Epidemiological Practice Research Articles

Management and outcomes of extreme preterm birth.

### What you need to know Extreme preterm birth, defined as birth before 28 weeks’ gestational age (box 1),1 affects about two to five in every 1000 pregnancies, and varies slightly by country and by definitions used. Severe maternal morbidity, including sepsis and peripartum haemorrhage, affects around a quarter of mothers delivering at these gestations.2 For the babies, survival and morbidity rates vary, particularly by gestational age at delivery but also according to other risk factors (birth weight and sex, for example) and by country.34 In this update, we focus on high income countries and provide a broad overview of extreme preterm birth epidemiology, recent changes, and best practices in obstetric and neonatal management, including new treatments such as antenatal magnesium sulphate or changes in delivery management such as delayed cord clamping and placental transfusion. We cover short and long term medical, psychological, and experiential consequences for individuals born extremely preterm, their mothers and families, as well as preventive measures that may reduce the incidence of extreme preterm birth. Box 1 ### Key definitions #### World Health Organization definitions relating to preterm birth #### Preterm #### Moderate to late pretermRETURN TO TEXT

Leukemia Perspective in Current Practice

Leukemia is cancer that affects the blood formation in the bone marrow, which is characterized by an increase in the number of leucocytes (leukocytosis) in the blood and bone marrow. Leukemia has four major types, which include acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphoid leukemia (CLL). Hematopoiesis is a process in which the stem cells differentiate into erythrocytes, megakaryocytes, and immune cells of myeloid, and lymphoid, in bone marrow or lymphatic tissues. The blood is made up of fluid called plasma and three types of cells and each type has special functions. White blood cells (also called WBCs or leukocytes) help the body fight infections and other diseases. Red blood cells (also called RBCs or erythrocytes) carry oxygen from the lungs to the body’s tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color. Platelets (also called thrombocytes) help form blood clots that control bleeding. Leukemias can affect any age and the incidence is different between each type. The Clinical presentation of leukemia cells may be mature, such as in chronic myeloid leukemia, and it may come in precursor form such as in acute myeloid leukemia It can also come in two forms (precursor and mature) such as chronic myeloid leukemia. Many risk factors have been identified, such as Klinefelter, Down syndromes, ataxia telangiectasia, Bloom syndrome, Viral infections from Epstein Barr virus, Human T-lymphotropic virus, ionizing radiation exposure, radiation therapy, environmental exposure with benzene, and smoking history. There is a strong relationship between nutrition status and leukemia which strongly affect the overall survival rate. This article aims to provide a brief introduction and the signs and symptoms of leukemia, its causes, epidemiology, nutrition profile, treatment prevention and good practice management advice. Keywords: Leukemia, Acute Myeloid Leukemia, Acute Lymphoid Leukemia, Chronic Myeloid Leukemia. Chronic Lymphoid Leukemia

A Multiplex PCR assay for a differential diagnostic of rickettsiosis, Lyme disease and scrub typhus.

Coexistence of tick-borne diseases in some regions in Latin America makes the diagnosis difficult due to shared initial signs and symptoms. Rickettsiosis, Lyme disease and recently, scrub typhus are gaining more importance. The objective of this study is to develop a multiplex-PCR assay for a differential diagnosis of rickettsiosis, Lyme disease and scrub typhus. By using bibliographic and bioinformatic analysis, we identify candidate regions to perform the multiplex- PCR assay for Rickettsia sp., Borrelia burgdorferi and Orientia tsutsugamushi as well as identify optimal melting temperature and sensibility analysis. We identified specific primer pairs for Rickettsia sp, Borrelia burgdorferi and Orientia tsutsugamushi with different PCR fragment length but a common melting temperature, 58°C. We successfully developed a Multiplex PCR assay for differential diagnosis of rickettsiosis, Lyme disease and scrub typhus that could be a rapid and easy option in clinical and epidemiological practice.

К 100-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ БЕЛЯКОВА ВИТАЛИЯ ДМИТРИЕВИЧА. Сообщение 2. ПРОГРЕСС НАУКИ И ЭВОЛЮЦИЯ УЧЕНОГО

The article is devoted to the scientific activity of the epidemiologist, Doctor of Medical Sciences, professor, academician, Major General of the medical service Vitaly Dmitrievich Belyakov. The main stages of the scientific path of academician V. D. Belyakov are traced, his merits in the development of epidemiology and medicine in general are noted. V. D. Belyakov was a reformer and innovator in the field of epidemiological practice and education in the field of all preventive medicine. A significant achievement in the management of anti-epidemic activities was the concept of epidemiological surveillance developed by the academician. The article presents the role of Academician Vitaly Dmitrievich Belyakov in the development of epidemiological science as a diagnostic and preventive discipline. Possible ways of further development of V. D. Belyakov's ideas and their implementation in medical scientific, practical and pedagogical activities are considered.

안원(顔元) 『사존편(四存編)』의 교육적 의미 —｢존학편(存學編)｣과 ｢존성편(存性編)｣을 중심으로—

This study attempted to examine the educational meaning through Yannyuan's 『Sicunbian(四存編)』. Here, Sicun(四存) refers to cunxing(存性), cunxue(存學), cunzhi(存治), and cunren(存人). Here, cunxing is about personality, cunxue is about politics, and cunren is about religion, and Yanyuan wrote his theories of ｢cunxingbian｣, ｢cunxuebian｣, and ｢cunzhibian｣. Through 『Sicunbian』, Yanyuan emphasized epidemiological knowledge and practice, criticized politics, and insisted on the practicality of Gyeongsechiyong(經世致 用). Yanyuan emphasized practice and expressed the importance of practice in learning through 『Sicunbian』. In addition, through 『Sicunbian』 education is said to be important acquired in order to secure the original goodness of human beings and to express this goodness. This study explored the educational meaning that Yanyuan wanted to reveal through ｢cunxuebian｣, and ｢cunxingbian｣

Emerging SARS-CoV-2 Genotypes Show Different Replication Patterns in Human Pulmonary and Intestinal Epithelial Cells.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quickly spread worldwide following its emergence in Wuhan, China, and hit pandemic levels. Its tremendous incidence favoured the emergence of viral variants. The current genome diversity of SARS-CoV-2 has a clear impact on epidemiology and clinical practice, especially regarding transmission rates and the effectiveness of vaccines. In this study, we evaluated the replication of different SARS-CoV-2 isolates representing different virus genotypes which have been isolated throughout the pandemic. We used three distinct cell lines, including Vero E6 cells originating from monkeys; Caco-2 cells, an intestinal epithelium cell line originating from humans; and Calu-3 cells, a pulmonary epithelium cell line also originating from humans. We used RT-qPCR to replicate different SARS-CoV-2 genotypes by quantifying the virus released in the culture supernatant of infected cells. We found that the different viral isolates replicate similarly in Caco-2 cells, but show very different replicative capacities in Calu-3 cells. This was especially highlighted for the lineages B.1.1.7, B.1.351 and P.1, which are considered to be variants of concern. These results underscore the importance of the evaluation and characterisation of each SARS-CoV-2 isolate in order to establish the replication patterns before performing tests, and of the consideration of the ideal SARS-CoV-2 genotype–cell type pair for each assay.

An in-depth analysis of 10 epidemiological terminologies used in the context of COVID-19.

Aim:In this paper, we explore the contextual use of 10 epidemiological terminologies, their significance, and interpretation/misinterpretation in explaining various aspects of the 2019 novel coronavirus disease (COVID-19) pandemic.Methods and Results:We first establish the different purposes of the terms ‘pandemic’ and ‘Public Health Emergency of International Concern.’ We then discuss the confusion caused by using the ‘case fatality rate’ as opposed to ‘infection fatality rate’ during the pandemic and the uncertainty surrounding the limited usefulness of identifying someone as ‘pre-symptomatic.’ We highlight the ambiguity in the ‘positivity rate’ and the need to be able to generate data on ‘excess mortality’ during public health emergencies. We discuss the relevance of ‘association and causation’ in the context of the facemask controversy that existed at the start of the pandemic. We point out how the accepted epidemiological practice of discussing ‘herd immunity’ in the context of vaccines has been twisted to suit the political motive of a public health approach. Given that a high proportion of COVID-19 cases are asymptomatic, we go on to show how COVID-19 has blurred the lines between ‘screening/diagnosis’ and ‘quarantine/isolation,’ while giving birth to the new terminology of ‘community quarantine.’Conclusions: Applying the lessons learned from COVID-19 to better understand the above terminologies will help health professionals communicate effectively, strengthen the scientific agenda of epidemiology and public health, and support and manage future outbreaks efficiently.

The ethics of child maltreatment surveys in relation to participant distress: Implications of social science evidence, ethical guidelines, and law

Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice.

Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain

Mortality rates among adults with candidemia vary widely in different geographical settings. Studies directly comparing epidemiology and clinical practices between countries are scarce and could bring insights into improving clinical outcomes. Retrospective cohort including adults with candidemia diagnosed in five tertiary hospitals from Brazil and Spain between 2010-2018. Adequate therapeutic management included appropriate antifungal therapy and central-venous-catheter (CVC) removal within 48h of fungemia. Primary endpoints were mortality rates at 14 and 30 days. Secondary endpoints were prognostic factors associated with 30-day mortality. Overall, 720 patients were included, being 323 from Spain. Spanish patients received echinocandins more often (52·5% vs. 39·3%, p=0.001), initiated antifungals earlier [2 (0-7) vs. 2 days (0-16), p<0.001], and had faster CVC-removal [1 (0-42) vs. 2 days (0-38), p=0.012]. Mortality was higher among Brazilians at 14 days (35·8% vs. 20·1%, p<0.001), and at 30 days (51·9% vs. 31·6%, p<0.001). Factors associated with mortality included: age [OR 1·02, 95%CI (1·008-1·032), p=0·001], neutropenia [OR 3·24, 95%CI (1·594-6·585), p=0·001], chronic pulmonary disease [OR 2·26, 95%CI (1·495-3·436), p<0·001], corticosteroids [OR 1·45, 95%CI (1·018-2·079), p=0·039], Pitt-Score>1 [OR 2·56, 95%CI (1·776-3·690), p<0·001], and inadequate therapeutic management [OR 2·84, 95%CI (1·685-4·800), p<0·001]. Being from Spain [OR 0·51, 95%CI (0·359-0·726), p<0·001] and C. parapsilosis [OR 0·36, 95%CI (0·233-0·568), p<0·001] were protective. Higher mortality rates were observed in Brazil. Factors associated with 30-day mortality included mainly epidemiological characteristics and inadequate therapeutic management. Thus, effective and prompt antifungals combined with CVC-removal still need to be emphasized in order to improve the prognosis of adults with candidemia. Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2017/02203-7); CAPES Foundation (PDSE 88881.187981/2018-01).

Orihime Study: Real World Treatment Patterns and Clinical Outcomes of 338 Patients with Acquired Hemophilia a from a Japanese Health Claims Database

Orihime Study: Real World Treatment Patterns and Clinical Outcomes of 338 Patients with Acquired Hemophilia a from a Japanese Health Claims Database

Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

BackgroundFall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.MethodsSelf-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.ResultsThe cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001).ConclusionsThe cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.

Contributing to a Healthier Nigeria through Public Health Workforce Capacity Development: Afenet Experience in Nigeria

The recent upsurge in the number and magnitude of outbreaks of infectious diseases in Nigeria has been managed effectively and efficiently by the Nigeria Centre for Disease Control (NCDC) in an increasingly epidemiology guided approach led by a skilled workforce within the one health collaborative agenda.1–4 The increasing number of the outbreaks of re-emerging infectious diseases could not have been unconnected to the effect of global warming with its resultant effect in the changing population activities and interaction with nature.5–7 Nigeria could not have effectively contained these emerging public health challenges had she not taken steps in developing her public health infrastructure, the laboratory capabilities and manpower development. Since 2008, the Nigeria Field Epidemiology Laboratory Training Program (NFELTP), a collaborative effort by NCDC, Federal Ministry of Health, Federal Ministry of Agriculture and Rural Development, African Field Epidemiology Network (AFENET) with financial and technical support from the US Centers for Disease Control and Prevention (CDC) has been building epidemiology capacity for disease prevention and control. Field epidemiology, the art and practice of epidemiology in the field, has been adopted as an effective tool and practice in preventing, detecting and controlling emerging public health threats and crisis. Field epidemiology provides the scientific evidence for public health actions.

Jacob Steere-Williams. The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England. Rochester Studies in Medical History. Rochester: University of Rochester Press, 2020. Pp. 340. $99.00 (cloth).

Jacob Steere-Williams. The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England. Rochester Studies in Medical History. Rochester: University of Rochester Press, 2020. Pp. 340. $99.00 (cloth). - Volume 60 Issue 4

Newborn Screening for G6PD Deficiency in Xiamen, China: Prevalence, Variant Spectrum, and Genotype-Phenotype Correlations.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common inherited enzymatic defect. The purpose of this study was to evaluate the profile of G6PD deficiency and investigate the factors associated with the accuracy of newborn screening (NBS) in Xiamen, China. Methods: A total of 99,546 newborns were screened by modified fluorescent spot test at the Women and Children’s Hospital, Xiamen University. High-risk neonates were recalled for diagnosis by either a measurement of G6PD activity or genetic testing for the presence of pathogenic G6PD variants using a quantitative G6PD enzymatic assay or the MeltPro® G6PD assay, respectively. Results: In the first-tier screening, 1,256 newborns were categorized as high risk. Of these, 1,051 were diagnosed with G6PD deficiency, indicating a prevalence of 1.39% in Xiamen, China. Among the 1,013 neonates who underwent genotyping, 851 carried hemizygous, heterozygous, homozygous, or compound heterozygous variants, for a positive predictive value (PPV) of 84.01%. In total, 12 variants and 32 genotypes were identified, and the six most common variants were c.1376G>T, c.1388G>A, c.95A>G, c.1024C>T, c.871G>A, and c.392G>T, which accounted for approximately 94% of the identified alleles. Different variants showed characteristic enzymatic activities, although high phenotypic heterogeneity was observed for each variant. The use of cold-chain transportation significantly improved the PPV of NBS. Conclusions: We determined the profile of G6PD deficiency in Xiamen, including the prevalence, variant spectrum, and genotype-phenotype correlations and confirmed that maintaining a low temperature during sample transport is essential to ensure the high screening accuracy of NBS. Our data provides epidemiological, genotypic, phenotypic, and clinical practice references to standardize future interventions for G6PD deficiency.

Costs of Infection Control and Special Challenges during the Covid-19 Pandemic: Experiences in a Military Hospital

Infection prevention and control (IPC) is a set of evidence-based practices of hospital epidemiology aiming to prevent and control healthcare-associated infections. The aim of the present study was two-fold. First, we estimated the costs of IPC in the Medical Centre of the Hungarian Defence Forces (MCHDF) in Hungary using a bottom-up microcosting approach. Second, we analysed how the involvement of the MCHDF in Covid-19 care changed the occurrence of multidrug-resistant infections in the hospital. Our results showed that depending on the type of ward, the daily costs of standard care ranged between 3,809–8,589 HUF, while the costs of isolation were between 9,203–11,200 HUF. Daily costs were highest in the intensive care unit (ICU). Total costs per patient ranged between 20,875–78,904 HUF for standard care and 79,996–282,892 HUF for isolation with highest values in the Neonatal Intensive Care Unit (NICU). The incremental isolation cost per patient compared to standard care ranged between 20,363–158,216 HUF. When the MCHDF became a Covid-19 care centre, the incidence of introduced Clostridium difficile and multidrug resistant cases increased by nearly 200 per cent and 40 per cent, respectively. Our results can be used as basic input data for the economic evaluation of IPC strategies and highlights an important IPC aspect to be considered for the redistribution of hospital capacities during the Covid-19 pandemic.

Did parental care in early life affect height? Evidence from rural Spain (19th-20th centuries)

This article examines the relationship between childhood mortality experienced within families and the height of surviving male children. Sibling mortality, controlled by different socioeconomic and environmental variables, is used as an approximation of the hygienic and epidemiological context and practices within the family. The analysis is based on a sample of 2783 individuals born between 1835 and 1977 in 14 villages in north-eastern Spain. The mortality data were obtained from the parish archives of the reference villages, and the height data from military service records of conscriptions at 21 years of age. The data were linked according to nominative criteria using family reconstitution methods. The results suggest the existence of a strong negative relationship between height and the childhood mortality experienced within families. Children born in families in which 50% of the children died before the age of five were up to 2.3 cm shorter than those of families with childhood mortality of less than 25%. General socioeconomic, hygienic and health improvements reduced childhood mortality, causing this link to gradually disappear between the 1940s and 1970s.

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

1263Exploring postgraduate epidemiology competencies in the Australian context

Abstract Background In response to emerging challenges faced by epidemiologists, it is timely to ensure that university teaching aligns with the competencies required in professional practice. Therefore, the field requires a regular evaluation of the educational competencies being covered. The aim of this research was to seek consensus from both students and experts on postgraduate epidemiology competencies relevant to the Australian context. Methods A two-round online survey using a modified Delphi method was used to establish expert consensus on postgraduate epidemiology competencies. Focus groups were also conducted with recent graduates who completed a postgraduate epidemiology course to assess their viewpoints on learning experiences and employability. Results In total, 41 experts participated in the first Delphi round. A total of 19/40 factors (general epidemiologic methods/concepts) reached consensus in the first round for importance (high/most important by &amp;gt; 70% of participants). Seventeen factors also reached consensus in terms of feasibility (usually/always/very feasible by &amp;gt; 70% of participants). Further results from the second Delphi round focusing on advanced analysis skills, applied fields and professional/transferrable skills will be available for presentation at the Conference. One main theme emerging from the graduate focus groups was the substantial value gained in undertaking a dissertation, acknowledging its benefit for applying research skills and for networking opportunities. Conclusions Competencies for postgraduate epidemiology students require periodic review to safeguard a workforce that can meet emerging challenges. Key messages To ensure that high quality epidemiological research and practice continues we need consensus on the set of essential skills required of graduating students.

Antibiotic Susceptibility Patterns of Bacteria Isolated from Hospital Surfaces and Environment in Kenya

Objective: Control of hospital environment is key to success of healthcare quality. Increasing emergence and spread of pathogenic bacteria is of great concern and continues to challenge infection prevention and epidemiology practice. This study aimed at providing information about the management of hospital environment and wastes in selected hospitals in Kenya, determine prevalence of pathogenic bacteria and their antibiotic susceptibility.&#x0D; Methods: A cross sectional study was conducted at Kenyatta National Hospital (KNH) (public) and Kikuyu Mission Hospital (KMH) (private) in Kenya from May 2015 to April 2017. In microbiological analysis, a total of 246 samples from each of the two hospitals was obtained using sterile cotton swabs from random sampling of hospital different surfaces, drainages, hands of healthcare givers and hospital waste dump site among others.&#x0D; Results: A total of 471 bacterial isolates were recovered, and were distributed as follows; Providentia spp, Staphylococcus aureus spp, Escherichia coli spp (E. coli), other Gram negative bacteria were, Pseudomonas spp, coagulase negative Staphylococcus (CONS), Serratia spp, Klebsiella spp, Proteus spp and Enterobacter spp. Susceptibility test revealed that Escherichia coli isolates were the most sensitive isolate to antibiotics. Imipenem drug showed 100% sensitivity for Gram negative, while Gram-positive isolates, linezolid antibiotic was the most sensitive drug.&#x0D; Discussion: There is need for stringent review of hospital waste management system in Kenya. The frequency of ESBL producing strains among clinical isolates has been steadily increasing.&#x0D; Conclusion: Continued drug resistance surveillance of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use.

Heart Best Research Paper Award 2021

Each year, the Heart editorial team selects the most meritorious research paper to receive the Heart Best Research Paper Award. Primary considerations are the relevance of the clinical question addressed...