Environmental health and clinicians: time to promote more action.

Climate change and ambient air pollution are threats to human health, with dramatic short- and long-term effects on mortality and morbidity. Pollution generates fears among citizens who rarely receive adequate information for risk mitigation. A large burden of evidence is describing since decades the health effects of pollution, linking environmental exposure to pathophysiological mechanisms (mainly, low-grade chronic inflammation) that lead to an array of chronic non-communicable diseases. Epidemiologists are deeply involved to depict environment-related diseases, identify risk factors as well as to offer suggestions for prevention policies. However, their warnings are frequently disregarded by clinicians and policymakers. In clinical practice, diagnostic evidence is the basis for therapeutic interventions. Conversely, epidemiological evidence in the field of environmental health rarely generates appropriate preventive and clinical actions. Despite the great interest and concerns of citizens and epidemiologists, the perception of pollution as a major hazard to health is often scarce among clinicians, as witnessed by the poor presence of environmental health in the majority of clinical guidelines, meetings of scientific societies, and medical curricula. As a consequence, inaction is not uncommon among clinicians, who often fail to routinely engage in counseling their patients on how to reduce their health risks from living in an unsafe environment nor to act as advocates in order to enact changes in the community. This gap should be urgently bridged by creating opportunities for health professionals to be adequately informed and trained to play an active role in tackling environmental risks.

Field Epidemiology: Fit for the future.

In recent years, field epidemiologists have embraced rapidly evolving digital tools, data sources and technologies, and collaborated with an ever-growing field of scientific specialisms. The COVID-19 pandemic put field epidemiology under unprecedented demand and scrutiny. As the COVID-19 emergency recedes, it is timely to reflect on the core values of our profession and the unique challenges and opportunities that lie ahead. In November 2022, alumni of the European Programme for Intervention Epidemiology Training (EPIET) and the European Public Health Microbiology (EUPHEM) training programme celebrated 25 years of EPIET, and the present and future of field epidemiology was discussed. The output was recorded and qualitatively analysed. This Perspective reflects the authors' interpretation of the discussion. We should reaffirm our commitment to field epidemiology's core strengths: competence and rigour in epidemiology, surveillance, outbreak investigation and applied research, leading to timely and actionable evidence for public health. Our future success will be defined by an ability to adapt, collaborate, harness innovation, communicate and, ultimately, by our tangible impact on protecting and improving health.

Using Machine Learning Models To Investigate The Relationship Between Corporeal Workload And Clinical And Epidemiological Features Of Patients Infected With COVID-19 In Egypt.

Objectives: To explore if clinical and epidemiological features of patients positive for coronavirus disease-2019 are affected by somatic work stress. Method: The retrospective study was conducted at Kafrelsheik University Hospital, Egypt, and comprised data of patients admitted between April 1, to June 6, 2020, with confirmed coronavirus disease-2019 infection. Health records of healthy subjects who had come to the hospital as part of their routine check-up were also included for comparison, and the researchers were blinded during the gathering and analysis phase. Demographic features, vitalsigns, infection severity,somatic workload of the patients'jobs at admission, and detailed discharge profile was noted. The relationship between clinical features and somatic work stress was evaluated. Data was analysed using SPSS 26. RESULTS: Of the 1072 cases, 602(56.2%) were men and 470(43.8%) were women. The overall median age was 43 years (interquartile range: 29 years). The healthy group had 500 random subjects. There were significant differences in all vital signs between the patients and healthy controls (p<0.05). Among the patients, infection severity was higher in men, but it was notsignificant (p>0.05). The overall mortality was 69(6.4%); 46(4.3%) men and 23(2.2%) women. There was no significant association between gender and outcome (p>0.05). There were 816(76.11%) patients with low intensity physical workload pre-infection, 136(12.68%) moderate and 120(11.19%) high. Infection severity was significantly high in the low-intensity group (p<0.05). However, the fate of the patients was notsignificantly associated with their pre-infection work profile (p>0.05). CONCLUSIONS: Coronavirus disease-2019 significantly affected patients'vitalsigns, and infection severity wassignificantly associated with physical work stress. However, mortality and pre-infection somatic workload were not associated.

Using Epidemiological Data to Inform Clinical Trial Feasibility Assessments: A Case Study.

BACKGROUND: Clinical trial enrollment and completion is challenging, with nearly half of all trials not being completed or not completed on time. In 2014, the National Institutes of Health StrokeNet in collaboration with stroke epidemiologists from GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) began providing proposed clinical trials with formal trial feasibility assessments. Herein, we describe the process of prospective feasibility analyses using epidemiological data that can be used to improve enrollment and increase the likelihood a trial is completed. METHODS: In 2014, DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) trialists, National Institutes of Health StrokeNet, and stroke epidemiologists from GCNKSS collaborated to evaluate the initial inclusion/exclusion criteria for the DEFUSE 3 study. Trial criteria were discussed and an assessment was completed to evaluate the percent of the stroke population that might be eligible for the study. The DEFUSE 3 trial was stopped early with the publication of DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct), and the Wilcoxon rank-sum statistic was used to analyze whether the trial would have been stopped had the proposed changes not been made, following the DEFUSE 3 statistical analysis plan. RESULTS: After initial epidemiological analysis, 2.4% of patients with acute stroke in the GCNKSS population would have been predicted to be eligible for the study. After discussion with primary investigators and modifying 4 key exclusion criteria (upper limit of age increased to 90 years, baseline modified Rankin Scale broadened to 0-2, time since last well expanded to 16 hours, and decreased lower limit of National Institutes of Health Stroke Scale score to <6), the number predicted to be eligible for the trial increased to 4%. At the time of trial conclusion, 57% of the enrolled patients qualified only by the modified criteria, and the trial was stopped at an interim analysis that demonstrated efficacy. We estimated that the Wilcoxon rank-sum value for the unadjusted predicted enrollment would not have crossed the threshold for efficacy and the trial not stopped. CONCLUSIONS: Objectively assessing trial inclusion/exclusion criteria using a population-based resource in a collaborative and iterative process including epidemiologists can lead to improved recruitment and can increase the likelihood of successful trial completion.

Increasing Incidence of Spotted Fever Group Rickettsioses in the United States, 2010-2018.

Spotted fever group Rickettsia species are intracellular bacteria transmitted by tick or mite vectors and that cause human diseases referred to as spotted fever group rickettsioses, or spotted fevers. In the United States, the most recognized and commonly reported spotted fevers are Rocky Mountain spotted fever (RMSF) (Rickettsia rickettsii), Rickettsia parkeri rickettsiosis, Pacific Coast tick fever (Rickettsia species 364D), and rickettsialpox (Rickettsia akari). In this study, we summarize and evaluate surveillance data on spotted fever cases reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System from 2010 to 2018. During this period, there were 36,632 reported cases of spotted fevers with 95.83% (N = 35,104) reported as meeting the case definition as probable and 4.17% (N = 1528) reported as meeting the case definition as confirmed. The average national incidence of total cases, both probable and confirmed, was 12.77 cases per million persons per year. The highest statewide incidence was in Arkansas, with 256.84 per million per year, whereas the lowest incidence occurred in California, with 0.32 per million per year (note that spotted fevers were not notifiable in Hawaii and Alaska). Cases of spotted fevers were reported more frequently among males by gender, White by race, and non-Hispanic by ethnicity. The incidence of spotted fevers increased significantly from 2010 to 2018, but it is uncertain how many of the reported cases were RMSF and how many developed from more moderate spotted fevers. Improvement of the ability to differentiate between spotted fever group Rickettsia species is needed.

COVID-19: Are We Ready for the Second Wave?

The coronavirus disease 2019 (COVID-19) pandemic has already exerted an enormous impact on the entire world. Everything is overwhelmed in the face of a rapid escalation of cases. The countries that have already reported the peak of transmission are easing their preventive measures yet fearing a second wave of infection. If the virus causes that next wave, are we sufficiently prepared to deal with it? I argue that the stakeholders concerned should simultaneously handle the ongoing pandemic while making effective preparations for its second wave. To relax the preventive measures, countries must thoroughly revisit their situations based on scientific evidence.

Recruiting epidemiologists: A developmental perspective on expanding epidemiology exposure for adolescents.

Adolescents are at a unique developmental stage that is well-primed for epidemiology instruction. Although a handful of pioneers have focused on expanding epidemiology instruction to teen audiences, there are still no systematic efforts in the United States to attain this goal. In this paper I posit that epidemiologists and other public health professionals are critical to this effort. Epidemiologists from public health agencies, academia and non-profit organizations can engage in partnerships with schools, such as by offering internships and pairing graduate students/mentees with teachers and adolescent learners. Through these efforts, we can leverage teens' natural interests in risk taking, health and wellness, and community change to learn population-level thinking. I posit that these measures can encourage widespread exposure to epidemiology principles, and also enhance the future of public health disciplines.

Development of Indicators for Public Health Surveillance of Substance Use and Mental Health.

Substance use and mental health disorders can result in disability, death, and economic cost. In the United States, rates of death from suicide, drug overdose, and chronic liver disease (a marker for alcohol abuse) have been rising for the past 15 years. Good public health surveillance for these disorders, their consequences, and their risk factors is crucially important for their prevention and control, but surveillance has not been conducted consistently in the states. In 2015, the Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor these disorders and to compare their occurrence in various jurisdictions. This report briefly describes the indicators and outlines the process used to develop them.

The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea.

We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.

Importance of Performance Measurement and MCH Epidemiology Leadership to Quality Improvement Initiatives at the National, State and Local Levels.

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

Trends in varicella mortality in the United States: Data from vital statistics and the national surveillance system.

This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008-2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996-2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008-2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008-2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 y declined by 99% in 2008-2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 y in 2008-2011 compared to 2005-2007. Among the 83 deaths reported to CDC during 1996-2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contacts of immunocompromised persons have evidence of immunity.

Time, place, and people: composition of the EPIET Alumni Network and its contribution to the European public health resource in 2013.

The EPIET Alumni Network (EAN) is an association of professionals who have completed field epidemiology or public health microbiology training programmes in the European Union. In 2013, we conducted a survey of EAN members to investigate this network's role within European public health. We distributed an online questionnaire to members registered at the time, collecting data on demographics, professional background, and attitudes towards EAN. Out of 362 registered members, 189 (52%) responded; 97% were from Europe; 65% were female. Their mean age was 39 years. The highest academic qualification was PhD for 44% and Master's degree for 55%. The majority (60%) worked in public health institutes. They were especially satisfied with having access to job offers and professional networking via EAN, but requested more learning opportunities and knowledge-sharing between members. EAN is a unique platform where highly skilled professionals can connect to control infectious diseases locally and internationally. Having a network of professionals that know each other, speak the same 'language', and can easily access each other's expertise, represents an important resource for European and global public health, which should be nurtured by encouraging more collaborations devoted to professional development.

The next generation of large-scale epidemiologic research: implications for training cancer epidemiologists.

There is expanding consensus on the need to modernize the training of cancer epidemiologists to accommodate rapidly emerging technological advancements and the digital age, which are transforming the practice of cancer epidemiology. There is also a growing imperative to extend cancer epidemiology research that is etiological to that which is applied and has the potential to affect individual and public health. Medical schools and schools of public health are recognizing the need to develop such integrated programs; however, we lack the data to estimate how many current training programs are effectively equipping epidemiology students with the knowledge and tools to design, conduct, and analyze these increasingly complex studies. There is also a need to develop new mentoring approaches to account for the transdisciplinary team-science environment that now prevails. With increased dialogue among schools of public health, medical schools, and cancer centers, revised competencies and training programs at predoctoral, doctoral, and postdoctoral levels must be developed. Continuous collection of data on the impact and outcomes of such programs is also recommended.

Estudos epidemiológicos na área de saúde mental realizados no Brasil / Epidemiology of mental health and insanity: a review of literature

The studies epidemiologists in the area of mental health still are seen as and few used in the elaboration of politics of health, action of health incipient, planning of the investments and programs of promotion and social whitewashing for this population. This study it has as objective to make a revision of literature on the subject, tracing as beginning of the line of the time the decade of 1970, dates probable of the trajectory of the studies epidemiologists in the area of mental health, until the present moment, focusing the studies epidemiologists in the northeast region, more specifically, in the Paraíba, where the research epidemiologist starts the spoon fruits.

Os estudos epidemiológicos na área de saúde mental ainda são vistos como incipientes e pouco utilizados na elaboração de políticas de saúde, ações de saúde, planejamento dos investimentos e programas de promoção e reabilitação social para os doentes mentais. Esse estudo tem como objetivo fazer uma revisão da literatura sobre o assunto, traçando como início da linha do tempo, a década de 1970, data provável da trajetória dos estudos epidemiológicos na área de saúde mental, até o presente momento. A pesquisa bibliográfica foi realizada em acervos de bibliotecas, bem como em consultas na base de dados do Scielo, Medline e Lillacs, através da internet. Os resultados evidenciaram a predominância de estudos na região Região Sudeste, Sul e Nordeste, e a carência desses estudos em outras regiões do país. Evidenciou-se a necessidade de que mais estudos sejam realizados abordando-se outros grupos e temáticas poucos investigadas na determinação dos riscos para o adoecimento mental.

The public health information infrastructure. A national review of the law on health information privacy.

Our objectives were to review and analyze the laws in the 50 states, the District of Columbia, and Puerto Rico that regulate the acquisition, storage, and use of public health data and to offer proposals for reform of the laws on public health information privacy. Virtually all states reported some statutory protection for governmentally maintained health data for public health information in general (49 states), communicable diseases (42 states), and sexually transmitted diseases (43 states). State statutes permitted disclosure of data for statistical purposes (42 states), contact tracing (39 states), epidemiologic investigations (22 states), and subpoena or court order (14 states). The survey revealed significant problems that affect both the development of fair and effective public health information systems and the protection of privacy. Statutes may be silent about the degree of privacy protection afforded, confer weaker privacy protection to certain kinds of information, or grant health officials broad discretion to disseminate personal information. Our proposals for law reform are based on a meeting of experts at the Carter Presidential Center under the auspices of the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists: (1) an independent data protection commission should be established, (2) health authorities should justify the collection of personally identifiable information, (3) subjects should be given basic information about data practices, (4) data should be held and used in accordance with fair information practices, (5) legally binding privacy and security assurances should attach to identifiable health information with significant penalties for breach of these assurances, (6) disclosure of data should be made only for purposes consistent with the original collection, and (7) secondary uses beyond those originally intended by the data collector should be permitted only with informed consent.