Preventing Outbreaks through Interactive, Experiential Real-Life Simulations.

Operation Outbreak (OO) is a Bluetooth-based simulation platform that teaches students how pathogens spread and the impact of interventions, thereby facilitating the safe reopening of schools. OO also generates data to inform epidemiological models and prevent future outbreaks. Before SARS-CoV-2 was reported, we repeatedly simulated a virus with similar features, correctly predicting many human behaviors later observed during the pandemic.

The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) Fellowship, a Novel Training Program in Public Health for Infectious Diseases Physicians.

The severe acute respiratory syndrome coronavirus 2 pandemic demonstrated a critical need for partnerships between practicing infectious diseases (ID) physicians and public health departments. The soon-to-launch combined ID and Epidemic Intelligence Service fellowship can only address a fraction of this need, and otherwise US ID training lacks development pathways for physicians aiming to make careers working with public health departments. The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship is a model compatible with the current training paradigm with a proven track record of developing careers of long-term collaboration. Established in 2017 by the ID Society of America, Society for Healthcare Epidemiology of America, Pediatric ID Society, and supported by the Centers for Disease Control and Prevention, LEAP is a single-year in-place, structured training for senior trainees and early career ID physicians. In this viewpoint, we describe the LEAP fellowship, its outcomes, and how it could be adapted into ID training.

A call for sex-positive epidemiology.

The World Health Organization specifies that sexual health requires the potential for pleasurable and safe sexual experiences. Yet epidemiologic research into sexual pleasure and other positive sexual outcomes has been scant. In this commentary, we aim to support the development and adoption of sex-positive epidemiology, which we define as epidemiology that incorporates the study of pleasure and other positive features alongside sexually transmitted infections and other familiar negative outcomes. We first call epidemiologists' attention to the potential role that stigma plays in the suppression of sex-positive research. We further describe existing measures of sex-positive constructs that may be useful in epidemiologic research. Finally, the study of sex-positive constructs is vulnerable to biases that are well-known to epidemiologists, especially selection bias, information bias, and confounding. We outline how these biases influence existing research and identify opportunities for future research. Epidemiologists have the potential to contribute a great deal to the study of sexuality by bringing their considerable methodological expertise to long-standing challenges in the field. We hope to encourage epidemiologists to broaden their sexual health research to encompass positive outcomes and pleasure.

Positive epidemiology, revisited: the case for centering human rights and economic justice.

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health.

The world was their laboratory: how two pioneer scientist-administrators, James Watt and Zdenek Fejfar, advanced methods and international collaboration in cardiovascular disease epidemiology during the Cold War.

In 1952, James Watt, a young US Public Health Service (PHS) infectious disease epidemiologist, was appointed-amid wide surprise-director of the US National Heart Institute (NHI) where he served until 1961. He skillfully advanced epidemiologic research methods and study conduct nationally while also establishing epidemiology in the administrative hierarchy of the institute. Watt soon turned to development of an effective program in international cardiovascular disease (CVD) epidemiology under auspices of the World Health Organization (WHO) at the United Nations in Geneva. That effort resulted in the 1959 appointment of Zdenek Fejfar, a young Czech clinical investigator, as director of the WHO CVD Unit. The coming together of Watt and Fejfar, with a joint focus on improved methods and population comparisons, helped establish a vigorous international community of CVD epidemiology. Their collaboration and friendship remained active and close throughout their career assignments and thereafter, as documented in this story.

Three things we learned along the way: lessons for training in psychiatric epidemiology.

The coronavirus disease 2019 (COVID-19) pandemic, and its associated mortality, morbidity, and deep social and economic impacts, was a global traumatic stressor that challenged population mental health and our de facto mental health care system in unprecedented ways. Yet, in many respects, this crisis is not new. Psychiatric epidemiologists have recognized for decades the need and unmet need of people in distress and the limits of the public mental health services in the United States. We argue that psychiatric epidemiologists have a critical role to play as we endeavor to address population mental health and draw attention to 3 areas of consideration: elevating population-based solutions; engaging equitably with lived experience; and interrogating recovery. Psychiatric epidemiology has a long history of both responding to and shaping our understanding of the relationships among psychiatric disorders and society through evolving methods and training, and the current sociohistorical moment again suggests that shifts in our practice can strengthen our field and its impact. This article is part of a Special Collection on Mental Health.

Defining Spatial Epidemiology: A Systematic Review and Re-orientation.

BACKGROUND: Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk-factor studies but is not yet aligned with epidemiology's current focus on causal inference and intervention. METHODS: We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded articles were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, and intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined articles coded as analytic ecologic studies using scales for lexical content. RESULTS: A total of 482 articles met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (incidence rate ratio =1.3; 95% confidence interval [CI] = 1.1, 1.5) and causal inference (incidence rate ratio =1.1; 95% CI = 1.1, 1.2). CONCLUSIONS: Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Epidemiology and reporting characteristics of preclinical systematic reviews.

In an effort to better utilize published evidence obtained from animal experiments, systematic reviews of preclinical studies are increasingly more common-along with the methods and tools to appraise them (e.g., SYstematic Review Center for Laboratory animal Experimentation [SYRCLE's] risk of bias tool). We performed a cross-sectional study of a sample of recent preclinical systematic reviews (2015-2018) and examined a range of epidemiological characteristics and used a 46-item checklist to assess reporting details. We identified 442 reviews published across 43 countries in 23 different disease domains that used 26 animal species. Reporting of key details to ensure transparency and reproducibility was inconsistent across reviews and within article sections. Items were most completely reported in the title, introduction, and results sections of the reviews, while least reported in the methods and discussion sections. Less than half of reviews reported that a risk of bias assessment for internal and external validity was undertaken, and none reported methods for evaluating construct validity. Our results demonstrate that a considerable number of preclinical systematic reviews investigating diverse topics have been conducted; however, their quality of reporting is inconsistent. Our study provides the justification and evidence to inform the development of guidelines for conducting and reporting preclinical systematic reviews.

Recognizing Excellence in Maternal and Child Health (MCH) Epidemiology: The National MCH Epidemiology Awards.

Purpose: Professionals in the field of maternal and child health (MCH) epidemiology are publicly recognized by the Coalition for Excellence in MCH Epidemiology representing 16 national MCH agencies and organizations. Description: During the CityMatCH Leadership and MCH Epidemiology Conference, the national awards are presented to public health professionals for improving the health of women, children, and families. The awards have evolved over the last two decades with focus on awardees that represent more types of MCH public health professionals. Assessment: Since 2000, the Coalition has presented 111 national awards in the areas of advancing knowledge, effective practice, outstanding leadership, excellence in teaching and mentoring, early career professional achievement, and lifetime achievement. Effective practice awards were most often presented at 45 awards, followed by early career professional achievement with 20. The awardees varied by place of employment with 37 employed at academic institutions, 33 in federal government positions, 32 in state or county government, seven in non-profit and two in clinical organizations. Awards were almost equally distributed by gender with 49 presented to women and 48 to men. Assessment of career advancement among previous awardees and acknowledging workforce challenges are gaps identified within the national awards process. Conclusion: Recognition of deserving MCH professionals sets the standard for those entering the field of MCH epidemiology and offers opportunity to recognize those who have built capacity and improved the health of women, children, and families.

[Italian Association of Epidemiology: How has the demographic, educational, and occupational profile of members changed in recent years]. / Associazione Italiana di Epidemiologia: com'è cambiato il profilo demografico, formativo e occupazionale dei soci e delle socie negli ultimi anni.

In recent years, the number of members of the Italian Association of Epidemiology (AIE) has increased considerably, and their profile has undergone many changes. The aim of this work is to describe the characteristics of the members, with particular attention to those who have been continuously enrolled. To evaluate these characteristics, the data from membership forms submitted to the Association and information available on the new website in the personal profile area (period 2016-2024) were used. The characteristics considered were: gender, age, education, and job position of the member, Region, and type of affiliated institution. Members with at least three registrations during the period considered, including at least one in the last three years (2022-2024), are considered continuous members.In 2024, AIE counts 557 members, of whom 340 (61.0%) are female and 182 (32.7%) are under 35 years old. This data confirms the growing trend observed since 2015, when the number of members was just above 300, considering that each year there is a quota of new members amounting to about 30%. A total of 382 members can be considered continuous. Over 90% of these members work in 8 Regions (Lazio, Piedmont, Emilia-Romagna, Lombardy, Tuscany, Veneto, Puglia, and Sicily), while the other regions are scarcely or not represented at all. Over time, and with the arrival of new members, the Association is shifting towards the academic world, while the proportion of professionals working in public health institutions has decreased. Members are overall highly educated; however, while older cohorts have predominantly a medical and biological education, younger cohorts increasingly have statistical/mathematical education. Seventy percent of the members have a permanent contract, 5% have a fixed-term contract, and 13% have an atypical contract. Precarious contracts tend to be lower among medical graduates and remain higher in other health professions and non-health-related degrees.AIE is dealing with a period of dynamism and openness, marked by the increase in the number of the members and the transformation of their occupational and educational profile. It is crucial to support and promote the ongoing positive changes, such as the wider geographic representativeness and the entry of new recruits, also facilitated by multiple activities carried out by AIE, including congresses, working groups, webinars, training courses, and collaborations with other scientific societies. At the same time, it might be useful to open a discussion on the meaning and consequences of the increase of academic members and the reduction, at least in relative terms, of individuals coming from public health. Finally, it will be necessary to approach some critical issues, such as the still poor multidisciplinarity and the persistence of job insecurity, especially among graduates in educational pathways that still do not fit into the professional profiles recognized by the NHS.

Too few epidemiologists in humanitarian crises: a critical gap that needs addressing. A new course organised by the Italian Association of Epidemiology

The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained 'humanitarian epidemiologists' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.

Introduction to Special Issue: Geneses, organizations and transformations of psychiatric epidemiology.

Recent historiography has revealed a growing interest in the developments of psychiatric epidemiology. This volume aims to explicitly tackle the problem of transforming a diversity of knowledge into a structured scientific unit. Furthermore, it aims to answer this by bringing together historical studies that demonstrate how epistemic authority has led to the hierarchization of knowledge and the institutionalization of psychiatric epidemiology. Interdisciplinary research teams are traced back in history, and their organization is interrogated. Tracing the history of psychiatric epidemiology involves an exploration of disciplinary divisions of labour, such as how survey methods are based on theoretical frameworks, how research programmes are regulated with political and moral ideals, and how the wider public recognizes public health expertise.

The Stirling County Study: a case study of interdisciplinarity and its effects on the history of psychiatric epidemiology.

Epidemiology of mental disorders emerged in the post-1945 era at the intersections of different areas of knowledge. Given its ambitions, the Stirling County Study provides an instructive case study. It is also a good example of how the epidemiology applied methodological skills from social sciences. This paper aims, first, to reconstruct one of the first episodes in the development of psychiatric epidemiology. Its second purpose is to provide a detailed description of interdisciplinarity at work, and to examine its effects. After explaining some of the major features of the Stirling County Study, I emphasize the links between some of the first results, particularly regarding young people as a population at risk, and the job market after the Great Depression.

Psychiatric epidemiology and the Chicago School of Sociology.

This article explores the Chicago School of Sociology's influence on psychiatric epidemiology. While the Chicago School text usually associated with psychiatric epidemiology is the 1939 book by Faris and Dunham, it is important to acknowledge the influence of earlier Chicago School projects during the 1920s. These projects, tackling everything from homelessness and delinquency to the ghetto and suicide, provided models not only for Faris and Dunham, but also for numerous methodological and theoretical insights for the social psychiatry projects that would emerge after World War II. The social sciences and the humanities still have important roles to play in informing contemporary approaches to psychiatric epidemiology and deriving ways to tackle the socio-economic problems that contribute to mental illness.

Metamorphosis: The American Journal of Hygiene Becomes the American Journal of Epidemiology.

In this brief Commentary, Neal Nathanson recounts his memories of the metamorphosis of the American Journal of Hygiene into the American Journal of Epidemiology, and his subsequent service as the Editor-in-Chief from 1964 to 1979.

Breaking Research Silos and Stimulating "Innovation at the Edges" in Epidemiology.

Epidemiological training often requires specialization in a subdiscipline (e.g., pharmacoepidemiology, genetic epidemiology, social epidemiology, or infectious disease epidemiology). While specialization is necessary and beneficial, it comes at the cost of decreased awareness of scientific developments in other subdisciplines of epidemiology. In this commentary, we argue for the importance of promoting an exchange of ideas across seemingly disparate epidemiologic subdisciplines. Such an exchange can lead to invaluable opportunities to learn from and merge knowledge across subdisciplines. It can promote "innovation at the edges," a process of borrowing and transforming methods from one subdiscipline in order to develop something new and advance another subdiscipline. Further, we outline specific actionable steps at the researcher, institution, and professional society level that can promote such innovation.

Enhancing Epidemiology's Impact on Policy: Mediation by Expert Committees.

Epidemiologic evidence is often a key source of information used by expert committees to guide policy decisions, yet epidemiologists rarely consider this audience for their research. For a better understanding of the pipeline from epidemiologic research to expert committee assessment to policy, several reports from the National Academies of Sciences, Engineering, and Medicine were reviewed and discussed with staff and committee members. The topics of these consensus committee assessments included health behaviors, medical care, and military exposures. The focus was often on emerging issues of immediate concern for which there was little relevant research available but a need for prompt action. Committees generally sought a comprehensive assessment of potential health effects of a given product or exposure, which often included social and behavioral health outcomes that are rarely addressed by epidemiologists. To enhance epidemiology's contribution to societal decisions, the choice of research topics should expand to consider emerging societal concerns. Research funding agencies need to be engaged as mediators between committee needs and the research community to stimulate contributory research. Improved communication of research needs to the epidemiology community would be beneficial to researchers aspiring to have an impact and to those who use epidemiologic information to help guide policy decisions.

Snippets of the History of the American Journal of Epidemiology.

In this article, I present a brief summary of landmark events in the American Journal of Epidemiology, including its founding, the first few decades, the change in name, the increasing focus on nontransmissible disease, and selected key manuscripts. A list of developments that will likely result in new papers submitted to epidemiology journals are also described, and they include themes such as consequential epidemiology and the use of artificial intelligence methods in epidemiologic data analyses.

Toward Open and Reproducible Epidemiology.

Starting in the 2010s, researchers in the experimental social sciences rapidly began to adopt increasingly open and reproducible scientific practices. These practices include publicly sharing deidentified data when possible, sharing analytical code, and preregistering study protocols. Empirical evidence from the social sciences suggests such practices are feasible, can improve analytical reproducibility, and can reduce selective reporting. In academic epidemiology, adoption of open-science practices has been slower than in the social sciences (with some notable exceptions, such as registering clinical trials). Epidemiologic studies are often large, complex, conceived after data have already been collected, and difficult to replicate directly by collecting new data. These characteristics make it especially important to ensure their integrity and analytical reproducibility. Open-science practices can also pay immediate dividends to researchers' own work by clarifying scientific reasoning and encouraging well-documented, organized workflows. We consider how established epidemiologists and early-career researchers alike can help midwife a culture of open science in epidemiology through their research practices, mentorship, and editorial activities.

Selection Bias with Outcome-dependent Sampling.

In a seminal paper, Hernán et al. 2004 provided a systematic classification of selection biases, for scenarios where the selection is a collider between the exposure and the outcome. Hernán 2017 discussed another scenario, where the selection is statistically independent of the exposure, but associated with the outcome through common causes. In this note, we extend the discussion to scenarios where the selection is directly influenced by the outcome, but not by the exposure. We discuss whether these types of outcome-dependent selections preserve the sharp causal null hypothesis, and whether or not they allow for estimation of causal effects in the selected sample and/or in the source population.