Traditional Epidemiological Methods Research Articles

Introducing the nutrition & metabolism section of journal of translational medicine

Nutrition experts, as well as specialists of different pathologies, are disclosing an ever increasing interest for protocols devoted to the welfare of patients and to prevention of nutrition related diseases. In fact, it is extensively acknowledged that nutrition plays a primary role in those complex diseases most widespread in the western countries like cardiovascular disease [1], cancer [2], Alzheimer's disease [3], diabetes [4], nephrolithiasis [5] etc. that account for over 60% of deaths world-wide. Even in our country, Italy, and in other South Europe's countries, until now protected by the Mediterranean diet, which in 2010 was awarded by UNESCO the human heritage status, the next generation will be the first with a life expectancy lower than of their parents, principally due to unhealthy eating habits and the obesity epidemic. To counteract this trend, in the last decade attention has been focused on the human nutrition field, with significant research topics being new molecules contrasting cholesterol accumulation in the arterial walls or capable of diminishing visceral fat [6], the role of bacterial microflora [7], the production of functional foods, studies on antioxidant properties of vitamins and polyphenols, etc. Moreover, beside knowledge acquired with traditional investigation techniques, the field of human nutrition can now avail itself of the new omics techniques that could give a significant contribute to mapping the interactions between genetics, nutrition and health [8]. In the area of Translational Medicine, we believe that the field of nutrition ought to be taken into greater account, as an interaction and mutual validation agency between basic and applied research, in order to generate advanced applications for diagnosis and therapy and to develop at the same time new instruments of investigation. We here propose a new section devoted to the rapid publication of research papers on all aspects of nutrition with applications in medicine and biotechnology. This section welcomes contributions that employ traditional clinical, metabolic and epidemiologic methods, but is also open to molecular and cell biology research applied to animal and human nutrition. Topics include: diet interactions in chronic diseases, gene-environment interactions, genes and cell metabolism, protein and aminoacid metabolism, lipid metabolism and diseases, carbohydrate metabolism and diseases, micronutrients and functional foods. Other topics relevant to nutrition will be appreciated as well.

Emergence and Rapid Regional Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae

Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae over a 1-year period. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria. Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are an emerging antibiotic resistance threat with demonstrated epidemic potential. We conducted an outbreak investigation of KPC-producing Enterobacteriaceae among patients of acute and long-term acute care hospitals (LTACHs) in 4 adjacent counties in Indiana and Illinois from 1 January 2008 through 31 December 2008 (cases). The study used traditional and molecular epidemiologic methods and an adaptation of social network analysis ("exposure network analysis"). Clinical records for 40 (95%) of 42 patients were available. Patients were mostly older with multiple comorbid conditions. Eleven patients (27.5%) died during the index hospitalization or were discharged to hospice; 23 (57.5%) were discharged to a nursing home, and 4 (10.0%) were discharged to home. One LTACH (LTACH-A) was central to the regional outbreak: 24 (60%) of 40 cases were linked to LTACH-A, and at least 10 patients (25%) acquired KPC there. Of 16 cases not linked to LTACH-A, 12 (75%) were linked to 3 nursing homes. Only 4 patients (10%) definitely acquired KPC during an acute care hospital stay. Molecular typing revealed the 31 available KPC-positive K. pneumoniae isolates to be similar and to cluster with epidemic multilocus sequence type 258; 2 KPC-positive Escherichia coli isolates were unique. We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.

Life Course, Social Determinants, and Health Inequities: Toward a National Plan for Achieving Health Equity for African American Infants—a Concept Paper

Despite the best efforts by the public health community, the existence of disparity in African American infant mortality appears to be insurmountable. Eliminating this disparity is the public health challenge of the next decade. The public health community has engaged in copious activity regarding the identification and analysis of the etiology of health disparities. The resulting literature is substantial, yet, despite well-meaning interventions that have had varying degrees of success, the problem is so daunting that there has been very little progress in developing a comprehensive national plan to eradicate health disparities, in general, and, African American infant-mortality disparities, in particular. The process of identifying the causal pathways and risks of adverse African American birth outcomes could potentially impact the elimination of other health disparities since infant outcomes are the foundation for adult health. Unfortunately, as a nation, we have never deliberately invested the time and resources into developing an evidence base specific to the achievement of health equity. This endeavor will require dedicated resources, creativity, and a breadth of vision to work within, and exceed, the limits of traditional epidemiological and social science theory and methods. The literature cites various causes of overall disparities, including adverse health behaviors like smoking or drug use, poor nutrition, inadequate health care, and stress, to name a few [1]. The World Health Organization (WHO) Commission on Social Determinants of Health considers the major contributors to health disparities to be the conditions in which people are born, grow, live, work, and age [2]. In the United States, ethnic minorities, particularly African Americans, are more likely to be in socially and economically vulnerable positions. A number of studies have demonstrated that even while controlling for SES, racial and ethnic disparities are still found in health outcomes [3]. For example, African American women in Illinois at the highest education level have higher, i.e., worse low-birthweight rates than women of any other ethnicity at lower strata. The process that determines social stratification leading to poorer health outcomes is rooted in history, and while it is not about ‘‘race’’ as a risk factor, scientific investigation has resulted in a corpus of knowledge that places racism, perceived acts of racism, poverty, socialenvironment degradation, and violence into the etiological pathway [4–10]. These manifestations of ‘‘social ecology’’ are the type that WHO describes as resulting in unfair and avoidable differences in health status [2]. Some think that because racism is a causal factor, any quest for solutions may be doomed to failure, because, as one funding institution’s peer reviewer stated, ‘‘It is not a good investment of [our] dollars to study racism [as a cause of health disparities], because even if we fund something, there is nothing we can do about it’’ [11]. However, pre-term birth (PTB) and low birth weight (LBW) are the causes of firstyear mortality for African American infants. Therefore, understanding and eliminating the factors that cause high rates of PTB and LBW should remain at the forefront. V. K. Hogan (&) ! D. Rowley ! T. Bennett Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 425 Rosenau Hall, 421 Pittsboro Street, 135 Dauer Drive, Campus Box 7445, Chapel Hill, NC 27599, USA e-mail: vhogan@email.unc.edu

Two Tuberculosis Genotyping Clusters, One Preventable Outbreak

In 2006, eight community tuberculosis (TB) cases and a ninth incarceration-related case were identified during an outbreak investigation, which included genotyping of all Mycobacterium tuberculosis isolates. In 1996, the source patient had pulmonary TB but completed only two weeks of treatment. From February 2005 to May 2006, the source patient lived in four different locations while contagious. The outbreak cases had matching isolate spoligotypes; however, the mycobacterial interspersed repetitive unit (MIRU) patterns from isolates from two secondary cases differed by one tandem repeat at a single MIRU locus. The source patient's isolates showed a mixed mycobacterial population with both MIRU patterns. Traditional and molecular epidemiologic methods linked eight secondary TB cases to a single source patient whose incomplete initial treatment, incarceration, delayed diagnosis, and housing instability resulted in extensive transmission. Adequate treatment of the source patient's initial TB or early diagnosis of recurrent TB could have prevented this outbreak.

Analytical Epidemiology of Genomic Variation among Pan Asia Strains of Foot-and-Mouth Disease Virus

Genetic data from field isolates of foot-and-mouth disease virus (FMDV) have been used to trace the source of recent outbreaks of FMD, to design better vaccines and diagnostic tests for FMDV, and to make conclusions regarding the general variability in the FMDV genome. Though epidemiologic data associated with FMDV isolates are available, these data have been used rarely to explore possible associations of epidemiologic factors with evolution or variation of the FMDV genome. In this study, factors associated with variation in the primary immunogenic peptide gene of FMDV (VP1), for a sample of 147 serotype O, Pan Asia strain sequences were explored using traditional analytical epidemiologic methods: logistic regression and multinomial-response logistic regression. Hypothesized factors included host type (bovine, ovine, buffalo, or porcine) and geographical region (Middle East, South Asia, East Asia, Southeast Asia, and Europe). Results of two regression analyses suggest that host type and region, considered to be possible surrogates for host management, may be associated with selection in the VP1 amino acid sequence in FMDV. For example, isolates from cattle and sheep in South Asia appear to converge with a proposed ancestor sequence, whereas isolates from the same species in the Middle East and Southeast Asia appear to diverge. The methods demonstrated here could be used on a more detailed dataset to explore the selective pressure of host immunity on the evolution of FMDV antigens in an endemic setting. More broadly, epidemiologic methods could be applied extensively to molecular data to explore the causes of genomic variation in disease-causing organisms.

Exploring gender, work and living conditions and health - suggestions for contextual and comprehensive approaches

New methods are needed to complement traditional epidemiological methods in the analyses of complex multivariate exposures. Contextual and comprehensive analyses such as multilevel and cluster analyses are particularly suitable for comparisons of women's and men's risk factors for health in working life as well as for guidance in preventive action. Such methodologies are presented in this discussion paper. Contextual and comprehensive (or holistic) approaches help identify the gender-structured situations for women and men and facilitate the discovery of differences among all women and all men. Empirical studies using these approaches show that it is important to take gender composition in both the workplace and the sector into consideration when exploring risk factors for health.

A stochastic biomechanical model for risk and risk factors of non-contact anterior cruciate ligament injuries

Gender has been identified as a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Although some possible biomechanical risk factors underlying the gender differences in the risk for non-contact ACL injuries have been identified, they have not been quantitatively confirmed yet because of the descriptive nature of the traditional epidemiological methods. The purpose of this study was to validate a stochastic biomechanical model for the risk and risk factors for non-contact ACL injuries. An ACL loading model was developed and instrumented to a Monte Carlo simulation to estimate the ACL injury rate for a stop–jump task in which non-contact ACL injuries frequently occur. Density distributions of independent variables of the ACL loading model were determined from in-vivo data of 40 male and 40 female athletes when performing the stop–jump task. A non-contact ACL injury was defined as the peak ACL loading being greater than 2250 N for males and 1800 N for females. The female-to-male non-contact ACL injury rate ratio was determined as the ratio of the probability of ACL ruptures of females to that of males. The female-to-male non-contact ACL injury rate ratio predicted by the stochastic biomechanical model was 4.96 (SD=0.22). The predicted knee flexion angle at the peak ACL loading in the simulated injury trials was 22.0 (SD=8.0) degrees for males and 24.9 (SD=5.6) degrees for females. The stochastic biomechanical model for non-contact ACL injuries developed in the present study accurately predicted the female-to-male injury rate ratio for non-contact ACL injuries and one of the kinematic characteristics of the injury.

Reduced prefrontal and temporal processing and recall of high “sensation value” ads

Public service announcements (PSAs) are non-commercial broadcast ads that are an important part of televised public health campaigns. “Message sensation value” (MSV), a measure of sensory intensity of audio, visual, and content features of an ad, is an important factor in PSA impact. Some communication theories propose that higher message sensation value brings increased attention and cognitive processing, leading to higher ad impact. Others argue that the attention-intensive format could compete with ad's message for cognitive resources and result in reduced processing of PSA content and reduced overall effectiveness. Brain imaging during PSA viewing provides a quantitative surrogate measure of PSA impact and addresses questions of PSA evaluation and design not accessible with traditional subjective and epidemiological methods. We used Blood Oxygenation Level Dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) and recognition memory measures to compare high and low MSV anti-tobacco PSAs and neutral videos. In a short-delay, forced-choice memory test, frames extracted from PSAs were recognized more accurately than frames extracted from the NV. Frames from the low MSV PSAs were better recognized than frames from the high MSV PSAs. The accuracy of recognition of PSA frames was positively correlated with the prefrontal and temporal, and negatively correlated with the occipital cortex activation. The low MSV PSAs were associated with greater prefrontal and temporal activation, than the high MSV PSAs. The high MSV PSAs produced greater activation primarily in the occipital cortex. These findings support the “dual processing” and “limited capacity” theories of communication that postulate a competition between ad's content and format for the viewers' cognitive resources and suggest that the “attention-grabbing” high MSV format could impede the learning and retention of an ad. These findings demonstrate the potential of using neuroimaging in the design and evaluation of mass media public health communications.

Isolation and characterization of Mycobacterium bovis strains from indigenous Zambian cattle using Spacer oligonucleotide typing technique

BackgroundBovine tuberculosis (BTB), caused by Mycobacterium bovis, has remained a major source of concern to public health officials in Zambia. Previous investigations have used traditional epidemiological methods that are unable to identify the causative agent and from which dynamics of disease dispersion is difficult to discern. The objective of this study was to isolate, characterize and determine the genetic diversity and relatedness of M. bovis from major cattle rearing districts in Zambia by spoligotyping. A total of 695 carcasses were examined and 98 tissues had gross post-mortem lesions compatible with BTB.ResultsForty-two out of the ninety-eight suspected tissues examined had culture properties characteristic of mycobacteria from which 31 isolates yielded interpretable spoligotypes. This technique showed good discriminatory power (HGDI = 0.98), revealing 10 different spoligotype patterns. Twenty-seven isolates belonged to one cluster with more than 95% similarity and inside the cluster, one predominant spoligotype was found in 20 (64.5%) of the isolates tested. The highest number of spoligotypes was observed among samples from Namwala district. Spoligotypes from 26 (83.9%) of the isolates belonged to five spoligotypes that have been reported before while the remaining 5 (16.1%) isolates had unique spoligotypes that are being reported for the first time; these have been assigned numbers SB1763 to SB1767. Five of the 6 districts had the predominant spoligotype (SB0120).ConclusionThe study has described the dispersion patterns of M. bovis in Zambian cattle for the first time and has identified 5 spoligotype patterns specific to Zambia. The observation of an overlap in the spoligotype pattern SB0120 in 5 of the 6 districts suggests the probability of sharing a common source of infection.

PW08-03 The use of drugs for mood disorders in Italy: Preliminary results

Background:Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools).Objectives:The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression.Methods:Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute.Expected results:The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes.

P02-95 The use of drugs for mood disorders in Italy: Preliminary results

Background:Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools).Objectives:The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression.Methods:Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute.Expected results:The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes.

Adaptation of Bayesian Data Mining Algorithms to Longitudinal Claims Data

Bayesian data mining methods have been used to evaluate drug safety signals from adverse event reporting systems and allow for evaluation of multiple endpoints that are not prespecified. Their adaptation for use with longitudinal data such as administrative claims has not been previously evaluated or validated. In this pilot study, we evaluated the feasibility of adapting data mining methods using the empirical Bayes Multi-item Gamma Poisson Shrinkage (MGPS) algorithm to longitudinal administrative claims data. The Medicare Current Beneficiary Survey was used to identify a cohort of Medicare enrollees who were exposed to cyclooxygenase selective (coxib) or nonselective nonsteroidal anti-inflammatory drugs (NS-NSAIDs) from 1999 to 2003. Empirical Bayes MGPS algorithm was used to simultaneously evaluate 259 outcomes associated with current use of coxibs versus NS-NSAIDs while adjusting for key covariates and multiple comparisons. For comparison, a parallel analysis used traditional epidemiologic methods to evaluate the relationship between coxib versus NS-NSAID use and acute myocardial infarction, with the goal of establishing the concurrent validity of the data mining approach. Among 9431 Medicare beneficiaries using NSAIDs and considering all 259 possible outcomes, empirical Bayes MGPS identified an association between current celecoxib use and acute myocardial infarction (Empirical Bayes Geometric Mean ratio 1.91) but not other outcomes. Rofecoxib use was associated with acute cerebrovascular events (Empirical Bayes Geometric Mean ratio 1.85) and several other diagnoses that likely represented indications for the drug. Results from the analyses using traditional epidemiologic methods were similar and indicated that the data mining results were valid. Bayesian data mining methods seem useful to evaluate drug safety using administrative data. Further work will be needed to extend these findings to different types of drug exposures and to other claims databases.

Genetic Association Studies

With the completion of the HapMap project1 and the development of technology that allows the examination of ≥1 million genetic polymorphisms at once, genetic association studies are becoming more comprehensive. This article first provides a brief overview of the rationale for genetic association studies; it then discusses the primary features differentiating genetic from standard association studies and emphasizes these differences with an example. Finally, this article reviews methods for addressing 2 of the main pitfalls of genetic association studies: population stratification and multiple testing. The principal focus of this primer is population-based association studies using unrelated individuals. A future article will address family-based linkage and association studies. Traditional epidemiological studies focus on assessing the impact of specific risk factors on disease risk in populations. The goal of a genetic association study is to establish statistical associations between ≥1 genetic polymorphisms and phenotypes or disease states and thus to identify genetic risk factors that can later be studied in a more comprehensive manner using traditional epidemiological methods. Ideally, the statistical analyses brings us to the point where 1 or several genetic variants are identified as the potential functional variants within a gene, so that laboratory scientists can then use experimental methods to determine what functional purpose the variants have and how it might relate to the phenotype. Historically, the term polymorphism has been used to refer to genetic mutations that occur with a frequency ≥1% in the population. This article refers to genomic locations with multiple alleles interchangeably as genetic variants or polymorphisms. Pollex and Hegele2 describe many types of genetic variants found in the human genome and review the current state of knowledge concerning copy number variants and cardiovascular disease. This article focuses on single-nucleotide polymorphisms (SNPs), although much of what is presented is relevant to all types …

Clusters of circulating Neisseria gonorrhoeae strains and association with antimicrobial resistance in Shanghai

(i) To distinguish Neisseria gonorrhoeae isolates in Shanghai by porB typing; (ii) to ascertain the congruence of porB DNA sequence typing with cases linked epidemiologically; (iii) to determine the association of specific PorB mutations with antimicrobial resistance to penicillin or tetracycline. porB DNA sequences of 174 N. gonorrhoeae isolates, collected from 143 male patients and 31 female sexual partners in Shanghai were determined. Phylogenetic analysis was used to determine sequence associations and concordance with epidemiologically linked cases. PorB protein sequences were compared with the wild-type sequence to identify mutations associated with antimicrobial resistance to penicillin and tetracycline. porB1a genotypes comprised 27.0% of the isolates and included 15 distinct DNA sequences, while 73.0% of the isolates carried porB1b genotypes with 63 distinct DNA sequences. porB DNA sequence typing was congruent with patient-reported sexual contacts. In addition, porB DNA sequence analysis revealed a number of strains with identical DNA sequences not identified through traditional epidemiological methods. The porB1b isolates had a significantly higher percentage of chromosomally mediated resistance to tetracycline and higher MIC50s to penicillin and ciprofloxacin. G120K/A121D mutations were observed in 71.1% of PIB isolates and were associated with resistance to penicillin and/or tetracycline. The majority of the PIA isolates (82.1%) also carried G120D/A121G double mutations. The index of discrimination for porB DNA sequence analysis was 95%. The porB1b genotype was found to be predominant in Shanghai. porB DNA sequence typing was sufficiently discriminatory for differentiating N. gonorrhoeae isolates and was congruent with epidemiological linkages. Novel porB sequences of N. gonorrhoeae and novel mutations of PorB proteins were identified.

Las tecnicas de estadistica espacial en la investigación salubrista: caso síndrome de Down

Introduction: One of the advantages of spatial statistical analysis techniques is that they can summarize the complex spatial pattern by making such complexity assimilable into the human eyes and mind, and decision-making and interventions more feasible. This reasoning is exemplified by means of the study of a health event in which the result of spatial analysis is compared with those of traditional epidemiological methods. Objectives: To use spatial statistical analysis in a case study and to compare it with conventional epidemiological analysis in order to show the feasibility and advantages of this method in the event surveillance for the decision-making. Methods: Data from 15 years of Down's syndrome surveillance work carried out in Villa Clara province from 1985 to 2000 were used. Kulldorff's cluster detection techniques were employed in the spatial analysis. Mapping was based on MapInfo v 5.0, importing the statistical results to the geographical information system. Epidemiological analyses included relative real risk assessment and the estimation of other relational and central tendency statistic. Results: The differentiation of Down's syndrome determinants associated to the spatial context was put in perspective, which served to supplement in a timely manner the case data-based analysis. This provided evidence that could not have been drawn if conventional analysis had solely been used. Conclusions: The spatial analysis could quickly show findings and projections that were further backed up by the conventional analysis made in this case. The differentiation of Down's syndrome determinants in rural and urban areas allowed implementing differentiated strategies to prevent this chromosome disorder in both settings.

An outbreak of pulmonary tuberculosis in young Australians

To characterise a pulmonary tuberculosis (TB) cluster in the Hunter Area of New South Wales using a combination of traditional epidemiological methods and molecular typing. Review of all notifications of TB in the Hunter Area between January 1994 and June 2005, with a detailed analysis of cases among people born in Australia or New Zealand. Comparison of genotypes of Mycobacterium tuberculosis isolates; extent of TB cluster. Over the period studied, there were 72 TB notifications among people born in Australia or New Zealand. Genotypic testing was available for 20 of these cases, of which nine were confirmed to be part of a cluster. Two further cases for which genotyping was not available were epidemiologically linked to the cluster and regarded as probable cluster cases. Members of the cluster were relatively young (median age at diagnosis, 35 years; range, 21-57 years), and eight were women. Over the same period, there were 83 TB notifications among people born overseas, the majority being from Asia (47%) or central and eastern Europe (24%) (median age, 54 years; range, 9-63 years). Clinicians should maintain a high index of suspicion for pulmonary TB in a person presenting with a productive cough lasting more than 3 weeks, weight loss, haemoptysis, night sweats and chest pain, even if the person is not overseas-born or elderly. A comprehensive tuberculosis genotyping network at regional and national level in Australia could help identify clusters resulting from recent transmission.

Developing world rehabilitation strategy II: Flex the muscles, train the brain, and adapt to the impairment

Purpose. To understand some reasons behind the lack of medical rehabilitation resources in developing regions and to propose some actions that can change this problem.Methods. Focused Medline literature review on AIDS disability in Africa. Editorial observation.Results. Disability, rather than death or cost of treatment, is likely the greatest burden from AIDS. However only 0.05% of published research on AIDS in Africa relates to disability, so we cannot know this with certainty. This is a direct result of funding priorities, and a consequence of both traditional epidemiological methods and old-line ‘cure or die’ medical education. The disproportionate lack of medical rehabilitation specialists and facilities is a consequence of the same forces. Similar patterns are seen in rural and developing regions around the world.Conclusions. Rehabilitation professionals must change healthcare service by using rehabilitation techniques: flexing muscle by insisting that governments, agencies, and philanthropists look at the cost of disability, not just disease; training the brains of young professionals who will practice, research and advocate locally; adapting intervention strategies to the impairments imposed by poverty and distance.

Doe Program—Developing a Scientific Basis for Responses to Low-Dose Exposures: Impact on Dose-Response Relationships

The DOE Low Dose Radiation Research Program focuses on biological mechanisms involved in response to low doses of both low and high-LET radiation (< 0.1Gy). This research program represents a merging of new technologies with cutting edge biological techniques associated with genomics. This merger enables observation of radiation-induced cellular and molecular changes previously undetectable. These low-dose responses define mechanisms of interaction of radiation with living systems, and characterize the shape of dose-response. The research from this program suggests radiation paradigms regarding the involvement of radiation in the carcinogenic process. New biological phenomena observed at low doses include initial radiation-induced DNA damage and repair, changes in gene expression, adaptive responses and bystander effects. However, information from this cellular-molecular level cannot be directly extrapolated to risks in human populations. Links must be carefully developed between dose-response relationships at the cell and tissue levels and risk to human populations. The challenge and the ultimate goal of the Program is to determine if basic scientific data can be combined with more traditional epidemiological methods to improve the estimation of radiation risk from low level radiation exposures.

Genetic Determinants of Prepubertal and Pubertal Growth and Development

This article surveys the current general understanding of genetic influences on within- and between-population variation in growth and development in the context of establishing an International Growth Standard for Preadolescent and Adolescent Children. Traditional genetic epidemiologic analysis methods are reviewed, and evidence from family studies for genetic effects on different measures of growth and development is then presented. Findings from linkage and association studies seeking to identify specific genomic locations and allelic variants of genes influencing variation in growth and maturation are then summarized. Special mention is made of the need to study the interactions between genes and environments. At present, specific genes and polymorphisms contributing to variation in growth and maturation are only beginning to be identified. Larger genetic epidemiologic studies are needed in different parts of the world to better explore population differences in gene frequencies and gene-environment interactions. As advances continue to be made in molecular and statistical genetic methods, the genetic architecture of complex processes, including those of growth and development, will become better elucidated. For now, it can only be concluded that although the fundamental genetic underpinnings of the growth and development of children worldwide are likely to be essentially the same, there are also likely to be differences between populations in the frequencies of allelic gene variants that influence growth and maturation and in the nature of gene-environment interactions. This does not necessarily preclude an international growth reference, but it does have important implications for the form that such a reference might ultimately take.

Carcinogens in the Construction Industry

The construction industry is a complex work environment. The work sites are temporary and rapidly changing. Asbestos has been widely used in construction industry, but the risks were primarily detected in specialized trades, such as insulation workers and plumbers. Today, the majority of cases related to asbestos exposure will occur in other occupational groups in the construction industry. In a large cohort of Swedish construction workers, insulators and plumbers constituted 37% of all cases of pleural mesothelioma between 1975 and 1984 while they constituted 21% of the cases between 1998 and 2002. It is estimated that 25-40% of all male cases of pleural mesothelioma in Sweden are caused by asbestos exposure in the construction trades. There are many other known carcinogens occurring in the construction industry, including PAHs, diesel exhausts, silica, asphalt fumes, solvents, etc., but it is difficult to estimate exposures and thus the size of the risk. The risk of cancer is less easy to detect with traditional epidemiological methods in the construction industry than in other industrial sectors. It is not sufficient to rely upon broad epidemiological data to estimate the risk of cancer due chemicals in the construction industry. Thus, a strategy to decrease exposure, e.g., to dust, seems a feasible way to reduce the risk.