Epidemiology and Public Health

Epidemiology and Public Health

  • Paschal Awingura Apanga added an answer:
    Are there recent studies on Health Care waste management in Africa?

    I am starting the process of my dissertation and I am looking at medical or healthcare waste management in rural Africa. I want to know which direction do I go: formative evaluation where I try to do a need assessment in rural clinics present in rural Africa or do an impact evaluation of past community -based interventions to control infectious diseases as a result of contact with hospital or medical waste at open dumpsites in rural Africa. 

    So my question is Are there recent studies done on this aspect and what are possible research gaps. Thanks

    Paschal Awingura Apanga

    You can access the following papers from PubMed from the link below:


  • William Mendes Lobão added an answer:
    Are there any recent articles (RCTs and metaanalyses) for diabetic glycemic control with mult. daily inj. versus cont. subcutaneous insulin infusion?

    Interested in improved glycemic control RCTs and Meta-Analysis looking at MDI or glargine injections versus CSII pump administration

    William Mendes Lobão

    Hello Jennifer,
    You can do a search on Pubmed using the following search strategy (Mesh + boolean operators):
    (((("Blood Glucose"[Mesh]) AND "Diabetes Mellitus"[Mesh]) AND "Insulin"[Mesh]) AND "Insulin Infusion Systems"[Mesh]) AND "Injections, Subcutaneous"[Mesh]

    Then you can filter by type of search:
    Clinical Trial;
    And Publication dates:
    5 or 10 years ago.

    Using this strategy I managed to find 180 articles who meets these criteria.

    Good luck.

  • Michael Felfernig added an answer:
    Is anyone aware of any offshore worker related epidemiological studies outside the US?

    I am currently looking into studies for epidemiological data of offshore workers outside the US in order to use it for a project looking into the nature of medical cases on offshore installations and their causes.

    Michael Felfernig

    thanks everyone

  • Lars Lafferty added an answer:
    What are some of the current, most innovative public and private wireless medical device test bed programs today, and where are they housed?

    (ex. hospitals, non-hospital settings, homes, universities, etc.) What components and characteristics comprise these test beds? Are there different types of medical device test beds(ex. hardware, software, etc)? Where do these devices operate in the radio frequency? Is there a central repository of test results/data that the medical community and other stakeholders can access? What types of medical devices and innovations are being tested? How are tests and simulations being conducted in these settings? What testing standards, if any, are being applied for current wireless medical device test beds? Who are the primary users of wireless medical device test beds (researchers, doctors, innovators, entrepreneurs) and what knowledge can be gleaned from them?

    Lars Lafferty

    Mr. Don Kaiser,

            Thank you for providing me with another excellent and credible source, pertaining to the Health Level Seven International, a level of the International Organization for Standardization (ISO) seven-layer communications model for Open Systems Interconnection (OSI) - the application level. Have you, or do you currently engage with the HL7? Would be thrilled to discuss with you in further detail, at your earliest convenience. Hope the you are having and continue to have a wonderful day. Looking forward to hearing from and speaking with you in further detail. Thanks.


    Lars Lafferty

  • Lawrence Broxmeyer, MD added an answer:
    Where can I find age-structured incidence data for AIDS defining opportunistic infections starting from before AIDS epidemic in Sub-Saharan Africa?

    I am interesting in finding prevalence/incidence rates of specific opportunistic infections of young age groups (not adult) from before and after the start of the AIDS epidemic (~1980). 

    In particular I am looking for trends in: Tuberculosis, Cryptosporidium, and Non-Typhi Salmonella. 

    Does anyone know if such data exists and where I can find it? I would want to look in an area where HIV/AIDS is widespread, so somewhere in Sub-Saharan Africa would be ideal (or the whole region). 

    Lawrence Broxmeyer, MD

    "Where can I find age-structured incidence data for AIDS defining opportunistic infections starting from before AIDS epidemic in Sub-Saharan Africa?
    I am interesting in finding prevalence/incidence rates of specific opportunistic infections of young age groups (not adult) from before and after the start of the AIDS epidemic (~1980). 

    In particular I am looking for trends in: Tuberculosis, Cryptosporidium, and Non-Typhi Salmonella. "


    Very well. But why go to WHO? Perhaps you should start by seeking statistical data and maps for Tuberculosis and M. avium, which still are the leading causes of infectious death in HIV/AIDS. Before such typical and atypical mycobacteria were proclaimed "AIDS-defining illness" by the likes of WHO, you will notice that they admitted that tubercular disease killed close to 3 million people a year. Then since it has magically  "defined" AIDS -  it is now purported that tubercular disease kills merely a million and a quarter annually. Interesting math.

  • Olamide omitade-osinowo added an answer:
    How do nurses support self management and health education in people with type 2 diabetes?

    health education

    can an individual self manage diabetes?

    Olamide omitade-osinowo

    Thank you very much for sharing your knowledge and skills.

  • Nour H. Abdel-Hamid added an answer:
    prevalence Vs Incidence
    Finding it difficult to understand the difference between 'prevalence' and Incidence. Any help is welcome.
    Nour H. Abdel-Hamid

    Incidence is the rate of new (or newly diagnosed) cases of the disease. It is generally reported as the number of new cases occurring within a period of time (e.g., per month, per year). It is more meaningful when the incidence rate is reported as a fraction of the population at risk of developing the disease (e.g., per 100,000 or per million population). Obviously, the accuracy of incidence data depends upon the accuracy of diagnosis and reporting of the disease. In some cases (including ESRD) it may be more appropriate to report the rate of treatment of new cases since these are known, whereas the actual incidence of untreated cases is not. Incidence rates can be further categorized according to different subsets of the population – e.g., by gender, by racial origin, by age group or by diagnostic category. while Prevalence is the actual number of cases alive, with the disease either during a period of time (period prevalence) or at a particular date in time (point prevalence). Period prevalence provides the better measure of the disease load since it includes all new cases and all deaths between two dates, whereas point prevalence only counts those alive on a particular date.

    Prevalence is also most meaningfully reported as the number of cases as a fraction of the total population at risk and can be further categorized according to different subsets of the population.

    The relationship between incidence and prevalence depends greatly on the natural history of the disease state being reported. In the case of an influenza epidemic, the incidence may be high but not contribute to much growth of prevalence because of the high, spontaneous rate of disease resolution. In the case of a disease that has a low (or zero) cure rate, but where maintenance treatment permits sustained survival, then incidence contributes to continuous growth of prevalence. In such cases, the limitation on prevalence growth is the mortality which occurs in the population. Obviously, prevalence will continue to grow until mortality equals or exceeds the incidence rate.

  • Emmanuel Aboagye added an answer:
    How to calculate the reliability and validity?

    I am doing a cross sectional study, using surveys, about prevalence of tobacco chewing. I will study the prevalence and its characteristic in population. Survey includes sociodemographic factors and behavioral questions about risk factors.how are we going to calculate the reliability and validity ? for this type of questionnaire. I have adapted from state forms for surveillance

    Emmanuel Aboagye

    I hope your aim is to assess the validity and reliability of the behavioral questions about risk factors. To get the right you have specify how you intend to gather data and then one will be able to guide you on which specific methods or tests you can apply to calculate the reliability and validity. The example papers other people have suggested are all good and can help in the future but they can at the same time be frustrating if you do not know the form of validity or reliability you want to examine. Ask questions if you need further clarification. 

  • Ali Salm added an answer:
    Is it necessary to observe random sampling methodology if one is doing a retrospective analysis where N (1254) is small?
    The quantitative analysis is basically descriptive in nature of a database which has been built from patient records having a specific illness.
    Ali Salm

    An unbiased random selection and a representative sample is important in drawing conclusions from the results of a study. remember you should have the entire population ?

  • Odontuya Davaasuren added an answer:
    Does anyone know of a tool that can be used to assess effectiveness of a new service component in general practice (GP) settings?

    A local health service has recently introduced a, add on service to assist GPs in offering better service to people with chronic mental illness, after four years, there is need to determine whether that service is having desired outcomes.

    Odontuya Davaasuren

    When we implement palliative care in general practice, we provide comparative study and as a tool of these, we used number of served palliative care patients by GP, number of opioid prescription form ordered by GP, number of opioids prescribed by GPs, number of home visits of PC pts by GP, knowledge on PC e.s. 

  • Hans-Guenter Meyer-Thompson added an answer:
    Should OST be offered to non-injectors?
    PWID programs
    Hans-Guenter Meyer-Thompson

    Dear Madeline, according to the duration of opiate-addiction in Germany we include even younger people, at least for a short term treatment before they leave for detox and  abstinence based treatment.

    Dear John, given the resources in your country I agree with the inclusion criteria.



  • Mervyn Thomas 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?
    Mervyn Thomas

    @Susan,  God preserve me from gifted amateur statisticians. I'd rather not use a gifted amateur as a statistician or as a surgeon.

  • Andrei Gonzales I. 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.
    Andrei Gonzales I.

    Thanks Dr. Partha Pratim Dhar, yes I tried to mean that a lot of traditional knowledge are inside of alternative medicine, so they are a lot of applications like Dr Partha mentioned; they are very useful, the problem is that a lot of people dont like this type of medicine because they are not proved scientifically, how ever they are a lot of new publications that are proving this facts, we scientists must try to help in this topics.
    I am aware that in many cases the knowledge of alternative medicine have been misrepresented, used only for trade and deceit and also for illegal things. It is a difficult task trying to keep the original knowledge that many cultures that left, most of this knowledge is dying with their carriers ancestors who had 80-100 years old.
    At this point I dare say that it is possible to mention that many people when they hear about alternative medicine only comes to their minds facts unconvincing, because the most part of the information is already infected, to the point that people believe in such superstitions.

    Another reason why many of knowledge of alternative medicine is not demonstrated is by the difficulty you have when making experiments or controlling the confounding factors in the observations.

    Then the task is to separate objectively all knowledge that show significant solutions and their real applications, but often involves taking a multivariate analysis and even a lot of protocols sustain that the essence of the expression of the fact it is on non physical (touchable) variables (subjective) and non counting this facts could affect the experiment (or observation) (For example the problem with the Masaru Emoto experiments ). To the other hand we must to correct the distorted knowledge.

    There are already people working on this topic, even objectively trying to improve the reputation of alternative medicine.

    A strong example in the application of alternative medicine is the effect of the moon on living organisms through its gravitational field, as this example there are others.

  • Olivier Duperrex added an answer:
    How do social and natural environments affect patterns of disease and survival?

     Appreciating this ecological perspective on human population health – at a time when large-scale stresses are appearing in our world – is a prerequisite to achieving a sustainable future.

    Olivier Duperrex

    Some answers to your question are in the 2009 Lancet series on climate change.




  • Hualiang Lin added an answer:
    Can anyone tell me the difference between case-control study and a cross-sectional survey ?
    I think cross-sectional surveys must be representative of the targeted population (often leading to important sample sizes). Is it the same for case-control study ?
    Hualiang Lin

    Cross-sectional study can not only provide prevalence, but also can be used to examine the exposure and outcome relationships. One important thing is that in a cross-sectional study the controls are not selected according to the prior design as in case-control study. However, we can used cross-sectional study to have our own case-control study by selecting controls, can be called "case-control study nested in cross-sectional study"?

  • Pard Is added an answer:
    How can I study the relevance of a decision support prescribing benzodiazepines in general practice ?

    In France, the prescription of benzodiazepines (BZD ) is a problem . Care for patients with chronic use is difficult. In terms of public health, it is particularly relevant to avoid this situation by prescribing these treatments wisely. A thesis carried out in 2012 resulted in the design of two brief first prescription of BZD guides , one to complaints for anxiety and the other for insomnia.
    How would it be possible to assess the relevance of these guides, in actual practice conditions of general practice (GP) , knowing that the conditions of research in MG do not allow a large-scale intervention study ?

  • David Gross 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.
    David Gross

    Thanks,  Dee for  a  very  thoughtful  and  enlightening  post.

  • James Stewart-Evans added an answer:
    Do you know recent epidemiological studies or complete review studies about pollution due to incineration?

    Thermal treatments, like incineration, are consolidated methods to treat waste to recover thermal and electrical energy. Flue gas treatment technologies, if well operated, can permit to control pollution.

    Public opinion and politicians sometimes claim that incineration plants or similar sites create serious problems to people's health, without citing scientific basis.

    I would like to know if there are recent studies, from all over the world, about this topic, that can describe what happened when the site was monitored and exposure risk was calculated, or references to full scale studies (national level). I add a very interesting article which treated a specific case in Italy.

    James Stewart-Evans

    This may be of interest: The Impact on Health of Emissions to Air from Municipal Waste Incinerators RCE 13

  • Rick Weiss added an answer:
    Anyone who knows about validation studies comparing electronically answered food frequency questionnaires and paper version?
    Can we expect different results depending on whether the food frequency questionnaire is provided electronically or as paper version?
    Rick Weiss

    Yes, our diet assessment validation study is published in JAND http://www.andjrnl.org/article/S2212-2672(13)01776-0/abstract. Let me know if you'd like to try our FFQ.

  • Saeideh Ghaffarifar added an answer:
    Is the CIPP evaluation approach used for multidisciplinary primary care programs?

    Hi. The CIPP (context, input, process, and product evaluation) evaluation approach has been proposed for healthcare programs (1).

    I am looking for examples/references of this approach in a multidisiplinary primary care program setting.

    Thanks, David

    1. Kennedy-Malone L. Evaluation strategies for CNSs: application of an evaluation model... context, input, process, and product (CIPP) evaluation model developed by Stufflebeam. Clin Nurse Spec. 1996;10:195–198.

    Saeideh Ghaffarifar

    Yes. You can also apply PRECEDE PROCEED model as well as other planning models. 

  • Mariel Didato added an answer:
    Can we use 24-hour recall intervals for analysis of dietary patterns or is an appropriate food frequency questionnaire needed?
    I am currently working on my master thesis regarding “Dietary patterns and dietary diversity among overweight and obese children”
    This project is based on a “cross-sectional study” amongst a rural population. Since a validated food frequency questionnaire for this population does not exist, can we use 24-hour recall intervals for analysis of dietary patterns or is an appropriate food frequency questionnaire needed for this project?
    Mariel Didato

    For tracking individual dietary patterns, FFQ's are more appropriate. 24 hour recalls are more appropriate if you are trying to gauge a specific demographic's eating patterns.

  • Dominic Cortis added an answer:
    Recommendations for research methods textbooks?

    My team have been discussing investing in some research methods textbooks. We've got as few ideas but would be keen to hear recommendations on the following areas:

    • Qualitative methods (general)
    • nVivo
    • Statistics/quantative methods (general)
    • SPSS
    • Epidemiology (general)



    Dominic Cortis

    I would greatly recommend any of Alan Bryman's research methods textbooks as an introduction.

  • Márcio C Mancini added an answer:
    If BMI beyond 35 with obesity comorbidities or 40 kg/m² is not a perfect index to qualify a patient for bariatric surgery, which would be better?

    BMI = body mass index.

    • Source
      [Show abstract] [Hide abstract]
      ABSTRACT: ABE&M todos os direitos reservados. 875 review Bariatric surgery – An update for the endocrinologist Cirurgia bariátrica – Uma atualização para o endocrinologista ABSTRACT Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdis-ciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgi-cal candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic tre-atments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab.
      Full-text · Article · Dec 2014 · Arquivos Brasileiros de Endocrinologia & Metabologia
    Márcio C Mancini

    Evidence suggests that for individuals of Asian origin, bariatric surgery should be offered at a lower BMI than other populations. On the other hand, some people can have apparently good (at least metabolic) health with a BMI above 35 (even above 40), while others have type 2 diabetes at a BMI below 30! I agree with Renward Sebastian Hauser, that the Edmonton Obesity Surgery Score (EOSS) by Sharya Sharma is far more interesting, because obesity comorbities "weigh" more than the body weight per se.

  • Lalitha Kabilan added an answer:
    Is this the case with Europe, besides Africa that Dengue cases are not registred in non-endemic areas?

    A similar pattern in Brazil, but with better dengue data. See http://onlinelibrary.wiley.com/doi/10.1111/tmi.12227/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

    Lalitha Kabilan

    I agree with Dr.Lacour.The efforts for detection of indigenous cases of dengue vary across the countries. Lack of competent vectors decrese the alarm of epidemics in europe. lalitha kabilan  

  • Beckie Tagbo added an answer:
    Can someone provide me with demographic and health survey data?


    I want to find the factors effecting the immunization of children of age 12-23 months. I want to use the data of demographic and health survey but could not find the variable  about the children of age 12-23 months and their immunization status ()wether they were immunized or not). Can anybody help me to identify, or can generate such a variable?



    Beckie Tagbo

    It is routine data that should be available from your country EPI office. I guess a little more effort and you will have it just for the asking.

  • Prakash B Patel added an answer:
    How do we assess the magnitude of HIV towards a population?

    Besides the type of epidemic how do we determine the overall severity (i.e mild moderate severe)?

    Prakash B Patel

    Link for the software is as follows.

  • Suhail A. Doi added an answer:
    When undertaking a meta-analysis, which effect is most appropriate: fixed effect or random effect?

    Meta-analyses, epidemiology, public health

    Suhail A. Doi

    Dr Kumar, thanks for your response, A weighting sensitivity plot is used to assess to what extent the effect model (fixed or random) may influence the results. This is meta-analysis dependent and tells us nothing whatsoever about which estimator has the lesser variance and MSE and that is actually what is of interest. A simple simulation will demonstrate that the fixed effect estimator always has a lesser MSE and therefore performs  better and all the theories above about choice of estimator are indeed wrong. Yes, fixed effect estimators are biased, but since we only do a meta-analysis once, the lower MSE estimator will be closest to to reality irrespective of bias. The only situation where the MSE of random and fixed effect estimators come together (because of bias in the latter) is when there are hundreds of studies in the meta-analysis - really unrealistic situation. Keep in mind that if you do decide to use the fixed effect estimator for heterogenous studies, only the IVhet approach is valid as this has a corrected variance (corrected for overdispersion).

  • Seyed Ramin Radfar added an answer:
    Are there any suggestions to Design Patient Education Material with Holistic Approach for HIV-AIDS ?

    Dear all,

    kindly give your valuable suggestion as i am going to design patient Education Material with Holistic Approach. for HIV-AIDS Patients.

    Thanks in Advance

    Seyed Ramin Radfar

    Our experiences shows that more inter active is more effective .Side effects of ART and how to cope with it is very important for patients' adherence, other important based on our study is family stigma that should be targeted by IEC approaches.

  • Rodney P Jones added an answer:
    Is the UK in the middle of an unrecognised infectious outbreak?
    In 1993, 1996, 2002, 2007 and 2012 the UK saw an unexpected and unexplained increase in deaths, emergency medical admissions, emergency department attendances and GP referrals. These events appear to initiate earlier in Scotland and involve infectious-like spread for the increase in morbidity and mortality. It has been suggested that increases in the level active cytomegalovirus infection may be implicated. Further papers investigating this phenomena are available at www.hcaf.biz. Any thoughts, comments or suggestions would be useful.
    Rodney P Jones

    I have subsequently published additional studies demonstrating small-area spread of this unknown agent.

    Easiest option is to go to 


    and download some of the more recent publications.

About Epidemiology and Public Health

Identifying patterns of health and disease among populations.

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