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.

Asthma prevalence among US elderly by age groups: age still matters.

OBJECTIVE: For over three decades, the greatest burden of asthma deaths has occurred among persons aged 65 years and older. This study analyzed the association between increasing age and asthma prevalence among age groups within the US elderly population. METHODS: We analyzed aggregated data on 54,485 civilian, noninstitutionalized US adults aged 65 years and older from the 2001-2010 National Health Interview Survey (NHIS). We estimated the prevalence of current asthma, lifetime asthma, and chronic obstructive pulmonary disease (COPD) among US elderly by 5-year age groups and age stages ("young elderly" aged 65-84 years and "oldest old" aged ≥85 years). We calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) to identify asthma prevalence patterns among elderly populations. RESULTS: From 2001 to 2010, the estimated average annual prevalence of current asthma among US elderly was 7.0%. Estimates of lifetime asthma, COPD, and co-occurring current asthma and COPD were 9.9%, 9.7%, and 3.0%, respectively. Prevalence of asthma decreased with advancing age while prevalence of COPD increased with advancing age. When controlling for study variables and significant interactions (p = .05) with COPD, the odds of reporting current asthma decreased with advancing age: 0.87 (95% CI, 0.76-1.01) for 70- to 74-year-olds; 0.76 (95% CI, 0.66-0.87) for 75- to 79-year-olds; 0.62 (95% CI, 0.51-0.75) for 80- to 84-year-olds; and 0.45 (95% CI, 0.36-0.55) for ≥85-year-olds, as compared to 65- to 69-year-olds. CONCLUSIONS: Asthma continues to affect a substantial proportion of the US elderly population. Increased diagnosis of COPD may overshadow correct diagnosis and treatment in populations with advancing age. Treatment guidelines should focus on preventable risk behaviors to increase the quality of life within this population.

Attitudes about carbon monoxide safety in the United States: results from the 2005 and 2006 HealthStyles Survey.

OBJECTIVES: We sought to identify attitudes and behaviors related to carbon monoxide (CO) safety that can be targeted with public health prevention strategies in the U.S. METHODS: The Centers for Disease Control and Prevention added questions about (1) proper placement of gas-powered generators, (2) maintenance of fuel-burning appliances, and (3) use of CO detectors to the 2005 and 2006 HealthStyles national health marketing surveys. RESULTS: In 2005, 63.3% of HealthStyles respondents agreed with or were uncertain about the incorrect statement, "It is safe to run a generator in a garage as long as the door is open," while 43.1% agreed with or were uncertain about the incorrect statement, "It is safe to run a generator in the basement." Most of the 2006 respondents (63.5%) agreed that it is important to have their furnace inspected annually. However, fewer than half of the 2006 respondents (42.0%)-most of whom were homeowners-reported owning a CO detector. CONCLUSIONS: A large proportion of adults in the U.S. reported attitudes and behaviors that may place them at increased risk for unintentional, non-fire-related CO poisoning, suggesting that current safety messages may not be reaching much of the public. Prevention messages should continue to promote proper generator placement, maintenance of fuel-burning appliances, and use of CO detectors. Development of a comprehensive national strategy for CO surveillance and communication may help identify populations at increased risk and prevent future poisonings.

Effect of certified health programs on the sale price of beef calves marketed through a livestock videotape auction service from 1995 through 2005.

OBJECTIVE: To quantify effects of certified health programs on the sale price of beef calves sold through a livestock videotape auction service. DESIGN: Longitudinal study. SAMPLE POPULATION: 26,502 lots representing 3,205,192 beef calves sold through a livestock videotape auction service between 1995 and 2005. PROCEDURES: Data describing each lot of beef calves that were marketed from 1995 through 2005 by a livestock videotape auction service were obtained from sale catalogues. For each year of the study, multiple regression analysis was used to quantify the effect of certified health programs on sale price. RESULTS: For each year of the study, beef calves that qualified for the 2 most intensive certified health programs sold for significantly higher prices, compared with prices for similar calves that were not in a certified health program, had not been vaccinated against respiratory tract viruses, and were not weaned before delivery. Price premiums for calves in the most intensive certified health program ranged from $2.47/100 lb (hundredweight [cwt]; 1 cwt equals 45.45 kg) in 1995 to $7.91/cwt in 2004. Price premiums paid for calves qualifying for the next most intensive certified health program ranged from $0.99/cwt in 1996 to $3.47/cwt in 2004. The percentage of the total number of lots in the 2 most intensive certified health programs increased over time. CONCLUSIONS AND CLINICAL RELEVANCE: Findings from this study indicated that implementation of the 2 most intensive certified health programs consistently increased the price of beef calves, and these price premiums increased over time.

A brief report of surveillance of traumatic experiences and exposures after the earthquake-tsunami in American Samoa, 2009.

CONTEXT: Rapid mental health surveillance during the acute phase of a disaster response can inform the allocation of limited clinical resources and provide essential household-level risk estimates for recovery planning. OBJECTIVE: To describe the use of the PsySTART Rapid Mental Health Triage and Incident Management System for individual-level clinical triage and traumatic exposure assessment in the aftermath of a large-scale disaster. METHODS: We conducted a cross-sectional, comparative review of mental health triage data collected with the PsySTART system from survivors of the September 2009 earthquake-tsunami in American Samoa. Data were obtained from two sources--secondary triage of patients and a standardized community assessment survey-and analyzed descriptively. The main outcome measures were survivor-reported traumatic experiences and exposures--called triage factors--associated with risk for developing severe distress and new mental health disorders following disasters. RESULTS: The most common triage factors reported by survivors referred for mental health services were "felt extreme panic/fear" (93%) and "felt direct threat to life" (93%). The most common factor reported by persons in tsunami-affected communities was "felt extreme panic or fear" (75%). Proportions of severe triage factors reported by persons living in the community were consistently lower than those reported by patients referred for mental health services. CONCLUSIONS: The combination of evidence-based mental health triage and community assessment gave hospital-based providers, local public health officials, and federal response teams a strategy to match limited clinical resources with survivors at greatest risk. Also, it produced a common operating picture of acute and chronic mental health needs among disaster systems of care operating in American Samoa.

National surveillance of asthma: United States, 2001-2010.

BACKGROUND: Asthma is prevalent but treatable: adherence to evidence-based treatment lessens impairment and lowers the risk of future exacerbations. OBJECTIVE: This report details recent trends in asthma prevalence, health care use, and mortality since 2001 and presents an overview of trends since 1980. METHODS: Asthma prevalence estimates were obtained from the National Health Interview Survey (2001-2010). Physician office visit data were obtained from the National Ambulatory Medical Care Survey, hospital outpatient department and emergency department (ED) visit data from the National Hospital Ambulatory Medical Care Survey, hospitalization data from the National Hospital Discharge Survey, and death data from the National Vital Statistics System (2001-2009). Two types of rates were calculated: population-based rates based on the total population and risk-based rates based on the population with asthma. RESULTS: Current asthma prevalence increased from 2001 to 2010. There were no significant changes in rates for hospital outpatient department visits, ED visits, or hospitalizations, whereas risk-based rates for private physician office visits declined. Asthma death rates decreased from 2001 to 2009. Over the long term, asthma prevalence rose more slowly after 2001 than during 1980-1996, asthma hospitalizations declined since 1984 and deaths declined since 1999. Disparities by race and sex for adverse outcomes remained high despite these declines. CONCLUSION: Since 2001, asthma prevalence increased, risk-based rates for visits to private physician offices and deaths declined, and risk-based rates for other types of ambulatory visits and for hospitalizations showed no clear trend.

Effect of management, marketing, and certified health programs on the sale price of beef calves sold through a livestock video auction service from 1995 through 2009.

OBJECTIVE: To evaluate and update the previously quantified effects of management, marketing, and certified health programs on the sale price of beef calves sold through a livestock video auction service. DESIGN: Longitudinal study. SAMPLE: 41,657 lots representing 5,042,272 beef calves sold from 1995 through 2009. PROCEDURES: Data describing each lot of beef calves marketed from 1995 through 2009 by a livestock video auction service were obtained from sale catalogues. For each year of the study, multiple regression analysis was used to quantify the effect of management, marketing, and certified health programs on sale price. RESULTS: Sale date, base sale weight, quadratic effect of base weight, sex of calf, region of origin, breed description, inclusion in a certified health program, and number of calves in the lot significantly affected sale price for every year of the study. Variation in body weight, flesh score, and number of days between sale and delivery date had significant effects on price in most of the years; frame score and calves with horns affected price in 7 of 15 years; age and source verification influenced sale price in every year since source verification was introduced in 2005; and the auction service's progressive genetics program increased price during the 1 year that program was available. CONCLUSIONS AND CLINICAL RELEVANCE: Some management, marketing, and certified health initiatives have consistently increased the sale price of beef calves, and producers can increase the price of their calves by implementing these practices.

Asthma and serious psychological distress: prevalence and risk factors among US adults, 2001-2007.

BACKGROUND: For millions of adults, effective control of asthma requires a regimen of care that may be compromised by psychological factors, such as anxiety and depression. This study estimated the prevalence and risk factors for serious psychological distress (SPD) and explored their relationship to health-related quality of life (HRQOL) among adults with asthma in the United States. METHODS: We analyzed data from 186,738 adult respondents from the 2001-2007 US National Health Interview Survey. We calculated weighted average prevalence estimates of current asthma and SPD by demographic characteristics and health-related factors. We used logistic regression analysis to calculate odds ratios for factors that may have predicted asthma, SPD, and HRQOL. RESULTS: From 2001 to 2007, the average annual prevalence of current asthma was 7.0% and the average prevalence of SPD was 3.0%. Among adults with asthma, the prevalence of SPD was 7.5% (95% CI, 7.0%-8.1%). A negative association between HRQOL and SPD was found for all adults, independent of asthma status. A similar pattern of risk factors predicted SPD and the co-occurrence of SPD and asthma, although adults with asthma who reported lower socioeconomic status, a history of smoking or alcohol use, and more comorbid chronic conditions had significantly higher odds of SPD. CONCLUSION: This research suggests the importance of mental health screening for persons with asthma and the need for clinical and community-based interventions to target modifiable lifestyle factors that contribute to psychological distress and make asthma worse.