken to improve the socioeconomic status of its residents so that in the future residents are empowered to eradicate the bedbugs.

Factores asociados a riesgo cardiovascular en estudiantes de bachillerato de un colegio público de la ciudad de Santiago de Cali, Colombia

Introducción: las enfermedades cardiovasculares son la principal causa de muerte en todo el mundo, lo que las convierte en un problema de interés en salud pública, tanto para países desarrollados, como en vías de desarrollo. La disminución del tiempo dedicado a la actividad física y el aumento de las actividades sedentarias son parte de los muchos factores de riesgo para las enfermedades cardiovasculares. El objetivo fue determinar los factores asociados al riesgo cardiovascular en los estudiantes de una institución educativa de la ciudad de Cali, Colombia. Materiales y métodos: estudio epidemiológico observacional y analítico, con una muestra de 227 estudiantes seleccionados de forma aleatoria, con una confiabilidad del 95%. Para determinar el nivel de actividad física en los escolares, se aplicó el cuestionario internacional de actividad física IPAQ; igualmente, se tomaron medidas antropométricas como peso, talla, perímetro de cintura y cadera. Resultados: el 96% de los participantes presentó riesgo cardiovascular bajo. Así mismo, las variables que mostraron una asociación estadísticamente significativa con el riesgo cardiovascular fueron el consumo de alcohol y el índice de masa corporal, los cuales predicen en un 81 % la posibilidad de tener riesgo. Conclusiones: prevaleció el bajo riesgo cardiovascular y el alto nivel de actividad física en los escolares evaluados, con diferencias significativas respecto al sexo. Los hombres presentan valores más altos en peso, talla y relación cintura/cadera en comparación con las mujeres. Se estableció que los factores asociados con el riesgo cardiovascular son el índice de masa corporal y el consumo de alcohol.

Temporal Trends and Geographic Variations in Mortality Rates from Prescription Opioids: Lessons from Florida and West Virginia.

To explore temporal trends and geographic variations in mortality from prescription opioids from 1999 to 2016. Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death files were used to calculate age-adjusted rates and 95% confidence intervals (CIs) and create spatial cluster maps. From 1999 to 2016, counties in West Virginia experienced the highest overall mortality rates in the United States from prescription opioids. Specifically, from 1999 to 2004, the highest rate in West Virginia of 24.87/100,000 (95% CI 17.84-33.73) was the fourth highest in the United States. From 2005 to 2009, West Virginia experienced the highest rate in the United States, 60.72/100,000 (95% CI 47.33-76.71). From 2010 to 2016, West Virginia also experienced the highest rate in the United States, which was 90.24/100,000 (95% CI 73.11-107.36). As such, overall, West Virginia experienced the highest rates in the United States and the largest increases overall of ~3.6-fold between 1999 and 2004 and 2010 and 2016. From 1999 to 2004, Florida had no "hot spots," but from 2006 to 2010 they did appear, and from 2011 to 2016, they disappeared. These data show markedly divergent temporal trends and geographic variations in mortality rates from prescription opioids, especially in the southern United States. Specifically, although initial rates were high and continued to increase alarmingly in West Virginia, they increased but then decreased in Florida. These descriptive data generate hypotheses requiring testing in analytic epidemiological studies. Understanding the divergent patterns of prescription opioid-related deaths, especially in West Virginia and Florida, may have important clinical and policy implications.

Évolution de la pression artérielle après introduction d’un antidépresseur en établissement public de santé mentale

IntroductionPrimary prescribing of antidepressants is common in general practice. The relationship between antidepressant introduction and blood pressure (BP) changes is not well established in the literature. The purpose of our study was to examine the short-term course of AHR with and without the introduction of an antidepressant into a public institution of mental health (EPSM). Materials and methodsAn exposed/non-exposed single-centre analytical epidemiological study on a retrospective cohort, with a collection of data on stays between 2013 and 2015 at the EPSM in Armentières. The stays were divided into two groups: antidepressant treatment (introduced during the stay) and control (without antidepressant). BP measurements were taken over a 30-day period per stay. To assess the evolution of AHR across groups, we used a nested mixed linear regression model with multivariate adjustment. ResultsOut of 1241 stays analysed, 124 were in the treated group and 1117 in the control group. The average age was 44.6±14.7 years. The two groups were comparable on most of the variables analyzed. The change in systolic BP was associated with systolic BP values at baseline, history of hypertension, presence of an antihypertensive drug and BMI; the change in diastolic BP was associated with diastolic BP values at baseline, presence of an antihypertensive drug, BMI and history of bipolar disorder. We find no significant difference in the evolution of BP over time between the treated group and the control group over the 30 days of measurement per stay, after adjustment (evolution coefficient of +0.12mmHg systolic BP and −0.1mmHg diastolic BP, P=0.45 and 0.38 respectively). ConclusionThese results are reassuring on the early development of BP after the introduction of antidepressants. They should not overlook the frequent effects of depression and antidepressants on cardiovascular risk (decreased physical activity, dyslipidemia, weight gain, etc.).

Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data

ObjectivesTo describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. Study designA cross-border outbreak control team was established to investigate the outbreak. MethodsEpidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). ResultsConfirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. ConclusionsThis outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.

Lessons From an Early-stage Epidemiological Study of Minamata Disease.

The Revisit series in this issue introduced the article by Kitamura and colleagues.1 Dr. Shoji Kitamura, born in 1915, was a medical doctor and a professor of Department of Public Health in the Medical School at Kumamoto University when Minamata disease happened. The article summarized findings from a very-early-phase epidemiological study conducted by researchers from Kumamoto University immediately after the Minamata disease incident was officially recognized on May 1, 1956. The epidemiological study was very well-conducted in a timely manner and the article was available as early as January 1957 in an academic journal published by the Medical School at Kumamoto University. This is a very influential report that demonstrated associations between fish intake and the Minamata disease after careful descriptive and analytical epidemiological studies. Although the Japanese society should have taken some actions to prevent the disease with the evidence that a research group at Kumamoto University had at that time, the pollution was not stopped until 12 years had passed since the official identification in 1956. Moreover, the struggle with Minamata disease is still in progress. This unfavorable response by the Japanese society could partly be explained by the important economic role of the causative factory at that time, when Japan had recorded a trade deficit since the end of the Second World War.2 Plastic products of the factory were key Japanese exports helping to reduce this deficit. In this commentary, after introducing the study by Kitamura and colleagues, I discuss the potentials of epidemiology, as well as consequences on public health that occurred when we did not follow the findings from the epidemiological study.

Tumor-node-metastasis staging and treatment patterns of 73,167 patients with lung cancer in Brazil.

ABSTRACTObjective:To characterize the clinical and histological profile, as well as treatment patterns, of patients with early-stage, locally advanced (LA), or advanced/metastatic (AM) lung cancer, diagnosed between 2000 and 2014, in Brazil. Methods:This was an analytical cross-sectional epidemiological study employing data obtained for the 2000-2014 period from the hospital cancer registries of two institutions in Brazil: the José Alencar Gomes da Silva National Cancer Institute, in the city of Rio de Janeiro; and the São Paulo Cancer Center Foundation, in the city of São Paulo. Results:We reviewed the data related to 73,167 patients with lung cancer. The proportions of patients with early-stage, LA, and AM lung cancer were 13.3%, 33.2%, and 53.4%, respectively. The patients with early-stage lung cancer were older and were most likely to receive a histological diagnosis of adenocarcinoma; the proportion of patients with early-stage lung cancer remained stable throughout the study period. In those with LA lung cancer, squamous cell carcinoma predominated, and the proportion of patients with LA lung cancer decreased significantly over the period analyzed. Those with AM lung cancer were younger and were most likely to have adenocarcinoma; the proportion of patients with AM lung cancer increased significantly during the study period. Small cell carcinoma accounted for 9.2% of all cases. In our patient sample, the main treatment modality was chemotherapy. Conclusions:It is noteworthy that the frequency of AM lung cancer increased significantly during the study period, whereas that of LA lung cancer decreased significantly and that of early-stage lung cancer remained stable. Cancer treatment patterns, by stage, were in accordance with international guidelines.

MEDICAL TECHNOLOGIES AFFECTING INFECTION OF CHILDREN WITH BACTERIA OF THE GENUS KLEBSIELLA, PREVENTION OF INFECTION

Relevance. The bacteria of the genus Klebsiella are among the leading pathogens of health care-related infections (HAI). Newborn children are a special risk group for HAI and Klebsiella etiology. It is necessary to look for new approaches to the prevention of HAI of Klebsiella etiology. Purpose. To identify medical technologies that have a high risk of nosocomial infection in children, to develop a risk-oriented methodology for the prevention of Klebsiella infections. Materials and methods. In order to identify possible risk factors, an analytical epidemiological study of the "case-control" type was performed. The observation group consisted of 52 people, the comparison group - 744 people. Results and discussion. Out of 18 studied risk factors for 9 (catheterization of peripheral and central veins, intravenous infusion, catheterization of the bladder, lumbar puncture, oxygen inhalation, hygienic treatment of the oral cavity, drinking regimen and the use of drugs by mouth), the effect on the frequency of infection of patients was not established. Effective 3 preventive measures are not possible without risk identification. To solve this problem, the Ishikawa diagram was applied. The medical technologies that determine the risk in this group of patients are the technologies of respiratory support and nutrition of the newborn baby. To a large extent, the risk of Klebsiella spp. depends on how widely antibiotics of the carbapenem group are used, which determine the colonization of the intestine of a newborn child by carbapenemase-producing Klebsiella. Conclusions. The chances of infection in children with Klebsiella pneumoniae are 3.07 times higher with antibiotics and depends on the group. 9 risk factors influencing the infection of children were identified. The risk-oriented approach to the prevention of HAI is based on identifying risk factors that contribute to infection and monitoring the properties of the hospital population of Klebsiella spp