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Emerging Themes in Epidemiology

Daniel A Sprague, Caroline Jeffery, Nadine Crossland, Thomas House, Gareth O Roberts, William Vargas, Joseph Ouma, Stephen K Lwanga, Joseph J Valadez
BACKGROUND: It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. METHODS: We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points...
2016: Emerging Themes in Epidemiology
Odile Sauzet, Jürgen Breckenkamp, Theda Borde, Silke Brenne, Matthias David, Oliver Razum, Janet L Peacock
BACKGROUND: Dichotomisation of continuous data has statistical drawbacks such as loss of power but may be useful in epidemiological research to define high risk individuals. METHODS: We extend a methodology for the presentation of comparison of proportions derived from a comparison of means for a continuous outcome to reflect the relationship between a continuous outcome and covariates in a linear (mixed) model without losing statistical power. The so called "distributional method" is described and using perinatal data for illustration, results from the distributional method are compared to those of logistic regression and to quantile regression for three different outcomes...
2016: Emerging Themes in Epidemiology
Severine Frison, Francesco Checchi, Marko Kerac, Jennifer Nicholas
BACKGROUND: Wasting is a major public health issue throughout the developing world. Out of the 6.9 million estimated deaths among children under five annually, over 800,000 deaths (11.6 %) are attributed to wasting. Wasting is quantified as low Weight-For-Height (WFH) and/or low Mid-Upper Arm Circumference (MUAC) (since 2005). Many statistical procedures are based on the assumption that the data used are normally distributed. Analyses have been conducted on the distribution of WFH but there are no equivalent studies on the distribution of MUAC...
2016: Emerging Themes in Epidemiology
Adrian Bauman, Philayrath Phongsavan, Alison Cowle, Emily Banks, Louisa Jorm, Kris Rogers, Bin Jalaludin, Anne Grunseit
BACKGROUND: The issue of poor response rates to population surveys has existed for some decades, but few studies have explored methods to improve the response rate in follow-up population cohort studies. METHODS: A sample of 100,000 adults from the 45 and Up Study, a large population cohort in Australia, were followed up 3.5 years after the baseline cohort was assembled. A pilot mail-out of 5000 surveys produced a response rate of only 41.7 %. This study tested methods of enhancing response rate, with three groups of 1000 each allocated to (1) receiving an advance notice postcard followed by a questionnaire, (2) receiving a questionnaire and then follow-up reminder letter, and (3) both these strategies...
2016: Emerging Themes in Epidemiology
Hiraku Kumamaru, Sebastian Schneeweiss, Robert J Glynn, Soko Setoguchi, Joshua J Gagne
BACKGROUND: Multivariable confounder adjustment in comparative studies of newly marketed drugs can be limited by small numbers of exposed patients and even fewer outcomes. Disease risk scores (DRSs) developed in historical comparator drug users before the new drug entered the market may improve adjustment. However, in a high dimensional data setting, empirical selection of hundreds of potential confounders and modeling of DRS even in the historical cohort can lead to over-fitting and reduced predictive performance in the study cohort...
2016: Emerging Themes in Epidemiology
Veronica Tuffrey, Andrew Hall
BACKGROUND: In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology...
2016: Emerging Themes in Epidemiology
Amelia Catharine Crampin, Ndoliwe Kayuni, Alemayehu Amberbir, Crispin Musicha, Olivier Koole, Terence Tafatatha, Keith Branson, Jacqueline Saul, Elenaus Mwaiyeghele, Lawrence Nkhwazi, Amos Phiri, Alison Jane Price, Beatrice Mwagomba, Charles Mwansambo, Shabbar Jaffar, Moffat Joha Nyirenda
BACKGROUND: The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies...
2016: Emerging Themes in Epidemiology
Lara R Dugas, Miles Fuller, Jack Gilbert, Brian T Layden
The obesity epidemic has emerged over the past few decades and is thought to be a result of both genetic and environmental factors. A newly identified factor, the gut microbiota, which is a bacterial ecosystem residing within the gastrointestinal tract of humans, has now been implicated in the obesity epidemic. Importantly, this bacterial community is impacted by external environmental factors through a variety of undefined mechanisms. We focus this review on how the external environment may impact the gut microbiota by considering, the host's geographic location 'human geography', and behavioral factors (diet and physical activity)...
2016: Emerging Themes in Epidemiology
Laura M Grajeda, Andrada Ivanescu, Mayuko Saito, Ciprian Crainiceanu, Devan Jaganath, Robert H Gilman, Jean E Crabtree, Dermott Kelleher, Lilia Cabrera, Vitaliano Cama, William Checkley
BACKGROUND: Childhood growth is a cornerstone of pediatric research. Statistical models need to consider individual trajectories to adequately describe growth outcomes. Specifically, well-defined longitudinal models are essential to characterize both population and subject-specific growth. Linear mixed-effect models with cubic regression splines can account for the nonlinearity of growth curves and provide reasonable estimators of population and subject-specific growth, velocity and acceleration...
2016: Emerging Themes in Epidemiology
Marco J Haenssgen
BACKGROUND: The increasing availability of online maps, satellite imagery, and digital technology can ease common constraints of survey sampling in low- and middle-income countries. However, existing approaches require specialised software and user skills, professional GPS equipment, and/or commercial data sources; they tend to neglect spatial sampling considerations when using satellite maps; and they continue to face implementation challenges analogous to conventional survey implementation methods...
2015: Emerging Themes in Epidemiology
Shannon C Grabich, Whitney R Robinson, Stephanie M Engel, Charles E Konrad, David B Richardson, Jennifer A Horney
BACKGROUND: Epidemiological analyses of aggregated data are often used to evaluate theoretical health effects of natural disasters. Such analyses are susceptible to confounding by unmeasured differences between the exposed and unexposed populations. To demonstrate the difference-in-difference method our population included all recorded Florida live births that reached 20 weeks gestation and conceived after the first hurricane of 2004 or in 2003 (when no hurricanes made landfall). Hurricane exposure was categorized using ≥74 mile per hour hurricane wind speed as well as a 60 km spatial buffer based on weather data from the National Oceanic and Atmospheric Administration...
2015: Emerging Themes in Epidemiology
Margaret Anne Hurley
BACKGROUND: Epidemiologists have debated the appropriate time-scale for cohort survival studies; chronological age or time-on-study being two such time-scales. Importantly, assessment of risk factors may depend on the choice of time-scale. Recently, chronological or attained age has gained support but a case can be made for a 'reference relative time-scale' as an alternative which circumvents difficulties that arise with this and other scales. The reference relative time of an individual participant is the integral of a reference population hazard function between time of entry and time of exit of the individual...
2015: Emerging Themes in Epidemiology
Julian M Somers, Stefanie N Rezansoff, Akm Moniruzzaman, Carmen Zabarauckas
BACKGROUND: A subgroup of individuals becomes entrenched in a "revolving door" involving corrections, health, and social welfare services. Little research has investigated the numbers of people that are in frequent contact with multiple public agencies, the costs associated with these encounters, or the characteristics of the people concerned. The present study used linked administrative data to examine offenders who were also very frequent users of health and social services. We investigated the magnitude and distribution of costs attributable to different categories of service for those in the top 10 % of sentences to either community or custodial settings...
2015: Emerging Themes in Epidemiology
Joshua B Mendelsohn, Liviana Calzavara, Lucia Light, Ann N Burchell, Jinma Ren, Laiyi Kang
BACKGROUND: China's growing population of internal migrants has exceeded 236 million. Driven by rapid development and urbanization, this extreme population mobility creates opportunities for transmission of HIV and sexually-transmitted infections (STI). Large numbers of rural migrants flock to megacities such as Shanghai in search of employment. Although migrants constitute a key population at heightened risk of acquiring HIV or an STI, there is a lack of easily accessible sexual health services available for them...
2015: Emerging Themes in Epidemiology
Stefan Vilges de Oliveira, Lidsy Ximenes Fonseca, Keline Medeiros de Araújo Vilges, Fernanda Voietta Pinna Maniglia, Simone Valéria Costa Pereira, Eduardo Pacheco de Caldas, Pedro Luiz Tauil, Rodrigo Gurgel-Gonçalves
BACKGROUND: Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease. METHODS: Incidence of hantavirus infections in Brazil (1993-2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities' vulnerability to disease by means of multi-criteria decision analysis (MCDA)...
2015: Emerging Themes in Epidemiology
Kristen M Fedak, Autumn Bernal, Zachary A Capshaw, Sherilyn Gross
In 1965, Sir Austin Bradford Hill published nine "viewpoints" to help determine if observed epidemiologic associations are causal. Since then, the "Bradford Hill Criteria" have become the most frequently cited framework for causal inference in epidemiologic studies. However, when Hill published his causal guidelines-just 12 years after the double-helix model for DNA was first suggested and 25 years before the Human Genome Project began-disease causation was understood on a more elementary level than it is today...
2015: Emerging Themes in Epidemiology
John Townend, Cosetta Minelli, Imed Harrabi, Daniel O Obaseki, Karima El-Rhazi, Jaymini Patel, Peter Burney
BACKGROUND: The importance of studying associations between socio-economic position and health has often been highlighted. Previous studies have linked the prevalence and severity of lung disease with national wealth and with socio-economic position within some countries but there has been no systematic evaluation of the association between lung function and poverty at the individual level on a global scale. The BOLD study has collected data on lung function for individuals in a wide range of countries, however a barrier to relating this to personal socio-economic position is the need for a suitable measure to compare individuals within and between countries...
2015: Emerging Themes in Epidemiology
Maud M A Verscheijden, Petra J Woestenberg, Hannelore M Götz, Maaike G van Veen, Femke D H Koedijk, Birgit H B van Benthem
BACKGROUND: Specialised sexually transmitted infection (STI) clinics in the Netherlands provide STI care for high-risk groups, including female sex workers (FSW), at the clinic and by outreach visiting commercial sex workplaces with a permit. The objective was to investigate the STI positivity rate and determinants of an STI diagnosis among FSW tested by STI clinics in the Netherlands. METHODS: Sexually transmitted infection clinics report demographic, behavioural and diagnostic information of every consultation to the National Institute for Public Health and the Environment...
2015: Emerging Themes in Epidemiology
Neal Alexander
Statistical inference is commonly said to be inapplicable to complete population studies, such as censuses, due to the absence of sampling variability. Nevertheless, in recent years, studies of whole populations, e.g., all cases of a certain cancer in a given country, have become more common, and often report p values and confidence intervals regardless of such concerns. With reference to the social science literature, the current paper explores the circumstances under which statistical inference can be meaningful for such studies...
2015: Emerging Themes in Epidemiology
Andrew Page, Geeske Peeters, Dafna Merom
Sedentary behaviour (too much sitting, as distinct from too little exercise) has emerged as a potentially significant public health issue. Analytically, researchers have reported 'independent' associations between sedentary behaviour (SB) and a number of health outcomes by adjusting for physical activity (PA) (and other confounders), and conclude that SB is associated with the outcome even in those who are physically active. However, the logical rationale for why adjustments for PA are required is often not delineated, and as a consequence, PA has been conceptualised as a confounder, an intermediary, and an effect measure modifier-sometimes simultaneously-in studies of SB and health outcomes...
2015: Emerging Themes in Epidemiology
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