Search results

Epidemiology is often described as “the basic science of public health” (Savitz, Poole & Miller, 1999; Syme & Yen, 2000). This description suggests both a close association with public health practice, and the separation of “pure” scientific knowledge from its application in the messy social world. Although the attainability of absolute objectivity is rarely claimed, epidemiologists are routinely encouraged to “persist in their efforts to substitute evidence for faith in scientific reasoning” (Stolley, 1985, p. 38) and reminded that “public health decision makers gain little from impassioned scholars who go beyond advancing and explaining the science to promoting a specific public health agenda” (Savitz et al., 1999, p. 1160). Epidemiology produces authoritative data that are transformed into evidence which informs public health. Those data are authoritative because epidemiology is regarded as a neutral scientific enterprise. Because its claims are grounded in science, epidemiological knowledge is deemed to have “a special technical status and hence is not contestable in the same way as are say, religion or ethics” (Lock, 1988, p. 6). Despite the veneer of universality afforded by its scientific pedigree, epidemiology is not a static or monolithic discipline. Epidemiological truth claims are embodied in several shifting paradigms that span the life of the discipline. Public health knowledges and practices, competing claims internal and external to epidemiology, and structural conditions (such as current political economies, material technologies, and institutions) provide important contexts in which certain kinds of epidemiological knowledge are more likely to emerge.

In 2009, Blacks earned about 6% of the doctoral degrees awarded in the field of epidemiology (NSF, 2010). This one year snapshot of attainment estimated that 17 of the 273 doctoral degrees in the field were granted to Blacks. Aschengrau and Seage (2008) defined epidemiology as “the study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems” (p. 6). The research in epidemiology is often organized by disease or source of risk – e.g., infectious disease, cancer, occupational injury, psychiatric, respiratory, intestinal, renal, dental, or cardiovascular. Another way to categorize the research in epidemiology is by method – spatial, meta-analysis, economic, environmental, clinical, surveillance, disease informatics, biostatistics, and so on. For example, the progress in the Human Genome Project, in computing power, and in the development of powerful statistical approaches has expanded the analytical possibilities in genetic epidemiology, a discipline that seeks to understand how genetics, environmental factors, and their interactions produce various diseases and traits in humans. Genetic epidemiology as well as the other methodologies associated with field of epidemiology is part of population science where population history and dynamics are modeled. The scientific discipline of epidemiology is rarely part of discussions focused on opportunity pathways in STEM fields. Nor are many other fields aligned with population science (e.g., demography and population sociology) included in these discussions. These omissions represent blind spots that deserve to be clearly seen as part of discussions of STEM fields that require sound inquiry and serve to advance human development and human capital, while contributing to the common good.

This paper aims to describe the initial experiences in a new option of an established fellowship program, which can serve as a model that strengthens the next generation of our workforce for preventing healthcare‐associated infections.

Historical narrative.

The CSTE Applied Epidemiology Fellowship has a long history of success in producing future leaders for the public health workforce. As it expands into a healthcare‐associated infections option, it is addressing an area new to traditional public health departments. However, this also is an area where public health must be viewed as part of the continuum of healthcare systems, where tomorrow's professionals must be credible in a number of settings (health departments, hospitals, clinics and extended care facilities).

CSTE's first class of HAI Fellows offers a new model for producing the type of professionals necessary for the field of hospital epidemiology and infection control to achieve its full potential.

This is the first published description of the Council of State and Territorial Epidemiologists new Applied Epidemiology Fellowship “HAI” graduating class.

Environmental epidemiology is the science which analyses and measures adverse health effects of environmental factors and evaluates the effectiveness of their control strategies. With increased industrialisation and urban development in Europe, these problems and efforts to solve them are now very much at the forefront of world attention. The analysis of the consequences of Chernobyl is a prime example of a situation where environmental epidemiology can help. Other current examples include the so‐called ‘green’ issues of urban sewage disposal, the effects of agricultural pesticides and fertilisers on the food chain, air quality and motor vehicle emissions, environmental planning deficiencies leading to traffic accidents and urban crowding, pollutant exposure in the work place, and the consequences of individual behaviour such as AIDS, the use of tobacco, alcohol and drugs. Environmental epidemiology thus brings several disciplines together. There is still much to learn though from the formulation and analysis of appropriate strategies to help maintain an optimal balance between desired technological, economic, health and lifestyle factors, and sustained environmental quality.

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

Recently, there has been a renewed interest in medical students’ mental health. The purpose of this paper is to determine factors associated with psychological distress in medical students and to assess the correlation between major lifestyle behaviours and mental health.

The authors conducted a cross-sectional questionnaire survey among 530 medical students randomized from a faculty of medicine in 2017. The authors used the 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) to assess mental health and lifestyle, respectively.

The mean value of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. Bivariate correlation analysis showed that SLIQ was significantly correlated to GHQ-12 (r=−0.26; p<0.001). The prevalence of psychological distress (GHQ-12=4) was 50.1%. The authors found that low/middle financial situation of the family (OR=1.5; CI 95%=[1.1–2.3]), internship level, (OR=1.8; CI 95%=[1.1–3.3]), medium/poor perceived academic performance (OR=2.2; CI 95%=[1.5–3.2]) and medium/poor perceived health status (OR=2.3; CI 95%=[1.5–3.6]) were significantly associated with psychological distress. Multivariate analysis performing logistic regression showed that average and unhealthy lifestyle were independently associated with psychological distress, with an adjusted OR of 3.7 (CI 95%=[1.7–7.7]) and 5.8 (CI 95%=[2.4–14.8]), respectively.

The study highlighted the magnitude and the risk factors of psychological distress in medical students. Unhealthy lifestyle was a potential predictive of mental disorders. These findings provide fundamental information for future researches.

Describes a study to measure the quality of service provided by food‐poisoning surveillance agencies in England and Wales in terms of the requirements of a representative consumer ‐ the egg producing industry ‐ adopting “egg associated” outbreak investigation reports as the reference output. Defines and makes use of four primary performance indicators: accessibility of information; completeness of evidence supplied in food‐poisoning outbreak investigation reports as to the sources of infection in “egg‐associated” outbreaks; timeliness of information published; and utility of information and advice aimed at preventing or controlling food poisoning. Finds that quality expectations in each parameter measured are not met. Examines reasons why surveillance agencies have not delivered the quality demanded. Makes use of detailed case studies to illustrate inadequacies of current practice. Attributes failure to deliver “accessibility” to a lack of recognition on the status or nature of “consumers”, combined with a self‐maintenance motivation of the part of the surveillance agencies. Finds that failures to deliver “completeness” and “utility” may result from the same defects which give rise to the lack of “accessibility” in that, failing to recognize the consumers of a public service for what they are, the agencies feel no need to provide them with the data they require. The research indicates that self‐maintenance by scientific epidemiologists may introduce biases which when combined with a politically inspired need to transfer responsibility for food‐poisoning outbreaks, skew the conduct of investigations and their conclusions. Contends that this is compounded by serious and multiple inadequacies in the conduct of investigations, arising at least in part from the lack of training and relative inexperience of investigators, the whole conditioned by interdisciplinary rivalry between the professional groups staffing the different agencies. Finds that in addition failures to exploit or develop epidemiological technologies has affected the ability of investigators to resolve the uncertainties identified. Makes recommendations directed at improving the performance of the surveillance agencies which, if adopted will substantially enhance food poisoning control efforts.

The purpose of this chapter is to offer reflections on conventional theories concerning causes and determinants of diseases. It also intends to examine both theoretical and empirical bases for adopting an Integrated Social-Ecological Systems (ISES) lens as a tool for understanding complexities related to drivers, determinants and causes of diseases.

We assessed the theoretical underpinnings of a range of historical and contemporary lenses for viewing infectious disease drivers and the implications of their use when used to explain both personal (i.e. individual) and population health. We examined these issues within the empirical context of the City of Dhaka (Bangladesh) by adopting an ISES lens. Within this study an emphasis has been placed on illustrating how feedback loops and non-linearity functions in systems have a direct bearing upon various aspects of infectious disease occurrences.

A brief triumph over microbes during the last century stemmed in part from our improved understanding of disease causation which was built using disciplinary-specific, monocausal approaches to the study of disease emergence. Subsequently, empirical inquiries into the multi-factorial aetiology and the ‘web of causation’ of disease emergence have extended frameworks beyond simplistic, individualistic descriptions of disease causation. Nonetheless, much work is yet to be done to understand the roles of complex, intertwined, multi-level, social-ecological factors in affecting disease occurrence. We argue, a transdisciplinary-oriented, ISES lens is needed to explain the complexities of disease occurrence at various and interacting levels. More theoretical and empirical formulations, with evidence derived from various parts of the world, is also required to further the debate.

Our study advances the theoretical as well as empirical basis for considering an integrated human-nature systems approach to explaining disease occurrence at all levels so that factors at the individual, household/neighbourhood, local, regional and global levels are not treated in isolation.

What does evidence‐based health care add to the numerous initiatives in the UK over the last 10 years to improve the quality, effectiveness and efficiency of health care? The health care research and development industry has evolved into a patchwork of activities — clinical audit, clinical effectiveness, health services research, health outcomes, health technology assessment, quality in health care, clinical guidelines, systematic reviews, and medical informatics — with many blurred boundaries. Is evidence‐based health care just an old product in a new package, or does it offer new concepts?

Alcohol and tobacco consumption are significant public health concerns and considered some of the riskiest behaviors among students. Despite strong indications of heavy consumption of these substances, certain sections of the student population remain unexplored regarding their consumption patterns and associated factors, including research scholars pursuing Doctor of Philosophy degrees. This study aims to explore the patterns and correlations of consumption of alcohol and tobacco among doctoral students in three Indian universities.

A cross-sectional study was conducted on a total of 530 scholars from three central universities, Aligarh Muslim University, Banaras Hindu University and Jawahar Lal Nehru University, and focused on two substances (alcohol and tobacco) frequently used by students in India. Bi-variate analysis and penalized logistic regressions were applied to analyse the prevalence and associated factors of alcohol, smoking and smokeless tobacco among doctoral students.

Tobacco consumption was observed to be the dominant form of substance use among doctoral students. Findings revealed that 34% of scholars smoked and 25% consumed smokeless tobacco daily and around 14% consumed alcohol at least once a week. Major significant correlates of substance consumption among scholars were found to be gender, religion, parental mortality, dissatisfaction with academic performance and stress about future career/employment. Significant variation in substance use patterns was observed among universities.

This study provides first-hand evidence on substance use patterns and the correlates among doctoral students in three Indian universities. Findings indicate the implementation of specific intervention programs for mental health and counselling for this section of students to prevent substance use addiction would be beneficial.