Epidemiology and Public Health

Epidemiology and Public Health

  • Rohit P Ojha added an answer:
    What are the text books that you recommend to use in teaching epidemiology in post graduate programs?
    Please keep suggestions to books written in English language.
    Rohit P Ojha · St. Jude Children's Research Hospital
    Similar to a few other respondents, I support the use of "Modern Epidemiology" by Rothman, Greenland, and Lash for doctoral students. In addition, I suggest "Interpreting Epidemiologic Evidence: Strategies for Study Design and Analysis" by Savitz as a standard textbook for graduate and doctoral students.
  • Ana-Maria Ciobotaru added an answer:
    Hello everyone...
    Good to see like minded people on the board discussing public health. I belong to a developing country where public health training is in a nascent stage. So, I keep looking for online courses where I can upgrade my skills. I came across one such course by John Hopkins, which I would like to share with the group. The link is http://globaltobaccocontrol.org/. You can register for the course free of cost and the content is quite good. It would be particularly useful to the guys dealing with dental public health. If anyone knows other good online courses, kindly let me know....
    Ana-Maria Ciobotaru · University of Bucharest
    hy, on this link https://iversity.org/ also are some free courses.
  • Saban Tekin added an answer:
    What is being done in your country concerning compartmentalization of health science studies; to control diseases that involve human and animal hosts?
    The study of health sciences is often compartmentalized: human diseases, live-stock diseases, wild animal diseases. Some of us grew up thinking that doctors were responsible for human health, and vets for animal health.
    But for the past decade, we have had severe diseases that involve both human and animal hosts. In Malaysia, we had the fear of H1N1 or swine flu.
    What is being done in your country or institution concerning this compartmentalization of health science studies? What innovative collaborations are being put in place to control diseases that involve human and animal hosts?
    Saban Tekin · TUBITAK Marmara Research Center
    Yes indeed the study of health sciences is generally compartmentalized in Turkey as you mention. However, stuation is changing that basic life scientist doing interesting an very important studies in health sciences. In addition, colloboration between scientists in health science and life sciences will limit compartmentalisation. In this way the biology of human and animals are well understood to solve problem in health sicences.
    If national and international regulatory and grant organisations promote or force the colloboration of scientists in health and life sciences, this problem will disappear and we will find or reach better solutions of problems sooner than today in health sciences.
  • Sivanandam S. added an answer:
    Can "Electrolipolysis of the abdomen" prevent diabetes type two?
    Electrolipolysis is said cause a reduction in the amount or the appearance of fat and the reduction of the number of adipocytes. So, maybe it causes reduction of insulin resistance, and finally prevention of diabetes type two?
    Sivanandam S. · SRM University
    The electrolipolysis of the abdomen alone will not prevent type 2 diabetes but this procedure may either decrease the insulin resistance to a considerable level or it may delay the onset. The tissue cells present at all of the body region has to be involved in the physical activity to increase the insulin sensitivity.

    The usage of electrolipolysis method has to be carefully examined for every individual for its various side effects. This method could be suggested only for an exceptional subjects who could not able to carry out their physical activity.

    The natural physical activity like brisk walking, swimming and non-weight bearing exercises not only increases the insulin sensitivity but also improve the performance of the other physiological functions like respiration, increased blood perfusion to the extremities, relieve of mental stress and also it greatly enhances the self confidence of the individual.

  • Karen Gold added an answer:
    Can anyone recommend me literature on the "perception of home based health care services by clients (patients).
    To find how PLWHA perceive home based care services.
    Karen Gold · Quanta Scientific, Washington, DC
    I believe that this AHRQ research has a patient evaluation component for home health care.
  • Pitchai Arumugam added an answer:
    Is it necessary to include statisticians in the institutional research and ethical committee for reviewing a manuscript and research proposal?
    Several institutions from developing countries like Nepal don't have a single statistician or any personel from community medicine in the research and ethical committee of the medical institution. Finally there will be a poorly conducted trial. Is it correct?
    Pitchai Arumugam · Sri Muthukumaran Medical College And Research Institute
    Most of the researchers are not having the statistical back ground. In my experience i have met most of the researchers with out knowing what is random sample, what is confidence interval and what is level of significance.At this context it is very much essential the statistician must be included as a member in both Research and Ethics committee of the institution. The humble advice to the statistician to equip them selves for guiding them properly.in an appropriate manner. Most of the researchers' intuition about the results is significant. That attitude may be evaded if the statistician is able to remove the bottle necks of research.
  • Matthias Templ added an answer:
    Analysis of official statistics
    Believing that only trained personnel works at official statistical agencies (like IBGE in Brazil), I would like to ask why they insist in the presentation of results from studies (census and others) in a bivariate form, like income by gender or income by race, instead of a multivariate presentation, including some (or all) important variables in a single regression model?

    Anyone has a clue?
    Matthias Templ · Vienna University of Technology
    linear regression with income as response variable and some predictors to explain the response is not multivariate, it is multiple.

    I agree with previous comments. I think you have to divide this: tables for usual publications and methodological reports and deeper analysis on the other hand.
    Regression would fall into the second part. For example, Statistics Austria provides both: publication with tables and detailed analysis using regression models in separated analysis reports.
  • Can your share your experience about teaching research methodology to undergraduate students ?
    We are planning to introduce a new course on research methodology for 4th year undergraduate students in medical sciences. It is a new independent course that will be no longer included in the Public Health course.
    Can someone help us to discuss a content that is not too heavy and well balanced between quantitative and qualitative methods?
  • Jerome R E del Castillo added an answer:
    Does anybody have the reference for log transformed mixed effect models on child growth?
    Anyone have the reference for logarithmic transformation for both dependent and independent variables on child growth (mixed effect models)?
    Jerome R E del Castillo · Université de Montréal
    Hi Karthikeyan Ramanujam! I'll write you a personal message so I can ask you some specific questions about your dataset and provide you the best advice I can.
  • Tohlang Sehloho added an answer:
    Is BMI modification needed further as the lifestyle deviates dramatically?
    Tohlang Sehloho · Department of Health, South Africa
    I agree with Huq and Subhashisa. It is time that the reliability of the current BMI classification as a indicator of ideal body weight is validated against health outcomes across different BMI levels. I suspect the results will reveal that the ideal BMI is probably a bit higher than currently accepted as evolutionary pressures on both the internal and external human environments manifest.
  • Timothy Lawes added an answer:
    Can a variable assume the role of a predictor as well as a confounder in the same study? If yes, why? If no, why not?
    Example: IN the association between education and family planning, economic status was considered as a confounder. IN the same study, can we consider education as a confounder in the association between economic status and use of family planning? Economic status was considered as a confounder and a predictor.
    Timothy Lawes · NHS Grampian
    If you are running a multi-variable analysis including both SES and education then you will find the independent association with each 'predictor' (removing the confounding influence of other predictor). In this sense it is possible to be both predictor + confounder.

    However, any analysis should start from a hypothesis and theoretical framework. It is better to define a priori (before study) which is your primary exposure variable and primary outcomes. This avoids risks of "fishing for associations". From a theoretical perspective economists would see education-level as a stable indicator of socio-economic status. I am not sure what you mean by economic status but if it means current income or occupation (e.g. converted into social class) then you might consider this a more variable indicator of socio-economic well-being. You need to consider risk of colinearity. If you include 2 very similar predictors they will simply 'crowd out' each out. If it is a reasonably small dataset I would say stick with education-level - probably the more robust indicator of life-long SES.
  • Ibtissam Sabbah added an answer:
    Can anyone suggest a questionnaire to measure positive mental health or mental wellbeing for pre-school children?
    I am looking for a scale that measures positive mental health (consisting of eudaimonic and hedonic indicators of mental wellbeing) in pre-school children (aged 4-6). Can anyone suggest one? We would implement it in Germany - so a scale in German would be great, but English is fine as well.
    Ibtissam Sabbah · Lebanese University
    The Peds QL 4.0 is a good scale to assess wellbeing / quality of life for children starting from 2 years. the PedsQL Cognitive Functioning Scale may be useful.
    Please visit: http://www.proqolid.org/instruments/pediatric_quality_of_life_inventory_generic_core_scales_pedsql_generic_core_scales
  • Amit Kumar added an answer:
    Can the PICO apply to in-vitro experimental studies?
    If so, what can be the "C" here? Only control? Thanks.
    Amit Kumar · All India Institute of Medical Sciences
    Dear Ibrahim
    PICO can be applied to in vitro studies also. It would be better to apply PICO in in vitro studies also so that you will not miss any thing to define your research question. PICO Patient - Intervention - Comparison - Outcome. I think in your case also you will have all these information in your research question. Some manipulation some times required depending upon the study design and research question.
  • Andrew Ekstrom added an answer:
    Looking for variance components (intraclass correlation) data for human biomarkers
    I am trying to collect between- and within- person variance data for common environmental and medical biomarkers. Right now, I am focussing on hydroxy PAHs such oh-pyrene in urine, cytokines, lipid (cholesterol) in blood, pesticides in various biological media, volatiles (chloroform, BTEX) in breath, etc.

    Surprisingly, these data are difficult to find in the literature. Would love some assistance.
    Andrew Ekstrom · University of Michigan
    Something of interest, even if it is a bit late.

    George Box and his friends performed an experiment where they ran a Gauge R&R study on blood samples and cholesterol levels. George and a few others gave blood samples, and a lot of them, and sent 2-3 samples from each person out to different medical testing labs. The results showed that the cholesterol levels of each participant were similar within any one lab. However, some labs showed a large positive bias. Others showed a large negative bias. So, according to the results, some labs reported really high cholesterol levels that would require medication. Others showed cholesterol levels that were so low, they were unhealthy.

    Having worked in commercial testing facilities, I know the same thing happens with environmental samples too.

    I would try to set up a Gauge R&R study with repeated measures.
  • Kathleen Thimsen added an answer:
    Is it ethical to make eye exams mandatory for kindergarten children?
    Sounds straightforward, and many states and provinces do this. However, Optometrists have an inherent financial conflict of interest when prescribing and selling glasses or vision therapy. Studies suggest a tendency to overprescribe glasses for negligible refractive errors. Optometrists also look for signs of problems causing 'visual stress' and may overprescribe costly vision therapies which could be unnecessary burdens on families. Mandatory eye exams also infringe on parental rights to choose how health care is delivered for there children.

    If alternatives exist for screening by personnel in the school who don't stand to gain from referrals and specifically trained for pediatric visual assessments, would that not be ethically preferable?
    Kathleen Thimsen · Barnes-Jewish College
    I have another lens to your posting. That is the increased access that vulnerable populations achieve by the mandated screening provide. The benefits to such mandates far outweigh disadvantages. To the ethics of the mandates, improving access and actual provision of services to children who may otherwise not be identified.
    The benefits of leveling the playing field by normalizing health conditions by medical necessary interventions, improve and increasing the child's ability to be successful because they can see, study and learn.

    One can look to the studies on determinants of health and school performance to justify the approaches based on the outcomes.
  • Matthew Ellis added an answer:
    Can we challenge some of the widely used terminologies in scientific literature when addressing developing countries?
    This has been on my mind for quite a while. Most people in academia refer to developing countries as "resource limited" or "deprived" or "third world". I do not agree with using such terminologies as we are not quite clear what type of resource we are talking about. Because they are definitely not resource limited when it comes to culture, history, or natural resources (such as mines). What do you think? Isn't it time to stop referring to them as resource limited?
    Matthew Ellis · University of Bristol
    Echoes of the rhetoric of 'development' here which preoccupied the debate in the 70's....when this terminology was much contested......resulting in some interesting reformulations.....underdevelop as an active verb for instance...as in I underdevelop you!
    I moved to income banding in the 1990's and have stuck with 'low' 'middle' and 'high income' ever since. The comments about regions are well made but as virtually all data is estimated using nation states as units its hard to see us moving from this any time soon.
    However the point made about generalisability is well made. The heterogeneity of populations within low income states is one of their defining features. Which reminds us that the whole concept of income banding country populations is misleading as income heterogeneity is extremely high.
    As we grapple with the post 2015 agenda there is an emergent concensus to tackle this intra state population inequality which requires a language to describe the haves and have nots....which brings us back to the discussion above - are terms 'rich' and 'poor' too loaded?
  • Ashwani Kumar Mishra added an answer:
    Is it necessary to learn statistics for writing original research articles for publishing in high impact factor journals?
    Sometimes BMJ reviewers reject the articles because of poor statistical analysis. If the data of a manuscript submitted can be analyzed with advanced statistical techniques, then the editor will be saying that the manuscript should be shown to a statistician first. Is it necessary for the researcher to also know the basic concept of analysis as well as the statistician?
    Ashwani Kumar Mishra · National Drug Dependence Treatment Centre (NDDTC)
    Dear Dr, Shree and Other colleagues, hello

    Its a nice discussion and i am sure the solution rests on the policy issues. How can we operationalize the definition of due credit and acknowledgement. Moreover, to whom and to which level, Meaning professionals in their early career, mid term career or later stage. From my experiences over decade and a half have realized that seldom are clinicians and biologists who give due credit or acknowledgement. If i may be allowed to elaborate it further, the mindset needs to be changed. If i ask simple question to fellow colleagues at what time statisticians are being contacted for academic discussions. When the sample size estimation was required, to get the significant result, approaching for commenting on the observations raised by the peer reviewers

    First of all we need to understand that Statistics is also one of the professional discipline which demands lots of expertise. The expertise in itself is like an evolution process and it does not happen overnight. Moreover, that the statisticians themselves should be ready to face the challenging, demanding clinical questions from the fellow colleagues. That means knowledge acquisition should be attempted continuously and try to understand the clinical terminology too. My views are especially targeted for colleagues who feel that it is difficult to understand the clinical or its related dimensions.

    Lastly, to the question being raised as
    i) Statistics of why authors get accepted
    ii) Statistics of why authors get rejected
    iii) Statistics of authors whose accepted papers that continue to get accepted
    iv) Statistics of authors whose rejected papers that now get accepted based on changes made based on committee's feedback
    v) We could go on and on and add value as leaders to this demographical element in our society and make a significant difference.

    In the competitive world involving economic, social, health, and other related dimensions will the journals think on these lines. Moreover, the performance indicators like Impact factor, 5 years impact factors, immediacy index, H index, are functions of these statistics directly or indirectly. I would be more than happy if the journals adopt such policy. May be i put another dimensions. How many journals put such inference on the main home page of theirs. To search for such important performance indicators are sometimes very time consuming and laborious. We sometimes need to go to the Database like Scopus, Web of Science, CINHAL, and others.

    Mine own view as to the specific questions of Is it necessary to learn statistics for writing original research articles for publishing in high impact factor journals?, perhaps it is necessary and specifically necessary and desirable. An expert is an expert and he should attempt to raise his or her own horizon of knowledge and expertise which is like an evolution process to survive in this ever changing world of technology and methodology innovation.

    Regards to All
    Dr. Ashwani Kumar Mishra
  • Vickie Lynn added an answer:
    Considering such strong evidence of alcohol and others drugs in the spread of HIV, why aren't more HIV/AIDS prevention policies addressing it?
    I am really surprised when I see absence of any discussion on the sexual behaviour influenced by alcohol consumption.

    For instance: http://www.aidsmap.com/HIV-prevention-policy/cat/80322/
    Vickie Lynn · University of South Florida
    Those of us who have worked in the HIV community we are fully aware of the HIV, alcohol, and substance use cause and effect relationship. Many of the individuals I have worked with over the past 20 years discuss their use of alcohol and drugs and its role in their seroconversion. Furthermore, many individuals who test positive for HIV turn to alcohol and drugs to cope with their diagnosis and fears and also engage in unprotected sex with others. It is a vicious sad circle.
  • Brecht Devleesschauwer added an answer:
    How to calculate disability adjusted life years
    I would like to ask how to calculate disability adjusted life years due to a disorder. Can any one suggest good articles on the methodology? Thanks!
    Brecht Devleesschauwer · Ghent University
    Dear all,

    We have now published two Hints & Kinks papers in International Journal of Public Health, describing how to calculate DALYs and how to conduct a DALY-based burden of disease study. You may find these papers through my profile.

    These are the journal links:
    * http://link.springer.com/article/10.1007/s00038-014-0552-z
    * http://link.springer.com/article/10.1007/s00038-014-0553-y

    Ps, if you find my answer useful, please consider promoting them by clicking the green triangle.
  • Tim Noonan added an answer:
    Are you familiar with the notion of complementary and alternative medicine more than conventional primary care?
    Conventional medicine prides itself on being science-based, and shuns alternative medicine for being "unproven," however, many of the non-communicable diseases have been taken care of successfully by alternative medicine. Conventional medicine is still behind and it will send your health into a downward spiral.
    Tim Noonan · STAT Medical Transport
    "Eg desferrioxamine has been around for about 48 years as an iron chelator, I would consider that safe and effective (not withstanding, as with all drugs there can be side effects)."

    That is not evidence of safety or efficacy.

    Please provide some valid evidence.

    The macrolide antibiotics have been around for decades, which would be evidence of safety and efficacy according to your earlier mentioned standard.

    I have been critical of the rampant use of antibiotics, but they remain popular. The side effects are not really new.

    This is why we need to have high standards for evidence. Too many treatments are used without good evidence that the treatment is better than a similar drug with a better safety profile.

    Again, we need to raise our standards, not lower them.

    "I could go on, but I think it is incumbent upon all of us to be open minded and not follow slavishly."

    Why should we open our minds - if that means endangering our patients with treatments that are not safe and do not work?

    "We need to use what works, and saying a treatment does not work because it is a CAM is not an accurate statement."

    Here is what I wrote. If you want to quote me, go ahead, but do not make up statements that I did not make.

    "I include everything that does not have evidence of safety and efficacy - efficacy of improved outcomes that matter, not just surrogate endpoint outcomes.

    I hold alternative medicine to the same standard, but there does not appear to be anything of benefit to patients from alternative medicine."

    CAM is not useless because it is CAM, it is useless because there is no evidence that it works. Provide valid evidence and I will change my mind about any particular treatment that has valid evidence that it improves outcomes.

    If we cannot have an honest discussion among ourselves, how can our patients expect us to be honest with them?

  • Maryam Aminu added an answer:
    Is there any published data on using toilet paper after deification or after cleaning a child anus- in urban or rural setting?
    Since hands are one of the important vectors for transmitting diseases, I would like to work on toilet paper/cloth use after deification and before using water to clean feces.
    Maryam Aminu · Ahmadu Bello University
    Thank you Nuhu,
    I have not browse to check this out. It is going to be an interesting topic to research on.
    Please give it a shot
  • Sultan Salah added an answer:
    Who is the best professor in the field of epidemiology ? Which website link is useful ? Thank you very much
    Who is the best professor in the field of epidemiology
    I mean RG or Research Gate.
  • Scott Patten added an answer:
    Does difference in prevalence of a disease in different study populations explain the variability in validity indices of a measurement tool?
    For example, the sensitivity and specificity of a tool to diagnose anemia can be different in various study populations (e.g., pregnant women, children under the age of 5, male adults, or blood donors). Or will it remain the same, irrespective of the study population?
    Scott Patten · The University of Calgary
    I should have added an example to my comment above. Suppose that you wish to validate a depression rating scale and you choose a sample that is 50% volunteers (probably all of upbeat mood and energy) and psychiatric inpatients admitted for depression. A low qualtiy scale could probably distinguish quite well between these two groups and appear to have excellent sensitivity and specificity. Yet, when used in a more realistic spectrum of respondents it could perform quite poorly. This is usually called spectrum bias.
  • Piotr Szwed added an answer:
    Is it possible to model transmission blocking of infectious diseases by using and applying Petri-nets?
    In the spread of infectious diseases, transmission blocking plays a very important role.
    Is it possible to model transmission blocking of infectious diseases by using and applying the knowledge of Petri-nets?

    Piotr Szwed · AGH University of Science and Technology in Kraków
    Petri nets are a general modeling language aiming at analysis of behavior of various types of systems. Especially, colored Petri nets are expressive and powerful, as they allow to use in models data types, transform the data and use conditional execution.

    Probably, you expect a kind of simulation giving the answer, how the system state (e.g. a number of infected peple) will evolve with or without disease transmission blocking. Usually, Petri net tools provide such functionality as simulation and (limited) analysis of reachable states.

    However, to get more concrete answer you should describe the nature of the planned model. The range of possible models can be very large: from low-level biochemical interactions to statistical modeling of a population exposed to a disease. However, I am sure that the mosquito lifecycle model that you included in one of yours papers can be expressed with Petri nets and the simulation would give some computational results.
  • Marco Antonio Prado Nunes added an answer:
    What factors may be related to the adaptation of prosthesis in patients with major lower limb amputations?
    We observed that the prevalence of adaptation to lower limb prostheses was 38%. And patients with a low level of education were the least frequently adapted to the prosthesis.
    Marco Antonio Prado Nunes · Universidade Federal de Sergipe
    Hi Aria Tsam? How can I refer on VA/DoD Evidence-Based Practice Working Group site?
    Thank you
  • Tee Guidotti added an answer:
    Who first thought up the idea of the "epidemiological triangle" [or "triad"] of agent - host - environment?
    I am writing a book and in it, I mention the epidemiological triangle (sometimes called the public health or infectious disease triad). Where did the formulation come from? Who first described it? The references I have found are not informative but it is clearly a very old idea. I am aware that the idea as applied to animal health was formulated in 1974 by an eminent fisheries biologist, Stanislas F. Snieszko (1902 – 1984) to apply to fish diseases. However, I am sure that there must be earlier versions for human health. So far I have been unable to find them.
    Tee Guidotti · University of Ottawa
    Thank you, all three! This has been very helpful. The earliest usage I could find for the triad on Google Ngrams was 1937, but haven't tracked down the actual cite. However, I now have as much as I need, thanks to you three and to ResearchGate!
  • Behzad Pourhossein added an answer:
    Is there any form of shift and drift with the HIV virus?
    Different HIV sero-types and Subtypes have been discovered over time and studies have shown their resistance to Anti-Retro viral drugs has been reported. Can these phenomenons be conceptualize to be Shift and Drift of the Virus?
    Behzad Pourhossein · Tehran University of Medical Sciences
    Dear Mukoro
    in human immunodeficiency viruses antigenic drift mutations usually happened and about antigenic shift may be accrue in this virus some comments( "Selection of escape mutants from immune recognition during HIV infection" ") says it happens in silent phase of hiv disease to scape the immune responce
  • Vincent Dalbo added an answer:
    Can someone advise on non-parametric statistics (survey data)?
    I was running a binary regression (2 nominal variables each with two outcomes). Now I have 2 nominal variables (1 with two outcomes and 1 with 1 outcome). What statistic should I use? There are further details attached.
    Thank you greatly for the help.
    Vincent Dalbo · Central Queensland University
    Hi all,

    Thank you for your comments. My table headings were a bit confusing. I have the problem solved and your comments reaffirmed the stats I wound up running were correct.

    Thank you all greatly for the comments!

    Have a great week,


About Epidemiology and Public Health

Identifying patterns of health and disease among populations.

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