Use Of Epidemiological Methods Research Articles

An approach to the background, methods and challenges of research in disasters

Disasters are phenomena of global distribution and increasing impact, with a social and interdisciplinary nature and that often require the use of quantitative and qualitative methods to be investigated. The purpose of this paper is to explore the historical background of disaster research, the current use of epidemiological methods in disasters, as well as the difficulties and future challenges of research in this field. This study considers bibliographic elements and specific non-bibliographic events that have determined the historical evolution of disaster research, as well as its conceptual framework, particularly in relation to the approaches from which the research has been carried out and the range of methods epidemiological used. This is not a standard review. Current disaster research is developed for a wide variety of purposes, including the identification and characterization of populations exposed or at risk of disaster; the study and establishment of the exposure model for each specific type of disaster; the estimation of the incidence and prevalence of the different types of disaster and the quantification of the impacts in the short, medium and long term. Research is also carried out in the field of disasters to assess needs, plan relevant and efficient types of aid; model and predict the occurrence and to design adequate and efficient prevention, preparedness, mitigation and rehabilitation strategies. Even so, the predominant research on disasters is still very much focused on certain partial aspects of the phenomenon such as the response to the disaster and directed towards specific types of disasters, especially those of rapid onset. There is still little multidisciplinary and collaborative research among researchers from the different areas of interest that constitute the disaster phenomenon. Important challenges persist in disaster research, including the design of a common conceptual framework that allows multidisciplinary research in disasters, the development of specific methods to investigate complex emergencies (complex humanitarian emergencies) or disasters related to climate change; the development of a specific approach to investigate slow-onset disasters and their social, political and cultural factors, as well as research to develop feasible and cost-efficient prevention and response strategies. Solving these challenges will depend to a large extent to which the investigative capacity of managers and heads of organizations and field personnel working in disasters is improved.

An approach to the background, methods and challenges of research in disasters

Disasters are phenomena of global distribution and increasing impact, with a social and interdisciplinary nature and that often require the use of quantitative and qualitative methods to be investigated. The purpose of this paper is to review the historical background of disaster research, the current use of epidemiological methods in disasters, as well as the difficulties and future challenges of research in this field. This study is a review of bibliographic elements and specific non-bibliographic events that have determined the historical evolution of disaster research, as well as its conceptual framework, particularly in relation to the approaches from which the research has been carried out and the range of methods epidemiological used. Current disaster research is developed for a wide variety of purposes, including the identification and characterization of populations exposed or at risk of disaster; the study and establishment of the exposure model for each specific type of disaster; the estimation of the incidence and prevalence of the different types of disaster and the quantification of the impacts in the short, medium and long term. Research is also carried out in the field of disasters to assess needs, plan relevant and efficient types of aid; model and predict the occurrence and to design adequate and efficient prevention, preparedness, mitigation and rehabilitation strategies. Even so, the predominant research on disasters is still very much focused on certain partial aspects of the phenomenon such as the response to the disaster and directed towards specific types of disasters, especially those of rapid onset. There is still little multidisciplinary and collaborative research among researchers from the different areas of interest that constitute the disaster phenomenon. Important challenges persist in disaster research, including the design of a common conceptual framework that allows multidisciplinary research in disasters, the development of specific methods to investigate complex emergencies (complex humanitarian emergencies) or disasters related to climate change; the development of a specific approach to investigate slow-onset disasters and their social, political and cultural factors, as well as research to develop feasible and cost-efficient prevention and response strategies. Solving these challenges will depend to a large extent to which the investigative capacity of managers and heads of organizations and field personnel working in disasters is improved.

Invited Commentary: Use of Epidemiologic Methods to Guide Comprehensive and Equitable Approaches to Policy.

Despite a dramatic reduction in the prevalence of commercial cigarette smoking in the United States, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue of the Journal, Titus et al. (Am J Epidemiol. 2023;192(1):25-33) use natural experiment evaluation methods (difference-in-differences) to test whether the recently implemented US Department of Housing and Urban Development policy that forbade smoking in and around New York City Housing Authority buildings affected child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiologists to engage in policy evaluation at all stages of the policy life cycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.

Ancient Disease, Modern Epidemiology: A Century of Progress in Understanding and Fighting Tuberculosis.

A century's worth of efforts to better understand the epidemiology of tuberculosis (TB) and to develop new vaccines, drugs, preventive interventions, and case-finding approaches have provided important insights and helped to advance the field of epidemiology as a whole. Wade Hampton Frost developed methods for cohort analysis that formed the early basis for adjustment of confounding variables. The streptomycin trial in the United Kingdom in the 1940s introduced random allocation for participants to either the treatment or control group, ensuring blinded treatment assignment and comparable treatment groups, which is now a key element in randomized clinical trials. Research into the bacille Calmette-Guérin vaccine demonstrated the importance of comparative analyses, potential difficulties in generalizability to populations not under study, and the role of meta-analysis for discrepant data-approaches now strongly recommended prior to implementing any novel public health intervention. George Comstock's work on preventive therapy for TB demonstrated the use of epidemiologic methods to evaluate interventions on a population level. Finally, studies from the Consortium to Respond Effectively to the AIDS/TB Epidemic focused on the evaluation of real-world effectiveness and of targeting of high-risk subpopulations. In this article, we discuss how TB research in each of these domains has helped to advance epidemiologic thinking and methodology over the past 100 years.

Current practice of epidemiology in Africa: highlights of the 3rd conference of the African epidemiological association and 1st conference of the Cameroon society of epidemiology, Yaoundé, Cameroon, 2014.

As the study of disease occurrence and health indicators in human populations, Epidemiology is a dynamic field that evolves with time and geographical context. In order to update African health workers on current epidemiological practices and to draw awareness of early career epidemiologists on concepts and opportunities in the field, the 3rd African Epidemiology Association and the 1st Cameroon Society of Epidemiology Conference was organized in June 2-6, 2014 at the Yaoundé Mont Febe Hotel, in Cameroon. Under the theme«Practice of Epidemiology in Africa: Stakes, Challenges and Perspectives», the conference attracted close to five hundred guest and participants from all continents. The two main programs were the pre-conference course for capacity building of African Early Career epidemiologists, and the conference itself, providing a forum for scientific exchanges on recent epidemiological concepts, encouraging the use of epidemiological methods in studying large disease burden and neglected tropical diseases; and highlighting existing opportunities.

Case–control analysis in highway safety: Accounting for sites with multiple crashes

There is an increased interest in the use of epidemiological methods in highway safety analysis. The case–control and cohort methods are commonly used in the epidemiological field to identify risk factors and quantify the risk or odds of disease given certain characteristics and factors related to an individual. This same concept can be applied to highway safety where the entity of interest is a roadway segment or intersection (rather than a person) and the risk factors of interest are the operational and geometric characteristics of a given roadway. One criticism of the use of these methods in highway safety is that they have not accounted for the difference between sites with single and multiple crashes. In the medical field, a disease either occurs or it does not; multiple occurrences are generally not an issue. In the highway safety field, it is necessary to evaluate the safety of a given site while accounting for multiple crashes. Otherwise, the analysis may underestimate the safety effects of a given factor.This paper explores the use of the case–control method in highway safety and two variations to account for sites with multiple crashes. Specifically, the paper presents two alternative methods for defining cases in a case–control study and compares the results in a case study. The first alternative defines a separate case for each crash in a given study period, thereby increasing the weight of the associated roadway characteristics in the analysis. The second alternative defines entire crash categories as cases (sites with one crash, sites with two crashes, etc.) and analyzes each group separately in comparison to sites with no crashes. The results are also compared to a “typical” case–control application, where the cases are simply defined as any entity that experiences at least one crash and controls are those entities without a crash in a given period. In a “typical” case–control design, the attributes associated with single-crash segments are weighted the same as the attributes of segments with multiple crashes.The results support the hypothesis that the “typical” case–control design may underestimate the safety effects of a given factor compared to methods that account for sites with multiple crashes. Compared to the first alternative case definition (where multiple crash segments represent multiple cases) the results from the “typical” case–control design are less pronounced (i.e., closer to unity). The second alternative (where case definitions are constructed for various crash categories and analyzed separately) provides further evidence that sites with single and multiple crashes should not be grouped together in a case–control analysis. This paper indicates a clear need to differentiate sites with single and multiple crashes in a case–control analysis. While the results suggest that sites with multiple crashes can be accounted for using a case–control design, further research is needed to determine the optimal method for addressing this issue. This paper provides a starting point for that research.

Applied (and appealing…) Epidemiology

Giuseppe La Torre has, in his manual “Applied Epidemiology and Biostatistics”, drawn upon his experience (long and intense despite his young age) as applied epidemiology expert in the Catholic University of Sacred Heart. For some years, in fact, he has offered valuable advice to many researchers who had failed to publish in international journals because of an inappropriate use of epidemiological methods and biostatistics, and has helped many of them present the results of their research. After numerous rejected papers, researchers would turn to his expertise and knowhow of the most modern epidemiological tools. The results were flattering: the papers which Professor La Torre and his staff had dealt with the epidemiological issues, as if by magic, were accepted for publication. It is therefore justified and understandable that the author has decided to propose, to a wider public, his epidemiological expertise about applied epidemiology. But there is no magic. The author simply focuses on the need to apply epidemiological methods to areas of public health practice for determining disease etiology and the “real-life” applications to public health and health services research.

Use of Epidemiologic Methods to Assess Effects of Climate Change on Health: Methodological and Philosophical Challenges

Use of Epidemiologic Methods to Assess Effects of Climate Change on Health: Methodological and Philosophical Challenges

Effects of anaesthetic drugs on the developing brain in children less than 1 year of age: an epidemiological study

Introduction: Each year millions of neonates, infants and young children worldwide are exposed to anaesthetic drugs. The last 5 years concerns have been raised regarding a possible association of anaesthesia and neuro-degeneration in young children, which represents an enormous potential burden to public health. Animal data is compelling and involves a variety of anaesthetic drugs, settings and species, including most recently primates. Implicated are n-methyl-d-aspartate receptor antagonists and γ-amino-butyric acid agonists, including most of the commonly used anaesthetics for both children and adults. However, as yet, it is not clear whether the effects observed in animals are clinical relevant in humans [1]. The scientific approach to solve this question is difficult. One approach is the use of epidemiological methods, which have proven in many setting to be powerful tools for exploring the relationship between exposure and disease. Methods: We are currently conducting an epidemiological study in Denmark comparing the educational achievement of all children operated before the age of 1 year during the period 1977–1990, (n = 45.000+) to the background Danish population. The study, which has been approved by the Danish Data Protection Agency, is based on linkage of a series of available registries. The Danish civil registration system identifies individuals by unique social security numbers, which can be linked to a number of thematically organized population databases, called registers. Information from three registers is used: (1) the Danish Demographic Database, which includes information on parental identities, deaths, migrations, adoptions and education, (2) the National Hospital Discharge Register, which includes information on overnight hospital stays for non-psychiatric illnesses and (3) the Register of Compulsory School Completion Assessment and Test Scores, which is compiled from school reports by the Ministry of Education (at ninth grade, aged 15–16 years). The primary outcome in this study is academic achievements rather than IQ. The use of this cohort has several strengths: it is of unprecedented size, it is population-based, and the important covariates such as: age, gestational age, birth weight, parental age and parental education are available for practically all participants in the study. Discussion: The data is currently being analyzed and will be presented at the 2009 APA Meeting in Brighton, as will pitfalls and strengths of epidemiological studies over randomized clinical studies for addressing this paediatric anaesthetic challenge. This challenge may, however, extend beyond paediatric anaesthesia because the implicated drugs are widely used in a variety of other settings in infants and young children around the world.

Mining data, gathering variables and recombining information: the flexible architecture of epidemiological studies

Since the second half of the twentieth century, biomedical research has made increasing use of epidemiological methods to establish empirical evidence on a population level. This paper is about practices with data in epidemiological research, based on a case study in Denmark. I propose an epistemology of record linkage that invites exploration of epidemiological studies as heterogeneous assemblages. Focusing on data collecting, sampling and linkage, I examine how data organisation and processing become productive beyond the context of their collection. The case study looks at how a local population database established in 1976 to investigate possibilities for the prevention of cardiovascular disease is used thirty years later to test hypotheses on the aetiology of breast cancer. For two breast cancer investigations based on the same core data set, I follow the underlying record linkage practice and describe how research objects such as molecular markers become relevant with respect to public health through information networking. Epidemiological association studies function as tools that performatively enrol different contexts into statistical risk estimation, thereby configuring options for research as well as for clinical testing and public health policy.

Clinical Research Methods in CJASN

Epidemiology and biostatistics have played an increasingly important role in the study of renal disease and, therefore, the nephrology literature. As a result, many nephrologists seek opportunities to improve their ability to read this literature critically. Responding to this need, we begin a series of articles in this issue of the Clinical Journal of the American Society of Nephrology ( CJASN ) that will highlight major clinical research methods that many of CJASN ’s contributors use in their studies of renal diseases. Although this series will cover only a portion of the large set of methods and issues that are relevant to the conduct of clinical research in nephrology, it will be extended periodically to expand opportunities for CJASN readers to be exposed to the full array of clinical research tools. The number of published clinical research studies has increased greatly in the past decade. Since 2000 alone, Medline contains nearly 24,000 citations that both address kidney disease and are identified as using epidemiologic study methods. Clinical epidemiologic studies can be categorized according to broad areas of inquiry listed in Figure 1. Although questions in these areas can be informed by a variety of study methods, each …

New research directions in neuroepidemiology.

Many of the risk factors previously identified for disorders such as Alzheimer's disease, periventricular leukomalacia, multiple sclerosis, stroke, cerebral palsy, mental retardation, and acquired learning and attention disorders ultimately may be shown to damage the central and peripheral nervous systems through activation of inflammatory mediators. The challenge to epidemiologists in the future is to expand use of epidemiologic methods to explore how immune-mediated insults produce CNS disorders in human populations. Studies of the association of use of nonsteroidal anti-inflammatory drugs with risk of Alzheimer's disease and those of the association of immune parameters with risk of cerebral palsy are excellent examples of how epidemiology can contribute to our understanding of the causes of neurologic and/or neurodevelopmental disorders. Many of the immune parameters of interest have short half-lives and are difficult to measure outside of the laboratory setting. Questions also remain as to the proper timing of measurements in relation to the initial insult and, in some cases, which tissue is the most appropriate to sample. These measurement issues will need to be resolved before use of immune biomarkers in epidemiologic studies of the etiologies of neurologic disorders can be fully realized. Epidemiologists are most likely to help identify ways to prevent neurologic disorders if they are knowledgeable about the molecular biology of inflammation, modulators of CNS vulnerability, and genetic polymorphisms that influence both inflammation and CNS vulnerability and are prepared to become adept at biomarker epidemiology. This does not necessarily compel them to gain extensive knowledge of neurobiology. Rather, neuroepidemiology in the 21st century will require increased collaboration between epidemiologists, neurologists, and neurobiologists.

EVOLUCIÓN DE LOS DISEÑOS EPIDEMIOLÓGICOS DE LA INVESTIGACIÓN CLÍNICA EN ESPAÑA (1975-1994)

BACKGROUND: Previous studies have shown a sparing utilization of analytical and experimental designs in Spanish clinical research journals. The study aims are to compare among countries, the use of epidemiologic method in articles published in scientific journals, and to determine the extent to which this research has direct funding. METHODS: Cross-sectional study including all original papers published during 1994 in Medicina Clinica [(Med Clin (Barc)], Revista Clinica Espanola (Rev Clin Esp), The Lancet (Lancet) and New England Journal of Medicine (N Engl J Med). They were classified according to epidemiological design and we verified the financial support mention. RESULTS: 594 papers were included. Epidemiological studies without control group prevailed in Spanish journals. The most common designs were descriptive studies in Med Clin (Barc), with 45.5%, and clinical series in Rev Clin Esp, with 41.7%. The 33.6% of original papers published in Lancet and 28.4% of N England J Med were randomized trials. We found information about financial support in 73.7% of papers published in Lancet, in 77.4 % of N Engl J Med, in 23.1% of Med Clin (Barc) papers and not one in the Rev Clin Esp studies. CONCLUSIONS: In Spanish clinical journals the use of epidemiological methods with control group is limited and direct financial support unusual. Wherefore these studies have a limited applicability.

A Critique of the Epidemiologic Study of Firearms and Homicide

Public health professionals have called for the use of epidemiologic methods to study violence, particularly firearm-related homicide. This literature review uses epidemiology texts to evaluate the extent to which public health research has complied with epidemiologic methodology, focusing primarily on the two medical journals publishing most extensively on the topic. Most studies and reports surveyed failed in at least one way to observe basic standards of the science of epidemiology.

The Application of Epidemiologic Methods to the Assessment of Cardiology Outcomes

While the options available for treatment of congenital heart disease continues to expand, rigorous evaluation of outcome has not always accompanied the introduction of new therapeutic modalities. For example, transcatheter implantation of the Rashkind double‐umbrella occluder for persistent patent ductus arteriosus had not previously been compared to conventional surgery in a rigorous fashion. Consequently, a 14‐center retrospective study compared outcomes of 631 prognostically similar patients treated concurrently with these two modalities. Particular efforts were made to reduce the bias and confounding that often plague nonrandomized comparisons. The study's design is described in detail as an example of the use of epidemiologic methods to enhance the rigor of observational studies of outcomes of cardiology interventions.

Epidemiology and health policy—A world of difference?: A case-study of a cholera outbreak in Kaputa district, Zambia

The relationship between epidemiology and health policy is an area of considerable debate. This article demonstrates the use of epidemiological methods to make health policy formulation more ‘policy significant’ and ‘down to earth’. A case-study of a cholera outbreak in Kaputa district, Zambia is used as an illustration. A closer liaison between epidemiology and social sciences is advocated. Epidemiological data should be supplied as feed back to the study population to facilitate community-based action for health.

Epidemiological measures of participation in community health promotion projects.

The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioural subgroups. Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a two-stage sampling design. Thirteen of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents aged > or = 10 years was sampled from the 43 selected projects. Population-based incident participants were estimated and were related to person-years at risk. The total participation rate was 4.01 per person-year. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of population, the participation rate fell by around one-third in the medium and high disadvantage groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of population. The effect was most pronounced at ages 10-19 years. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn and reported low consumption of fruit and vegetables. However, participation was reduced in people who were sedentary. Epidemiological methods can be used to evaluate the distribution of participation of a population in community health promotion projects. The Western Australian Health Promotion Foundation has been successful in reaching disadvantaged youth.

Social psychiatry and sociology of mental health: a view on their past and future relevance.

The origins of social psychiatry can be traced to the age of enlightenment and to the effects of the industrial revolution. Social psychiatry deals with social factors associated with psychiatric morbidity, social effects of mental illness, psycho-social disorders and social approaches to psychiatric care. Since the end of World War II up to the early seventies it has been claimed that social psychiatry should concentrate on the fight against war, poverty, racial discrimination, urban decay and all other social ills affecting people's mental health, and that the psychiatrist should be responsible for the mental health of the society. In contrast, sociology of mental health questioned the expertise of the psychiatrist and the very existence of mental illness, claiming that it covers deviant behaviour rejected by the society. The paper refutes this approach indicating that not the existence but the perception and presentation of psychiatric illness are socially determined. Acknowledging the contribution of sociology and social sciences to psychiatry, it is suggested that the heroic period of social psychiatry and the iconoclastic approach of sociology of mental health are over. However, social psychiatry, enriched by the use of epidemiological methods, has still much to offer to the daily practice of psychiatry.

Osteoporosis and Hip Fractures

Epidemiologic studies have contributed to our understanding of osteoporosis through identification of groups at high risk of fracture and through discernment of factors associated with increased risk of low bone density and fracture. Many of the questions remaining can be addressed only through the use of epidemiologic methods in human populations. These include longitudinal studies in large cohorts to better delineate factors associated with bone loss and fracture and randomized clinical trials to adequately assess therapies. Particularly needed are studies in adolescents to assess determinants of peak bone mass and the effect of subsequent bone loss with aging.

Epidemiological research on non-auditory effects of occupational noise exposure

Epidemiological studies about non-auditory effects of noise have been reviewed. For methodological reasons, only occupational studies are compared with each other. Most studies were directed, as before, to the relation between noise and arterial blood pressure. In about half of the studies, a positive relation could be demonstrated, in the other studies, however, no relation was found. Methodological comments are given. Definite conclusions are still not possible. In three investigations the effects of noise on pregnancy were studied. A negative effect on birth weight is presented in one of these studies. More research is needed. Task components probably interact with noise exposure producing annoyance and stress symptoms. The use of epidemiological methods in research of non-auditory effects of noise is still very limited.