Community Epidemiology Research Articles

SINAVE’s quality: completeness for Meningococcal Disease – Northern Portugal, 2020-2022

Abstract Due to Meningococcal’s Disease (MD) severity and impact in public health, in Portugal it is mandatory to notify the suspicious cases to implement effective control measures. MD cases are notified in the National Surveillance System (SINAVE), which triggers epidemiological investigation, risk assessment and community intervention. The quality of SINAVE is defined by various attributes, being their evaluation crucial to improve and guarantee quality standards. Our goal is to evaluate the external and internal completeness of SINAVE for MD in northern Portugal from 2020 to 2022. We have conducted a cross-sectional study, using MD cases from 2020 to 2022. External Completeness was estimated using a two-source capture-recapture method, with data from SINAVE and Diagnostic-Related Group (DRG) cases. Hospital readmissions’, duplicates and cases from other regions were excluded. Internal completeness of SINAVE was accessed for each case and for each non-mandatory variable. For external completeness (EC) analysis, 21 of the 23 DRG cases were eligible for matching. Out of 31 SINAVE confirmed cases, 20 were eligible for matching. EC of SINAVE was 66,7%. For internal completeness (IC) analysis, we excluded 7 cases that did not meet the criteria for inclusion. The mean IC was 73,5% (min 38,5%, max 85,7%) when analysing by case. When assessing each of the 30 non-mandatory variables of the reports, 7 (23,3%) had an IC of 100% and 13 (43,3%) had an IC of 0%, the mean value was 49,7%. SINAVE assessment, as a routine, is crucial to identify the need for improvement. Completeness is fundamental to ensure an effective public health response. Our results confirm under-reporting and incomplete report of MD. There is a need to strengthen the improvement of data quality of SINAVE. Future studies may be important to estimate true incidence of MD and compare the results for other diseases in order to improve public health actions. Key messages • Meningococcal disease requires timely public health intervention. • valuation of the surveillance system is crucial, with completeness playing an important role for data quality and prompt response.

Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have.

Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world's deadliest infectious diseases. Despite being the world's oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This "preparing of the ground" for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission.

Epidemiology And Outcomes Of Community Acquired Acute Kidney Injury: A Prospective Single Center Study

Purposes Community Acquire AKI (CAAKI) develops outside the hospital settings and imposes significant burden on healthcare with its high mortality rate and long-term consequences in selected cases. Infective causes are commonly incriminated and thus CAAKI incidence can be curtailed with social and preventive aspect of modern medicine. We studied patients of CAAKI admitted at our institute with follow-up for 6 months. Methods All patients aged >18yrs, with diagnosis of CAAKI admitted to our Institute, a tertiary care centre located in northern part of India, was included in the study for a period of 3 years (2019-2022). The etiological spectrum and renal and patient outcomes of CA-AKI at the index visit and at 1-month, 3-month and 6 month follow-ups were analyzed. Findings Sepsis (38.8%) was the most common cause of AKI followed by Acute Gastroenteritis. Drug induced AKI was the third most common cause with 9.4% of total cases. Mortality at the index admission was 8.5% and Complete recovery at discharge was observed in 14% of patients. Remaining patients (77.5%) had partial recovery on discharge. On follow Up at 6 Months, 13 patients (5.5%) had persistent renal dysfunction of which 2 (0.85%) were on Renal replacement therapy. Conclusion Infective causes remain the common culprits of CAAKI with large contribution from Drug induced AKI. Significant number of patients progress to CKD and/or ESRD. Improving Socio-economic status is likely to lower the incidence of CAAKI.

Effective and inclusive mentorship in the field of epidemiology.

Quality mentoring improves outcomes across career stages, including a sense of belonging, persistence, and productivity. However, the status quo in mentorship culture-including in epidemiology-is an ad hoc approach. This pervasive culture adversely affects individual mentees and the entire scientific research enterprise. Public health disciplines such as epidemiology bear a distinct responsibility to foster an inclusive mentorship culture, ensuring the next generation is equipped not only with methodological expertise but also with a commitment to diversity, equity, inclusion, and the principles of public health. In this commentary, we outline the primary attributes of effective mentors, core competencies, and the evidence base underlying how mentors can improve their skills with comprehensive training. We call on mentors, as well as institutional leaders, to make personal and structural changes, such as requiring mentor training, implementing evidence-based tools (e.g., individual development plans), and regularly evaluating mentorship quality. Institutional leaders can remove barriers (e.g., costs to enroll in mentor training) and facilitate mentorship in non-monetary ways, for example, by making it a formal part of the promotion process. Mentors and leaders must champion these changes, fortifying not only individual career trajectories but also advancing scientific integrity, inclusivity, and justice within the epidemiologic community.

Host Barriers Limit Viral Spread in a Spillover Host: A Study of Deformed Wing Virus in the Bumblebee Bombus terrestris.

The transmission of pathogens from reservoir to recipient host species, termed pathogen spillover, can profoundly impact plant, animal, and public health. However, why some pathogens lead to disease emergence in a novel species while others fail to establish or do not elicit disease is often poorly understood. There is strong evidence that deformed wing virus (DWV), an (+)ssRNA virus, spills over from its reservoir host, the honeybee Apis mellifera, into the bumblebee Bombus terrestris. However, the low impact of DWV on B. terrestris in laboratory experiments suggests host barriers to virus spread in this recipient host. To investigate potential host barriers, we followed the spread of DWV genotype B (DWV-B) through a host's body using RT-PCR after experimental transmission to bumblebees in comparison to honeybees. Inoculation was per os, mimicking food-borne transmission, or by injection into the bee's haemocoel, mimicking vector-based transmission. In honeybees, DWV-B was present in both honeybee faeces and haemolymph within 3 days of inoculation per os or by injection. In contrast, DWV-B was not detected in B. terrestris haemolymph after inoculation per os, suggesting a gut barrier that hinders DWV-B's spread through the body of a B. terrestris. DWV-B was, however, detected in B. terrestris faeces after injection and feeding, albeit at a lower abundance than that observed for A. mellifera, suggesting that B. terrestris sheds less DWV-B than A. mellifera in faeces when infected. Barriers to viral spread in B. terrestris following oral infection may limit DWV's impact on this spillover host and reduce its contribution to the community epidemiology of DWV.

Few Prison Systems Release Individual Death Data: Death in Custody Reporting Act Completeness, Speed, and Compliance.

The United States has one of the largest incarcerated populations per capita. Prisons are dangerous environments, with high in-prison and postrelease mortality. The Death in Custody Reporting Acts (DCRAs) of 2000 and 2013 require deaths of people in correctional custody or caused by law enforcement to be reported to the Bureau of Justice Assistance. These deaths must be reported within 3 months of the death and include 10 required fields (eg, age, cause of death). There is no public reporting requirement. Our Third City Mortality project tracks near-real-time data about individual deaths released publicly and prison system metadata, including data completeness and release speed, across (N = 54) US state, federal (N = 2; Bureau of Prisons, Immigration and Customs Enforcement), Washington, District of Columbia, and Puerto Rico prison systems. Twenty-one (38%) systems release no individual death data; 13 systems release incomplete data slower than 1 year; 19 release timely, but incomplete, death data; and only one system (Iowa) releases complete and timely data. Incomplete, untimely, public prison mortality data limit protective community responses and epidemiology.

Musculoskeletal Disorders among Dentists in the Private Sector

Objective: To assess the prevalence of musculoskeletal disorders among dentists practicing in the private sector in the city of Agadir, Morocco. Materials and Methods: We conducted a cross-sectional study among dentists in the city of Agadir after informed consent. An anonymous questionnaire containing 19 closed questions was distributed. Data entry and statistical analysis were performed using SPSS software at the Community Health, Epidemiology and Biostatistics Laboratory of the Faculty of Dentistry of Casablanca. Results: 100% of doctors reported at least one musculoskeletal complaint. 19.42% of these musculoskeletal disorders were diagnosed and under treatment, 80.58% were undiagnosed, mainly affecting the neck, shoulders and lumbar region. 40% of dentists were diagnosed between 5 and 10 years of practice, 50% had been practicing for less than 10 years, 46.6% were overweight and 40.3% of the participants did not practice sports. Discussion: The rate of dentists reporting musculoskeletal complaints is alarmingly high compared to rates recorded in the literature. Several factors linked to lifestyle and professional activity may explain the results found. Musculoskeletal suffering can also be amplified if the dentist does not respect ergonomics in his dental practice. Conclusion: The rate of musculoskeletal disorders found in our population is alarming. Further studies are needed to evaluate ergonomic compliance to understand better the results of our study.

The peer-review process: critical issues and challenges from an online survey

the peer-review process, which is the foundation of modern scientific production, represents one of its essential elements. However, despite numerous benefits, it presents several critical issues. to collect the opinions of a group of researchers from the epidemiological scientific community on peer-review processes. cross-sectional study using a questionnaire evaluation. a 29-question survey was administered to 516 healthcare professionals through the SurveyMonkey platform. The questions focused on the individual characteristics of the respondents and their perceived satisfaction with some characteristics of the review process as well as their propensity of changing some aspects of it. In addition, three open-ended questions were included, allowing respondents to provide comments on the role that reviewers and the review process should play. Descriptive statistics were produced in terms of absolute frequencies and percentages for the information collected through the questionnaire. Secondly, a multiple logistic regression analysis was conducted to assess the willingness to change certain aspects of peer review, adjusting for covariates such as age, sex, being the author of at least one scientific work, being a reviewer of at least one scientific work, and belonging to a specific discipline. The results are expressed as odds ratios (ORs) and their 95% confidence intervals (95%CI). Text analysis and representation using word cloud were also used for an open-ended question. level of satisfaction regarding some characteristics of the peer-review process. a total of 516 participants completed the questionnaire. Specifically, 87.2% (N. 450) of the participants were the authors of at least one scientific publication, 78.7% were first authors at least once (N. 406), and 71.5% acted as reviewers within the peer-review process (N. 369). The results obtained from the multiple logistic regression models did not highlight any significant differences in terms of propensity to change for age and sex categories, except for a lower propensity of the under 35 age group towards unmasking, defined as the presence of reviewers and editorial boards names on the publish article (OR <35 years vs 45-54 years: 0.51; 95%CI 0.29-0.89) and a higher propensity for post-formatting proposals, defined as the possibility of formatting the article following journal guidelines after the acceptance, among those under 45 (OR <35 years vs 45-54 years: 1.73; 95%CI 0.90-3.31; OR 35-44 years vs 45-54 years: 2.02; 95%CI 1.10-3.72). Finally, approximately 50% of respondents found it appropriate to receive credits for the revision work performed, while approximately 30% found it appropriate to receive a discount on publication fees for the same journal in which they acted as reviewers. the peer-review process is considered essential, but imperfect, by the professionals who participated in the questionnaire, thus providing a clear picture of the value that peer-review adds rigorously to each scientific work and the need to continue constructive dialogue on this topic within the scientific community.

Comparison of Cardiovascular Disease-Related Mortality and Morbidity in Urban and Rural Residential Areas in Jatinangor Subdistrict, West Java, Indonesia: An Epidemiological Community Study

Objectives: Residential areas are considered part of the sociocultural aspect for determining health but are rarely studied in a cardiovascular disease-community study in developing countries. Jatinangor, considered a university area, has unique characteristics surrounded by urban and rural villages. We aim to investigate the association of residential areas in Jatinangor with cardiovascular morbidity and mortality. Methodology: A cross-sectional study from July to November 2018 was done in appointed rural and urban areas in Jatinangor district, West Java, Indonesia. Cardiovascular disease is defined using a self-reported questionnaire. Cardiovascular death was identified through a verbal autopsy performed by a general practitioner as an interviewer. The morbidity data were obtained from September to October 2018, while the mortality data were obtained from July to November 2018. Poisson regression was done to determine the association of residential areas to cardiovascular disease morbidity. Results: Data were obtained from 1469 respondents; 58.7% were from rural areas. The prevalence of cardiovascular disease morbidity is higher in urban than rural areas (5.6% vs. 2.5%, p=0.004). There were 42 cases of death reported during the study period, with 33 deaths considered caused by cardiovascular disease. The urban-rural differences in cardiovascular mortality showed no significant differences (p=0.388). The unadjusted model of the association of the urban-rural residential area with cardiovascular disease morbidity was (PR 2.253 (95% CI 1.262, 4.024)) while the adjusted model was (PR 2.264 (95% CI 1.257, 4.078, p = 0.007)). Conclusion: Urban area is associated with two times higher cardiovascular disease morbidity but not with mortality than those who live in rural areas.

EPIDEMIOLOGICAL PROFILE OF DENGUE CASES IN BRAZIL BETWEEN THE YEARS 2018 AND 2022

The present study aimed to analyze the epidemiological profile of dengue cases notified in Brazil between 2018 and 2022. This is a descriptive, retrospective, epidemiological study based on secondary data from the National Disease Notification Information System (SINAN). A total of 4,701,914 notified cases were analyzed in this period, with a focus on distribution by sex, age group, race/color, and region. There was a predominance of females (54.8%), young adults between 20 and 49 years old (53.6%), browns (36.7%) and whites (37.1%). The Southeast region had the most cases (43%), but the Northeast and Midwest also had high numbers. An expressive increasing trend was identified starting in 2019, with alarming peaks in 2021 and 2022. The study reveals that dengue persists as a serious public health problem in Brazil, making it essential to strengthen integrated strategies for vector prevention and control, epidemiological surveillance, community mobilization, and health education to reverse this trend.

Epidemiology and Outcome of Community- and Hospital-Acquired AKI in a Developing Country

Epidemiology and Outcome of Community- and Hospital-Acquired AKI in a Developing Country

Closing the gap in the Janzen-Connell hypothesis: What determines pathogen diversity?

The high tree diversity in tropical forests has long been a puzzle to ecologists. In the 1970s, Janzen and Connell proposed that tree species (hosts) coexist due to the stabilizing actions of specialized enemies. This Janzen-Connell hypothesis was subsequently supported by theoretical studies. Yet, such studies have taken the presence of specialized pathogens for granted, overlooking that pathogen coexistence also requires an explanation. Moreover, stable ecological coexistence does not necessarily imply evolutionary stability. What are the conditions that allow Janzen-Connell effects to evolve? We link theory from community ecology, evolutionary biology and epidemiology to tackle this question, structuring our approach around five theoretical frameworks. Phenomenological Lotka-Volterra competition models provide the most basic framework, which can be restructured to include (single- or multi-)pathogen dynamics. This ecological foundation can be extended to include pathogen evolution. Hosts, of course, may also evolve, and we introduce a coevolutionary model, showing that host-pathogen coevolution can lead to highly diverse systems. Our work unpacks the assumptions underpinning Janzen-Connell and places theoretical bounds on pathogen and host ecology and evolution. The five theoretical frameworks taken together provide a stronger theoretical basis for Janzen-Connell, delivering a wider lens that can yield important insights into the maintenance of diversity in these increasingly threatened systems.

Noncollapsibility of the odds ratio unraveled

Purpose of review The concept of noncollapsibility of the odds ratio has intrigued the epidemiology community for decades. Despite often being overlooked or negatively perceived, which can lead researchers to prefer collapsible measures, this study highlights the beneficial aspects of noncollapsibility of the odds ratio. Recent findings This study links recent diagnostic test research with effect measures. Noncollapsibility is a useful characteristic, and its understanding can have important implications in medical research. Summary We demonstrate that a change in effect could be due to confounding, noncollapsibility, or a combination of both and that noncollapsibility can be a powerful tool for data analysis and interpretation when properly understood. This study aims to help researchers demystify this complex issue and offers updated recommendations.

Mindful Attention as a Mediator Between Smartphone Overuse and Depressive Symptoms for Up to 6 Months Among Young People: Findings from Two Separate Epidemiological and Longitudinal Community Studies

Mindful Attention as a Mediator Between Smartphone Overuse and Depressive Symptoms for Up to 6 Months Among Young People: Findings from Two Separate Epidemiological and Longitudinal Community Studies

Special issue: molecular nutrition and chronic diseases.

"Let food be thy medicine and medicine be thy food"-the ancient adage proposed by Greek philosopher Hippocrates of Kos thousands of years ago already acknowledged the importance of the beneficial and health-promoting effects of food nutrients on the body (Mafra et al., 2021). Recent epidemiological and large-scale community studies have also reported that unhealthy diets or eating habits may contribute heavily to the burden of chronic, non-communicable diseases, such as obesity, type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), cancer, neurodegenerative diseases, arthritis, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) (Jayedi et al., 2020; Gao et al., 2022). Emerging evidence highlights that a diet rich in fruits and vegetables can prevent various chronic diseases (Chen et al., 2022). Food bioactive compounds including vitamins, phytochemicals, and dietary fibers are responsible for these nutraceutical benefits (Boeing et al., 2012). Recently, phytochemicals such as polyphenols, phytosterols, and carotenoids have gained increasing attention due to their potential health benefits to alleviate chronic diseases (van Breda and de Kok, 2018). Understanding the role of phytochemicals in health promotion and preventing chronic diseases can inform dietary recommendations and the development of functional foods. Therefore, it is crucial to investigate the health benefits of phytochemicals derived from commonly consumed foods for the prevention and management of chronic diseases.

Epidemiological intelligence community network intervention: a community response for COVID-19 community transmission

BackgroundExpanding and providing access to early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through testing community-based strategies among socially vulnerable communities (SVC) are critical to reducing health disparities. The Epidemiological Intelligence Community Network (EpI-Net) community-based intervention sought to increase coronavirus 2019 (COVID-19) testing uptake and prevention practices among SVC in Puerto Rico (PR). We evaluated EpI-Net’s community leaders’ capacity-building component by assessing pre-post COVID-19 public health workshops’ tests’ score changes and satisfaction among trained community leaders.MethodsA total of 24 community leaders from SVC in PR have completed four community workshops. Pre- and post-assessments were completed as part of the health promotors training program to evaluate participants’ tests score changes and satisfaction outcomes.ResultsPreliminary results showed: (1) high intervention retention levels of community leaders (85.7% acceptance rate); (2) change in post-test scores for community engagement strategies (p = 0.012); (3) change in post-test educational scores in COVID-19 prevention practices (p = 0.014); and (4) a change in scores in public health emergency management strategies (p < 0.001).ConclusionsThe overall workshop satisfaction was 99.6%. Community leaders have shown the importance of community capacity building as a key component for intervention feasibility and impact.Trial registrationOur study was retrospectively registered under the ClinicalTrial.gov ID NCT04910542.

SA6 The Utility of “Single Exposure” Versus Causal Architecture Approaches in Real-World Research

Over recent decades, epidemiologic methodology has evolved substantially to encompass a gamut of techniques for focalizing on the most unbiased effect estimate of a single exposure (e.g., a treatment effect). By contrast, less attention has been paid to the refinement of study designs and analytic techniques intended to encompass the underlying milieu of co-occurring clinical, environmental, and social determinants that interactively influence disease risk or outcomes. Single exposure approaches (i.e., the “potential outcomes framework”) have been criticized as being reductionist and have long been debated in the broader epidemiologic community, despite the utility of this approach in optimizing internal validity. Further, the gap between clinical trial efficacy and real-world (RW) effectiveness remains a concern for both regulatory entities and payers, though this gap may be partly attributable to varying prevalences of important effect modifiers between trial and RW patient populations. This conceptual paper will expand upon the existing conceptual paradigms by applying them to RW research and delineating key considerations related to assessing whether a single exposure or causal architecture approach would be fit-for-purpose based on the overarching research question. Drawing upon examples from RW research types, such as use of external control groups, comparative effectiveness, and prediction of likely responders to treatment, the strengths and weaknesses of each approach will be demonstrated using case studies related to regulatory and/or payer decision-making. Methodologic recommendations will be provided. Ultimately, both single exposure and causal architecture approaches to study design and analysis have a place in pharmacoepidemiology and real-world research. A careful examination of when each approach is fit-for-purpose can lead to the application of innovative strategies to the design and conduct of RW studies.

Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri.

This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure-creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas-sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.

Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri

This paper examines the impact of insecurity on the management of the Ebola virus disease epidemic in the Democratic Republic of the Congo provinces of North Kivu and Ituri. In these provinces, insecurity has been one of the biggest obstacles in the response to the Ebola outbreak. When the epidemic began, these provinces were already insecure—creating unfavorable circumstances for implementing epidemic response activities. While the ninth epidemic in the Equateur province was brought under control in record time, the same was not true for the tenth epidemic in North Kivu and Ituri. Since the epidemic began, teams were organized to address all aspects of the response. These response teams conducted extensive fieldwork, including epidemiological surveillance, risk communication and community involvement, infection prevention and control, vaccination, dignified and safe burials, care at transit centers and Ebola treatment centers, and medical and psychosocial care for the recovered. They faced confrontational reactions from the communities, which jeopardized their security. The insecure state of the provinces led to the destruction and damage of infrastructure, including healthcare facilities, which affected the ability of rescue teams to access people needing care as well as the resources they needed to care for the ill. Worse yet, the insecurity took other forms, including threatening and kidnapping members of the response teams, lodging protests against the response activities in towns or health zones, committing violence against teams responsible for safe and dignified burials, instigating altercations between community members and members of the response team, and encouraging general resistance by the population. This level of insecurity interrupted or even halted response activities in some areas—sometimes for more than two weeks, decreasing the efficiency of the response teams, particularly in monitoring contacts due to the inability to access certain communities. Additionally, certain acts of protest, such as community members handling bodies as a demonstration of their opposition to safe and dignified burials, likely intensified disease spread. However, the involvement of community leaders, at least, made dialogue and negotiation possible between the response teams and community members, as such efforts led to communities contributing to the security of personnel involved in the fight against the Ebola epidemic in North Kivu and Ituri provinces.

Enhancing Epidemiology's Impact on Policy: Mediation by Expert Committees.

Epidemiologic evidence is often a key source of information used by expert committees to guide policy decisions, yet epidemiologists rarely consider this audience for their research. For a better understanding of the pipeline from epidemiologic research to expert committee assessment to policy, several reports from the National Academies of Sciences, Engineering, and Medicine were reviewed and discussed with staff and committee members. The topics of these consensus committee assessments included health behaviors, medical care, and military exposures. The focus was often on emerging issues of immediate concern for which there was little relevant research available but a need for prompt action. Committees generally sought a comprehensive assessment of potential health effects of a given product or exposure, which often included social and behavioral health outcomes that are rarely addressed by epidemiologists. To enhance epidemiology's contribution to societal decisions, the choice of research topics should expand to consider emerging societal concerns. Research funding agencies need to be engaged as mediators between committee needs and the research community to stimulate contributory research. Improved communication of research needs to the epidemiology community would be beneficial to researchers aspiring to have an impact and to those who use epidemiologic information to help guide policy decisions.