Incidence Of Disease In Populations Research Articles

Preferred Reporting items for OBservational studies in Endodontics (PROBE) guidelines: a development protocol.

Observational studies have a significant role in establishing the prevalence and incidence of diseases in populations, as well as determining the benefits and risks associated with health-related interventions. Observational studies principally encompass cohort, case-control, case series and cross-sectional designs. Inadequate reporting of observational studies is likely to have a negative impact on decision-making in day-to-day clinical practice; however, no reporting guidelines have been published for observational studies in Endodontics. The aim of this project is to develop reporting guidelines for authors when creating manuscripts describing observational studies in the field of Endodontology in an attempt to improve the quality of publications. The new guidelines for observational studies will be named: 'Preferred Reporting items for OBservational studies in Endodontics (PROBE)'. A steering committee was formed by the project leaders (PD, VN) to develop the guidelines through a five-phase consensus process. The steering committee will review and adapt items from the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as identify new items that add value to Endodontics. The steering committee will create a PROBE Delphi Group (PDG), consisting of 30 members across the globe to review and refine the draft checklist items and flowchart. The items will be assessed by the PDG on a nine-point Likert scale for relevance and inclusion. The agreed items will then be discussed by a PROBE Face-to-Face meeting group (PFMG) made up of 20 individuals to further refine the guidelines. After receiving feedback from the PFMG, the steering committee will pilot and finalize the guidelines. The approved PROBE guidelines will be disseminated through publication in relevant journals, and be presented at national and international conferences. The PROBE checklist and flowchart will be available and downloadable from the Preferred Reporting Items for study Designs in Endodontics (PRIDE) website: www.pride-endodonticguidelines.org. The PROBE steering committee encourages clinicians, researchers, editors and peer reviewers to provide feedback on the PROBE guidelines to inform the steering group when the guidelines are updated.

Evolutionary Biology: A Basic Science for Medicine

When the Flexner Report was written, evolutionary biology was not yet a well‐developed science and few people were interested in its applications to medicine. As a result, Flexner's recommendations for pre‐medical and medical education did not include evolution. Increasingly, however, physicians and medical scientists are appreciating the clinical relevance of evolutionary biology. The need for antibiotic stewardship to minimize selection for antibiotic resistance and the recognition that cancer is an evolutionary process involving variation and selection among clones of cancer cells have highlighted the urgency of bringing evolutionary principles into medicine. An evolutionary perspective can enhance students' understanding of health and disease in many ways. Evolutionary biology provides an enriched view of variation. Medicine has traditionally considered variations as deviations from a “normal” state. Evolutionary biology recognizes variation, both within populations and between populations, as an important characteristic of biological species. Variation is a prerequisite for selection and, in addition, it provides a defense against the spread of pathogens within populations. This view of variation leads to an understanding of the differences between individual health and population health. The causes of disease in individuals are different from the causes of the incidence of disease in populations. Much of the within‐population variation is genetic while environmental differences are major components of between‐population variation. The focus of medicine on disease in individuals has led to an overemphasis on genetic risk factors and a dependence on pharmacologic therapies. An evolutionary view of population health emphasizes the importance of environmental risk factors or determinants of disease and the possible role of behavioral or cultural interventions in disease prevention. Evolutionary life history theory is an account of the ways in which natural selection has shaped our entire life course. The theory is especially concerned with the acquisition and allocation of metabolic energy and other needed resources. Among other things, we use metabolic energy to build up excess physiological capacities, or reserves, early in development and to prevent or repair the inevitable bodily damage that occurs throughout our lives. Diseases of aging result from unrepaired somatic damage and the depletion of our physiological reserves. This understanding suggests that interventions designed to promote the accumulation of physiological reserves and to slow the accumulation of bodily damage may postpone the onset of diseases of aging. Recognition that signs and symptoms of disease may be adaptations that decrease the fitness loss caused by disease heightens the need for caution in treating the manifestations of disease. These are just a few of the benefits of incorporating evolutionary insights into medicine. Evolutionary biology is a basic science for medicine. Our challenge is to figure out the best ways of integrating evolution into an already overcrowded medical curriculum and of bringing evolution to the attention of busy physicians whose first responsibility is to address the pressing problems of their patients.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Cardiac and mitochondrial dysfunction following acute pulmonary exposure to mountaintop removal mining particulate matter.

Throughout the United States, air pollution correlates with adverse health outcomes, and cardiovascular disease incidence is commonly increased following environmental exposure. In areas surrounding active mountaintop removal mines (MTM), a further increase in cardiovascular morbidity is observed and may be attributed in part to particulate matter (PM) released from the mine. The mitochondrion has been shown to be central in the etiology of many cardiovascular diseases, yet its roles in PM-related cardiovascular effects are not realized. In this study, we sought to elucidate the cardiac processes that are disrupted following exposure to mountaintop removal mining particulate matter (PM MTM). To address this question, we exposed male Sprague-Dawley rats to PM MTM, collected within one mile of an active MTM site, using intratracheal instillation. Twenty-four hours following exposure, we evaluated cardiac function, apoptotic indices, and mitochondrial function. PM MTM exposure elicited a significant decrease in ejection fraction and fractional shortening compared with controls. Investigation into the cellular impacts of PM MTM exposure identified a significant increase in mitochondrial-induced apoptotic signaling, as reflected by an increase in TUNEL-positive nuclei and increased caspase-3 and -9 activities. Finally, a significant increase in mitochondrial transition pore opening leading to decreased mitochondrial function was identified following exposure. In conclusion, our data suggest that pulmonary exposure to PM MTM increases cardiac mitochondrial-associated apoptotic signaling and decreases mitochondrial function concomitant with decreased cardiac function. These results suggest that increased cardiovascular disease incidence in populations surrounding MTM mines may be associated with increased cardiac cell apoptotic signaling and decreased mitochondrial function.

Differential impact of consanguineous marriages on autosomal recessive diseases in Tunisia.

Consanguinity is common in Tunisia. However, little information exists on its impact on recessive disorders. In this study, we evaluate the impact of consanguineous marriages on the occurrence of some specific autosomal recessive disorders and consider how other factors, such as population substructure and mutation frequency, may be of equal importance in disease prevalence. Consanguinity profiles were retrospectively studied among 425 Tunisian patients suffering from autosomal recessive xeroderma pigmentosum, dystrophic epidermolysis bullosa, nonsyndromic retinitis pigmentosa, Gaucher disease, Fanconi anemia, glycogenosis type I, and ichthyosis, and compared to those of a healthy control sample. Consanguinity was observed in 341 cases (64.94%). Consanguinity rates per disease were 75.63, 63.64, 60.64, 61.29, 57.89, 73.33, and 51.28%, respectively. First-cousin marriages were the most common form of consanguinity (48.94%) with the percentages of 55.46, 45.46, 47.87, 48.39, 45.61, 56.66, and 35.90%, respectively. A very high level of geographic endogamy was also observed (93.92%), with the values by disease ranging between 75.86 and 96.64%. We observed an overall excess risk associated to consanguinity of nearly sevenfold which was proportional to the number of affected siblings and the frequency of disease allele in the family. Consanguinity was significantly associated with the first five cited diseases (odds ratio = 24.41, 15.17, 7.5, 5.53, and 5.07, respectively). However, no meaningful effects were reported among the remaining diseases. This study reveals a variation in the excess risk linked to consanguinity according to the type of disorder, suggesting the potential of cryptic population substructure to contribute to disease incidence in populations with complex social structure like Tunisia. It also emphasizes the role of other health and demographic aspects such as mutation frequency and reproductive replacement in diseases etiology.

Authors' Response

To the Editor: We appreciate the opportunity to respond to the comments of Drs. Mandel and Maldonado. Certainly, the optimal study of the effectiveness of the Fernald Medical Monitoring Program (FMMP) would include health outcome data of those who were eligible but chose not to participate in the program; however, it is not feasible to conduct such a study. The standard mortality ratios (SMRs) in Table 4, however, clearly do represent a population with a mortality experience that is less than that of the general population.1 It is likely that those already diagnosed with cancer were less likely to enroll in the FMMP, because they were already under medical care. The low SMRs from 1994 to 1996 were probably a result of the healthy volunteer effect. Therefore, it is impressive that the SMRs remained so low over the later years of the program, as the entire cohort was followed. Over time, without the benefit of medical surveillance, the effect of the initial self-selection would have waned and the SMRs increased somewhat. As other evidence of improved health, persons who participated in at least five of seven examinations had a decrease in serum cholesterol that was greater than the decrease reported for the general population, and systolic blood pressure decreased in men. We did not find those same decreases in participants who came in for only two or three examinations. It may or may not be possible to alter the risk of exposure-related disease incidence in populations experiencing a significant environmental contaminant. Further study is needed to determine whether, by reducing the level of other lifestyle risk factors, the absolute risk of the disease may be lowered. Medical monitoring with active follow-up likely will result in earlier exposure-related disease detection, however, improving survival. In addition, a comprehensive screening program such as the FMMP will decrease the burden of other disease, which is not related to exposure. Drs. Mandel and Maldonado state that “offsetting risks may obfuscate the central issue (environmental contamination) and de-emphasize the importance of this.” The research resources developed through the FMMP represent one of the best opportunities to test the hypotheses that exposures to uranium and radiation in this population are related to disease occurrence. The population was followed prospectively with yearly questionnaires and comprehensive medical examinations every 2 to 3 years, with all information coded and stored in a SAS (SAS, Inc, Cary, NC) database. The amount and types of data available for exposure characterization of this cohort and the availability of the CDC exposure algorithm are unique in studies of environmental uranium exposure to communities. The biospecimens collected in the early years of the FMMP are valuable for the measurement of environmental biomarkers. Furthermore, these resources have been made available to the community of environmental scientists for testing hypotheses of the associations between exposure and disease. Written policies about access to FMMP data and biospecimens and the application forms are available on the FMMP web site.2 Robert Wones, MD Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati, Ohio Susan M. Pinney, PhD Department of Environmental Health University of Cincinnati College of Medicine Cincinnati, Ohio

Changing challenges in the control of blindness in children

One cannot address issues of control of blindness in children without first considering the epidemiology, as this allows priorities to be determined and appropriate strategies to be delineated. Control does not occur within a vacuum, and so it is also important to understand the context in which programmes are to be implemented, particularly in relation to development and poverty--the distal risk factors that are powerful determinants of the incidence of disease in populations. Interventions need to be considered from the perspective of patients as well as providers if services are to be acceptable and appropriate.

Equity and the goal of Health for All.

First let me thank you not only for the opportunityto address you here in Venezuela but also for hav-ing given me the opportunity to reflect again moreseriously on the concept of equity as it applies towhat we do. I hope to show you how the concept of equity is embedded in the vision of Health forAll, and the relevance of both to the struggles of the countries of the Americas for a better life for all their citizens. This is the centennial of the PanAmerican Health Organization (PAHO), and it isfitting that those of us who serve the Organizationtake time to reflect on some of the essential valuesthat underpin what we do. I believe that this hasbeen a forte of my predecessors throughout theyears as they must have believed, as I do, that no or -ganization can survive and flourish unless it hassome bright vision of what might be and the way toget there. I believe that the noble vision of Healthfor All, explicitly or implicitly, must have guidedwhat we have done and what we are.When I was a medical student, we weretaught that the social and physical environmenthad an effect on the development and progress ofdisease, and one could see obvious examples of thatalmost every day. But the focus was predominantlyon the individual. As I became a practicing internistmy concern was still mainly, if not exclusively, forthe health and well-being of my individual patient,and I believe that that is the proper focus of thoseengaged in personal-care medicine. Success wasmeasured in terms of the outcome of treatment Ihad prescribed or to the extent I could have him orher protected against some risk to health. I have toconfess that from time to time as I saw patientscome for treatment late in the course of their diseaseor saw their disease affected by conditions of depri-vation that were not of their own making, I couldnot help but reflect on the apparent social injusticethat made some healthy and others not.Later I became much more aware of the call ofpopulation medicine, or rather population health.Perhaps that is one of the reasons for my joining thePan American Health Organization 20 years ago.There is a basic difference between the causes ofdisease in patients and the incidence of disease inpopulations. We know that cigarette smokingcauses cancer of the lung. If everyone in a popula-tion smoked, some would develop cancer, but wewould never be able to identify tobacco as an etio-logic factor. However, if one is seeking to enhancethe health of populations, which is the main focus

Establishment and Dispersal of Puccinia thlaspeos in Field Populations of Dyer's Woad.

Dyer's woad rust is being intensively studied as a biocontrol agent for the noxious weed dyer's woad. These studies report on methods to establish this fungus in woad populations and to obtain information about disease incidence and dispersal of the rust subsequent to establishment. Inoculum dosages as low as 1 mg/plant established disease in dyer's woad rosettes. Dosages higher than 1 mg/plant resulted in better levels of infection, and inoculation was equally effective when the inoculum was placed directly on the plants or on the soil adjacent to the plants. The highest incidence of infection occurred when plants were inoculated in the spring, whereas summer or fall inoculations did not result in infections. Large-scale inoculation of woad was effective and resulted in significant levels of disease. However, it was not clear if artificial inoculation was effective in changing disease incidence in populations of woad where the rust was present prior to treatment because there were no significant differences between inoculated and check plots. Woad rust is systemic but apparently it is not seed dispersed, even though some infected plants occasionally produce seed. Two years after inoculation, dyer's woad rust had dispersed an average of 14.6 m from the focus of inoculation. After 3 years, the dispersal distance had not increased and infected plants averaged only 10 m from the point of inoculation. Disease was maintained naturally in woad populations after treatment, but the overall percent infection in the treated plots decreased by 3 years after inoculation.

Polymorphism of glutathione S-transferases M1 and T1 in several populations of Russia

Frequencies of the wild-type and null genotypes of the GSTM1 and GSTT1 genes were established in healthy donors from several Russian populations (ethnic Russians from the towns of Oshevensk and Kholmogory, Arkhangel'sk oblast; ethnic Khants; ethnic Kalmyks; and ethnic Buryats) in order to identify the ethnic group with the maximal frequency of the null genotype. The highest frequency of individuals with the null genotype of both genes was observed in the Kalmyk and Buryat populations. The results may be used to study the effect of climatic and ecological conditions on multifactorial disease incidence in populations.

Regional and local patterns in the spatial distribution of the flower-infecting smut fungus Sporisorium amphilophis in natural populations of its host Bothriochloa macra.

Regional variation in the incidence of the systemic floral-smut fungus Sparisorium amphilophis (Syd.) Langdon & Fullerton an the perennial grass Bothriochloa macra (Steud.) S. T. Blake was investigated through three surveys over a 12 yr period (1981-93). In all three surveys a marked north-south trend in percentage of infection was detected with a greater proportion of plants in northerly populations being infected than in populations located to the south. The incidence of disease in populations was negatively correlated with the frequency of days with temperatures <0°C in winter. Detailed exploration of local variation in a subset of five populations showed that the incidence of S. amphilophis was density-dependent and was greater in the edge areas of host populations than in the less disturbed core areas. Smut prevented seed production and negatively affected different aspects of the morphology of the plants, such as the height and basal diameter. Infection also significantly increased the number of inflorescences per plant. These field results were complemented by glasshouse-based competition experiments which indicated that, despite causing reductions in size, S. amphilophis only affected the competitive ability of infected plants grown under sub-optimal conditions. The results of this study indicate that an interplay between physical and biotic aspects of the environment determines regional and local levels of disease.

Plant Disease Incidence: Distributions, Heterogeneity, and Temporal Analysis

The statistical properties of disease incidence are reviewed and used to characterize spatial patterns of diseased entities (e.g. plants), satisfy assumptions of statistical analyses, and quantify change in incidence over time. Frequency of diseased plants can be represented by the binomial or, more commonly, the beta-binomial distribution. Spatial patterns of disease can be described by the aggregation parameter of the beta-binomial distribution, index of dispersion and related statistics, parameters of the binary form of the power law, as well as measures of spatial autocorrelation between sampling units. Disease incidence over time can be represented by continuous- and discrete-time nonlinear disease progress models, such as the logistic, and by autoregressive, integrated, moving average models. Ultimately, simultaneous spatio-temporal analyses can be performed to understand the dynamics of disease incidence in populations.

Sun Exposure and Amyotrophic Lateral Sclerosis

Letters15 May 1994Sun Exposure and Amyotrophic Lateral SclerosisIsrael Steiner, MD, Bettina Birmanns, MD, and Amos Panet, PhDIsrael Steiner, MDHadassah University Hospital; Jerusalem, 91120Search for more papers by this author, Bettina Birmanns, MDHadassah University Hospital; Jerusalem, 91120Search for more papers by this author, and Amos Panet, PhDHadassah University Hospital; Jerusalem, 91120Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-10-199405150-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Recently, mutations in the gene for Cu/Zn superoxide dismutase, an enzyme that scavenges the toxic free-radical superoxide anion (O2-), were reported in patients with familial amyotrophic lateral sclerosis [1]. This defective dismutase could be responsible for progressive motor neuron damage in amyotrophic lateral sclerosis. Although the familial version of the disorder has several unique features distinguishing it from the sporadic disease, the clinical and pathologic similarities [2] suggest a common pathogenesis. If free radicals play a role in the sporadic disease, one would expect a higher disease incidence in populations exposed to environmental factors, such as solar ...

Factors influencing the assessment of treatment needs

Epidemiologic surveys have provided data for health planning by estimating prevalence and incidence of diseases in populations. New ways of presenting epidemiologic data on periodontal diseases have changed our understanding of their extent and severity, and conversion of prevalence data into treatment need estimates has proved difficult. Furthermore, new concepts of the pathogenesis of periodontal diseases have questioned the validity of epidemiologic methods currently used. Treatment need assessments vary considerably between studies even when prevalence data from the same populations are similar. This may be due to lack of described goals for periodontal health. Various aspects of the concept of need for treatment are discussed. It is suggested that periodontal treatment need on a population level is defined as the intervention needed in order to change the existing periodontal condition to the described goal. Thus, treatment need assessments will have to include descriptive epidemiologic data as well as defined periodontal health goals. It is recommended that goals are described in terms compatible with the indicators used in the epidemiologic description of the disease status.

Adverse effects of fish oil

To the Editor .— Fisher et al 1 in their article on n-3 fatty acids and cellular aspects of atherogenesis suggest that urgent trials of n-3 fatty acid supplementation are needed to assess their effects on atherosclerotic disease. While epidemiological studies 2,3 have documented a reduced incidence of ischemic heart disease in populations with a high intake of n-3 fatty acids, there is also an unexplained increased incidence of stroke. 2,3 Apart from a high incidence of unpleasant side effects in patients taking fish oil supplements, clinical 4 and laboratory studies 5 have shown evidence of raised blood pressure in groups taking omega-3 fatty acid supplementation. In addition, recent epidemiological evidence has shown an increased incidence and prevalence of hypertensive related diseases 3 in the same type of population in whom there is a low incidence of ischemic heart disease. While the theoretical benefits of n-3 fatty acid supplementation are

The Management of Hyperlipoproteinemia

To the Editor.— It seems so logical, given the mass of epidemiologic data that correlates elevated cholesterol values with increased incidence of coronary disease in populations, that cholesterol must be the primary culprit and that a diet or drug that lowers cholesterol levels will a priori lower risk of death. If this is true, why haven't we been able to prove it? The article by Hoeg et al 1 in the Jan 24/31 issue of JAMA is the position of believers. My own view of the data is more agnostic. The real question is very straightforward: does diet or drug therapy to lower lipid levels save lives? An affirmative answer remains elusive. If the diet or drug causes as many noncardiac deaths as it prevents cardiac deaths, that's no good. We need safe therapy with proved efficacy; we need a positive prospective study. There is still no prospective intervention trial that