Epidemiological Reality Research Articles

Role of microbiology in epidemiology: before and beyond 2000.

Sustained attention to the epidemiology of classic and emerging infectious diseases is justified elsewhere in this issue (1) because, despite dazzling progress, infection will remain a major if not the leading cause of human mortality worldwide for the foreseeable future. As the handmaiden of infectious disease epidemiology, the science of microbiology has been educating us for decades about the ingenious microbial strategies that account for that epidemiologic reality. Her older lessons are worth reviewing in this millenial perspective on epidemiology because they involve not only the biologically critical exploration of the microbe-human interface but also the intellectually critical discovery of disease causation. There are also new lessons with equally wide ramifications. Insight into the behavior of transmissible, self-replicating biologic agents influences all of epidemiology, not just the domain of infectious diseases; microbiology imparts its wisdom about all disease in populations.

Armed conflicts, health and health services in Africa. An epidemiological framework of reference

Because of war, between the 1980s and early ‘90s Africa suffered about 5 million excess deaths and economic losses estimated at US$13 billion per year. In 1995, war was directly or indirectly affecting 550 million people in 35 countries. Besides violent deaths, injuries and disabilities, displacements of population increase the risk for acute respiratory infections, diarrhoeas, epidemics and parasitic diseases. The risk for malnutrition and deficiencies is made worse by the loss of means of production, of food stocks, of commerce and by banditism. Military operations target water plants and health facilities as means of deliberately hurting civilians. Economic crisis curtails the budgets of the social sectors and, together with social distress, undermines national capacities. The delivery of health care is hampered right when hazards and vulnerabilities increase, with general greater risk of illness and death. With the cessation of hostilities, the need for curative and preventative health activities increases and is a matter of emergency, as equitable access to services is important for peace. Repatriation of refugees, demobilization of soldiers and demining require special health activities. War leaves behind new hazards and vulnerabilities such as landmines, wide availability of weapons, artificial concentrations of population, loss of national capacities and psychological disorders. All this interacts tragically with Africa's wider epidemiological realities of poverty, food insecurity, proneness to natural disasters and endemic diseases.

Public Policy and Aids

In summary of some of the major issues raised by AIDS (Table 1), social, political, and economic forces all impact on the global outbreak of AIDS. Conversely the epidemiologic and medical realities of this disease have forced a reconsideration of moral and ethical values, prioritization of resource allocation, and pervasion of virtually every aspect of the health care delivery system. Advocates for AIDS funding have set a model for other espousing the significance of diseases ranging from rare disorders to breast cancer. As this issue was written (summer 1993), it was apparent that attention of the media had shifted to numerous other domestic and foreign concerns. Hopefully, when the Clinics next present perinatal AIDS, the pendulum will have swung back and there will be a wider variety of effective therapeutic agents available permitting longer survival of greater quality.

Pediatric Aids in the United States: Epidemiological Reality versus Government Policy

Pediatric AIDS cases constitute approximately 2 percent of total AIDS cases in the United States, but HIV infection and AIDS among children pose a growing concern. Government policies have failed to match the epidemiological reality of the disease. The powerful shapers of public opinion have dedicated their energies to a handful of cases, involving the school attendance of primarily middle-class children. Unfortunately, coverage of school placement issues has overshadowed both the demographically more serious issue of perinatally transmitted AIDS cases and the growing concern over adolescent AIDS. Seventy-five percent of perinatal AIDS sufferers are poor, urban minorities: the disease is clearly related to other indicators of poor child health--urban poverty and oppressive social conditions. School-based prevention efforts for adolescents have been rendered impotent because of moralistic obstacles to explicit education. Prevention of perinatal and adolescent HIV transmission must be both sensitive and relevant to communities in which the greatest threat to survival is poverty, not AIDS. Ultimately, issues surrounding pediatric AIDS only reinforce the long-term position of child health advocates: the best investment a society can make is a sincere commitment of resources to improve the health, education, and welfare of its children.

El aborto en el Ecuador (1964-1988). Propuesta para une lectura de las estadísticas hospitalarias

Abortion in Ecuador (1964-1988). Proposition for a new reading of institutional statistics Abstract Abortion is considered as one of the main causes of maternal mortality in Latin America. Nevertheless, its epidemiological reality, in terms of evolution or distribution, is not well known. The present research is based on the institutional statistics of Ecuador in the past quarter of century. In order to take into account the variations of access to medical care in this period, the ratio of abortions to pregnancies and deliveries attended in hospitals has been calculated. At the national level, after an initial increase from 1964 to 1973, the rate becomes stabilized until 1980, then begins a fast decrease from 1981 on. At the level of two andean provinces, one urban and the other rural, results differ: in the area of the capital city, evolution is comparable to what has been observed with national data, whereas in the area mainly agricultural, the tendency is of an irregular increase. This noticing, in contradiction with many reports and declarations about abortion, could be the consequence of a better control by women of their biological reproduction and of an earlier medical supervision of pregnancies. Anthropological research is necessary to explain these new phenomenons and study their social differenciation.

The Dimensions of the Problem of Eye Disease Among the Elderly

America is aging rapidly. Within the next 30 years, those over 65 years of age will grow to form 17% of the population of the United States; the number of people over 85 will more than double. Currently, the rates of eye disease such as cataract, macular degeneration, diabetic retinopathy, and glaucoma are highest in the older group. The risk of blindness is ten times greater for those over age 65 than for younger individuals. This combination of high rates of disease in the fastest growing segment of the population means that the demand for eye care services will increase dramatically. Undoubtedly, new approaches will appear to deal with the epidemiologic reality.

Planorbid distribution and the prevalence of schistosomiasis mansoni in the State of Espírito Santo

São apresentados os resultados de investigações sobre a distribuição dos planorbídeos e a prevalência da xistosomose mansoni por municípios do Estado do Espírito Santo. Foram ncontradas 9 espécies de planorbídeos, pertencentes a 3 gêneros: Biomphalaria glabrata, B. schrammi, B. straminea e B. tenagophila; Drepanotrema anatinum, D. cimex, D. depressissimum e D. lucidum; e Plesiophysa ornata. A área endêmica, delimitada por um levantamento preliminar por microrregião homogênea (1975) e por um inquérito por bacia hidrográfica em 15% dos escolares de 7-14 anos (1978 -80), compreende pelo menos 18 municípios ao longo da fronteira com os Estados de Minas Gerais e da Bahia. Das espécies de planorbídeos, a mais freqüente foi a Biomphalaria tenagophila, encontrada em 44 dos 53 municípios. Em seguida vieram o Drepanotrema lucidum (25 municípios), a Biomphalaria glabrata (23), a B. schrammi (16), a B. straminea (120, o Drepanotrema cimex (8), o D. anatinum (6), o D. depressissimum (5) e a Plesiophysa ornata (1). A presença da B. glabrata coincide com a transmissão da xistosomose, não estando ainda bem esclarecido o papel da B. tenagophila, que parece ser a espécie vetora na área da Grande Vitória, A B. straminea ocorre somente nos municípios com níveis significativos de endemicidade, mas sua participação na transmissão ainda não foi comprovada. As áreas de maior prevalência da xistosomose estão localizadas nas microrregiões homogêneas de Colatina, Colonial Serrana Espírito-Santense, Alto São Mateus e Vertente Oriental do Caparaó. A comparação entre os resultados desta investigação e os de levantamento anteriores permite afirmar que, se os índices de prevalência obtidos correspondem à realidade, a xistosomose mansoni expandiu-se consideravelmente no Espírito Santo no decurso dos últimos 30 anos.

Less Hazardous Cigarette Debated-Reply

In Reply.— Most of the issues raised by Drs Miller and Schumaker have been addressed in separate letters, three of which appeared inThe Journal(240:2005; 2142; 2143, 1978) and one that will appear in Science . We welcome the opportunity to summarize our responses here. Miller and Schumaker state that the assumptions for critical values have been criticized by a number of prominent statisticians. They support this statement by reference to a single letter by two statisticians, which Science declined to publish. However, a subsequent letter by these same statisticians is to be published in Science, with a rejoinder that refutes each criticism made. Basically, the rejoinder describes fundamental epidemiologic realities of which the critics may not have been aware. Since the rejoinder is to be published in its entirety, it is not repeated here. In any case, our article inThe Journaluses only one statistic from the