On the Need to Revitalize Descriptive Epidemiology.

Nearly every introductory epidemiology course begins with a focus on person, place, and time, the key components of descriptive epidemiology. And yet in our experience, introductory epidemiology courses were the last time we spent any significant amount of training time focused on descriptive epidemiology. This gave us the impression that descriptive epidemiology does not suffer from bias and is less impactful than causal epidemiology. Descriptive epidemiology may also suffer from a lack of prestige in academia and may be more difficult to fund. We believe this does a disservice to the field and slows progress towards goals of improving population health and ensuring equity in health. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak and subsequent coronavirus disease 2019 pandemic have highlighted the importance of descriptive epidemiology in responding to serious public health crises. In this commentary, we make the case for renewed focus on the importance of descriptive epidemiology in the epidemiology curriculum using SARS-CoV-2 as a motivating example. The framework for error we use in etiological research can be applied in descriptive research to focus on both systematic and random error. We use the current pandemic to illustrate differences between causal and descriptive epidemiology and areas where descriptive epidemiology can have an important impact.

Will Podcasting and Social Media Replace Journals and Traditional Science Communication? No, but...

The digital world in which we live is changing rapidly. The evolving media environment is having a direct impact on traditional forms of communication and knowledge translation in public health and epidemiology. Openly accessible digital media can be used to reach a broader and more diverse audience of trainees, scientists, and the lay public than can traditional forms of scientific communication. The new digital landscape for delivering content is vast, and new platforms are continuously being added. In this article, we focus on several, including Twitter and podcasting, and discuss their relevance to epidemiology and science communication. We highlight 3 key reasons why we think epidemiologists should be engaging with these mediums: 1) science communication, 2) career advancement, and 3) development of a community and public service. Other positive and negative consequences of engaging in these forms of new media are also discussed. The authors of this commentary are all engaged in social media and podcasting for scientific communication, and we reflect on our experiences with these mediums as tools to advance the field of epidemiology.

Code Review as a Simple Trick to Enhance Reproducibility, Accelerate Learning, and Improve the Quality of Your Team's Research.

Programming for data wrangling and statistical analysis is an essential technical tool of modern epidemiology, yet many epidemiologists receive limited formal training in strategies to optimize the quality of our code. In complex projects, coding mistakes are easy to make, even for skilled practitioners. Such mistakes can lead to invalid research claims that reduce the credibility of the field. Code review is a straightforward technique used by the software industry to reduce the likelihood of coding bugs. The systematic implementation of code review in epidemiologic research projects could not only improve science but also decrease stress, accelerate learning, contribute to team building, and codify best practices. In the present article, we argue for the importance of code review and provide some recommendations for successful implementation for 1) the research laboratory, 2) the code author (the initial programmer), and 3) the code reviewer. We outline a feasible strategy for implementation of code review, though other successful implementation processes are possible to accommodate the resources and workflows of different research groups, including other practices to improve code quality. Code review isn't always glamorous, but it is critically important for science and reproducibility. Humans are fallible; that's why we need code review.

Interpreting SARS-CoV-2 seroprevalence, deaths, and fatality rate - Making a case for standardized reporting to improve communication.

The SARS-CoV-2 virus has spread across the world, testing each nation's ability to understand the state of the pandemic in their country and control it. As we looked into the epidemiological data to uncover the impact of the COVID-19 pandemic, we discovered that critical metadata is missing which is meant to give context to epidemiological parameters. In this review, we identify key metadata for the COVID-19 fatality rate after a thorough analysis of mathematical models, serology-informed studies and determinants of causes of death for the COVID-19 pandemic. In doing so, we find reasons to establish a set of standard-based guidelines to record and report the data from epidemiological studies. Additionally, we discuss why standardizing nomenclature is be a necessary component of these guidelines to improve communication and reproducibility. The goal of establishing these guidelines is to facilitate the interpretation of COVID-19 epidemiological findings and data by the general public, health officials, policymakers and fellow researchers. Our suggestions may not address all aspects of this issue; rather, they are meant to be the foundation for which experts can establish and encourage future guidelines throughout the appropriate communities.

Reacting to crises: The COVID-19 impact on biostatistics/epidemiology.

Most crises, though difficult and challenging to address, offer opportunities for change and for development of new perspectives or approaches to deal with traditional strategies. The reaction to and the managing of the COVID-19 pandemic has provided a platform for evaluating how we quantify disease prevalence, incidence, time courses and sequellae as well as how well we plan, design, analyze and interpret health care associated data, including clinical trials and electronic medical records and health claims data. Whether the Covid-19 crisis provides opportunities to advance the fields of biostatistics and epidemiology in select ways remains to be seen. This article describes three areas of crises experienced by the author during a career in the regulation of pharmaceutical products and how they were responded to. Some suggestions for potential future opportunities in reaction to the Covid-19 crises are provided.

National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1.

OBJECTIVE: To provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: A task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted. RESULTS: The TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is limited in quality. CONCLUSION: These statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.

Nota técnica 09 DVE/DVZ/COVISA/2020: vigilância e manejo clínico da esporotricose humana no município de São Paulo / Technical report 09 DVE / DVZ / COVISA / 2020: surveillance and clinical management of human sporotrichosis in the city of São Paulo

A Esporotricose é uma infecção fúngica de implantação, subaguda ou crônica, causada por fungo do complexo Sporothrix schenkii. No Brasil, a espécie mais frequente é S.brasiliensis. No município de São Paulo, em 2011, foram identificados os primeiros casos de esporotricose em felinos e em humanos, na região de Itaquera, na Coordenadoria Regional de Saúde Leste. A partir de 2018, houve um aumento significativo do número de casos em felinos, acompanhado do aumento de casos humanos. Esta Nota técnica, elaborada pela Coordenadoria de Vigilância em Saúde de São Paulo, tem como objetivo orientar a vigilância e o manejo clínico da esporotricose humana no município de São Paulo. O documento aborda a situação epidemiológica da esporotricose no município de São Paulo, o agente etiológico, as formas de transmissão, as manifestações clínicas, os diagnósticos diferenciais, o diagnóstico laboratorial, o tratamento, o prognóstico e as definições de casos suspeito e confirmado, além dos fluxos de atendimento e vigilância epidemiológica de esporotricose humana na cidade e da orientação para coleta e armazenamento de amostras para envio ao laboratório.

"Can we agree on that"? Plurality, power and language in participatory research.

Participatory epidemiology (PE) is a method that gathers data from groups through focus group interviews and participatory visual and scoring exercises. The method is often used in poor communities in low-income countries where it is hard to obtain conventional epidemiological data. This paper draws on research on the public sphere and democratic deliberation, along with research on language and interpretation, to suggest how PE research could be better equipped to account for diversity in local knowledge, include minority views and acknowledge power dynamics. These aspects are discussed under the three themes of 'plurality', 'power' and 'language'. A review of highly-cited PE literature suggests that PE research engages with plurality and power to a very limited extent, and only marginally more so with language and translation. Examples are taken from the authors' own PE research on African swine fever in -Uganda, classical swine fever in Germany, peste des petits ruminants (PPR) in Eastern Europe, and Ugandan pastoralists' understanding of cattle disease to provide more detail as to why conventional PE studies might fail to record issues of plurality, power and language, and also to suggest how this can be addressed. With reference to the literature on the public sphere and democratic deliberation, and on language and interpretation, this paper concludes with some suggestions as to how to take plurality, power and language into greater consideration in PE studies in future, thus improving the validity and reliability of PE data.

Covid-19: Ministério da Saúde define critérios de distanciamento social

O Ministério da Saúde publicou, nesta segunda-feira (6), Boletim Epidemiológico Especial sobre Coronavírus que orienta a adoção de ações diferenciadas em relação ao distanciamento social por estados e municípios, a partir de distintos cenários. São considerados, tanto critérios epidemiológicos, quanto a disponibilidade de Equipamentos de Proteção Individual (EPIs), leitos e profissionais de saúde.

The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19.

The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR's Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies.

Directora de OPS llama a países de las Américas a intensificar sus actividades de preparación y respuesta para COVID-19

La Directora de la Organización Panamericana de la Salud (OPS), Carissa F. Etienne, recomendó hoy que los países intensifiquen sus planes de preparación y respuesta a la enfermedad por Coronavirus 2019 (COVID-19) ante la aparición de nuevos casos en la Región de las Américas.

Untangling the ethical intersection of epidemiology, human subjects research, and public health.

PURPOSE: Members of the American College of Epidemiology (ACE) Ethics Committee identified current ethics and epidemiology topic areas to consider for further discussion, consultation, teaching opportunities, and conference presentation. This article reflects on the activities of the Committee at the ACE Annual Meeting in New Orleans, Louisiana, September 24-26, 2017. METHODS: The overall aim for the Ethics Committee was to engage members of the College and other audiences and highlight the evolution of ethics and epidemiology since the inception of the original Ethics Guidelines published by the ACE Ethics and Standards of Practice Committee in 2000. The Ethics Committee organized a symposium session at the 2017 Annual Meeting of ACE on the ethics of human subjects research as it relates to specialized areas of epidemiology and the intersecting role of public health. This article presents a summary and further discussion of that symposium session. RESULTS: Three topic areas were presented: an overview of ethics and epidemiology (E.S.P.), very high biomarker levels in environmental epidemiology research (S.M.P.), and the interface of epidemiology, human subjects research, and public health interventions (S.M.). This article begins by reviewing the foundations of epidemiology and public health and the well-known ethical principles of human subjects research. Then, it considers the ethical considerations in the use of population registry data in epidemiological research, environmental epidemiology, and epidemic surveillance and response. This article may form the basis of teaching of ethics principles related to epidemiology and public health and may serve as a companion piece to the original ACE Ethics Guidelines. CONCLUSIONS: Researchers are increasingly faced with ethical considerations in diverse, nontraditional, and specialized areas of epidemiology and public health. This article illustrates these challenges with real-world examples of clinical and population registry data, the study of environmental biomarkers, and Zika virus epidemic; it also reviews relevant ethical principles underpinning these examples and identifies where gaps in knowledge may exist.

Epidemiology: Back to the Future.

In 2018, the Society for Epidemiologic Research and its partner journal, the American Journal of Epidemiology, assembled a working group to develop a set of papers devoted to the "future of epidemiology." These 14 papers covered a wide range of topic areas and perspectives, from thoughts on our profession, teaching, and methods to critical areas of substantive research. The authors of those papers considered current challenges and future opportunities for research and education. In light of past commentaries, 4 papers also include reflections on the discipline at present and in the future.

A Future for Observational Epidemiology: Clarity, Credibility, Transparency.

Observational studies are ambiguous, difficult, and necessary for epidemiology. Presently, there are concerns that the evidence produced by most observational studies in epidemiology is not credible and contributes to research waste. I argue that observational epidemiology could be improved by focusing greater attention on 1) defining questions that make clear whether the inferential goal is descriptive or causal; 2) greater utilization of quantitative bias analysis and alternative research designs that aim to decrease the strength of assumptions needed to estimate causal effects; and 3) promoting, experimenting with, and perhaps institutionalizing both reproducible research standards and replication studies to evaluate the fragility of study findings in epidemiology. Greater clarity, credibility, and transparency in observational epidemiology will help to provide reliable evidence that can serve as a basis for making decisions about clinical or population-health interventions.

On Being an Epidemiologist.

This commentary addresses being an epidemiologist at a time when the field of epidemiology again faces a paradigm shift as the tools for research on human health draw increasingly on emerging technologies-various omics and new methods for collecting individual data at high intensity-and on new methods for carrying out research through administrative and health care data bases linked to biobanks. At the same time, epidemiologists in public health practice continue to face the usual array of challenges, but with the threat of global issues as well. The profession of epidemiologist is not monolithic; it embraces a broad range of activities and professional venues, reflecting the many contexts where epidemiologists do their work, the nature of the problems addressed, and the span and application of their findings. Obtaining data from people and populations comes with serious ethical obligations related to privacy and confidentiality of individuals and respect for the populations studied. Beyond generating and analyzing data, epidemiologists engage in guiding action through the evidence they have created with the ultimate goal of advancing health. This commentary addresses "mega-trends" that will affect the profession in the decades to come.

Applied Epidemiology Training Needs for the Modern Epidemiologist.

Applied epidemiology training occurs throughout an epidemiologist's career, beginning with academic instruction before workforce entry, continuing as professional development while working, and culminating with mentoring the next generation. Epidemiologists need ongoing training on advancements in the field and relevant topics (e.g., informatics, laboratory science, emerging topics) to maintain and improve their skills. Even epidemiologists with advanced skills often want training on methodologic innovations or to practice a skill. Effective applied epidemiology training includes blended learning components of instruction that incorporate hands-on experiences such as simulations and experiential learning, allowing for real-time workflows and incorporation of feedback. To prepare epidemiologists for the future, public health training courses in applied epidemiology must consider the evolution in public health toward a focus on including informatics, technologic innovation, molecular epidemiology, multidisciplinary teams, delivery of population health services, and global health security. Supporting efforts by epidemiologists to increase their skills as part of their career paths ensures a strong workforce that able to tackle public health issues. We explore how to meet current training challenges for the epidemiology workforce, especially given limited resources, based on research and our experience in workforce development across federal agencies and state/local health departments, as well as with international governments and organizations.