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Atypical femoral fracture (AFF) is a rare complication related to the use of bisphosphonates (BPs). Herein, we analyzed the risk factors and onset patterns of AFF using the Japanese Adverse Drug Event Report database and reported the findings. First, the independent risk factors for AFF were gender (female), high body mass index, and medical history of osteoporosis, arthritis, and systemic lupus erythematosus (SLE). Drug-related risk factors for AFF included BPs (i.e., alendronic acid, ibandronic acid, etidronic acid, zoledronic acid, minodronic acid, risedronic acid), denosumab, prednisolone, lansoprazole, rabeprazole, exemestane, letrozole, eldecalcitol, and menatetrenone. Therefore, it appears that AFF is influenced by a combination of patient backgrounds and drugs, and that the risk of developing AFF is particularly high in patients with fragile bones (e.g., osteoporosis, arthritis, and SLE). Second, in the analysis of AFF onset patterns, the onset of AFF from BPs and denosumab took a long time (>1 year) to develop. Analysis using a Weibull distribution showed wear-out failure-type AFF onset for BPs and denosumab, and both osteoporosis and cancer patients with long-term administration of these drugs showed a tendency to have an increased risk of onset. AFF developed earlier in osteoporosis patients with long-term administration of BPs and denosumab than in cancer patients.

A scoping review to identify methodological challenges when using routinely collected healthcare data for research.

The validity of the use of a subjective-objective indicator of health as a significant indicator of its association with the prevalence of coronary artery disease is shown in both domestic and foreign scientific literature. At the same time, the subjective-objective indicator of health, and first of all, the attitude to one's health, is recognized as an indicator of a lifestyle that establishes the interpretation of conventional risk factors for coronary artery disease and interest in preventive measures at the population level. Purpose: to determine the attitude towards one's health in the age range and in groups with and without coronary artery disease in an open population of a medium-urbanized city of Western Siberia in terms of gender. Material and methods. Cross–sectional studies were carried out in the framework of two cardiac screenings on unorganized subpopulations of men and women 25–64 years old in Tyumen (with responses 85.0 and 70.3 %, respectively). The isolation of various forms of coronary heart disease was carried out on the basis of standard epidemiological methods, the comparison group was defined as the absence of coronary heart disease. The attitude of the population to their health was established using a rigidly standardized WHO questionnaire MONICApsychosocial «Knowledge and attitude to the health». Results. In the open population of a moderately urbanized city of Western Siberia, with a predominance among women, a low level of attitude towards their health was established, the prevalence of low responsibility for their health in the gender aspect took place in the third, fourth and sixth decades of life. Negative attitudes towards their health among persons of both sexes were determined mainly in groups with CHD; in women, the tendency towards a decrease in responsibility for their health was more pronounced than in men. Conclusion. When planning a preventive program for the population of a medium-urbanized city of Western Siberia, taking into account the priority impact on the subjective-objective indicator of population health, the implementation of the population strategy will probably not be enough. Taking into consideration the obtained regularities of the growth of negative attitudes towards their health among women, especially in groups with the presence of coronary heart disease, along with the population strategy, it would be optimal to use a high-risk strategy.

New local linear estimators are proposed for a wide class of nonparametric regression models. The estimators are uniformly consistent regardless of satisfying traditional conditions of depen\-dence of design elements. The estimators are the solutions of a specially weighted least-squares method. The design can be fixed or random and does not need to meet classical regularity or independence conditions. As an application, several estimators are constructed for the mean of dense functional data. The theoretical results of the study are illustrated by simulations. An example of processing real medical data from the epidemiological cross-sectional study ESSE-RF is included. We compare the new estimators with the estimators best known for such studies., 30 pages, 8 figures

The year 2020 celebrated the tenth anniversary of the recognition of the Mediterranean Diet as Intangible Cultural Heritage of Humanity by the UNESCO Intergovernmental Committee. This event represented a milestone in the history of nutrition, as the Mediterranean diet was the first traditional food practice to receive such award. Since then, a lot has been discussed not only on the beneficial aspects of the Mediterranean diet, but also on its complex role as a lifestyle model that includes a set of skills, knowledge and intercultural dialogue. This process ended up with the recognition in 2019 of Mediterranean diet as a possibly universal model of healthy diet from the EAT-Lancet Commission. These concepts were widely debated at the 2019 "Ancel Keys" International Seminar, held in Ascea (Italy) (for more information see: www.mediterraneandietseminar.org) with the aim to stimulate interest and awareness of a young group of participants on the current problems inherent to the effective implementation of the Mediterranean diet. The present article collects the contributions of several lecturers at the Seminar on key issues such as methodological and experimental approach, sustainability, molecular aspects in disease prevention, future exploitation, without neglecting a historical view of the Seven Countries Study. From the Seminar conclusions emerged a still vibrant and modern role of Mediterranean diet. The years to come will see national and international efforts to reduce the barriers that limit adherence to Mediterranean diet in order to plan for multi-factorial and targeted interventions that would guide our populations to a sustainable healthy living. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Following the population aging in China, dramatic changes have been observed in the spectrum of diseases among Chinese residents. E.g., the incidence and prevalence of chronic diseases, such as cardiovascular, cerebrovascular, metabolic, and respiratory diseases, are constantly growing. Additionally, osteoporosis, sarcopenia, and chronic renal disease have gradually become common chronic diseases among the elderly. Chronic diseases in the elderly have ranked first in the spectrum of diseases among Chinese residents. Therefore, understanding the trends of main chronic diseases among Chinese residents and developing proactive countermeasures have become a major public health issue for China.

The aim of this study was to describe and compare the mean usual dietary intakes of adults with type 1 diabetes (T1D) and without diabetes living in Australia. Our hypothesis was that adults with T1D have similar dietary intake profiles to adults without diabetes. Data from the National Nutrition and Physical Activity Survey 2011-2012, which formed part of the Australian Health Survey 2011–13, were used and participants ≥18 years of age with T1D and without diabetes were included in the analyses. T1D status was assigned to participants who reported a diabetes diagnosis at age

Survival analysis is a set of methods for statistical inference concerning the time until the occurrence of an event. One of the main objectives of survival analysis is to evaluate the effects of different covariates on event time. Although the proportional hazards model is widely used in survival analysis, it assumes that the ratio of the hazard functions is constant over time. This assumption is likely to be violated in practice, leading to erroneous inferences and inappropriate conclusions. The accelerated failure time model is an alternative to the proportional hazards model that does not require such a strong assumption. Moreover, it is sometimes plausible to consider the existence of cured patients or long-term survivors. The survival regression models in such contexts are referred to as cure models. In this study, we consider the accelerated failure time cure model with frailty for uncured patients. Frailty is a latent random variable representing patients’ characteristics that cannot be described by observed covariates. This enables us to flexibly account for individual heterogeneities. Our proposed model assumes a shifted gamma distribution for frailty to represent uncured patients’ heterogeneities. We construct an estimation algorithm for the proposed model, and evaluate its performance via numerical simulations. Furthermore, as an application of the proposed model, we use a real dataset, Specific Health Checkups, concerning the onset of hypertension. Results from a model comparison suggest that the proposed model is superior to existing alternatives.

Background Disability is a vital public health issue for health care programs. Affluent countries usually prioritize disability-related research, while often it remains neglected in resource-poor countries like Nepal. The aim of this study was to make available a translated and culturally adapted version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring disability in the Nepalese population. Methods WHODAS 2.0 (12-items version) was translated into Nepali using a standard forward–backward translation protocol. Purposive and convenience recruitment of participants with psychiatric disabilities was done at the Psychiatry services in a tertiary care hospital. Age and gender-matched participants with physical disabilities were selected from the Internal Medicine department, and participants with no disability were recruited from their accompanying persons. A structured interview in Nepali including the translated WHODAS 2.0 was administered to all participants. Exploratory factor analysis and parallel analysis assessed the construct validity. Content validity was explored, and a quality of life instrument was used for establishing criterion validity. Reliability was measured via Cronbach alpha. Mann–Whitney test explored score differences between the disabled and non-disabled. Results In total, 149 persons [mean age: 40.6 (12.8); 43.6% males, 56.4% females; 61.7% disabled, 38.3% non-disabled] consented to participate. Parallel analysis indicated that a single factor was adequate for the Nepali WHODAS version that captured 45.4% of the total variance. The translated scale got a good Cronbach alpha (= 0.89). Satisfactory construct, content and criterion validity was found. The WHODAS total scores showed a significant difference between the disabled and non-disabled (U = 2002.5; p = 0.015). However, the difference between psychiatric and physical disabilities was not significant, which underscores that the scale is rating disability in general. Conclusion The one-factor structure of the translated and culturally adapted Nepali-version of WHODAS 2.0 showed acceptable validity and an adequate reliability. For epidemiological research purposes, this version of WHODAS 2.0 is now available for measuring global disability in Nepal.

The HIV pandemic and the spectrum of diseases associated with its syndrome (AIDS) were noted for the first time in the early 1980s in the United States, with cases of death from pneumonia associated with Kaposi's sarcoma. The epidemiological investigation carried out by different teams in the United States –but mainly focusing on the Centers for Disease Control and Prevention– is portrayed in the film And the band played on (1993), by Roger Spottiswoode. Almost 30 years after its release, the film is still iconic and closely portrays the events of the investigation. This article presents a detailed analysis of the research process, the bioethical issues involved, and the psychological factors that allows to analyze the group and social confrontations of the epidemiological event that marked a before and after in the 20th century. It is suggested to use the film as a teaching tool. La pandemia de VIH (virus de inmunodeficiencia humana) y el espectro de enfermedades de su síndrome (SIDA) se registran por primera vez a principios de los años 1980 en Estados Unidos, con casos de muerte por neumonías asociados con el sarcoma de Kaposi. La investigación epidemiológica llevada a cabo por distintos equipos en los Estados Unidos –haciendo foco principalmente en el Centro para el Control y Prevención de Enfermedades– aparece retratada en la película En el filo de la duda / And the band played on (1993), de Roger Spottiswoode. Casi 30 años luego de su estreno, la película es sumamente actual y retrata de manera muy ajustada los hechos sucedidos en la investigación. En este artículo se presenta un análisis detallado del proceso investigativo, las cuestiones bioéticas implicadas y los factores psicológicos que permiten analizar los enfrentamientos grupales y sociales del acontecimiento epidemiológico que marcó un antes y un después en el siglo XX. Se sugiere utilizar la película como herramienta docente.

Telomere length in early life has been recently associated with biological aging and development of negative consequences in later adult life. A relevant area of research has emerged to understand the factors that impact telomere length in children. We conducted a bibliometric analysis to track research output and identify global trends and gaps in the knowledge of telomere length in children. Bibliographic data were retrieved from the Web of Science database and then analyzed by using Bibliometrix R package. A total of 840 publications were yielded from 1991 to 2019. The references were prominently published in journals, with 20 high ranked journals contributing to 30% of literature on telomere length in children. The USA was the most productive country (35.7%), followed by Europe (12.1%), and Asia (11.9%). A knowledge map of telomere length in children through keyword analyses revealed that there were two potential main lines of research based on two different approaches: genomic research and epidemiological research. This study shows that telomere length in children is a topic of research that has gained significant relevance in the last decade. This bibliometric study may be helpful in identifying research trends and finding research hot spots and gaps in this research field.

Background and aims: Chronic kidney disease (CKD) is a public health challenge worldwide, with adverse consequences of kidney failure, cardiovascular disease (CVD), and premature death. The CKD leads to the end-stage of renal disease (ESRD) if late/not diagnosed. Competing risk modeling is a major issue in epidemiology research. In epidemiological study, sometimes, inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In these situations, competing risk analysis is preferred to other models in survival analysis studies. The purpose of this study was to describe the bias resulting from the use of standard survival analysis to estimate the survival of a patient with ESRD and to provide alternate statistical methods considering the competing risk. Methods: In this retrospective study, 359 patients referred to the hemodialysis department of Shahid Ayatollah Ashrafi Esfahani hospital in Tehran, and underwent continuous hemodialysis for at least three months. Data were collected through patient’s medical history contained in the records (during 2011-2017). To evaluate the effects of research factors on the outcome, cause-specific hazard model and competing risk models were fitted. The data were analyzed using Stata (a general-purpose statistical software package) software, version 14 and SPSS software, version 21, through descriptive and analytical statistics. Results: The median duration of follow-up was 3.12 years and mean age at ESRD diagnosis was 66.47 years old. Each year increase in age was associated with a 98% increase in hazard of death. In this study, statistical analysis based on the competing risk model showed that age, age of diagnosis, level of education (under diploma), and body mass index (BMI) were significantly associated with death (hazard ratio [HR] = 0.98, P < 0.001, HR = 0.99, P < 0.001, HR = 2.66, P = 0.008, and HR = 0.98, P < 0.020, respectively). Conclusion: In analysis of competing risk data, it was found that providing both the results of the event of interest and those of competing risks were of importance. The Cox model, which ignored the competing risks, presented the different estimates and results as compared to the proportional sub-distribution hazards model. Thus, it was revealed that in the analysis of competing risks data, the sub-distribution proportion hazards model was more appropriate than the Cox model.

We thank Dr. Karp for his interest [1] in our paper [2]. We agree on some points, but our theoretical description differs from his in ways leading to important divergences for teaching and practice. We also see a danger of overextending abstract theory (with its inevitable and extensive simplifications) into practice [3], especially when the practical questions are causal but the theory applied lacks an explicit, sound longitudinal causal model to address these questions. As we will explain, a defect in the “study base” theory Dr. Karp adopts as a foundational belief system is that it takes as a foundation a parameter affected by baseline risk factors—including exposure when that has effects on follow-up or disease. It consequently leads to biases and misconceptions of the sort documented elsewhere [4, 5] and below, which require a coherent theory of longitudinal causality to address. Our divergence from Dr. Karp thus raises the issue of the role of theory and methods in research, although matching serves to illustrate our points in a familiar epidemiologic context.

OBJECTIVE: Research on effects of pregnancy termination on women’s alcohol, tobacco, and other drug (ATOD) use suffers from methodological and conceptual problems. Improving on prior methodologies, this study examines changes in ATOD use over 5 years among women seeking terminations. METHOD: Data are from the Turnaway Study, a longitudinal study of 956 women seeking terminations at 30 U.S. facilities. Participants presented just below a facility’s gestational limit and received terminations (Near-Limits) or just beyond the limit and were denied terminations (Turnaways). Using mixed-effects logistic regression, we assessed differences in ATOD use over 5 years among Near-Limits and Turnaways. RESULTS: There were no differences in ATOD use before pregnancy recognition; 1 week after termination seeking, Turnaways had lower odds than Near-Limits of any and heavy episodic alcohol use (p < .001), but not alcohol problem symptoms, tobacco use, or other drug use. Although both groups increased in any alcohol use over time, Turnaways increased more rapidly. Neither group increased any other ATOD measures over time. Turnaways’ lower odds of heavy episodic alcohol use at 1 week after termination seeking were maintained throughout the subsequent 5 years. There was no differential change in problem alcohol use or in tobacco or other drug use over time, yet fewer Turnaways than Near-Limits reported problem alcohol symptoms 6 months through 3.5 years. CONCLUSIONS: There is no indication that terminating a pregnancy led women to increase heavy episodic or problem alcohol use or to increase tobacco or other drug use. Women denied terminations had temporary or sustained reductions in all alcohol measures, but not tobacco or other drugs, suggesting that relationships between pregnancy/parenting and ATOD differ across substances.

OBJECTIVE: Exposure to sexual assault results in ongoing harms for women. After an assault, some women engage in higher levels of externalizing behaviors, such as problem drinking, and others experience higher levels of internalizing dysfunction, such as symptoms of anxiety and depression. We sought to understand the role of premorbid factors on the different post-assault experiences of women. METHOD: We studied 1,929 women prospectively during a period of high risk for sexual assault (the first year of college): women were assessed in July before arriving at college and in April near the end of the school year. RESULTS: A premorbid personality disposition to act impulsively when distressed (negative urgency) interacted positively with sexual assault experience to predict subsequent increases in drinking behavior; a premorbid personality disposition toward internalizing dysfunction positively interacted with sexual assault experience to predict increased symptoms of anxiety and depression. CONCLUSIONS: Women with different personalities tend to experience different forms of post-assault consequences.

OBJECTIVE: The purpose of this study was to assess whether pregnant smokers have the same nicotine intake from cigarettes as a general population of smokers and whether the known lower daily cigarette consumption among pregnant smokers is associated with higher nicotine intake among pregnant smokers. METHOD: The study was a cross-sectional comparison of pregnant smokers and a general population of smokers in smoking cessation clinics. Participants were treatment-seeking pregnant (n = 476), nonpregnant female (n = 116), and male (n = 195) smokers who participated in two independent smoking cessation trials. Nicotine intake was measured as saliva cotinine/cigarette/kg body weight ratio. RESULTS: The mean saliva cotinine (μg/L)/cigarette/kg body weight (0.21, SD = 0.15) of pregnant smokers was similar to that of nonpregnant female smokers (0.24, SD = 0.14) and higher than that of male smokers (0.18, SD = 0.12, p = .002) despite a substantially lower number of cigarettes per day (pregnant smokers: 12, SD = 6; nonpregnant female smokers: 26.6, SD = 11.7; male smokers: 23.5, SD = 9.5, p < .001). Among pregnant smokers, saliva cotinine, as expected, increased in parallel with the number of cigarettes per day, but nicotine intake (cotinine/cigarette/kg body weight) was inversely associated with daily cigarette consumption (p < .001). No association between cigarettes per day and nicotine intake was observed in male and nonpregnant female smokers (p = .43). CONCLUSIONS: This secondary analysis showed that pregnant smokers’ nicotine intake was similar to that of a general population of smokers despite a lower cigarette consumption rate. Among pregnant smokers, lower daily cigarette consumption was associated with higher nicotine intake from cigarettes, suggesting compensatory smoking.

Background In most research projects budget, staff and IT infrastructures are limiting resources. Especially for small-scale registries and cohort studies professional IT support and commercial electronic data capture systems are too expensive. Consequently, these projects use simple local approaches (e.g. Excel) for data capture instead of a central data management including web-based data capture and proper research databases. This leads to manual processes to merge, analyze and, if possible, pseudonymize research data of different study sites. Results To support multi-site data capture, storage and analyses in small-scall research projects, corresponding requirements were analyzed within the MOSAIC project. Based on the identified requirements, the Toolbox for Research was developed as a flexible software solution for various research scenarios. Additionally, the Toolbox facilitates data integration of research data as well as metadata by performing necessary procedures automatically. Also, Toolbox modules allow the integration of device data. Moreover, separation of personally identifiable information and medical data by using only pseudonyms for storing medical data ensures the compliance to data protection regulations. This pseudonymized data can then be exported in SPSS format in order to enable scientists to prepare reports and analyses. Conclusions The Toolbox for Research was successfully piloted in the German Burn Registry in 2016 facilitating the documentation of 4350 burn cases at 54 study sites. The Toolbox for Research can be downloaded free of charge from the project website and automatically installed due to the use of Docker technology.

Hazardous drinking in the armed forces is a significant problem. Alcohol use motivations, known risk factors for problem drinking, have been underexplored in this population. Our study extends knowledge about drinking motives among current and former U.S. service members and provides recommendations on their utility in identifying alcohol-related problems by examining the factor structure of multidimensional drinking motives and their association to alcohol use.Post-9/11 separated service members and current reservists were recruited from 35 Oregon employers to participate in a workplace study of supervisor support. The resulting sample (N = 509; 84% male; mean age = 39) completed a baseline assessment, which included a comprehensive drinking motives assessment.Drinkers comprised 88% of the sample, with a mean Alcohol Use Disorders Identification Test (AUDIT) score of 5.4 (SD = 4.6); 23.9% scored 8 or more. The four-factor structure of the Drinking Motives Questionnaire-Revised, short form (DMQ-R-SF) was affirmed through confirmatory factor analysis. Internal drinking motives related to enhancement (positive) and coping (negative) were most predictive of alcohol use; coping motives were uniquely predictive of alcohol-related problems, when drinking quantity/frequency, as well as psychological distress, were controlled for. Coping motives also mediate the relationship between psychological distress and AUDIT scores. Results thus demonstrated the generalizability of the DMQ-R-SF motives measure for use with separated service members and reservists.Drinking motives, assessed by the DMQ-R-SF, represent reliable and important predictors of drinking and associated problems among service members. Inclusion of motivated drinking questions may enhance screening for alcohol-related problems among current and former service members.

Background Nontyphoidal Salmonella spp. constitute a major bacterial cause of food poisoning. Each Salmonella serotype causes distinct virulence to humans. Method A small cohort study was conducted to characterize several aspects of Salmonella isolates obtained from stool of diarrheal patients (n = 26) admitted to Phayao Ram Hospital, Phayao province, Thailand. A simple CRISPR 2 molecular analysis was developed to rapidly type Salmonella isolates employing both uniplex and high resolution melting (HRM) curve analysis. Results CRISPR 2 monoplex PCR generated a single Salmonella serotype-specific amplicon, showing S. 4,[5],12:i:- with highest frequency (42%), S. Enteritidis (15%) and S. Stanley (11%); S. Typhimurium was not detected. CRISPR 2 HRM-PCR allowed further classification of S. 4,[5],12:i:- isolates based on their specific CRISPR 2 signature sequences. The highest prevalence of Salmonella infection was during the summer season (April to August). Additional studies were conducted using standard multiplex HRM-PCR typing, which confirmed CRISPR 2 PCR results and, using a machine-learning algorithm, clustered the majority of Salmonella serotypes into six clades; repetitive element-based (ERIC) PCR, which clustered the serotypes into three clades only; antibiogram profiling, which revealed the majority resistant to ampicillin (69%); and test for extended spectrum β-lactamase production (two isolates) and PCR-based detection of bla alleles. Conclusion CRISPR 2 PCR provided a simple assay for detection and identification of clinically-relevant Salmonella serotypes. In conjunction with antibiogram profiling and rapid assay for β-lactamase producers, this approach should facilitate detection and appropriate treatment of Salmonellosis in a local hospital setting. In addition, CRISPR 2 HRM-PCR profiling enabled clustering of S. 4,[5],12:i:-isolates according to CRISPR 2 locus signature sequences, indicative of their different evolutionary trajectories, thereby providing a powerful tool for future epidemiological studies of virulent Salmonella serotypes.

Source at https://doi.org/10.1080/03009734.2018.1556754. We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants’ data, better return of funders’ investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

Background Nontyphoidal Salmonella spp. constitute a major bacterial cause of food poisoning. Each Salmonella serotype causes distinct virulence to humans. Method A small cohort study was conducted to characterize several aspects of Salmonella isolates obtained from stool of diarrheal patients (n = 26) admitted to Phayao Ram Hospital, Phayao province, Thailand. A simple CRISPR 2 molecular analysis was developed to rapidly type Salmonella isolates employing both uniplex and high resolution melting (HRM) curve analysis. Results CRISPR 2 monoplex PCR generated a single Salmonella serotype-specific amplicon, showing S. 4,[5],12:i:- with highest frequency (42%), S. Enteritidis (15%) and S. Stanley (11%); S. Typhimurium was not detected. CRISPR 2 HRM-PCR allowed further classification of S. 4,[5],12:i:- isolates based on their specific CRISPR 2 signature sequences. The highest prevalence of Salmonella infection was during the summer season (April to August). Additional studies were conducted using standard multiplex HRM-PCR typing, which confirmed CRISPR 2 PCR results and, using a machine-learning algorithm, clustered the majority of Salmonella serotypes into six clades; repetitive element-based (ERIC) PCR, which clustered the serotypes into three clades only; antibiogram profiling, which revealed the majority resistant to ampicillin (69%); and test for extended spectrum β-lactamase production (two isolates) and PCR-based detection of bla alleles. Conclusion CRISPR 2 PCR provided a simple assay for detection and identification of clinically-relevant Salmonella serotypes. In conjunction with antibiogram profiling and rapid assay for β-lactamase producers, this approach should facilitate detection and appropriate treatment of Salmonellosis in a local hospital setting. In addition, CRISPR 2 HRM-PCR profiling enabled clustering of S. 4,[5],12:i:-isolates according to CRISPR 2 locus signature sequences, indicative of their different evolutionary trajectories, thereby providing a powerful tool for future epidemiological studies of virulent Salmonella serotypes.

Population-based linkage of patient-level information opens new strategies for dental research to identify unknown correlations of diseases, prognostic factors, novel treatment concepts and evaluate healthcare systems. As clinical trials have become more complex and inefficient, register-based controlled (clinical) trials (RC(C)T) are a promising approach in dental research. RC(C)Ts provide comprehensive information on hard-to-reach populations, allow observations with minimal loss to follow-up, but require large sample sizes with generating high level of external validity. Collecting data is only valuable if this is done systematically according to harmonized and inter-linkable standards involving a universally accepted general patient consent. Secure data anonymization is crucial, but potential re-identification of individuals poses several challenges. Population-based linkage of big data is a game changer for epidemiological surveys in Public Health and will play a predominant role in future dental research by influencing healthcare services, research, education, biotechnology, insurance, social policy and governmental affairs.

OBJECTIVE: The purpose of this study was to examine the prevalence and covariates among emerging adults of riding with an impaired peer or older adult driver (RWI) because of marijuana (MJ), alcohol (ALC), or illicit drugs (ID). METHOD: Data were from Waves 4 (W4, N = 2,085) and 5 (W5, N = 2,116) of the NEXT Generation Health Study, collected in 2013–2014, 1 and 2 years after high school. W5 RWI was specified for substance-specific impaired peer and older adult (peer/older adult) drivers. Multinomial logistic regressions estimated W5 association of substance-specific RWI with W4 RWI, and W5 heavy episodic drinking, MJ use, and school/residence/work status. RESULTS: At W5, 33% of the participants reported RWI in the past year, including riding with ALC- (21%), MJ- (17%), and ID- (5%) impaired peer drivers and ALC- (2%), MJ- (4%), and ID- (0.7%) impaired older adult drivers. W4 RWI was associated with W5 RWI with impaired peer/older adult drivers for ALC- (adjusted odds ratio [AOR] = 4.28, 2.69) and MJ-RWI (AOR = 2.34, 3.56). W5 heavy episodic drinking was positively associated with W5 peer ALC-related RWI (AOR = 2.16) and peer/older adult MJ-related RWI (AOR = 2.38, 5.45). W5 MJ use was positively associated with W5 peer ALC-related RWI (AOR = 2.23), peer/older adult MJ-related (AOR = 10.89, 2.98), and peer/older adult ID-related (AOR = 9.34, 4.26) RWI. ID-related RWI was higher among those not attending 4-year college (AOR = 3.38), attending technology school (AOR = 16.23), living on their own (AOR = 6.85), or living on campus (AOR = 11.50). CONCLUSIONS: The high prevalence of RWI among emerging adults occurred mostly with ALC- or MJ-impaired peer drivers. The findings support the need for precisely tailored programs to prevent impaired driving according to substance use and age.

The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.

The EZOP Poland study was the first national survey in the country using methodology elaborated and tested in the World Mental Health Survey Initiative (WMH) enabling planning and implementation national epidemiological research on mental health and disorders associated with alcohol and other psychoactive substances. This paper aims to present an estimate of the number of children below 18 years of age whose parent suffered from mental and behavioural disorders due to alcohol use. Results of the study show that over 900 thousand children and young people under 18 have a parent with alcohol related disorders, which constitutes almost 13% of children of this age group. This percentage varies between 11% in the group of children under 4 years of age and nearly 15% in the group aged 13-17.

Introduction Apart from its medical dimension, the current problem with obesity has acquired social urgency. This serious lifestyle disease has a negative impact on a number of life processes in the body, causing distortions and damaging different structures. It also contributes to clinical complications, lowers the quality of life and reduces life expectancy. Apart from health-related consequences, it can bring such unfavourable results as social, mental and emotional disorders. Material and methods A systematic review of relevant epidemiological studies on obesity in Poland relative to selected countries in Europe and the world over the past 15 years was conducted. Also an attempt was made at forecasting the development of the obesity problem. Results The analysed results demonstrated that the percentage of obese people among the adult population of Poland was on the rise in the period under investigation. Taking into account the estimated growth rate, we can assume that the percentage of obese people in Poland right now might total 23.7% for men and 23.3% for women. If no changes are introduced in this respect, in 2020 we can expect a rise to, respectively, 30.3% and 27.3%, and in 2030 to 37% for men and 31.4% for women. Conclusions The increase in the percentage of obese people among the adult population in Poland is most likely connected with a positive energy balance. In comparison to other European countries Poland has the highest percentage of obese men and women.

The results of the epidemiological research obtained on the territory of Chuvash Republic are presonted. The prevalence of arterial hypertension among the patients, sufferring from chronic heart failure was analyzed. The representative method in Chuvash Republic had proven the high prevalence (100%) of arterial hypertension in patients with inveterate cardiac decompensation. It was also established that arterial hypertension III has the same prevalence rate among both the population and the representative group. However, the severity of arterial hypertension correlates with the severity of inveterate cardiac decompensation, while the prevalence rate of arterial hypertension III is much higher among men than among women.

This paper examines the effect of air pollution on labor supply in Lima, Peru. It focuses on fine particulate matter (PM2.5), an important pollutant for health according to the medical literature, and shows that moderate levels of pollution reduce hours worked for working adults. The research design takes advantage of rich household panel data in labor outcomes to address omitted variables and allows investigation of whether the response to air pollution is non-linear. The analysis finds that the effect of moderate pollution levels on hours worked is concentrated among households with susceptible dependents, that is small children and elderly adults, while the highest concentrations affect all households. This suggests that caregiving is likely a mechanism linking air pollution to labor supply at moderate levels. Further evidence of this mechanism is provided using DHS data on children morbidity for the same time period. Finally, no evidence is found of intra-household attenuation behavior. For instance, there is no re-allocation of labor across household members, and earnings decrease with air pollution.

Public health as a segment of healthcare naturally is healthcare in the public domain, as distinct from healthcare outside of society’s purview; and the care naturally is paramedical care together with medical care – hence the term ‘health,’ rather than ‘medicine,’ in ‘public health.’ Medicine encompasses community medicine in addition to clinical medicine. This segment of medicine inherently is public-health medicine, whereas clinical medicine falls under public health only to the extent that national health insurance has been introduced. Community medicine used to be focused on epidemics of communicable diseases; and a natural term for this segment of medicine thus was epidemiology. As the concerns in community medicine were extended to encompass endemic occurrence of communicable – and also of non-communicable – illnesses, ‘endemology’ could have been introduced as a term for this extension; but instead, the concept of epidemiology was expanded to community medicine in the thus-expanded meaning of it. Epidemiological research naturally is research to advance (the practice of) community medicine – of epidemiology, that is. This research includes ‘bench’ or ‘basic’ research aimed at the development of vaccines, for example; and it falls under various medical sciences instead of constituting a science unto itself. All of this presumably is natural and quite obviously true in the judgements of beginning students of epidemiological research, but it is here said for the troubling reason that concepts of epidemiology and epidemiological research different from these are endemic in today’s epidemiologic academia. The purpose of this chapter is to help the beginning student to find proper orientation in this academia.

This text focus, on a series of author's opinions, on the difficulties that the current system of regulation of ethics in research represents for the practice of the epidemiological research, in the Country. It introduces a few understandings concerning the present subject in the international literature, pointing out some of the most relevant themes and problems. It also examines part of the difficulties faced by Brazilian epidemiologists. The main topic developed in the article is the specificity of the science's reasoning that guides acting of the public health and epidemiology with repercussions for the practice of scientific research in this field, plenty different from the science's reasoning that preside medical practice and biomedical research. Hence the inadequacy of the ethical recommendations in force, all of them based on biomedical research, particularly at that with experimental design. It concludes with the indication that procedures adopted by the system of the ethics in research should be reviewed, adapting such procedures to the characteristics of different kinds of research.Este artigo reúne uma série de opiniões do autor sobre as dificuldades que o atual sistema de controle da ética em pesquisa representa para a prática da pesquisa epidemiológica no país. São apresentadas algumas posições referentes ao assunto presentes na literatura internacional, apontados alguns dos temas e problemas mais relevantes e discutidas algumas das dificuldades enfrentadas pelos epidemiologistas brasileiros. O argumento principal desenvolvido no artigo é a especificidade da lógica de atuação da saúde pública e da epidemiologia em seu interior com repercussões para a prática da pesquisa científica nesse campo, bastante diferente da lógica que preside a prática médica e a pesquisa biomédica. Daí a inadequação das recomendações éticas vigentes, todas elas baseadas na pesquisa biomédica, em particular, naquelas com desenho experimental. Conclui-se com a indicação da necessidade de revisão dos procedimentos adotados pelo sistema de revisão da ética em pesquisa adaptando-os às características dos diferentes tipos de pesquisa.

The design and analysis of research may cause systematic gender dependent errors to be produced in results because of gender insensitivity or androcentrism. Gender bias in research could be defined as a systematically erroneous gender dependent approach related to social construct, which incorrectly regards women and men as similar/different. Most gender bias can be found in the context of discovery (development of hypotheses), but it has also been found in the context of justification (methodological process), which must be improved. In fact, one of the main effects of gender bias in research is partial or incorrect knowledge in the results, which are systematically different from the real values.This paper discusses some forms of conceptual and methodological bias that may affect women’s health. It proposes a framework to analyse gender bias in the design and analysis of research carried out on women’s and men’s health problems, and on specific women’s health issues.Using examples, the framework aims to show the different theoretical perspectives in a social or clinical research context where forms of selection, measurement and confounding bias are produced as a result of gender insensitivity. Finally, this paper underlines the importance of re-examining results so that they may be reinterpreted to produce new gender based knowledge. Spanish Research Network on Health and Gender (RISG)

São enfocadas as dificuldades do instrumento epidemiológico em lidar com as questões postas pelos problemas contemporâneos de saúde, nos quais o conceito de estresse encontrará ampla difusão. Assim, apresenta-se uma discussão sobre o arcabouço teórico-conceitual da teoria do estresse e seus desdobramentos. Além disso, são assinaladas as limitações do método e dos modelos epidemiológicos disponíveis, ao abordarem: 1) manifestações cuja previsibilidade não é delimitável; 2) fenômenos que se encontram em níveis hierárquicos distintos. Nesses casos, a teorização subjacente à noção de risco, utilizada para explicar o adoecer referido ao nível individual, mostra-se insuficiente. A complexidade do processo saúde-doença demanda outro paradigma epistêmico que permita ao sujeito da ciência epidemiológica desenvolver outras formas de demarcar e compreender seu objeto.The article focuses on the difficulties the epidemiological instrument faces when dealing wih questions posed by contemporary health problems, in which the concept of stress finds broad diffusion. Thus there is a discussion about the theoretical-concepual framework of the theory of stress and its developments. Besides, the text points out the limitation of the method and of the available epidemiological models when they talk about: 1) manifestations whose predicability cannot be delimited; 2) phenomena placed in different hierarchic levels. In such cases, the theorization underlying the notion of risk, used to explain sickliness at the individual level proves to be insufficient. The complexity of the health-illness process demands another epistemological paradigm which allows the subject of the epidemiological research develop other ways of demarcating and understanding its object.

O crescente consumo de drogas no Brasil atinge uma população cada vez mais jovem, inclusive estudantes. Os levantamentos epidemiológicos realizados entre alunos brasileiros de educação básica concluíram que a grande maioria dos alunos nunca teve contato com drogas, exceto tabaco e álcool. Quanto aos usuários, é avaliado o modo como agem para que se possa adotar contramedidas. O presente estudo tem como objetivo investigar os canais que os estudantes usuários utilizam para adquirirem as drogas (forma e/ou local). Os resultados apontam em primeiro lugar os amigos, seguidos de traficantes, farmácias, outros e familiares. Conclui-se pela necessidade das escolas promoverem ações preventivas que reduzam os riscos do abuso de drogas entre os estudantes, adotando um conjunto de medidas que visem a uma educação para a saúde e para a qualidade de vida. Destaca-se a importância das contribuições do psicólogo da saúde, atuando na prevenção primária, secundária e terciária. The increase of drug consumption in Brazil is reaching young populations, including students. Epidemiological surveys carried out among basic education Brazilian students had concluded that the majority of students have never had contact with drugs (with the exception of tobacco and alcohol). The way drug users usually act has also been evaluated in order to counteract such behaviours. Accordingly, the objective of the present study is to investigate how drugs users obtain drugs. Results evinced that friends are ranked first followed by drug dealers, pharmacies and family. The study pinpoints the need that schools direct their efforts toward preventive actions to reduce the risk of drug abuse among students through the adoption of measures aimed at providing health education and the enhancement of quality of life. The important role of health psychology in all levels of prevention is acnowledged and discussed.

O crescente consumo de drogas no Brasil atinge uma população cada vez mais jovem, inclusive estudantes. Os levantamentos epidemiológicos realizados entre alunos brasileiros de educação básica concluíram que a grande maioria dos alunos nunca teve contato com drogas, exceto tabaco e álcool. Quanto aos usuários, é avaliado o modo como agem para que se possa adotar contramedidas. O presente estudo tem como objetivo investigar os canais que os estudantes usuários utilizam para adquirirem as drogas (forma e/ou local). Os resultados apontam em primeiro lugar os amigos, seguidos de traficantes, farmácias, outros e familiares. Conclui-se pela necessidade das escolas promoverem ações preventivas que reduzam os riscos do abuso de drogas entre os estudantes, adotando um conjunto de medidas que visem a uma educação para a saúde e para a qualidade de vida. Destaca-se a importância das contribuições do psicólogo da saúde, atuando na prevenção primária, secundária e terciária.The increase of drug consumption in Brazil is reaching young populations, including students. Epidemiological surveys carried out among basic education Brazilian students had concluded that the majority of students have never had contact with drugs (with the exception of tobacco and alcohol). The way drug users usually act has also been evaluated in order to counteract such behaviours. Accordingly, the objective of the present study is to investigate how drugs users obtain drugs. Results evinced that friends are ranked first followed by drug dealers, pharmacies and family. The study pinpoints the need that schools direct their efforts toward preventive actions to reduce the risk of drug abuse among students through the adoption of measures aimed at providing health education and the enhancement of quality of life. The important role of health psychology in all levels of prevention is acnowledged and discussed.

This report is structured in three parts. Part one is a summary document, including: (i) an executive summary (ii) an introduction; (iii) a review of core concepts of reintegration that will be referred to in this study; (iv) a meta-analysis of reintegration process¬es in the Great Lakes Region (GLR) vis-à-vis the conceptual discussion; and (v) conclusions to the summary document. Part two (annex one) comprises an in-depth review and analysis of data on the reintegration process-es of ex-combatants across the GLR. Part three (annex two) is an in-depth analysis of community dynamics across the GLR. In brief, part one of the study is a meta-analytical and knowledge-focused piece that reflects more broadly on the detailed analysis of the datasets presented in annexes one and two, therefore, this part can be read as a freestanding report. However, it’s worth noting that any reading will benefit significantly from exploring the detailed findings in annexes one and two.

Background: DataSHIELD (Data Aggregation Through Anonymous Summary-statistics from Harmonised Individual levEL Databases) has been proposed to facilitate the co-analysis of individual-level data from multiple studies without physically sharing the data. In a previous paper, we investigated whether DataSHIELD could protect participant confidentiality in accordance with UK law. In this follow-up paper, we investigate whether DataSHIELD addresses a broader range of ethics-related data-sharing concerns. Methods: Ethics-related data-sharing concerns of Institutional Review Boards, ethics experts, international research consortia and research participants were identified through a literature search and systematically examined at a multidisciplinary workshop to determine whether DataSHIELD proposes mechanisms which can address these concerns. Results: DataSHIELD addresses several ethics-related data-sharing concerns related to privacy, confidentiality, and the protection of the research participant's rights while sharing data and after the data have been shared. The data remain entirely under the direct management of the study that collected them. Data processing commands are strictly supervised, and the data are queried in a protected environment. Issues related to the return of individual research results when data are shared are eliminated; the responsibility for return remains at the study of origin. Conclusion: DataSHIELD can provide an innovative and robust solution for addressing commonly encountered ethics-related data-sharing concerns.

Today, many countries are increasing their efforts to ensure that all cancer patients receive the best possible care. Population-based cancer registries have adapted their registration to collect additional clinical variables to provide clinicians with unbiased population data on cancer treatment and survival. Taking several examples of epidemiological cancer research performed at the Geneva Cancer Registry, we aim to illustrate how cancer registries oversee the treatment and outcomes of cancer patients to help clinicians continually improve quality of care and prevent cancer deaths in the population.

The research was partially supported by appropriated state funds for research allocated to Sofia University (contract 112/2010), Bulgaria., Caries is the most widespread dental disease around the world. Thus, caries prevalence and intensity are repeatedly studied. Epidemiological research has been conducted covering 1636 persons from Bulgaria. A statistical model for the number of teeth damaged from caries, depending on the age and sex of the patients has been considered in this work., 2000 Mathematics Subject Classification: 62P10, 62J12.

Background This article of the International Epidemiological Association commissioned paper series stocktakes the population health and status of epidemiology in 21 of the 53 countries of the WHO European Region. By United Nations geographical classification, these countries belong to Eastern Europe, Western Asia and South-Central Asia. Methods Published data were used to describe population health indicators and risk factors. Epidemiological training and research was assessed based on author knowledge, information searches and E-mail survey of experts. Bibliometric analyses determined epidemiological publication outputs. Results Between-country differences in life expectancy, amount and profile of disease burden and prevalence of risk factors are marked. Epidemiological training is affected by ongoing structural reforms of educational systems. Training is advanced in Israel and several Eastern European countries. Epidemiological research is mainly university-based in most countries, but predominantly conducted by governmental research institutes in several countries of the former Soviet Union. Funding is generally external and limited, partially due to competition from and prioritization of biomedical research. Multiple relevant professional societies exist, especially in Poland, the Czech Republic and Hungary. Few of the region's 39 epidemiological academic journals have international currency. The number of epidemiological publications per population is highest for Israel and lowest for South-Central Asian countries. Conclusions Epidemiological capacity will continue to be heterogeneous across the region and depend more on countries' individual historical, social, political and economic conditions and contexts than their epidemiologists' successive efforts. National and international research funding, and within- and between-country collaborations should be enhanced, especially for South-Central Asian countries.

U radu su prikazani rezultati epidemiološkog istraživanja rasprostranjenosti nasilja nad djecom u Republici Hrvatskoj. Korišteni su dvoetapni probabilistički uzorci djece od 11, 13 i 16 godina, redovnih polaznika hrvatskih osnovnih i srednjih škola (N=3,644). Podaci su prikupljeni u sklopu međunarodnog istraživačkog FP7 projekta »BECAN – Balkan Epidemiological Study on Child Abuse and Neglect«. U istraživanju je korištena revidirana verzija ISPCAN Child Abuse Screening Tool - Children’s Version (ICAST-C). Analiza prevalencija pokazala je da su djeca u obitelji najviše izložena psihičkoj agresiji (5. razred 59,0%; 7. razred 77,1%; 2. razred srednje škole 82,5%). Slijedi tjelesno kažnjavanje (5. razred 56,1%; 7. razred 68,4%; 2. razred srednje škole 72,3%), tjelesno zlostavljanje (5. razred 26,2%; 7. razred 34,0%; 2. razred srednje škole 40,7%) i, kao najmanje prisutno, psihičko zlostavljanje (5. razred 22,8%; 7. razred 26,8%; 2. razred srednje škole 34,8%). Postoji povezanost među svim kategorijama nasilja nad djecom, a najveća korelacija je između tjelesnog kažnjavanja i tjelesnog zlostavljanja (od 0,599 do 0,674). Očevi i majke su najčešći počinitelji psihičke agresije, psihičkog zlostavljanja i tjelesnog kažnjavanja. Kod djece u 5. razredu najčešći počinitelj tjelesnog zlostavljanja je brat. Oni su podjednako često navedeni kao počinitelji nasilja u obitelji prema djevojčicama i dječacima. Sestre se češće pojavljuju kao počiniteljice psihičke agresije, tjelesnog kažnjavanja i tjelesnog zlostavljanja prema djevojčicama nego prema dječacima. Većini djece nije bilo teško odgovarati na pitanja (95,2%) i biti iskren o nasilnim iskustvima u obitelji (90,8%). Ipak, kod djece koja su iskazala da im je bilo teško odgovarati i biti iskren statistički značajno je više onih koja su doživjela nasilje u obitelji., The paper presents the results of epidemiological research on the extent of family violence on children in the Republic of Croatia. The research used a two-phase design with a probability sample of children aged 11, 13 and 16 regularly enrolled into Croatian primary and secondary schools (N=3.644). Data was obtained within the international research FP7 project “BECAN – Balkan Epidemiological Study on Child Abuse and Neglect“. The research used the revised version of ISPCAN Child Abuse Screening Tool - Children’s Version (ICAST-C). The prevalence analysis has shown that the most prevalent form of family violence on children is psychological aggression (5th grade 59.0%; 7th grade 77.1%; 10th grade 82.5%), followed by corporal punishment (5th grade 56.1%; 7th grade 68.4%; 10th grade 72.3%), physical abuse (5th grade 26.2%; 7th grade 34.0%; 10th grade 40.7%). The psychological abuse (5th grade 22.8%; 7th grade 26.8%; 10th grade 34.8%) reveals to be the least frequent. A correlation is observed among all categories of violence on children and the highest one being between corporate punishment and physical abuse (from 0.599 to 0.674). The most common perpetrators of psychological aggression, psychological abuse and corporal punishment are fathers and mothers. Among the 5th graders, the most common perpetrators of physical abuse are brothers. They are approximately equally common perpetrators of family violence towards girls and boys. Sisters more commonly occur as perpetrators of psychological aggression, corporal punishment and physical abuse on girls than on boys. Most children did not find answering questions (95.2%) and being honest about violent experiences within family (90.8%) difficult. However, among those children who revealed that they had found it difficult to answer and be honest, there is statistically significant higher number of those with experience of violence within the family. The full text of this article will be available at

Background: In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies. Methods: We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers. Results: From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities. Conclusions: Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

INTRODUCTION: To establish strategic priorities for the German national public health institute (RKI) and guide the institute's mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research. METHODS: We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups. RESULTS: 127 pathogens were scored. Eighty-six experts participated in the weighting; "Case fatality rate" was rated as the most important criterion. Twenty-six pathogens were ranked in the highest priority group; among those were pathogens with internationally recognised importance (e.g., Human Immunodeficiency Virus, Mycobacterium tuberculosis, Influenza virus, Hepatitis C virus, Neisseria meningitides), pathogens frequently causing large outbreaks (e.g., Campylobacter spp.), and nosocomial pathogens associated with antimicrobial resistance. Other pathogens in the highest priority group included Helicobacter pylori, Respiratory Syncytial Virus, Varicella zoster virus and Hantavirus. DISCUSSION: While several pathogens from the highest priority group already have a high profile in national and international health policy documents, high scores for other pathogens (e.g., Helicobacter pylori, Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings. peerReviewed

This paper reviews the literature on the development consequences of internal armed conflict and state fragility and analyzes the relationship using data from World Development Indicators, Ukraine Corporate Development Project UCDP/Peace Research Institute of Oslo (PRIO) Armed Conflict Data (ACD), and World Bank state fragility assessments. Our main focus is on a set of development indicators that capture seven of the Millennium Development Goals, but the author also look briefly into the effect of conflict and fragility on growth, human rights abuses, and democratization. The author analyze these relationships using a variety of methods, averages by conflict and fragility status; cross-sectional regression analyses of change in each indicator over the time frame for which we have data; fixed-effects regression analyses of the impact on each indicator for each five-year period 1965-2009; as well as occasional panel time series models and matching techniques. In section two, the author summarizes the methodological choices and presents our conflict data. Section three summarizes the results of our analysis. Finally, section four analyzes the effects of internal armed conflict on the attainment of the individual Millennium Development Goals (MDGs).

This text focus, on a series of author's opinions, on the difficulties that the current system of regulation of ethics in research represents for the practice of the epidemiological research, in the Country. It introduces a few understandings concerning the present subject in the international literature, pointing out some of the most relevant themes and problems. It also examines part of the difficulties faced by Brazilian epidemiologists. The main topic developed in the article is the specificity of the science's reasoning that guides acting of the public health and epidemiology with repercussions for the practice of scientific research in this field, plenty different from the science's reasoning that preside medical practice and biomedical research. Hence the inadequacy of the ethical recommendations in force, all of them based on biomedical research, particularly at that with experimental design. It concludes with the indication that procedures adopted by the system of the ethics in research should be reviewed, adapting such procedures to the characteristics of different kinds of research. Este artigo reúne uma série de opiniões do autor sobre as dificuldades que o atual sistema de controle da ética em pesquisa representa para a prática da pesquisa epidemiológica no país. São apresentadas algumas posições referentes ao assunto presentes na literatura internacional, apontados alguns dos temas e problemas mais relevantes e discutidas algumas das dificuldades enfrentadas pelos epidemiologistas brasileiros. O argumento principal desenvolvido no artigo é a especificidade da lógica de atuação da saúde pública e da epidemiologia em seu interior com repercussões para a prática da pesquisa científica nesse campo, bastante diferente da lógica que preside a prática médica e a pesquisa biomédica. Daí a inadequação das recomendações éticas vigentes, todas elas baseadas na pesquisa biomédica, em particular, naquelas com desenho experimental. Conclui-se com a indicação da necessidade de revisão dos procedimentos adotados pelo sistema de revisão da ética em pesquisa adaptando-os às características dos diferentes tipos de pesquisa.

São enfocadas as dificuldades do instrumento epidemiológico em lidar com as questões postas pelos problemas contemporâneos de saúde, nos quais o conceito de estresse encontrará ampla difusão. Assim, apresenta-se uma discussão sobre o arcabouço teórico-conceitual da teoria do estresse e seus desdobramentos. Além disso, são assinaladas as limitações do método e dos modelos epidemiológicos disponíveis, ao abordarem: 1) manifestações cuja previsibilidade não é delimitável; 2) fenômenos que se encontram em níveis hierárquicos distintos. Nesses casos, a teorização subjacente à noção de risco, utilizada para explicar o adoecer referido ao nível individual, mostra-se insuficiente. A complexidade do processo saúde-doença demanda outro paradigma epistêmico que permita ao sujeito da ciência epidemiológica desenvolver outras formas de demarcar e compreender seu objeto. The article focuses on the difficulties the epidemiological instrument faces when dealing wih questions posed by contemporary health problems, in which the concept of stress finds broad diffusion. Thus there is a discussion about the theoretical-concepual framework of the theory of stress and its developments. Besides, the text points out the limitation of the method and of the available epidemiological models when they talk about: 1) manifestations whose predicability cannot be delimited; 2) phenomena placed in different hierarchic levels. In such cases, the theorization underlying the notion of risk, used to explain sickliness at the individual level proves to be insufficient. The complexity of the health-illness process demands another epistemological paradigm which allows the subject of the epidemiological research develop other ways of demarcating and understanding its object.

Проведено аналіз захворюваності на різні види лейкемій населення Житомирської області протягом 15 років після аварії на ЧАЕС. Порівнювались показники в радіаційно забруднених та так званих «чистих» районах. Спостерігався певний ріст захворюваності на гострі лейкемії в області в 1990-му році. В подальші роки цей показник стабілізувався та суттєво не відхилявся від рівня. В потерпілих районах показники захворюваності на різні види лейкемій суттєво не відрізнялись від відповідних показників «чистих» районів., Проведен анализ заболеваемости различными видами лейкемий населения Житомирской области в течение 15 лет после аварии на ЧАЭС. Сравнивались показатели в радиационно загрязнённых и так называемых «чистых» районах. Наблюдался определённый рост заболеваемости острыми лейкемиями в области в 1990-м году. В последующие годы этот показатель стабилизировался и существенно не отклонялся от уровня. В пострадавших районах показатели заболеваемости различными видами лейкемий существенно не отличались от соответствующих показателей в «чистых» районах., The authors analyze the sickness rate of various types of leukemia in the Zhytomyr region within 15 years after the Chernobyl accident and compare the indices in the contaminated and so-called «clean areas». In 1990 a certain growth is acute leukemia cases in the region was observed. In the following years this index stabilized and did not differ much from the spontaneous level. In the contaminated areas the indices of sickness rate of various types of leukemia did not essentially differ from the corresponding indices in the «clean areas».

Summary Aim The aim of our study was to describe investigate and association between improved glycaemic control on quality of life (QoL) during 1 year of treatment in a sample of 94 Type 2 diabetic patients referred for insulin therapy to an outpatient department (OPD). Treatment was aimed at achieving acceptable glycaemic control by means of maximizing oral therapy, if necessary switching over to insulin therapy, and information and education provided by a diabetes specialist nurse and dietitian. Methods QoL was measured using a disease-specific (Diabetes Health Profile (DHP)) and a generic questionnaire (RAND-36). After 1 year the medical examination and QoL measurements were repeated. The association between 1-year changes in QoL and achievement of good metabolic control (final glycosylated haemoglobin (HbA1c) ≤ 8%), switch to insulin therapy, and presence of hyperglycaemic complaints at baseline was analysed after adjustment for appropriate confounders. Results After 1 year, mean HbA1c was reduced from 10.4% to 7.8%. Also QoL improved in the total group. Patients who achieved good glycaemic control after 1 year (61%) improved in a similar manner as the others. Patients switched over to insulin (65%) improved in a similar manner as the others, but at the final examination they experienced more problems with social functioning and pain. Patients with hyperglycaemic complaints at baseline (49%) improved more in QoL than those without, especially in physical functioning, vitality and health change, but at the final examination still scored lower on a majority of the DHP and RAND-36 dimensions. Conclusion Symptoms of hyperglycaemia predict the strength of an association between improvements of glycaemic control and QoL. Diabet. Med. 16, 23–30 (1999)

The planning of eye care programmes requires data on the prevalence and causes of blindness. Unfortunately, programme planning is often hampered by the lack of data, because no surveys have been conducted in the area or the surveys are too old to be relevant. Programme planners are often reluctant to plan surveys, as they are believed to be expensive, time-consuming, and complicated. The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapid survey methodology that can provide data on the prevalence and causes of blindness. So far, RAAB has been successfully undertaken in Kenya,1 Bangladesh,2 the Philippines, Botswana, Rwanda, Mexico, and China (personal communication). RAAB is an updated and modified version of the Rapid Assessment of Cataract Surgical Services (RACSS).