Epidemiological Terminology Research Articles

Statistical implications of endogeneity induced by residential segregation in small-area modelling of health inequities

Health inequities are assessed by health departments to identify social groups disproportionately burdened by disease and by academic researchers to understand how social, economic, and environmental inequities manifest as health inequities. To characterize inequities, group-specific small-area health data are often modeled using log-linear generalized linear models (GLM) or generalized linear mixed models (GLMM) with a random intercept. These approaches estimate the same marginal rate ratio comparing disease rates across groups under standard assumptions. Here we explore how residential segregation combined with social group differences in disease risk can lead to contradictory findings from the GLM and GLMM. We show that this occurs because small-area disease rate data collected under these conditions induce endogeneity in the GLMM due to correlation between the model’s offset and random effect. This results in GLMM estimates that represent conditional rather than marginal associations. We refer to endogeneity arising from the offset, which to our knowledge has not been noted previously, as “offset endogeneity”. We illustrate this phenomenon in simulated data and real premature mortality data, and we propose alternative modeling approaches to address it. We also introduce to a statistical audience the social epidemiologic terminology for framing health inequities, which enables responsible interpretation of results.

Modern view of the evolution of the concept of "epidemiology". Analytical overview

The article analyzes the evolution of views on the concept of epidemiology in various phrases, provides a critical rationale and assessment of individual groups of definitions of epidemiology, presents a substantiated description of new scientific directions in epidemiology. Additions and changes to the existing structure of epidemiology have been developed and proposed, taking into account modern scientific data on infectious and somatic pathology. The formation of new directions in epidemiology has significantly enriched it not only in scientific but also in applied terms. The section epidemiology of infectious diseases forms the fundamentality of the science of epidemiology, which is constantly developing, which cannot be said about non-infectious epidemiology. Taking into account current trends, the author proposes his own vision of the modern structure of epidemiology as a science. The epidemiology of noncommunicable diseases is still at a lower stage of development than the epidemiology of infectious diseases. It lacks a full-fledged theoretical basis, both in general and in individual sections. There is no epidemiological terminology generally accepted in world medical science.

A semi-automated approach to data harmonization across environmental health studies

The NIEHS-supported Human Health and Exposure Analysis Resource (HHEAR) Data Center maintains a public-use data repository to promote reuse of environmental health data generated by the HHEAR program. The creation and maintenance of this repository requires the integration of information from a wide variety of epidemiologic studies. We have developed the Human Aware Data Acquisition Framework to enable this complex integration, supporting harmonization across multiple studies, and enabling meaningful search and access of the data deposited in the HHEAR Data Repository. To integrate data from a new study, investigators engage in an initial, time-consuming effort to link study data to the HHEAR ontology, a controlled vocabulary of environmental and public health terms. This is accomplished by generating a semantic data dictionary (SDD) from the data dictionaries and codebooks provided by HHEAR study investigators. Originally, this had been done manually by an expert in both epidemiological terminology and ontological modeling. To increase the accessibility of these tools for environmental health scientists who lack formal ontologic training, we have developed an SDD-Editor that simplifies the ontology modeling process. The SDD-Editor reuses elements common to epidemiologic data dictionaries and spreadsheet software, while integrating features needed to form semantic links between public health concepts and existing ontologies. The SDD-Editor suggests potential concept matches for study variables within the SDD using natural language processing to capture the semantic similarity between data dictionary and ontology class descriptions. If no suitable suggestion exists, investigators can search for ontology terms using a search engine powered by Bioportal. Once finished, a validator is run to check that the SDD has the correct format and all classes are valid. By automating parts of the ontology modeling process, the SDD-Editor greatly facilitates the dynamic integration of HHEAR environmental health studies into a single repository, benefiting the scientific community.

Theory of Sapronous Infections: the History of Development and Ways of Improvement in the System of Medical and Biological Sciences

The article represents the history of studies of human diseases caused by faсultative parasites of humans, animals and plants, attributed by microbiologist V.I. Terskych in 1958 to the third class of infections named sapronoses. The concept of sapronous pathogens ecology is one of priorities of Russian medicine. Since that time, facts and generalizations have been accumulated in the world and national science, allowing to revise the initial concept of sapronous infections of biota — from prokaryotes, plants and invertebrates to warm-blooded animals and humans. To decide the controversial issues of the sapronoses theory, epidemiological terminology and systematics of infectious pathology, it is necessary to integrate the knowledge and systemic participation of specialists in medicine and biology in studying this problem. The results of this cooperation will make it possible to clarify and form a unified theoretical concept of the population pathology of the biota based on the ecological approach and general biological regularities of life existence in the world.

Theory of Sapronous Infections: the History of Development and Ways of Improvement in the System of Medical and Biological Sciences

The article represents the history of studies of human diseases caused by faсultative parasites of humans, animals and plants, attributed by microbiologist V.I. Terskych in 1958 to the third class of infections named sapronoses. The concept of sapronous pathogens ecology is one of priorities of Russian medicine. Since that time, facts and generalizations have been accumulated in the world and national science, allowing to revise the initial concept of sapronous infections of biota — from prokaryotes, plants and invertebrates to warm-blooded animals and humans. To decide the controversial issues of the sapronoses theory, epidemiological terminology and systematics of infectious pathology, it is necessary to integrate the knowledge and systemic participation of specialists in medicine and biology in studying this problem. The results of this cooperation will make it possible to clarify and form a unified theoretical concept of the population pathology of the biota based on the ecological approach and general biological regularities of life existence in the world.

Concept and terms in the modern notion about the epidemic process of the respiratory infection group

The theoretical concepts of the epidemiology of infectious diseases are the basis for assessing and controlling the epidemic situation. First of all, these are concepts of epidemic and epizootic processes, the theory of self-regulation of parasitic systems, the socio-ecological concept, etc. But the polysemy of epidemiological terminology does not allow to adequately perceive the processes taking place in a parasitic system. Thus, in modern epidemiologic literature, various terminological units are used to determine the transmission mechanism of respiratory tract infections. Currently, the following terms are actively used: air-droplet, airborne, air, aspiration, aerosol, respiratory etc. The terminological non-coordination for this mechanism of transmission impedes both the work of scientists and effective education of students and epidemiologists. So, on the basis of experimental studies of aerodynamic processes and analysis of various terms for transmission mechanism of respiratory tract infections, we scientifically substantiated and proposed the term "aerosol-aspiration". There are three phases of the airborne mechanism of transmission: release of aerosol as a result of expiratory acts (sneezing, coughing, talking), its movement under the influence of surrounding air currents (aerodynamics) and its aspiration by respiratory tract. The inconsistency of the epidemic process nature with the aforementioned terms of the transmission mechanism of respiratory tract infections has been proved. Thus, the term "aerosol-aspiration" most closely corresponds to the process of implementing the transmission of the agent for respiratory tract infections, and therefore to the method of preservation this group of pathogens as biological species. The implementation of this term in epidemiology terminology system will allow improving both theoretical basis of this science and professional activity of epidemiologists.

A method for effect modifier assessment (EMA) in ergonomic intervention research

The numerous opportunities for effect modifications pose a major challenge in ergonomic intervention research. Even studies in systematic reviews that are assessed as being of high quality generally lack any proper consideration of the potential effect modifiers. We have developed a method for effect modifier assessment (EMA) in intervention research. The EMA method uses a participatory workshop consisting of representatives from all occupational groups in the investigated organization. The workshop identifies both intervention and modifier events including “confounders” and “effect modifiers” according to epidemiologic terminology. These are categorized into themes, then analyzed and evaluated for their potential effects on the investigated outcomes. The overall impact of the pooled modifier themes is finally estimated in relation to the estimated impact of the intervention events. In the present study, the EMA method was tested in two cases. The findings suggest that it provides information that strengthens inferences about the impact of the investigated ergonomic interventions. Further evaluation of the method is recommended.

Sapronoses: Ecology of Infection Agents, Epidemiology, Terminology and Classification

Presents the results of a critical analysis of the existing classifications of pathogens sapronoses and they cause human diseases. In relation to sapronoses investigated the compliance of the content of epidemiological terminology to new scientific data. Applied ecological approach differentiation sapronoses on biotic reservoirs of microorganisms common to humans, animals and plants (prokaryotes). Shows the inconsistencies and contradictions of the traditional concepts and categories that characterize causal factors and conditions a variety of symbiotic relationships facultative parasites of man and animals with their owners. Regulatory influence of the environment provides mechanisms for the transmission of microorganisms in natural reservoirs, modes of transmission of human (warm-blooded animals) and the temporary survival of populations of potential pathogens sapronoses in adverse effects. Environmental factors through a state of the hosts encourage alternation of types of food microorganisms - from saprophytism to pathogenic parasitism and development phase of the epizootic (epiphytotics) process. The incidence of people (animals, plants) sapronoses infections correlated with the feeding habits of organisms in the tanks, the number and status of populations of hosts, independent of the variability of seasonal factors and habitat characteristics. The necessity of differentiation of sapronoses on saprozoonoses, zooanthroponosis and saprozoonoses with the prospect of separation in the future on phytonoses (including prokaryotes as a reservoir of organisms), phytozoonoses and phytozoonoanthroposes. The principle of separation of biotic reservoirs of pathogens sapronoses and mechanisms of their circulation in parasitic and other symbiotic systems, established in the epidemiology of anthroponoses and zoonoses, will allow to unify the terminology and classification of diseases based on biological approach.

Current practices in teaching introductory epidemiology: how we got here, where to go.

The number of students and disciplines requiring basic instruction in epidemiologic methods is growing. As a field, we now have a lexicon of epidemiologic terminology and particular methods that have developed and become canonical through the historical development of the field. Yet, many of our basic concepts remain elusive to some students, particularly those not pursuing a career in epidemiology. Further, disagreement and redundancy across basic terms limit their utility in teaching epidemiology. Many approaches to teaching epidemiology generally start with labeling key concepts and then move on to explain them. We submit that an approach grounded not in labels but in foundational concepts may offer a useful adjunct to introductory epidemiology education. We propose 7 foundational steps in conducting an epidemiologic study and provide examples of how these steps can be operationalized, using simple graphics that articulate how populations are defined, samples are selected, and individuals are followed to count cases. A reorganization of introductory epidemiology around core first principles may be an effective way forward for educating the next generation of public health scientists.

Mid Day Meal Menace in Bihar: The Public Health Concerns of the Tragedy

Discussions regarding the Day programme have many times been an issue of public health professionals in many different ways. Most frequently it is related to the issues of policy, implementation and impact of the same in different communities but discussions in the name of MDM tragedy or disaster may not be much. The issue in Bihar is really distressing in many different ways. It is an issue of great socio-political and public health concern which requires attention from either one of them. Death of 23 children after a Mid Day Meal contaminated with pesticide in Gandaman- Dharmasati Primary school of Chhapra District of Bihar is of great concern. This is a case of point source or common source epidemic as per the classical epidemiological terminology with high case fatality ratio (51.11, n=100) and high attack rate (45, n=100). Institution of proper food and nutritional surveillance system and strengthening the primary health system is of paramount importance in handling situations like this. In this article an attempt has been made to discuss the public health concerns and the associated socio-political issue on the basis of data obtained from the published news articles of various national dailies.

Tipping Point Forewarnings in Climate Change Communication: Some Implications of an Emerging Trend

Prominent British and American sources now seek to structure public understanding of climate change by issuing “tipping point” forewarnings of danger with increasing frequency. This emerging trend announces a shift in the way we are likely to perceive and respond to climate change dangers. This paper reviews key statements to suggest a significant dimension of this trend is its enrollment of epidemiological terminology to communicate urgent and uncertain threats. First, key events in the popular employment of epidemiological and public health models of explanation are reviewed. Second, the author discusses the climate change “debate” to illuminate the limitations involved in treating climate change as a public issue detached from other problems involving atmospheric science. Third, the author reconstructs the tipping point tendency in this context. The essay concludes that the use of this concept signals a broader trend toward epidemiological models of explanation likely to activate public health styles of intervention for addressing climate change impacts. Some implications are briefly discussed.

The language of evidence based medicine: Answers to common questions?

Evidence based medicine (EBM) is an expanding field that combines clinical intuition with the best available evidence in clinical decision making. The shift to evidence based rationale encourages educating future physicians to formulate appropriate research questions and develop critical appraisal skills that are needed to practice EBM.This article identifies areas where clinicians may struggle with epidemiological terminology when critically appraising the literature. A review of the relevant terminology encountered in studies that focus on therapy, harm, diagnosis and prognosis can be beneficial to the clinician and are explained within this article.

Epidemiology of varicose veins.

Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50-55 per cent; men 40-50 per cent) but fewer than half of these will have visible varicose veins (women 20-25 per cent; men 10-15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins; there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.

Model development and research vision for the future of multiple chemical sensitivity.

Multiple chemical sensitivity (MCS) is characterized by heightened self-reported sensitivity to extremely low concentrations of chemicals. It has numerous symptoms in common with the sick building syndrome, the Gulf War syndrome, and chronic fatigue. Despite much research, reproducible objective findings are lacking for MCS, as is a sound model to explain it. This paper proposes a 2-step model combining the needed epidemiologic terminology with that of psychophysiological activation and sensitization. It is suggested that different environmental stressors act as initiators. After initiation, the limbic system and other parts of the brain become sensitized and hyperreactive to environmental triggers. Odor acts as one important trigger. Future research should use more biological assessments in combination with environmental and psychosocial data and involve patient groups with similar symptoms, although diagnosed as suffering from different entities. The similarities and differences of patients with such entities need to be understood before the entities themselves can be understood, diagnosed, treated, and prevented.

Confounding by indication: an example of variation in the use of epidemiologic terminology.

Confounding by indication is a term used when a variable is a risk factor for a disease among nonexposed persons and is associated with the exposure of interest in the population from which the cases derive, without being an intermediate step in the causal pathway between the exposure and the disease. However, in the literature, the term confounding by indication is not always used consistently. The authors found three different situations in which the term has been applied or might have been used but was not: confounding by indication as protopathic bias, as confounding by severity, or as a form of selection bias. It might be helpful to limit use of the term confounding by indication to the situation in which the disease that forms the indication acts as a confounder irrespective of its severity and to apply the term confounding by severity if the severity of this disease acts as a confounder. Protopathic bias and selection bias should not be confused with these terms. The use of appropriate terms ultimately will improve communication among researchers and contribute to the clarity of their papers.

The Epidemiology of Childhood Disorders

Epidemiology has come to the forefront not only as an important science but as a clinical tool as well. Both health care reform and continuous quality improvement, each with a need for outcomes data, and the rise of new diseases, such as the human immunodeficiency virus, have resulted in the necessity of both the academic investigator and the clinician to increase their ability to quantify and understand patterns of occurrences. In pediatrics, this has been more true than in most specialties. This volume, The<i>Epidemiology of Childhood Disorders,</i>edited by respected epidemiologist Ivan Barry Pless, pulls together in one volume core epidemiologic studies in pediatrics. The two introductory chapters provide a valuable review of epidemiologic terminology and examine the role of the longitudinal studies. The remainder of the book is divided into five sections: perinatal disorders, infectious disorders, mental and behavioral disorders, injuries and violence, and chronic disorders. Each of

Physicians' misunderstanding of normal findings.

Gorry, Pauker, and Schwartz [1] demonstrated that a normal test result, when assessed quantitatively, can sometimes be extremely valuable in differential diagnosis. In the present study we extend the principle of the normal finding to include signs and symptoms. This extension proved to be clinically valuable for the present population of patients with acute cough, because the identified normal findings provided significant (p less than 0.001) information predictive of radiographic pneumonia and unrelated to that provided by the abnormal findings. This suggests that both types of findings should be used to diagnose pneumonia efficiently. Another result of the extension of this principle to signs and symptoms was the identification of the clinicians' use (p less than 0.001) of abnormal findings but not (p greater than 0.75) normal findings when managing patients with acute cough. Several possible causes for this misuse of normal findings are discussed, including limitations in the clinicians' cognitive processing of "absent problems," emphasis on abnormal findings by patients, and confusing epidemiological terminology that discourages the recognition of pertinent normal findings.