Epidemiology Branch Research Articles

Length of Fellowship Training in Population Health Research and Long-term Bibliometric Outcomes.

The length of research fellowships, the number of doctorates pursuing them, and the academic job market have changed dramatically in recent years. However, there is limited investigation on attributes of fellowships most relevant to future scientific achievement. We analyzed the association of a modifiable aspect of research training, fellowship length, with future achievement and differences across research discipline in the Division of Intramural Population Health Research (DIPHR), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. Demographics of 88 DIPHR trainees from 1998 to 2016 were collected from publicly available annual reports. Research performance metrics, including total publication count and H index through 2016, were collected via Scopus. We used linear regression models for associations between fellowship length, including both total exposure to research training and duration of postdoctoral training alone, and research performance adjusted for start year, publications at entry, branch (e.g., Biostatistics and Bioinformatics, Epidemiology, and Health Behavior), and mentor seniority. Each additional year of research training in DIPHR was associated with a 15% increase in H index (95% confidence interval [CI] = 3.0, 28.4) and 21% more lifetime publications (95% CI = 3.0, 41.9). Results were similar, although attenuated, when evaluating postdoctoral training alone. Differences by discipline were observed, with the strongest positive associations in the Biostatistics and Bioinformatics and Epidemiology Branches. Longer training at DIPHR was associated with improved measures of research performance, though this relationship varied by discipline. Additional research is needed to tailor training programs to optimize success of trainees.

Strengthening the research and application of spatial epidemiology to promote precise prevention and control of parasitic diseases in China

Spatial epidemiology is a new branch of epidemiology, and is a subject that mainly analyzes the geographical distribution and changes of population health or diseases and its related impact factors. Recently, spatial epidemiology has been extensively applied in the prevention and control of parasitic diseases in China, and delightful results have been achieved. However, the research and application of theories and methods of spatial epidemiology are still needed to protect the people's health in China.

Meet the First Authors.

Meet the First Authors.

Risk ― A Basic Concept of Epidemiology

This article presents the analysis of current scientific understanding of the term «risk» along with theoretical justification of its use in epidemiological studies. Epidemiology commonly uses definitions such as «risk factor», «group of risk», «risk area», and «risk period». However, these definitions were useful only for specific groups or nosoligical infectious diseases. In Noninfectious Pathology the terms had been used exclusively in the applied studies. There is a lack of publications which compile theoretical basics of such fundamental term category. The authors suggest a definition of epidemiologic «risk» which can be used in the epidemiology of both infectious and noninfectious diseases. It is a probability of negative influence on illness (and/or its impact) of specific groups of general population which is defined by external and/or internal factors in specific times and territories. The authors differentiate types of risk and their evaluation measures into categories for used in applied studies of epidemiology. The relationships and the unity of the basic categories of the epidemiologic risk are discussed. The authors conclude that riskology is the main branch of epidemiology and the category of «risk» is the basic paradigm of this science.

Commentary: Causal Inference for Social Exposures

Social epidemiology seeks to describe and quantify the causal effects of social institutions, interactions, and structures on human health. To accomplish this task, we define exposures as treatments and posit populations exposed or unexposed to these well-defined regimens. This inferential structure allows us to unambiguously estimate and interpret quantitative causal parameters and to investigate how these may be affected by biases such as confounding. This paradigm has been challenged recently by some critics who favor broadening the exposures that may be studied beyond treatments to also consider states. Defining the exposure protocol of an observational study is a continuum of specificity, and one may choose to loosen this definition, incurring the cost of causal parameters that become commensurately more vague. The advantages and disadvantages of broader versus narrower definitions of exposure are matters of continuing debate in social epidemiology as in other branches of epidemiology.

Meet the First Authors.

Meet the First Authors.

Big Data and the Study of Social Inequalities in Health: Expectations and Issues.

Understanding the construction of the social gradient in health is a major challenge in the field of social epidemiology, a branch of epidemiology that seeks to understand how society and its different forms of organization influence health at a population level. Attempting to answer these questions involves large datasets of varied heterogeneous data suggesting that Big Data approaches could be then particularly relevant to the study of social inequalities in health. Nevertheless, real challenges have to be addressed in order to make the best use of the development of Big Data in health for the benefit of all. The main purpose of this perspective is to discuss some of these challenges, in particular: (i) the perimeter and the particularity of Big Data in health, which must be broader than a vision centerd solely on care, the individual and his or her biological characteristics; (ii) the need for clarification regarding the notion of data, the validity of data and the question of causal inference for various actors involved in health, such data as researchers, health professionals and the civilian population; (iii) the need for regulation and control of data and their uses by public authorities for the common good and the fight against social inequalities in health. To face these issues, it seems essential to integrate different approaches into a close dialog, integrating methodological, societal, and ethical issues. This question cannot escape an interdisciplinary approach, including users or patients.

Spatial epidemiology plays an important role in control and prevention of diseases

Spatial epidemiology is a new branch of epidemiology that aims to map the spatial distribution and characteristics as well as to explore the associated influencing factors of diseases by using the geographic information system and other spatial technologies. In recent years, with the rapid development of information-related modern technology, improvement of accessibility on health - related services, natural environment, social and economic big data etc., spatial epidemiology has made considerable progress in both theory and practice and played more important roles in the public health area of China.

Streamlining Foodborne Disease Surveillance with Open-Source Data Management Software

Objective: The “ledsmanageR”, a data management platform built in R, aims to improve the timeliness and accuracy of national foodborne surveillance data submitted to the Laboratory-based Enteric Disease Surveillance (LEDS) system by automating the data processing, validating, and reporting workflow.Introduction: The National Surveillance Team in the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention (CDC) collects electronic data from all state and regional public health laboratories on human infections caused by Campylobacter, Salmonella, Shiga toxin-producing E. coli, and Shigella in LEDS. These data inform annual estimates of the burden of illness, assessments of patterns in bacterial subtypes, and can be used to describe trends in incidence. Robust digital infrastructure is required to process, validate, and summarize data on approximately 60,000 infections annually while optimizing use of financial and personnel resources.Methods: We leveraged the robust and extensible programming facilities of the R programming language and the active community of R users to develop a data integration, processing, and reporting pipeline for LEDS via an internal software package we named “ledsmanageR”. We designed all data retrieval, cleaning, and provisioning algorithms using tools from RStudio software packages1–3 and tracked changes to source code and data using CDC’s internal Gitlab server. We automated data validation requests to reporting partners by generating customizable emails directly from the R console4. We streamlined the data reconciliation process using OpenRefine5, a point-and-click tool for cleaning big data. We automated generation of annual reports, a process that was previously manual, using parameterized RMarkdown documents. Staff epidemiologists performed design and implementation internally, requiring no external consulting.Results: Developing our free and open-source software platform for national foodborne surveillance data management has saved the Enteric Diseases Epidemiology Branch thousands of dollars because we no longer depend on proprietary software requiring annual licensing fees. This transition occurred without any disruption in surveillance operations. Partial automation of email-based data validation and annual report generation processes reduced employee time requirement from one full-time position to one part-time position. The modular nature of ledsmanageR permitted LEDS to collect an expanded set of data elements with no changes to the core data processing and reporting workflow.Conclusions: We developed and implemented a flexible tool that helps maintain the integrity of surveillance data and reduces the need for manual data cleaning, which can be laborious and error-prone. The user-friendly design features of ledsmanageR demonstrate that data management can be optimized using programming skills that are increasingly common among epidemiologists. Our work on improving the accuracy and efficiency of enteric disease surveillance has served as a proof of concept for plans to streamline data processing for other surveillance systems.

Social epidemiology for the 21st century

Social epidemiology, as defined by the textbook of the same name (Berkman et al., 2014) is “that branch of epidemiology concerned with the way that social structures, institutions, and relationships influence health” (p. 2). As our Special Issue commemorates the 50th anniversary of Social Science & Medicine, it is worth noting that the Social Epidemiology office within the journal has existed only for a fraction of that time (fifteen years). So what has been learned in the fifteen years since the establishment of the new office? In this commentary, we spotlight some of the achievements, substantive topics, and future trends in the research papers that we have featured in our Section of the journal.

Molecular epidemiology of infectious diseases.

Molecular epidemiology (ME) is a branch of epidemiology developed by merging molecular biology into epidemiological studies. In this paper, the authors try to discuss the ways that molecular epidemiology studies identify infectious diseases’ causation and pathogenesis, and unravel infectious agents’ sources, reservoirs, circulation pattern, transmission pattern, transmission probability, and transmission order. They bring real-world examples of research works in each area to make each study design more understandable. They also address some research areas and study design aspects that need further attention in future. They close with some thoughts about future directions in this field and emphasize on the need for training competent molecular epidemiology specialists that are capable of dealing with rapid advances in the field.

North Carolina State Agencies Working to Prevent Agricultural Injuries and Illnesses

ABSTRACTOver the past 25 years, the North Carolina Departments of Labor, Agriculture and Consumer Services, and Health and Human Services have worked with farmers, farmworkers, commodity and trade associations, universities, and cooperative extension agents to develop programs to decrease the occurrence of injuries and illnesses among agricultural workers and their families. The Bureau of Agricultural Safety and Health in the North Carolina Department of Labor helped craft the Migrant Housing Act, created the Gold Star program, and developed numerous projects promoting rural highway safety and farm safety. The Structural Pest Control & Pesticides Division in the North Carolina Department of Agriculture & Consumer Services administers programs funded by the Pesticide Environmental Trust Fund (PETF), including the Pesticide Container Recycling Program, Pesticide Disposal Assistance Program (PDAP), and Soil Fumigation Training. The Occupational and Environmental Epidemiology Branch (OEEB) in the North Carolina Department of Health and Human Services developed public health surveillance programs for pesticide incidents and carbon monoxide poisoning. These projects, programs, and policies demonstrate the work that North Carolina state agencies are doing to improve the health of agricultural workers and their families.

Exploiting Genetic Information to Trace Plant Virus Dispersal in Landscapes.

During the past decade, knowledge of pathogen life history has greatly benefited from the advent and development of molecular epidemiology. This branch of epidemiology uses information on pathogen variation at the molecular level to gain insights into a pathogen's niche and evolution and to characterize pathogen dispersal within and between host populations. Here, we review molecular epidemiology approaches that have been developed to trace plant virus dispersal in landscapes. In particular, we highlight how virus molecular epidemiology, nourished with powerful sequencing technologies, can provide novel insights at the crossroads between the blooming fields of landscape genetics, phylogeography, and evolutionary epidemiology. We present existing approaches and their limitations and contributions to the understanding of plant virus epidemiology.

Biomarkers in molecular epidemiology study of oral squamous cell carcinoma in the era of precision medicine

Oral cancer, which occurs in the mouth, lips, and tongue, is a multifactorial disease whose etiology involves environment, genetic, and epigenetic factors. Tobacco use and alcohol consumption are regarded as the primary risk factors for oral squamous cell carcinoma (OSCC), and betel use, other chemicals, radiation, environmental, and genetics are reported as relevant risk factors for oral carcinogenesis. The human papillomavirus infection is an independent risk factor. Traditional epidemiology studies have revealed that environmental carcinogens are risk factors for OSCC. Molecular epidemiology studies have revealed that the susceptibility to OSCC is influenced by both environmental and genetic risk factors. However, the details and mechanisms of risk factors involved in OSCC are unclear. Advanced methods and techniques used in human genome studies provide great opportunities for researchers to explore and identify (a) the details of such risk factors and (b) genetic susceptibility involved in OSCC. Human genome epidemiology is a new branch of epidemiology, which leads the epidemiology study from the molecular epidemiology era into the era of genome-wide association study. In the era of precision medicine, molecular epidemiology studies should focus on biomarkers for cancer genomics and their potential utility in clinical practice. Here, we briefly reviewed several molecular epidemiology studies of OSCC, focusing on biomarkers as valuable utility in risk assessment, clinical screening, diagnosis, and prognosis prediction of OSCC in the era of precision medicine.

Institutes in the Lead: Identifying Environmental Factors in Breast Cancer.

Institutes in the Lead: Identifying Environmental Factors in Breast Cancer.

Voices: A Conversation with Allen J. Wilcox.

Allen James Wilcox was born on 30 September 1946 in Columbus, OH. He studied medicine at the University of Michigan, graduated in 1973, and after a rotating internship, he completed a master's degree in maternal and child health (1976) and a PhD in epidemiology (1979) at the University of North Carolina in Chapel Hill. After graduation, he went to work at the National Institute of Environmental Health Sciences (NIEHS, one of the US National Institutes of Health) in Durham, NC, where he has spent his career. He developed a research program in reproductive and perinatal epidemiology, a relatively unexplored area at the time. His studies include the early pregnancy study, which documented the extent of subclinical pregnancy loss in humans and established the fertile days of a woman's menstrual cycle. He served as the Chief of the Epidemiology Branch from 1991 to 2001, and as Editor-in-Chief of the journal EPIDEMIOLOGY from 2001 to 2014. His textbook, Fertility and Pregnancy-An Epidemiologic Perspective, was published by Oxford University Press in 2010. He was elected to the American Epidemiological Society in 1989, and served as its president in 2003. He also served as president of the Society of Pediatric and Perinatal Epidemiological Research (1996) and the president of the Society of Epidemiological Research (1998). He holds adjunct teaching appointments at the University of North Carolina, Harvard University, and the University of Bergen (Norway), which awarded him an honorary doctoral degree in 2008.

The mysteries of type 2 diabetes in developing countries.

More research is needed in low- and middle-income countries where the epidemic of type 2 diabetes is on the rise. KM Venkat Narayan talks to Fiona Fleck. [ILLUSTRATION OMITTED] KM Venkat Narayan is one of the world's leading researchers on type 2 diabetes. He directs the Emory Global Diabetes Research Center. Prior to joining Emory University In 2006, he spent 10 years at the United States Centers for Disease Control and Prevention, leading the science efforts in his role as Chief of the Diabetes Epidemiology Section and later the Epidemiology and Statistics Branch. Narayan worked on the first diet-exercise intervention study as part of the Pima Indian Study of diabetes at the National Institute of Diabetes and Digestive and Kidney Diseases from 1992 to 1996, where he helped to develop the Diabetes Prevention Program (DPP). Before that, he worked in India, the United Arab Emirates and the United Kingdom of Great Britain and Northern Ireland as a tenured public health physician. He graduated in medicine in 1980 from St John's Medical College, Bangalore, India and subsequently qualified in geriatric medicine, public health and management. He is a member of several international and national committees on type 2 diabetes and other noncommunicable diseases. In 2015 he won the American Diabetes Association's Kelly West Award for outstanding achievement in epidemiology and is the Danish Diabetes Academy visiting professor at the University of Copenhagen. Q; How did you become interested in type 2 diabetes research? A: When I was a physician and public health person working largely on cardiovascular diseases (CVD) in the early 1990s, a leading cause of death in Scotland at the time, I was invited to join a study of people with type 2 diabetes. This study included a work group to develop standards of care and I got to attend the Cambridge Diabetes Epidemiology Seminar. I met Peter Bennett, who was leading the Pima Indian Study at the National Institutes for Health in the United States of America. He invited me to join his team for two years. It was a difficult decision. My wife and I had to leave tenured jobs and move to Phoenix, Arizona. But those two years have extended to 24 years. Spending time with the Pima Indians and studying the disease and the suffering it was causing was a defining experience for me. I sensed that what was happening in the Pima community could happen to the rest of the world. Q: And it did happen. As a cause of death, diabetes jumped from number 15 in 1990 to number nine in 2010. Which countries now have a high burden of type 2 diabetes and which are tackling this disease in the most effective way? A: Countries in the Middle East have a very high prevalence. The countries with the largest number of people with type 2 diabetes are China, India and the United States of America (USA). A major concern today is the increasing numbers of people with type 2 diabetes--not just in China and India--but also in other middle-income and low-income countries. The greatest success in the last 10 to 15 years has been in reducing deaths and complications in people with diabetes, such as heart attacks, stroke, amputations and kidney failure, particularly in Finland, the USA and other high-income countries. High-income countries now have effective tools for the control of blood glucose, blood pressure, lipids and screening for early complications and have done useful research to find ways to implement good quality of care. Q: So more people are living with type 2 diabetes than two decades ago? A: Yes, more people are surviving longer with the disease, but that means there are more and more people with costly complications. For example, diabetes is the leading contributor to the rise in inflation-adjusted health-care costs in the United States. Q: If it's so expensive to manage the disease and its complications, why isn't more done to prevent it? …

The Development of Surveillance Systems.

Surveillance systems in public health practice have increased in number and sophistication with advances in data collection, analysis, and communication. When the Communicable Disease Center (now the Centers for Disease Control and Prevention) was founded some 70 years ago, surveillance referred to the close observation of individuals with suspected smallpox, plague, or cholera. Alexander Langmuir, head of the Epidemiology Branch, redefined surveillance as the epidemiology-based critical factor in infectious disease control. I joined Langmuir as assistant chief in 1955 and was appointed chief of the Surveillance Section in 1961. In this paper, I describe Langmuir's redefinition of surveillance. Langmuir asserted that its proper use in public health meant the systematic reporting of infectious diseases, the analysis and epidemiologic interpretation of data, and both prompt and widespread dissemination of results. I outline the Communicable Disease Center's first surveillance systems for malaria, poliomyelitis, and influenza. I also discuss the role of surveillance in the global smallpox eradication program, emphasizing that the establishment of systematic reporting systems and prompt action based on results were critical factors of the program.

Medicinske struke preventivne medicine na području Timočke Krajine - medicinska bakteriologija u periodu od 1922. do 2013. godine - Rajačka škola zdravlja

In his work author writes about the beginning, development and work of medical bacteriology, later called microbiological and parasitology, over the past 94 years. The author describes the work of the Standing bacteriological station established in 1922 in Zajecar, led by dr Kosta Todorović, and serves the famous bacteriologist, professor of Kiev. dr Vsevolod Ljubinski, which had great significance both for the development of medical bacteriology in the area of the Timok region and for the development of other branches of preventive medicine, particulary epidemiology and hygiene. The largest contribution to medical bacteriology, between the two world wars in the House Public Health in Zajecar, and later, after World War II, in Hygiene, now at the Institute for Public Health 'Timok' in Zajecar, was the discovery of infectious and parasitic diseases, particularly syphilis and malaria, and intestinal infectious diseases. In his article, the author describes the working conditions, equipment, contents and methods of bacteriological, or micorobiological diagnostics and lists the doctors who took part in it. In addition to the contribution of bacteriological, ie microbiologically, serological and parasitological diagnostics, is a significant contribution to the development of serological and virological diagnosis in certain diseases and the use of susceptibility testing for the treatment of infectious diseases. Bacteriology of the Institute in Zajecar contributed to the development of microbiological diagnostics and establishment of micorbiologocal services and opening of microbiological laboratory at Bor, Negotin, Kladovo and Knjazevac, training of doctors and laboratory technicians, and be helped in the organization of laboratory work and processing of samples of different materials taken and subjected to microbiological serological analysis. The work has a historical and medical importance and represents a modest contribution to the history of preventive medical professions in Timok region.

Deciding on a Measure of Effect under Indeterminism

Estimating causal effects is a principal goal in epidemiology and other branches of science. Nonetheless, what constitutes an effect and which measure of effect is pre-ferred are unsettled questions. I argue that, under indeterminism, an effect is a change in the tendency of the outcome variable to take each of its values, and then present a critical analysis of commonly used measures of effect and the measures of frequency from which they are calculated. I conclude that all causal effects should be quantified using a unifying measure of effect called the log likelihood ratio (which is the log probability ratio when the outcome is a discrete variable). Furthermore, I suggest that effects should be estimated for all causal contrasts of the causal variable (i.e., expo-sure), on all values of the outcome variable, and for all time intervals between the cause and the outcome. This goal should be kept in mind in practical approximations.