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The logistical and operational challenges to improve public health practice capacity across Africa are well documented. This report describes Kenya's Field Epidemiology and Laboratory Training Program's (KFELTP) experience in implementing frontline public health worker training to transfer knowledge and practical skills that help strengthen their abilities to detect, document, respond to, and report unusual health events. Between May 2014 and May 2015, KFELTP hosted five training courses across the country to address practice gaps among local public health workers. Participants completed a 10-week process: two 1-week didactic courses, a 7-week field project, and a final 1-week course to present and defend the findings of their field project. The first year was a pilot period to determine whether the program could fit into the existing 2-year KFELTP model and whether this frontline-level training would have an impact on local practice. At the end of the first year, KFELTP certified 167 frontline health workers in field epidemiology and data management. This paper concludes that local, national, and international partnerships are critical for improving local public health response capacity and workforce development training in an African setting. [ABSTRACT FROM AUTHOR]

The ethics and scientific integrity of biomedical and public health research requires that researchers behave in appropriate ways. However, this requires more than following of published research guidelines that seek to prevent scientific misconduct relating to serious deviations from widely accepted scientific norms for proposing, conducting, and reporting research (e.g., fabrication or falsification of research data or failures to report potential conflicts of interest). In this paper we argue for a broader account of scientific integrity, one consistent with that defended by the United States Institute of Medicine, involving a commitment to intellectual honesty and personal responsibility for one's actions as a researcher and to practices consistent with the responsible conduct of research and protection of the research participants. Maintaining high standards of ethical and scientific integrity helps to maintain public trust in the research enterprise. An increasing number of authors have pointed to the importance of mentoring and education in relation to the responsible conduct of science in preventing transgressions of scientific integrity. Just like in clinical research and biomedicine, epidemiologists and other public health researchers have the responsibility to exhibit and foster the very highest standards of scientific integrity. [ABSTRACT FROM AUTHOR]

The world is currently experiencing two major demographic transitions: the ageing of populations, particularly in low and middle income countries, and urbanization. This paper briefly summarizes current theories on how the urban environment may influence the health and quality of life of an older person, reviews epidemiologic studies that have investigated this relationship, and highlights urban initiatives that foster active and healthy ageing. The review identified an extensive body of research consistent with an association between the health of an older person and the physical, social and economic environment in which they live. However, most research in this field has been cross-sectional, and interpretation has been difficult due to numerous methodological limitations, particularly the risk of social selection biases. More recently, a growing number of longitudinal studies have identified associations consistent with previous cross-sectional research, adding weight to these findings. In the last two years alone, at least thirteen new longitudinal studies examining these issues have been reported, with ten having positive findings. Unfortunately, few of these studies can yet point to specific pathways that may be amenable to intervention. Concurrent with this research, a number of sizable programmes have been developed to make urban environments more supportive of older people. Both theory and the epidemiologic evidence appear to justify the optimism of these initiatives, although little evaluation has yet been undertaken of their impact. [ABSTRACT FROM AUTHOR]

Neighbourhood and health research often relies on personal location data (e.g., home address, daily itineraries), despite the risks of geoprivacy breaches. Thus, geoprivacy is an important emerging topic, contemplated in international regulations such as the General Data Protection Regulation. In this mini-review, we briefly assess the potential risks associated with the usage of personal location data and provide geoprivacy-preserving recommendations to be considered in epidemiological research. Risks include inference of personal information that the individual does not wish to disclose, reverse-identification and security breaches. Various measures should be implemented at different stages of a project (pre-data collection, data processing, data analysis/publication and data sharing) such as informed consent, pseudo-anonymization and geographical methods. [ABSTRACT FROM AUTHOR]

The Epidemic Intelligence Service officers (EISOs) at the National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR) respond to public health outbreaks, assist public health surveillance, and recommend public health actions. We summarize the breadth of work done by EISOs assigned to NCEH/ATSDR during 2006-2015. We used the Web of Science, Scopus, and PubMed databases to identify articles authored by the EISOs, number and types of epidemiologic assistance field investigations (Epi-Aids), and interviewed NCEH/ATSDR programs with EISO assignees. The largest number of NCEH/ATSDR EISO publications (n = 61) and Epi-Aids (n = 110) related to toxic chemicals (23 and 37, respectively), followed by natural disasters and those caused by humans (19 and 25, respectively), extreme temperature-related illness (9), and chronic diseases (8). The investigations raised awareness, identified risk factors and public health needs, and introduced better prevention and protection measures for human health. Through field investigations and other technical assistance, NCEH/ATSDR provided leadership and staff scientists to assist in the field, as well as knowledge transfer to local, state, territorial, and international health departments. [ABSTRACT FROM AUTHOR]

Background: This Policy Brief aims to contribute to the debate on the resilience of the healthcare systems during the pandemic by discussing whether mortality indicators are appropriate for assessing resilience or whether other statistics should be employed. Evidence: During the first wave of the COVID-19, much emphasis was placed on case-fatality rates to offer a preliminary assessment of the resilience of healthcare systems. However, these statistics are often biased and do not consider the real figure of the population that has been infected. Policy Options and Recommendations: Comparing data obtained with different approaches based on statistical inference and large-scale serological survey, the brief highlights, that great care must be taken when using case-fatality data, which in the absence of careful analysis, can lead to erroneous conclusions. Conclusion: Using case-fatality rate gives us no sounding information about the real capability of healthcare systems to save lives during the pandemic. However, even in the absence of detailed epidemiological data new advancements in statistical methods can be useful to provide a more sounding evaluation of the resilience of the healthcare systems. [ABSTRACT FROM AUTHOR]

The epidemiology of schizophrenia in developing countries, and especially in Africa, is controversial. One of the major findings of the World Health Organization multisite studies of schizophrenia conducted during the 1970s-1990s was that outcome of schizophrenia was better in developing countries. More recent research suggests this may not be the case in contemporary Africa. Rapid urbanization, industrialization, migration, conflict and ongoing poverty and deprivation characterize most of sub-Saharan Africa in recent decades; and it is likely that these potent risk factors for psychosis have contributed to shifts in the social epidemiology of psychosis and schizophrenia in that continent. In studying the epidemiology of schizophrenia, it is also necessary to examine evidence on first-episode psychosis (FEP) since it is often difficult to confirm a diagnosis of schizophrenia at onset. The author reviews nearly 50 years of epidemiological research on psychosis and schizophrenia in Africa; and argues that novel and flexible methods are required in contemporary efforts to study schizophrenia in the region. Specific contexts require specific approaches that are relevant and sensitive to local political, socio-economic and cultural conditions and dynamics. The future role of social epidemiology in helping clarify the burden, risk factors and natural history of schizophrenia within Africa depends largely on its success in integrating classic approaches with novel methods that are relevant to the specific socio-economic, political and cultural transformations taking place on that continent. [ABSTRACT FROM AUTHOR]

In the United States in 1948, the newly formed National Heart Institute (NHI) responded to what its data showed as a rising tide of coronary heart disease (CHD) by underwriting new approaches to the elucidation of chronic disorders. In the process, it funded the application of epidemiology, previously almost exclusively concerned with communicable disease, to study CHD. With federal encouragement, CHD epidemiologists enriched research designs, helped develop the randomized controlled trial, and played a pioneering role in chronic disease prevention at the individual and population levels. While government funding was critical to the evolution of this rich scientific work, a vibrant epidemiological imagination was able to capitalize on decades of national political commitment to chronic disease research. Epidemiologists developed longitudinal studies meant to determine the relationship between well-measured clinical variables and subsequent CHD events. Here, consistent associations within and across populations, eventually reinforced by analyses of pooled data from multiple cohort investigations, demonstrated the existence of well-founded risk factors, but left open the question of causal inference based on observed relationships. After substantial ambivalence, the U.S. government, under pressure from epidemiologists, committed to an agenda of clinical trials to test that proposition. In addition, the results of the cohort studies elicited a demand by epidemiologists for a broader, population-wide approach, testing whether community-level models of risk factor modification through broad cultural change would demonstrate a reduction in the probability of disability and premature death from heart attack. To tell the story of the community studies and to analyze outcomes, we focus on the Minnesota Heart Health Program and the Finnish North Karelia Project. From the North Karelia experience, we find that health promotion campaigns in communities at very high risk of disease, where the population lives in traditional patterns and considerable poverty and is also unsophisticated in health knowledge and behaviors, are more likely to achieve major and measurable population effects. We argue that as chronic disease rates rise globally, and CHD rates increase in lower- and middle-income nations, as they have over the past several decades, population-level prevention interventions have become particularly relevant. But it remains to be seen whether the international community, prodded by its member states, can successfully reproduce the urgency and agenda-setting that sparked the successful epidemiologic and public health interventions in the affluent countries in the decades after World War II. [ABSTRACT FROM AUTHOR]

Mediterranean-type diet patterns are consistently associated with reduced risk for cardiovascular disease, diabetes, and cancer in the general population. In contrast, several randomized controlled trials (RCTs) focusing on nutrient supplements have shown no or adverse long-term effects on long-term chronic disease. Food in its natural form is a nonrandom mixture of numerous molecules, orchestrated evolutionarily to maintain the life of the organism being eaten. Food synergy assumes that the biologically determined combination of nutrients and other bioactive substances found in food plays a concerted role in influencing health. Coupled with reduced risk in the Mediterranean-type diet pattern, food synergy implies that the concerted action of nutrients and other bioactive substances in fruit, vegetables, whole grain cereals, nuts, and legumes is beneficial for health. The assumption that single molecules work in isolation as they work in food violates the food synergy concept of concerted action and often leads to a partial picture. Public health nutrition strategies that focus on single nutrients have led to a flourishing diet supplement industry and advice to the public to eat low-fat diets. The latter is questionable in two respects: not all fats are equal, and industry efforts to comply spun-off products high in refined carbohydrates. It is time to rethink the research paradigm concerning diet and health. Reductionist research, though valuable, focuses on partial pathways, rather than the whole system integrating a lifetime of food intake with the long-term health of intact humans. Epidemiology provides this information, but is subject to residual confounding. RCTs are useful, but RCTs of food differ fundamentally from RCTs of drugs; for example, in terms of blinding, long-term adherence, and specificity of the reference treatment. All research inferences are most secure when based on convergent evidence from multiple research approaches. A balanced approach is therefore needed in nutrition research. [ABSTRACT FROM AUTHOR]

Public health education in Bulgaria has developed strong traditions since the introduction of medical education in the country at the beginning of the 20th century. In the periods before and during the socialist regime, public health training suffered from a lack of integration and comprehensive epidemiological studies, insufficient training in management, and limited involvement of non-medical professionals. During the transition to a market economy after 1989, changes in the national context and the acceptance of modern European trends in health and educational policy became a solid base for further reform of public health education on all levels: undergraduate, postgraduate, and continuing education. Four new academic entities (faculties) for public health training were created in Bulgarian medical universities. The new faculties offering bachelors', masters' and doctoral degree programmes provided the basis for further expansion of public health education and research advancement. [ABSTRACT FROM AUTHOR]

The strengthening of health systems is becoming increasingly recognized as necessary for the achievement of many objectives promoted or supported by global public health initiatives. Key within the effort to strengthen health systems is the development of a well-prepared, skilled, and knowledgeable public health workforce. Over 60 years ago, the United States Centers for Disease Control and Prevention (CDC) began the first training program in applied epidemiology, the Epidemic Intelligence Service (EIS), a two-year, in-service training program in epidemiology and public health practice. Since 1951, the EIS has produced well-trained and highly qualified applied or field epidemiologists, many of whom later became leaders within the US public health system. In 1980, the CDC began assisting other countries to develop their own field epidemiology training programs (FETPs), modeling them after the highly successful EIS program. FETPs differ from other training programs in epidemiology in that: (1) they are positioned within Ministries of Health and the activities of the residents are designed to address the priority health issues of the Ministry; (2) they stress the principle of training through service; and (3) they provide close supervision and mentoring by trained field epidemiologists. While FETPs are designed to be adaptable to the needs of any given country, there exist many fundamental similarities in the skills and knowledge required by public health workers. Recognizing this, CDC developed a standard core FETP curriculum that can be adapted to any country's needs. Countries can further customize FETP trainings to meet their specific needs by adding specialized "tracks" or by targeting different audiences and levels of the health system. Although FETPs require substantial investments in time and resources as well as significant commitment from ministries, CDC's vision is that every country will have access to an FETP to help build its public health workforce and strengthen its public health systems. [ABSTRACT FROM AUTHOR]

When I was a medical student, there were few lectures on public health at our university and such was true at most. The focus was on the treatment of individual patients with limited regard for the problems of the community. But as time has passed, there has been increasing concern about the population as a whole and approaches that might be appropriate for prevention of both acute and chronic diseases, for containing the spread of infection and for fostering healthy lifestyles. Many disciplines are involved but epidemiology, being the primary discipline of public health, lends itself well to serving as a common platform in joining all the disciplinary fields. Such was the case with the smallpox eradication program. The lessons learned from this experience are very relevant to current and future issues in public health. This is undoubtedly the most exciting time in history to enter the field of public health--so much is changing and so many new opportunities are presenting as the importance of population-based public health is increasingly perceived by governments, universities, and the community as a whole. The experience of working on the eradication of smallpox was a major development in my career as it was for many colleagues who served with me. I am pleased to be able to share this experience with a new generation, which faces both enormous challenges and opportunities in disease control and health promotion. [ABSTRACT FROM AUTHOR]

Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the lifecourse also has implications for the conduct of research on adult risk factors for disease. We review alternative conceptual models that describe how the timing of risk factor exposure relates to the development of disease. We propose some expansions of lifecourse models to improve their relevance for research on adult chronic disease, using the relationship between education and adult cognitive decline and dementia as an example. We discuss the important implications each of the lifecourse conceptual models has on study design, analysis, and interpretation of research on aging and chronic diseases. We summarize several research considerations implied by the lifecourse framework, including: advantages of analyzing change in function rather than onset of impairment; the pervasive challenge of survivor bias; the importance of controlling for possible confounding by early life conditions; and the likely heterogeneity in responses of adults to treatment. [ABSTRACT FROM AUTHOR]

The New Public Health is a contemporary application of a broad range of evidencebased scientifi c, technological, and management systems implementing measures to improve the health of individuals and populations. Its main objectives are the political and practical application of lessons learned from past successes and failures in disease control and the promotion of preventive measures to combat existing, evolving and re-emerging health threats and risks. We address present and anticipated health problems in a complex world with great inequalities with specifi c targets which would help to achieve higher standards of health and a more just and socially responsible distribution of resources. We present some examples of achievements in public health and clinical medicine, particularly from the past half century, that have resulted in improved disease control and increased health and longevity for populations. Many remaining challenges must be overcome in order to reduce the toll of avoidable morbidity and mortality and to achieve improved and equitable health nationally and internationally. The tools at our disposal today are much more effective than they were even just ten years ago. Promoting wider application of these tools and greater awareness of achievements and failures in public health will improve our capacity to affect greater change in population health in the future. The New Public Health is a moving target, as the science and practice of public health grow in strength. It is relevant to all countries, developing, transitional, or industrialized, all facing different combinations of epidemiologic, demographic, economic and health systems challenges. A greater understanding of these issues is vital to both a European and a wider audience of policy makers, educators, students, health systems managers, and practitioners of public health to address these challenges. [ABSTRACT FROM AUTHOR]