Epidemiology Branch Research Articles

Pharmacoepidemiology and rheumatic diseases: 2001-2002.

Pharmacoepidemiology is the branch of epidemiology that focuses on medications and their outcomes, including both adverse events and intended consequences. Such studies have become more prominent in rheumatology as the number of new medications has grown and prescribing databases have become more available. In the past year, the potential cardiovascular complications associated with selective COX-2 inhibitors have become an important concern. A number of pooled analyses suggest the possibility of an increased risk of acute myocardial infarction, and studies of naproxen have found a possible protective effect. Accumulating evidence supports the contention that early initiation of disease modifying antirheumatid drug therapy improves outcomes of patients with rheumatoid arthritis. Open-label extensions of biologic therapies found continued benefits extending several years with the TNF-alpha antagonists, but concerns have arisen regarding tuberculosis and central nervous system demyelination with these agents. Data continue to be published quantifying the risk of osteoporosis associated with glucocorticoids, and the association between biphosphonate therapy and upper gastrointestinal events appears to be less of a concern that originally described.

Scourge: The Once and Future Threat of Smallpox

Journal Article Scourge: The Once and Future Threat of Smallpox Get access Scourge: The Once and Future Threat of Smallpox By Jonathan B. Tucker Published by Atlantic Monthly Press, 841 Broadway, New York, NY 10003, 2001. 291 p. Price $26.00 Paul J. Weidle, Pharm.D., MPH Paul J. Weidle, Pharm.D., MPH Senior Staff Epidemiologist Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, & TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333 Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 59, Issue 19, 1 October 2002, Pages 1904–1905, https://doi.org/10.1093/ajhp/59.19.1904a Published: 01 October 2002

New reasons and new ways to study birth physiology

The age of cesarean sections on request, epidurals and drips of oxytocin is a turning point in the history of childbirth. Until recently women could not give birth without releasing a complex cocktail of ‘love hormones’. Today, in many countries, most women have babies without releasing these specific hormones. The questions must be raised in terms of civilization. This turning point occurs at the very time when several scientific disciplines suggest that the way human beings are born has long-term consequences, particularly in terms of sociability, aggressiveness or, in other words, ‘capacity to love’. I find it relevant to combine data provided by perspectives as diverse as ethology, animal experiments, studies of the behavioral effects of hormones that fluctuate in the perinatal period, and a branch of epidemiology I call ‘Primal Health Research’. This combination of data offers new reasons to disturb the physiological processes as little as possible. We are also at a time when a physiological approach can help to rediscover the basic needs of women in labor. These women firstly need to be protected against any sort of neocortical stimulation. We must keep in mind what the main stimuli of neocortical activity are: language, bright lights, the ‘feeling of being observed’ and situations associated with a release of catecholamines.

Stratum-specific likelihood ratios of two versions of the general health questionnaire.

In other branches of epidemiology, stratum specific likelihood ratios (SSLRs) have been found to be preferable to fixed best threshold approaches to screening instruments. This paper presents SSLRs of GHQ-12 and GHQ-28 and compares the SSLR method with the traditional optimal threshold approach. Random effects meta-analysis and meta-regression were used to obtain pooled estimates of SSLRs of the two questionnaires for the 15 centres participating in the WHO study of Psychological Problems in General Health Care. We illustrated the use of SSLRs by applying them to random samples of patients from centres with different backgrounds. For developed and urban centres, the estimates of SSLRs were homogeneous for 10 out of 12 strata of the GHQ-12 and GHQ-28. For other centres, the overall results, which were heterogeneous for six out of 12 strata, were deemed the currently available best estimates. When we applied these results to centres with different prevalences of mental disorders and backgrounds, the estimates matched the actually observed closely. These examples showed how the SSLR approach is more informative than the traditional threshold approach. Those working in developed urban settings can use the corresponding SSLRs with reasonable confidence. Those working in non-urban or developing areas may wish to use the overall results, while acknowledging that they must remain less certain until further research can explicate heterogeneity. These SSLRs have been incorporated into nomograms and spreadsheet programmes so that future researchers can swiftly derive the post-test probability for a patient or a group of patients from a pre-test probability and GHQ score.

Uses of New South Wales Health Survey Program data - A survey of users.

The Epidemiology and Surveillance Branch of the NSW Department of Health established the NSW Health Survey Program (HSP) in 1996 to consider the need for state and local area-level information about the health of the NSW population.

Using the International Classification of Diseases with HOIST.

This article provides assistance with using the International Classification of Diseases (ICD) with the Health Outcomes and Information Statistical Toolkit (HOIST), which is a collection of databases (data warehouse) maintained by the Epidemiology and Surveillance Branch of the NSW Department of Health. The article is for readers who have access to HOIST or who want to learn how to use HOIST. Please note that HOIST is only available to staff of the NSW public health system.

History and current status of reproductive health surveys at CDC

Since the development of immunization surveys in the 1950s to evaluate poliomyelitis immunization programs, the Centers for Disease Control and Prevention (CDC) has traditionally used populationbased surveys to evaluate public health programs.1 The use of population-based surveys continued overseas in the smallpox eradication program during the late 1960s and 1970s.2,3 Family planning epidemiology was begun at CDC in the late 1960s, first as an activity, then as the Family Planning Evaluation Division, and later as part of the Division of Reproductive Health (DRH). At first, service statistics systems were developed for local and state health departments.4,5 It quickly became apparent that population-based household surveys would be needed to obtain data on family planning users in the private sector and nonusers.6–9 Jack Smith, chief of the statistics activity, spearheaded the early efforts to improve service statistics systems and to develop populationbased surveys for evaluating family planning programs. In 1979, Smith was the lead researcher for a joint household survey with the Mexican Ministry of Health that was carried out along the U.S.–Mexico border to obtain family planning data on non-Hispanics and Hispanics.10–13 Since that effort, with the development of the random-digit dialing method, statewide surveys on reproductive health have been carried out by telephone in Idaho, Arizona, New York, Hawaii, and Georgia.14,15 The switch to telephone as the survey mode has been due largely to cost considerations. Parallel to the development of family planning survey methodologies in the United States, the Family Planning Evaluation Division, in collaboration with the U.S. Agency for International Development, developed the Contraceptive Prevalence Survey (CPS) for use in developing countries.16 The first of these surveys was conducted in El Salvador in 1975.17 The CPS is a regional or national probability household-based sample survey designed primarily for managing and evaluating family planning programs. This survey collects information on knowledge and use of contraception in relation to desire for more children, choice of contraceptive methods, availability of family planning services, and other program-related factors. The survey provides rapid feedback to program administrators on the use of family planning services and on program success in serving women at risk of unintended pregnancy. To ensure representativeness, the CPS (and subsequent surveys described below) uses a three-stage sampling design. The first stage is a selection of census sectors with probability proportional to size. Within the selected census sectors, a random sample of households is then chosen. In the third stage of the sample design, one woman of reproductive age is selected from each household. In a standardized interview, each woman is asked about her knowledge, use, and attitudes concerning contraceptive methods and sources of contraceptive supplies and services. Results are weighted to compensate for geographic oversampling or undersampling, the selection of one woman per household, and nonresponse differentials. Contraceptive Prevalence Surveys do more than reveal the extent of contraceptive use. They also help administrators evaluate family planning programs, check service statistics, and identify groups of women in need of family planning services. Each CPS provides the rapid feedback necessary to evaluate and improve family planning information and service delivery programs. Because questionnaires are short and usually only several thousand women are interviewed, the surveys can be repeated every few years to gauge the impact of new or reoriented programs undertaken on the basis of earlier findings. The CPS data are especially useful in determining how many women are at risk of unintended pregnancy; that is, how many do not want to become pregnant but may do so because they are fecund, sexually active, and not using contraception. Included among these are women whom family planning services have not yet reached. Identifying these women is of prime importance to program administrators. Around 1980, the CPS evolved into the Family Planning and Maternal Child Health Survey (FP-MCH), which expanded the content of the CPS to include data From the Behavioral Epidemiology and Demographic Research Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address correspondence and reprint requests to: L. Morris, MD, CDC-MS K-35, Behavioral Epidemiology and Demographic Research Branch, 1600 Clifton Road, Atlanta, GA 30333. E-mail: lmorris@ cdc.gov.

Development of the New South Wales Child Health Survey.

This article describes the process undertaken by the Epidemiology and Surveillance Branch, as part of the NSW Health Survey Program, to develop the NSW Child Health Survey, which will be conducted in 2001. This survey is planned as the first in a series of tri-annual surveys looking strategically at the health of children aged 0–12 years, and the factors that affect their health and wellbeing

Implantation: timing is everything.

Understanding the many facets of human reproduction has long been considered a guessing game. According to Allen Wilcox, chief of the Epidemiology Branch at the NIEHS, until now, knowing exactly when implantation of an egg into the uterine wall occurs has been impossible because the event has never been observed in humans. However, Wilcox and his team have recently taken some of the guessing out of the process by shedding light on how the timing of implantation may affect a pregnancy's outcome. The results of their research were published in the 10 June 1999 issue of the New England Journal of Medicine.

Epidemiological Concepts in Human, Veterinary, and Botanical Ecosystems: An Introduction to This Special Issue of Ecosystem Health

This special issue is dedicated to our friend and colleague, C. Lee Campbell, Professor of Plant Pathology, North Carolina State University, who died suddenly while this contribution was in press. We live in a time in history when there is a need to understand, not just the individual disciplines of epidemiology, but how these individual disciplines are interrelated in a global system. In this context, the interrelationships between botanical (plant disease), human, and veterinary epidemiology, as well as how these disciplines relate to ecosystem health, is of considerable interest (Rapport 1999). Our purpose in organizing the symposium “Epidemiological Concepts on Human, Veterinary, and Botanical Ecosystems,” sponsored by the American Phytopathological Society (APS), was to provide a forum to facilitate the exchange of epidemiological concepts and models that would serve to unite (rather than fragment) the different branches of epidemiology.

Understanding the Interrelationships Between Botanical, Human, and Veterinary Epidemiology: The Ys and Rs of It All

ABSTRACT Epidemiology is concerned with disease dynamics within host populations. The botanical (plant disease), human (medical), and veterinary fields of epidemiology all have a common lineage in that all three disciplines share ecology as a common parent, yet all three fields have also evolved from a practical need to better manage diseases in their respective host populations. The analysis of botanical, human, and veterinary epidemics shares six common steps: 1) Defining disease problems in quantitative terms (attainable production or attainable population health minus the current production or population health management level presently being achieved); 2) Quantifying state and rate variables of pathosystem components (pathosystem analysis) to determine the effect of host, pathogen, and vector populations on the rate of pathogen spread (r), and the source and strength of inoculum reservoirs (y0); 3) Identifying the most effective management strategy(ies) (i.e., reduce y0, r, and/or t) to achieve effective control; 4) Developing and then quantifying the impacts of specific and integrated management tactics on disease dynamics as a means to evaluate a proposed disease management strategy or strategies; 5) Integrating management tactics into management programs and reevaluating the epidemiologic impacts of whole disease management programs on pathosystem dynamics, and finally; 6) Assessing the economic and environmental risks versus the actual benefits achieved by implementing integrated disease management programs. Although the botanical, human, and veterinary fields of epidemiology share many common concepts, the terminology used to express these concepts within the different disciplines has evolved different dialects (operational definitions) as well as different approaches to solve epidemiologic questions. By improving communication among epidemiologists who work mostly within their own disciplines (botanical, medical, and veterinary branches of epidemiology), we can better understand not only our own pathosystems, but we can vastly improve our understanding of disease dynamics at the ecosystem and global scales as well.

Low incidence of human papillomavirus type 16 antibody seroconversion in young children.

Low incidence of human papillomavirus type 16 antibody seroconversion in young children.

Author reply

Our report concerned peculiarities in the epidemiologic distribution of thyroid carcinoma, which occurs excessively among Japanese but not white patients with Werner syndrome (WS). In addition to the difference by race, there are differences by age (younger patients), gender (fewer females), and cell type (much more follicular) in WS patients compared with a registry for thyroid carcinoma in the general population of Japan. All four follicular thyroid tumors studied had germline mutations in the C-terminal region, and the single papillary tumor studied was in the N-terminal region, possibly a genotype-phenotype relation. Based on three studies that were unavailable to us at the time of our study because the reports were not yet published, Dr. Monnat states that “ …many (and perhaps all) WS-associated WRN mutations are likely to be functionally equivalent null alleles.” Therefore, it is “unlikely that a different spectrum of WRN mutations alone explains the elevated risk of thyroid carcinoma in Japanese WS patients.” The speed of progress in molecular genetics rapidly can change the interpretation of durable clinical data, a foundation of our study. Until the functions of wild and mutant WRN proteins are understood fully, we keep open the possibility that different mutations may cause different phenotypes. The recently announced website for WRN mutations cited by Monnat should speed the resolution of these and other questions from clinical data regarding WS. Yuichi Ishikawa M.D.*, Haruo Sugano M.D.*, Robert W. Miller M.D. , Makoto Goto M.D. , * Department of Pathology, The Cancer Institute, Tokyo, Japan, Genetic Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, Tokyo Metropolitan, Otsuka Hospital, Tokyo, Japan

Author reply

Our report concerned peculiarities in the epidemiologic distribution of thyroid carcinoma, which occurs excessively among Japanese but not white patients with Werner syndrome (WS). In addition to the difference by race, there are differences by age (younger patients), gender (fewer females), and cell type (much more follicular) in WS patients compared with a registry for thyroid carcinoma in the general population of Japan. All four follicular thyroid tumors studied had germline mutations in the C-terminal region, and the single papillary tumor studied was in the N-terminal region, possibly a genotype-phenotype relation. Based on three studies that were unavailable to us at the time of our study because the reports were not yet published, Dr. Monnat states that “ …many (and perhaps all) WS-associated WRN mutations are likely to be functionally equivalent null alleles.” Therefore, it is “unlikely that a different spectrum of WRN mutations alone explains the elevated risk of thyroid carcinoma in Japanese WS patients.” The speed of progress in molecular genetics rapidly can change the interpretation of durable clinical data, a foundation of our study. Until the functions of wild and mutant WRN proteins are understood fully, we keep open the possibility that different mutations may cause different phenotypes. The recently announced website for WRN mutations cited by Monnat should speed the resolution of these and other questions from clinical data regarding WS. Yuichi Ishikawa M.D.*, Haruo Sugano M.D.*, Robert W. Miller M.D. , Makoto Goto M.D. , * Department of Pathology, The Cancer Institute, Tokyo, Japan, Genetic Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, Tokyo Metropolitan, Otsuka Hospital, Tokyo, Japan

Contamination of poliovirus vaccine with SV40 and the incidence of medulloblastoma

Medical and Pediatric OncologyVolume 32, Issue 1 p. 77-78 Brief Report Contamination of poliovirus vaccine with SV40 and the incidence of medulloblastoma Howard D. Strickler MD, MPH, Corresponding Author Howard D. Strickler MD, MPH Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandViral Epidemiology Branch, National Cancer Institute, Executive Plaza North 434, Bethesda, MD 20892Search for more papers by this authorPhilip S. Rosenberg PhD, Philip S. Rosenberg PhD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorSusan S. Devesa PhD, Susan S. Devesa PhD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorJoseph F. Fraumeni Jr. MD, Joseph F. Fraumeni Jr. MD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorJames J. Goedert MD, James J. Goedert MD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this author Howard D. Strickler MD, MPH, Corresponding Author Howard D. Strickler MD, MPH Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandViral Epidemiology Branch, National Cancer Institute, Executive Plaza North 434, Bethesda, MD 20892Search for more papers by this authorPhilip S. Rosenberg PhD, Philip S. Rosenberg PhD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorSusan S. Devesa PhD, Susan S. Devesa PhD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorJoseph F. Fraumeni Jr. MD, Joseph F. Fraumeni Jr. MD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorJames J. Goedert MD, James J. Goedert MD Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MarylandSearch for more papers by this author First published: 29 January 1999 https://doi.org/10.1002/(SICI)1096-911X(199901)32:1<77::AID-MPO21>3.0.CO;2-FCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue1January 1999Pages 77-78 RelatedInformation

An overview of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC), located in Atlanta, Georgia, USA, is a public health agency of the US Department of Health and Human Services. CDC employs approximately...

Views from funding agencies. National Institute of Mental Health.

Acting Director; Division of Services and Intervention Research; National Institute of Mental Health; Rockville, Maryland (Norquist) Chief; Services Research and Clinical; Epidemiology Branch; National Institute of Mental Health (Magruder)

Psychiatric epidemiology.

Statisticians working in psychiatric epidemiology regularly confront a variety of problems that are rare in other branches of epidemiology. These problems range from the frequent absence of 'objective' biological markers and consequent reliance on informant and self-reports of considerable fallability, to the perhaps corresponding frequent use of multivariate statistical methods such as latent variable modelling. Equally, such difficulties can be regarded as challenges that offer the statistician a critical role.

Relationship between unsupplemented vitamin A serum concentrations and measles vaccine response in Jamaican children.

Relationship between unsupplemented vitamin A serum concentrations and measles vaccine response in Jamaican children.

Atypical melanocytic nevi of the genital type with a discussion of reciprocal parenchymal-stromal interactions in the biology of neoplasia.

Melanocytic lesions of the genital area, especially those on the vulva, may present great difficulty in histological interpretation. A histological diagnosis of malignant melanoma was made in more than one third of 56 genital area melanocytic lesions submitted in consultation to the authors. The median age of the patients with these lesions was 25 years. This article is a clinicopathological study of these lesions and distinguishes them from malignant melanoma. The stroma of the lesions of the genital area was different from the stroma seen in the dysplastic nevi and melanoma. The differences in the stromal form in the diverse lesions is useful in diagnosis and is of profound biological significance. The stroma in the reported lesions and in some lesions of melanocytic neoplasia is described in detail, and its biological significance is discussed. Three sets of cases are used in this comparative study to delineate the clinicopathological nature and the biology of the genital nevi. The 56 cases submitted in consultation constitute the primary series of our work (The Clark Cutaneous Pathology Laboratory Series). These are compared with a series of cases from the Pigmented Lesion Group of the University of Pennsylvania and Pathology Services, Inc, and another series of cases from the Genetic Epidemiology Branch of the National Cancer Institute. The two series used for comparative study contain approximately the same number of cases of dysplastic nevi and malignant melanoma as there are atypical melanocytic nevi of the genital type in the primary series. The total number of cases was studied by comparison of their attributes in a relational database. The clinical data of the primary series was acquired through the use of a questionnaire completed by the contributors. The 56 cases presented two distinctive pathological pictures. One of these is termed atypical melanocytic nevi of the genital type (AMNGT), whereas dysplastic nevi (DN) formed the second of the two pathological pictures. There were 36 AMNGT and 14 DN. The remaining six cases were common nevi without atypia or ill-defined melanocytic hyperplasias. The lesions of AMNGT are usually located on the vulva, but they are seen on the perineum and, rarely, on the mons pubis and in the axilla. Lesions similar to AMNGT have been seen uncommonly on the male genitalia. The stromal patterns were distinctive and related to specific melanocytic lesions. An unclassified (unclass) or nonspecific stromal pattern was associated with AMNGT; a pattern of regression with differentiation (diff-regress) dominated the stroma of common dermal nevi; concentric eosinophilic fibroplasia (cef) and lamellar fibroplasia (lf) were present in dysplastic nevi; fibroplasia with a plaquelike lymphocytic infiltrate (fl) and diffuse eosinophilic fibroplasia (def) were noted in radial growth phase melanoma; and fibroplasia with angiogenesis (fa) or an absence of evidence for parenchymal stromal reciprocal interactions (nopsi) marked thick or deeply invasive vertical growth phase melanomas. Recommendations for management of the lesions are suggested. One kind of atypical melanocytic proliferation in the genital area forms a distinctive clinicopathological entity that can be distinguished from melanoma and dysplastic nevi, the AMNGT. Such lesions are more common on the labia minora or the mucosa of the clitoral region than they are on the labia majora. The other common atypical melanocytic proliferation of this area is a dysplastic nevus, which is much more common on the labia majora than on the labia minora. The reciprocal interactions between parenchyma and stroma are discussed as homeostatic processes, a continually functioning template maintaining tissue, organ, and organismal form and function. The progressive disorganization of this template in neoplasia is illustrated and is considered to be a cardinal element in the biology of neoplasia.