Visions for the 20th International Epidemiological Association's World Congress of Epidemiology (WCE 2014).

During August 17th-21st, 2014, the University of Alaska Anchorage, along with other local, state, and federal agencies throughout Alaska, will host the 20(th) International Epidemiological Association's (IEA) World Congress of Epidemiology (WCE 2014). The theme for this Congress is "Global Epidemiology in a Changing Environment: The Circumpolar Perspective." The changing environment includes the full range of environments that shape population health and health inequities from the physical to the social and economic. Our circumpolar perspective on these environments includes views on how political systems, work, immigration, Indigenous status, and gender relations and sexuality affect the global world and the health of its people. Suggestions and insights from the 3(rd) North American Congress of Epidemiology (2011) and the first-ever joint regional workshop co-organized by the IEA North American Region and the IEA Latin American and Caribbean Region held at the 19(th) IEA World Congress of Epidemiology (2011) have helped direct the focus for WCE 2014. Since the Arctic regions are feeling the effects of climate change first, we believe focusing on the emerging data on the health impacts of climate change throughout the world will be an important topic for this Congress. This will include a broad range of more traditional epidemiology areas such as infectious disease epidemiology, environmental epidemiology, health disparities, and surveillance and emergency preparedness. Addressing health inequities and promoting health equity is likewise a key concern of the Congress. This Congress will also host presentations on injury epidemiology, occupational health, infectious diseases, chronic diseases, maternal and child health, surveillance and field epidemiology, mental health, violence (from self-directed, e.g., suicide, to interpersonal to structural), psychoactive substance use (including tobacco), and measures of subjective health. Attention will be given to epidemiology's theoretical frameworks and emphasizing knowledge translation, from epidemiology to health systems, to policy, and to the broader public. We also plan to offer many hands-on workshops including practical uses of epidemiology to improve health systems and reduce health inequities within and between countries; the manner in which epidemiology can inform public health practice; the understanding and use of the Dictionary of Epidemiology; and many others.

Age-period-cohort analysis of tuberculosis notifications in Hong Kong from 1961 to 2005.

BACKGROUND: Despite its wealth, excellent vital indices and robust health care infrastructure, Hong Kong has a relatively high incidence of tuberculosis (TB) (85.4 per 100 000). Hong Kong residents have also experienced a very rapid and recent epidemiological transition; the population largely originated from migration by southern Chinese in the mid 20th century. Given the potentially long latency period of TB infection, an investigation was undertaken to determine the extent to which TB incidence rates reflect the population history and the impact of public health interventions. METHODS: An age-period-cohort model was used to break down the Hong Kong TB notification rates from 1961 to 2005 into the effects of age, calendar period and birth cohort. RESULTS: Analysis by age showed a consistent pattern across all the cohorts by year of birth, with a peak in the relative risk of TB at 20-24 years of age. Analysis by year of birth showed an increase in the relative risk of TB from 1880 to 1900, stable risk until 1910, then a linear rate of decline from 1910 with an inflection point at 1990 for a steeper rate of decline. Period effects yielded only one inflection during the calendar years 1971-5. CONCLUSIONS: Economic development, social change and the World Health Organisation's short-course directly observed therapy (DOTS) strategy have contributed to TB control in Hong Kong. The linear cohort effect until 1990 suggests that a relatively high, but slowly falling, incidence of TB in Hong Kong will continue into the next few decades.

A prospective study of back belts for prevention of back pain and injury.

CONTEXT: Despite scientific uncertainties about effectiveness, wearing back belts in the hopes of preventing costly and disabling low back injury in employees is becoming common in the workplace. OBJECTIVE: To evaluate the effectiveness of using back belts in reducing back injury claims and low back pain. DESIGN AND SETTING: Prospective cohort study. From April 1996 through April 1998, we identified material-handling employees in 160 new retail merchandise stores (89 required back belt use; 71 had voluntary back belt use) in 30 states (from New Hampshire to Michigan in the north and from Florida to Texas in the south); data collection ended December 1998, median follow-up was 6(1/2) months. PARTICIPANTS: A referred sample of 13,873 material handling employees provided 9377 baseline interviews and 6311 (67%) follow-up interviews; 206 (1.4%) refused baseline interview. MAIN OUTCOME MEASURES: Incidence rate of material-handling back injury workers' compensation claims and 6-month incidence rate of self-reported low back pain. RESULTS: Neither frequent back belt use nor a belt-requirement store policy was significantly associated with back injury claim rates or self-reported back pain. Rate ratios comparing back injury claims of those who reported wearing back belts usually every day and once or twice a week vs those who reported wearing belts never or once or twice a month were 1.22 (95% confidence interval [CI], 0.87-1.70) and 0.95 (95% CI, 0.56-1.59), respectively. The respective odds ratios for low back pain incidence were 0.97 (95% CI, 0.83-1.13) and 0.92 (95% CI, 0.73-1.16). CONCLUSIONS: In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain. JAMA. 2000;284:2727-2732.

Preventable hospitalization and avoidable maternity outcomes: implications for access to health services for Medicaid recipients.

This study demonstrates how readily available hospital discharge data and small area methods can be used to identify potential problems of access to primary and prenatal outpatient health services for Medicaid populations. We examine whether rates of preventable hospitalization and avoidable maternity outcomes differ across geographic areas by their concentration of Medicaid recipients. Five county and twenty-four intra-county areas in Upstate New York are examined. Individuals living in Medicaid intra-county areas had significantly higher rates of these hospitalizations than persons living in non-Medicaid areas. Public health managers can use these methods to identify and compare areas in which access problems exist and to target and evaluate programs designed to improve access.

Model for the statewide delivery of programming services.

Elements of a model for delivering behavioral programming services to individuals with mental retardation in residential, training, and educational settings were described. The model includes (a) identification of levels of behavioral competence among staff members, (b) an intervention approval process, (c) regional behavioral programming committees, (d) a doctoral advisory committee, (e) client advocacy committees, (f) a monitoring system, (g) a regulatory manual, and (h) leadership from a state agency office.

Nosocomial outbreak of hand-foot-and-mouth disease among operating suite personnel.

In the fall of 1983 an outbreak of hand-foot-and-mouth disease occurred in a large urban hospital. The outbreak began among surgical nurses confined to one area of the operating suite and appeared to spread by direct contact to personnel working in the other areas. No cases were diagnosed among hospital patients. There was no evidence to support an ongoing community epidemic as only three of 98 physicians surveyed had seen hand-foot-and-mouth disease in their practices, and none occurred among family members of 94 unaffected employees. The outbreak resulted in 82 lost workdays at an estimated cost to the hospital of $5,676. Existing infection control guidelines do not address the issue of transmission of hand-foot-and-mouth disease from hospital personnel to patients; our experience suggests that the risk of transmission, at least in the operating suite environment, may be greater for other personnel than for patients.