The paper examines definitions of ‘cause’ in the epidemiological literature. Those definitions all describe causes as factors that make a difference to the distribution of disease or to individual health status. In the philosophical jargon, causes in epidemiology are difference-makers. Two claims are defended. First, it is argued that those definitions underpin an epistemology and a methodology that hinge upon the notion of variation, contra the dominant Humean paradigm according to which we infer causality from regularity. Second, despite the fact (...) that causes be defined in terms of ‘difference-making’, this cannot fixes the causal metaphysics. Causality in epidemiology ought to be interpreted according to the epistemic theory. In this approach relations are deemed causal depending on the evidence and on the available methods. Indeed, evidence to establish causal claims requires difference-making considerations; furthermore, those definitions of cause reflect the ‘variational’ epistemology and methodology of epidemiology. (shrink)

Although epidemiology as a scientific study of disease in populations claimed an independent disciplinary status already in the mid–nineteenth century, its history in the twentieth century can be seen as a continuous and often contentious attempt to define the field’s social and intellectual boundaries vis-à-vis a variety of neighboring scientific fields and public health practices. In a period dominated by laboratory biomedical sciences, epidemiologists repeatedly tried to spell out how their discipline met the requirements of scientificity despite its focus on (...) disease as a collective phenomenon and its reliance on nonlaboratory methods. This article asks about the relationship between the changing institutional and intellectual contexts of British epidemiological practice and the epidemiologists’attempts to define both science in general and epidemiology in particular. An examination of the epidemiologists’boundary-making endeavors is also used to reflect on the circumstances in which scientists engage in the discourse of disciplinary demarcations. (shrink)

Objective: This paper describes the variety of ways that information about ethics-related methods are included or not included in public health research articles. Methods: Information about the ethics-related content of all articles published in nine highly-respected public health journals in 2006 was extracted. Results: Of 989 primary analyses, 73% of the articles commented on ethics committee approval or exemption, 63% mentioned participant consent and 9% indicated whether or not inducement or compensation was given. 84% of articles mentioned a (...) funding source, but fewer than 4% identified any potential conflict of interest. Reporting rates for committee review and consent were higher for experimental than for observational studies and were comparatively higher in studies conducted among potentially vulnerable populations like children and residents of low income countries. Conclusions: More complete reporting would facilitate the design, evaluation and comparison of future research studies. (shrink)

Epidemiology is a science of disease which specifies rates . Evolution is a science of life which specifies changes . ‘Evolutionary Epidemiology’ is a synthesis of these two sciences which combines the empirical power of classical methods in genetical epidemiology with the interpretive capacities of neo-darwinian evolutionary genetics. In particular, prevalence rates of genetical diseases are important data points when reformulated for the purpose of analysis in terms of their evolutionary frequencies. Traits which exceedprevalences beyond the rates of mutation (...) or evidence unusualrange of phenotypic reaction are of special interest. This is because traits which did not confer advantages in the environment of evolutionary adaptation cannot accede, through natural selection, to anything but low rates of genomic prevalence.Evolutionary epidemiology is, in all of medicine, of particular promise in ongoing efforts to better understand psychopathology. Many complexities of phenotypic adjustment arise when new developmental demands are placed on an ‘old’ genome. The new and complex biosocial ecology of human mass society now evokes different phenotypes than those in the prehistorical ecology to which the genome is structurally and functionally better adapted. Some of these new phenotypes are darwinian failures. In this paper, the theoretical implications of evolutionary epidemiology are extended and some tentative points of clinical application are offered. (shrink)

Epidemiology is a field torn between practices of surveillance and methods of analysis. Since the onset of COVID-19, epidemiological expertise has been mostly identified with the first, as dashboards of case and mortality rates took centre stage. However, since its establishment as an academic field in the early 20th century, epidemiology’s methods have always impacted on how diseases are classified, how knowledge is collected, and what kind of knowledge was considered worth keeping and analysing. Recent advances in digital (...) epidemiology, this article argues, are not just a quantitative expansion of epidemiology’s scope, but a qualitative extension of its analytical traditions. Digital epidemiology is enabled by deep and digital phenotyping, the large-scale re-purposing of any data scraped from the digital exhaust of human behaviour and social interaction. This technological innovation is in need of critical examination, as it poses a significant epistemic shift to the production of pathological knowledge. This article offers a critical revision of the key literature in this budding field to underline the extent to which digital epidemiology is envisioned to redefine the classification and understanding of disease from the ground up. Utilising analytical tools from science and technology studies, the article demonstrates the disruptive expectations built into this expansion of epidemiological surveillance. Given the sweeping claims and the radical visions articulated in the field, the article develops a tentative critique of what I call a fantasy of pathological omniscience; a vision of how data-driven engineering seeks to capture and resolve illness in the world, past, present and future. (shrink)

The paper discusses the evolving concept of causationin epidemiology and its potential interaction with logic and scientific philosophy. Causes arecontingent but the necessity which binds them totheir effects relies on contrary-to-fact conditionals,i.e. conditional statements whose antecedent is false.Chance instead of determinism plays a growing role inscience and, although rarely acknowledged yet, inepidemiology: causes are multiple and chancy; a priorevent causes a subsequent event if the probabilitydistribution of the subsequent event changesconditionally upon the probability of the prior event.There are no known (...) sufficient causes in epidemiology.We merely observe tendencies toward sufficiency ortendencies toward necessity: cohort studies evaluatethe first tendencies, and case-control studies thelatter.In applied sciences, such as medicine andepidemiology, causes are intrinsically connected withgoals and effective strategies: they are recipewhich have a potential harmful or sucessful use; theyare contrastive since they make a differencebetween circumstances in which they are present andthose in which they are absent: causes do notexplain Event E but event E rather thaneven F. Causation is intrinsically linked with thenotion of ``what is pathological''.Any definition of causation will inevitably collapseinto the use made of epidemiologic methods. Theprogressive methodological sophistication of the lastforty years is in perfect alignment with a gradualimplicit overhaul of our concept of causation. (shrink)

Since at least the mid-1970s, public health and law enforcement officials have conducted joint or parallel investigations of both health problems possibly associated with criminal intent and crimes having particular health dimensions. However, the anthrax and other terrorist attacks of fall 2001 have dramatically underscored the needs that public health and law enforcement officials have for a clear understanding of the goals and methods each discipline uses in investigating such problems, including and especially the potential use of biologic agents (...) as weapons of mass destruction. Recognition of these needs has prompted some experts to call for the application of “forensic epidemiology” to such problems. Even before the attacks of fall 2001, other problems, such as the detection of the West Nile Virus in the United States and concerns that the emergence of this infectious agent was the consequence of a deliberate act, raised novel challenges to the combined interests of public health and criminal investigators. (shrink)

This article describes contrasting ideas for a set of topics in epidemiological thinking. The premise underlying this contribution to the special edition is that researchers develop their epidemiological thinking over time through interactions with other researchers who have a variety of in-practice commitments, such as to kinds of cases and methods of analysis, and not simply to a philosophical framework for explanation. I encourage discussants from philosophy and epidemiology to draw purposefully from across a range of topics and contrasting (...) positions, and thereby pursue critical thinking in the sense of understanding ideas and practices better when we examine them in relation to alternatives. After an initial topic concerning practices for developing epidemiological literacy, a number of conceptual steps follow—the characterization of the very phenomena we might be concerned with, the scope and challenges of the field of epidemiology, the formulation of categories—before linking associations, predictions, causes and interventions and examining the confounding of purported links. Building on that conceptual basis, the remaining topics consist of issues or angles of analysis related to the complexities of inequalities within and between populations, context, and changes over the life course. The organization of topics derives from a graduate course that I teach that aims for epidemiological literacy, not technical ability in statistical formulas and data analysis, and shares the underlying premise and critical thinking goals of this article. During the topic-by-topic description, some assertions about explanation and intervention emerge, notably, that epidemiological–philosophical discussion about causality often leaves unclear or unexamined whether a modifiable factor shown to have been associated with a difference in the data from past observations should be thought of as factor that, when modified, would generate that difference going forward. The article concludes with a “Limitations of this Study” section that teases out different kinds of description–prescription relationship that are implied in undertaking philosophy of epidemiology and identifies some other considerations that are implied but not emphasized by this article. (shrink)

Since the second half of the twentieth century, biomedical research has made increasing use of epidemiological methods to establish empirical evidence on a population level. This paper is about practices with data in epidemiological research, based on a case study in Denmark. I propose an epistemology of record linkage that invites exploration of epidemiological studies as heterogeneous assemblages. Focusing on data collecting, sampling and linkage, I examine how data organisation and processing become productive beyond the context of their collection. (...) The case study looks at how a local population database established in 1976 to investigate possibilities for the prevention of cardiovascular disease is used thirty years later to test hypotheses on the aetiology of breast cancer. For two breast cancer investigations based on the same core data set, I follow the underlying record linkage practice and describe how research objects such as molecular markers become relevant with respect to public health through information networking. Epidemiological association studies function as tools that performatively enrol different contexts into statistical risk estimation, thereby configuring options for research as well as for clinical testing and public health policy. (shrink)

The challenges posed by chronic illness have pointed out to epidemiologists the multifactorial complex nature of disease causality. This notion has been referred to as a web of causality. This web extends theoretically beyond risk markers. It includes determinants of emergence/non-emergence of disease. This web of determinants is a form of complex system. Due to its complexity, the determinants within such system are not linked to each others in a linear, predictable manner only. Predictability is possible only on a short-term (...) basis, and unpredictability sets in over the long run. Understanding such a system of determinants calls for articulation and testing of complex models which synthesize our knowledge of multiple determinants at many scales, both biological and otherwise. Given the complexity of this web and existing knowledge about the nonlinearity of such systems, the following question is posed: Can the challenge of studying causality be adequately addressed if emphasis continues to be placed on using tools and methods that are geared towards looking at such system from a linear paradigm? Or is it time to add to the epidemiologic research agenda the notion of nonlinearity and its relevant form of analytical approaches that are being tested in other disciplines? Furthermore, the question posed here applies as well to the study of determinants of health. Addressing determinants of heath adds further complexity to our task. (shrink)

Background: The purpose of the current study was to assess the prevalence of sleep disturbances among Chinese people during the COVID-19 pandemic in a large national survey, analyze the relationship between sleep disturbances and mental health status, and explore the influencing factors of the relationship between sleep disturbances and mental health status.Methods: An online survey was accessed by 19,740 people throughout China from February 14 to 21, 2020. The survey included the Depression Anxiety Stress Scale-21 to measure psychological distress (...) and two questions about sleep disturbances. Logistic regression analyses and moderation analysis were performed.Results: Among the 14,505 respondents included in analyses, 3,783 reported sleep disturbances at least 3 days during the past week. Sleep disturbances increased the risk of depression, anxiety, and stress. Gender, age, education, occupation, frequency of attending to epidemic information, nervousness about supplies, receiving provisions of living necessities from the service department during the outbreak, number of correct responses to questions about the epidemic, and isolation/quarantine affected the risk of mental health problems among participants experiencing sleep disturbances. A moderation analysis found that sleep problems were more likely to affect depression, anxiety, and stress scores in men than women during the COVID-19 outbreak.Conclusion: During the COVID-19 outbreak, 26.08% people surveyed experienced sleep disturbances, and the presence of sleep disturbances was positively related to depression, anxiety, and stress, especially among front-line anti-epidemic workers, younger people, people living in isolation/quarantine, people with a college or greater education, and males. (shrink)

Dissociation is the psychological aspect of stress response. It is an adaptive reaction to a stressor on a short-term basis but can be maladaptive if under- or overutilized and comprises the partitioning of consciousness, ranging from barely to rigidly partitioned. Current means of measuring dissociation focus primarily on DSM-IV-TR Dissociative Disorders and do not sufficiently account for adaptive sub-clinical forms or maladaptive under-dissociating. These measures of pathology are not useful for determining how well-adapted a population is to stress– i.e., how (...) well dissociation is generally put to use. The purpose of this paper is: (1) to analyze the general population and university student studies that have been conducted using current epidemiological methods of assessing dissociation in sub-clinical populations; and (2) to compare and contrast anthropological and epidemiological models of dissociation. An alternative method for assessing dissociation that synthesizes these two views is proposed. (shrink)

Alternatives to convenience sampling (CS) are needed for HIV/STI surveillance of most-at-risk populations in Latin America. We compared CS, time space sampling (TSS), and respondent driven sampling (RDS) for recruitment of men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. During concurrent 60-day periods from June-August, 2011, we recruited MSM/TW for epidemiologic surveillance using CS, TSS, and RDS. A total of 748 participants were recruited through CS, 233 through TSS, and 127 through RDS. The (...) TSS sample included the largest proportion of TW (30.7 %) and the lowest percentage of subjects who had previously participated in HIV/STI research (14.9 %). The prevalence of newly diagnosed HIV infection, according to participants' self-reported previous HIV diagnosis, was highest among TSS recruits (17.9 %) compared with RDS (12.6 %) and CS (10.2 %). TSS identified diverse populations of MSM/TW with higher prevalences of HIV/STIs not accessed by other methods. (shrink)

Epidemiology for and by Indigenous peoples uses quantitative and statistical methods to better document Indigenous health concerns, and is oriented around providing data for use in advocacy to promote Indigenous health equity. This advocacy-oriented, technoscientific work bridges the often distinct social worlds of Indigenous communities, professional public health research, and public policy-making. Using examples from a multisited ethnographic study in three settings, this paper examines the forms of expertise that researcher/practitioners enact as they conduct research that simultaneously harnesses epidemiology’s (...) persuasive power in social worlds like public health and public policy, while also critically challenging legacies of colonialist erasures and misrepresentations of Indigenous health in population statistics. By demonstrating how these continual translations across multiple social worlds enact expertise, this analysis offers a new integration of discussions about both coloniality and expertise within science and technology studies. By focusing on the experiences of technoscientific professionals themselves, this study’s findings also pose new questions for broader STS conversations about how activism is shaping the production of knowledge about health in the twenty-first century. (shrink)

In this commentary, I discuss the scientific changes brought by the exposome, asking what is new about this approach and line of research. I place the exposome in a historical perspective, by analyzing the conditions under which the exposome has been conceived, developed and established in the context of contemporary epidemiological research. I argue that the exposome has been developed by transferring approaches, methods and conceptualizations from other lines of research in the life and health sciences. I thus discuss (...) the conceptual and methodological innovations of the exposome as a result of the merging and adaptation of these elements for new uses and purposes. On this basis, I argue that the novelty of the exposome should be seen in incremental rather than revolutionary terms and, in this sense, the exposome shares significant elements with other projects and repertoires in postgenomics. I conclude by discussing the consequences of this analysis for the potential limitations and future development of exposome research. (shrink)

Policymakers increasingly draw on scientific methods, including simulation modeling, to justify their decisions. For these purposes, scientists and policymakers face an extensive choice of modeling strategies. Discussing the example of smallpox epidemiology, this paper distinguishes three types of strategies: Massive Simulation Models (MSMs), Abstract Simulation Models (ASMs) and Macro Equation Models (MEMs). By analyzing some of the main smallpox epidemic models proposed in the last 20 years, it discusses how to justify strategy choice with reference to the core characteristics (...) of these respective strategies. First, I argue that MEMs often suffice for policy purposes, and need to be replaced only if they are insufficiently robust. Such robustness results, however, only requires the use of ASMs, not MSMs. Second, I argue that although MSMs have larger potentials than ASMs in various dimensions, they are also more likely to fail—and that in many cases, this probability of failing outweighs their higher potential. In particular, these dimensions include the representation of the relevant target, the accurate measurement of the relevant parameters, the number of parameters included, the number of mechanisms modeled simultaneously, and the ways of dealing with structural uncertainty. While this in no way excludes the prospect that some MSMs provide good justifications for policy decisions, my arguments caution against a general preference for MSMs over ASMs for policy decision purposes in general and vaccination problems in particular. (shrink)

Agent-based models (ABMs) are one of the main sources of evidence for decisions regarding mitigation and suppression measures against the spread of SARS-CoV-2. These models have not been previously included in the hierarchy of evidence put forth by the evidence-based medicine movement, which prioritizes those research methods that deliver results less susceptible to the risk of confounding. We point out the need to assess the quality of evidence delivered by ABMs and ask the question of what is the risk (...) that assumptions entertained in ABMs do not include all the key factors and make model predictions susceptible to the problem of confounding. (shrink)

We study the SIS and SIRI epidemic models discussing different approaches to compute the thresholds that determine the appearance of an epidemic disease. The stochastic SIS model is a well known mathematical model, studied in several contexts. Here, we present recursively derivations of the dynamic equations for all the moments and we derive the stationary states of the state variables using the moment closure method. We observe that the steady states give a good approximation of the quasi-stationary states of the (...) SIS model. We present the relation between the SIS stochastic model and the contact process introducing creation and annihilation operators. For the spatial stochastic epidemic reinfection model SIRI, where susceptibles S can become infected I, then recover and remain only partial immune against reinfection R, we present the phase transition lines using the mean field and the pair approximation for the moments. We use a scaling argument that allow us to determine analytically an explicit formula for the phase transition lines in pair approximation. (shrink)

The role of bacterial variation in the waxing and waning of epidemics was a subject of lively debate in late nineteenth and early twentieth-century bacteriology and epidemiology. The notion that changes in bacterial virulence were responsible for the rise and fall of epidemic diseases was an often-voiced, but little investigated hypothesis made by late nineteenth-century epidemiologists. It was one of the first hypotheses to be tested by scientists who attempted to study epidemiological questions using laboratory methods. This paper examines (...) how two groups of experimental epidemiologists, the British group led by W. W. C. Topley and Major Greenwood, and an American group directed by Leslie T. Webster at the Rockefeller Institute, studied the role of variations in bacterial virulence in the course of laboratory epidemics of mouse typhoid. Relying on Ludwik Fleck’s concept of thought styles and thought collectives, the paper analyzes the fundamental conceptual differences between these two groups of researchers and analyzes the kinds of innovations they introduced as they attempted to integrate bacteriological and epidemiological approaches. The paper shows that the stylistic differences between the two groups can be understood better in the context of the institutional histories and disciplinary relations of epidemiology and bacteriology in the two countries. (shrink)

Background: Both the Council for International Organization of Medical Sciences and the Helsinki Declaration emphasize that the potential benefits of research should outweigh potential harms; consequently, some work has been conducted on participants' perception of benefits in therapeutic research. However, there appears to be very little work conducted with participants who have joined non-therapeutic research. This work was done to evaluate participants' perception of benefits in a genetic epidemiological study by examining their perception of the potential benefits of enrollment.Methods: (...) In-depth interviews lasting between 45 and 60 minutes were conducted with a convenient sample of 25 ill patients and 25 healthy accompanying relatives enrolled in a genetic epidemiological study of tuberculosis. Recorded interviews were transcribed and analyzed using content analysis.Results: Participants perceived that research was beneficial and some of the benefits included the generation of new knowledge, finding the cause of diseases, as well as the control, eradication and prevention of disease. Some thought that research was risky whilst others thought that the benefits outweighed the risks.Conclusion: Participants perceived research to be beneficial and most of them thought that, though it was risky, the benefits outweighed the risks. It is our view that researchers need to give serious consideration to participant's perception of benefits in designing their consent forms, to see to the fulfillment of achievable goals. (shrink)

Background: Health systems globally face ncreasing challenges from health crises and epidemic threats, necessitating the pivotal role of epidemiological teams in emergency response. This study investigates the significance of collective competence within these teams, focusing on their ability to collect, analyze, and manage laboratory data effectively. Methods: A cross-sectional descriptive study design was used to survey epidemiological teams in Saudi Arabia. A structured questionnaire was developed based on existing literature and distributed electronically to participants. Data analysis was performed using (...) the Statistical Package for the Social Sciences (SPSS), using descriptive and inferential statistics to summarize participant characteristics and explore associations between variables. Results: A total of 208 epidemiological teams member completed the questionnaire, yielding insights into their The Role of Collective Competence in Epidemiological Teams. The findings reveal high levels of agreement regarding the effectiveness of management approaches, knowledge sharing, and team collaboration, with the average score exceeding 4.0 on a 5-point scale. Notably, team efficacy was found to significantly enhance the efficiency of laboratory data collection and analysis, accounting for approximately 25.9% of the variance in efficacy. Discussion: These findings underscore the need to invest in developing team competencies within epidemiological teams to improve emergency response capabilities. The study provides practical insights into enhancing team collaboration and coordination, ultimately contributing to more effective public health interventions in future health crises. (shrink)

Fundamento: La investigación científica y la divulgación de los resultados obtenidos es uno de los puntales del desarrollo científico del país. Objetivo: Considerar la productividad científica de los especialistas de Higiene y Epidemiología de su Centro Provincial en Camagüey, a partir del número de publicaciones en los últimos cinco años. Método: Se diseñó un estudio transversal desde abril de 2008 hasta abril de 2013, a través de un cuestionario estructurado, de carácter anónimo y con el consentimiento informado de los mismos, (...) donde se recogieron las variables tiempo de graduado, publicaciones en los últimos cinco años, categoría docente e investigativa, conocimientos de técnicas estadísticas, motivación, participación en eventos científicos, dificultades para publicar y dominio del idioma inglés para consultar las bases de datos EBSCO y PUBMED. Resultados: Se mostró una escasa productividad científica independientemente del tiempo de graduado; el número de categorías investigativas por especialista es muy pobre y si bien la mayoría de los mismos reconoce que la especialidad le confiere los conocimientos y motivación necesarias durante su formación, al final expresan tener dificultades para publicar y en el manejo del idioma inglés para estos fines. Conclusiones: La formación del especialista de Higiene y Epidemiología no da salida, al menos de la manera deseada, a uno de sus perfiles básicos como es la investigación. Basis: Scientific research and promotion of the obtained results is one of the objectives of the scientific development of the country, mainly when a specialty is involved, in which this task is included in different versions of the study plans. Objectives: to consider starting from the number of publications in the last five years, the scientific productivity of the specialists of Hygiene and Epidemiology of the Provincial Center of Hygiene, Epidemiology and Microbiology of Camagüey. Method: To carry out this task a cross sectional study was designed by authors through a small, anonymous structured questionary and with the informed consent of all of them, in which the following variables were analyzed: graduation date, publications in the last five years, teaching or scientific category, knowledge of statistical techniques, motivation, participation in scientific events, difficulties for publishing and knowledge of the English language to consult de databases EBSCO and PUBMED. Results: Poor scientific performance is observed, apart from graduation experience, the number of scientific categories by specialists is very low and even though most of them accept that the specialty promotes knowledge and necessary motivations during their postgraduate studies, finally they confirm there are difficulties for publishing and to manage English language for this purpose. Conclusions: The teaching curriculum of Hygiene and Epidemiology specialist does not promote research, one of its basic fields. (shrink)

Introduction. Improving control and supervisory activities on the basis of introducing risk-oriented approaches is an urgent area of public administration reforms both in Russia and abroad. Traditionally, assessing the effectiveness of this area is carried out on the basis of the state control intensity indicators (the number of inspections), and assessing risks in controlled areas is carried out on the basis of statistical indicators, partially dependent on state control bodies. To obtain a balanced assessment of the state control effectiveness and (...) efficiency, it is important to take into account other data sources reflecting the citizens’ and the business community position. The purpose of the study is to conduct a comprehensive assessment of the effectiveness and efficiency of sanitary and epidemiological surveillance on the basis of both statistical data and the results of sociological studies reflecting the position of citizens and business. Methods. The authors suggest their own methods for comprehensive assessment of the effectiveness and efficiency of state control. The scientific novelty of the study consists in a comprehensive assessment of the effectiveness and efficiency of sanitary and epidemiological surveillance, taking into account various data sources and making it possible to assess the progress of implementing the reform of state control in this area. Results. The results of the study indicate, in general, an increase in the effectiveness and budgetary efficiency of sanitary and epidemiological surveillance over the last years of the reform implementation. At the same time, at the level of intermediate and immediate results, there are multidirectional trends, and the growth in the total costs of business and the state is ahead of the growth in the results achieved. Conclusions. The use of the authors’ comprehensive methodology for assessing the effectiveness and efficiency of state control makes it possible to obtain reliable data characterizing the actual state of things in the area under consideration. Further improving the efficiency and effectiveness of sanitary and epidemiological surveillance requires expanding the scope of applying risk-oriented approaches and improving the quality of considering the appeals of the citizens who faced with risks of wrongdoing. (shrink)

Fundamento: El currículo de estudios, principalmente de posgrado, no puede considerarse como un plan al que hay que ajustarse de manera estricta, sino que debe ser más flexible, que dé salida a los objetivos propuestos según las situaciones del entorno. Objetivo: mostrar algunos resultados de la vinculación del residente de Higiene y Epidemiología a actividades epidemiológicas emergentes en la actualidad. Método: se realizó un estudio descriptivo transversal en el Centro Provincial de Higiene, Epidemiología y Microbiología de Camagüey durante junio de (...) 2014. Se entrevistó a un universo de 32 profesionales. Las variables utilizadas fueron: utilidad de la vinculación extracurricular a programas y tareas de control epidemiológico, desarrollo práctico de los aspectos teóricos, vencimiento con calidad del diseño curricular de la residencia y si se consideró necesario o no interrumpir el plan de estudios ante eventos epidemiológicos de emergencia. Resultados: La mayoría de los especialistas consideró que la vinculación a actividades específicas le permitió vencer con calidad el plan de estudios, mientras que el mayor porcentaje de los residentes no lo estimó así. Ningún residente entrevistado estuvo de acuerdo con la interrupción del plan de estudios ante situaciones emergentes. Conclusiones: la vinculación del residente a actividades prácticas emergentes puede servir de incentivo para la graduación de un especialista con mayor competencia profesional, sin abandonar el diseño curricular establecido. Fundament: The study curriculum, especially of post grade, cannot be considered as a plan to which one has to be adjusted in a strict way, but to be more flexible, offering a way out to the proposed objectives according to the situations of the environment. Objective: to offer some results of the linking of the medical resident of Hygiene and Epidemiology to emergent epidemiological activities at the present time. Method: A cross-sectional descriptive study at the Provincial Center of Hygiene, Epidemiology and Microbiology during June 2014 was carried out. A universe of 32 professionals was interviewed. The variables used were: usefulness of the extracurricular linking to programs and tasks of epidemiological control, practical development of theoretical aspects, quality achievement of the curricular design of the medical residency, and if it was necessary or not to interrupt the study plan in emergent epidemiological events. Results: Most of the specialists considered the linking to emergent epidemiological activities allowed to finish with quality its study plan, while that the biggest percentage of the residents did not estimate it in the same way. None of the interviewed resident agreed with the interruption of the study plan in front of emergent situations. Conclusions: the linking of the medical resident to practical emergent activities can serve as incentive for the graduation of the specialists with better professional competence without abandoning the established curricular design. (shrink)

There are challenges to the dominant research paradigm in breast cancer science. In the United States, science and social activism create paradigmatic shifts. Using interviews, ethnographic observations, and an extensive review of the literature, we create a three-dimensional model to situate changes in scientific controversy concerning environmental causes of breast cancer. We identify three paradigm challenges posed by activists and some scientists: to move debates about causation upstream to address causes; to shift emphasis from individual to modifiable societal-level factors beyond (...) an individual’s control; and to allow direct lay involvement in research, which may raise new questions and change how questions are approached, the methods used, and the standards of proof. We use our model to examine controversies about doing scientific research, interpreting scientific results, and acting on science. Ultimately, we aim to understand what impedes construction of new methodologies and knowledge about environmental factors in human disease. (shrink)

In this study the theory of risk factors is discussed. The risk-concept is essential in cardiology and is, furthermore, important not only in medicine in general, but also and particularly in ecology. Since environmental risk factors endanger our health, ecological risks have to be taken as medical problems. If a factor or a set of factors is a necessary but not a sufficient condition for a disease we speak of a risk factor or of risk factors. Statistical analysis of risk (...) factors can be performed by multivariate methods. A method which is particularly useful for finding the most important of a set of risk factors, is discriminant analysis. (shrink)

In 2000, US Secretary of Health and Human Services Secretary Tommy Thompson mobilized the US public health infrastructure to deal with escalating trends of excess body weight. A cornerstone of this effort was a report entitled The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. The report stimulated a great deal of public discussion by utilizing the distinctive public health terminology of an epidemic to describe the growing prevalence of obesity in the US population. We suggest (...) that the ensuing controversy was fueled in part by the report's ambiguous usage of the evocative term “epidemic.” In some passages, the report seems to use “epidemic” in a literal sense, suggesting that rising prevalence of excess body weight should be defined technically as a disease outbreak. Other passages of the report present the same key term metaphorically, leaving readers with the impression that the epidemic language is invoked primarily for rhetorical effect. Here, we explore dynamics and implications of both interpretations. This analysis sheds light on the ongoing public argument about the appropriate societal response to steadily increasing body sizes in the US population; likewise, it capitalizes on the accumulated knowledge that the field of public health has garnered from combating diverse historic epidemics. Our interdisciplinary approach deploys critical tools from the fields of rhetoric, sociology and epidemiology. In particular, we draw from metaphor theory and public address scholarship to elucidate how the Call to Action frames public deliberation on obesity. We turn to the applied public health literature to develop a reading of the report that suggests a novel approach to the problem—application of the Epidemic Investigation protocol to streamline the public health response and reframe the public argument about obesity. (shrink)

One of the great challenges for students of any discipline is to be able to put into practice the knowledge learned in theory. Public health does not escape this challenge. Research Methods for Public Health is a book that seeks to help students understand in a simple way how to enter into the practice of public health research. This book stands out for its easy reading, but especially because it emphasizes the existence of quantitative and qualitative methods, as (...) well as the combination of both methods. On the other hand, the authors show between the lines, and sometimes more clearly, the importance of teamwork in research groups, a key element to avoid errors, validate procedures or instruments and increase the reliability of the results, as well as the importance of criteria of validity, reliability, precision, relevance, transparency and credibility, among others. -/- Uno de los grandes retos para los estudiantes de cualquier disciplina es poder poner en práctica los conocimientos aprendidos en la teoría. La salud pública no se escapa de este desafío. Research Methods for Public Health es un libro que busca ayudar a comprender de manera sencilla cómo introducirse en la práctica de la investigación en salud pública. Este libro se destaca por su fácil lectura, pero especialmente porque pone el énfasis en la existencia de los métodos cuantitativos y cualitativos, así como en la combinación de ambos métodos. Por otro lado, los autores dejan ver entrelíneas, y a veces más claramente, la importancia del trabajo en equipo en los grupos de investigación, elemento clave para evitar errores, validar procedimientos o instrumentos y aumentar la confiabilidad de los resultados, así como la importancia de criterios de validez, confiabilidad, precisión, relevancia, transparencia y credibilidad, entre otros. -/- Reseña del libro: Stuart McClean, Isabelle Bray, Nick de Viggiani, Emma Bird and Paul Pilkington. Research Methods for Public Health. London: SAGE, 2020. 273 p. (shrink)

The case of John Snow has long been important to epidemiologists and public health officials. However, despite the fact that there have been many discussions about the various aspects of Snow’s case, there has been virtually no discussion about what guided Snow’s reasoning in his coming to believe his various conclusions about cholera. Here, I want to take up this question in some detail and show that there are a number of specific principles of reasoning that played a crucial role (...) for Snow. Moreover, these principles were episte- mologically important to Snow, a fact about which Snow is explicit in many places. An analysis of Snow’s case suggests that, because of the epistemic role such principles of reasoning can play, health care practitioners ought to understand their practices to be theoretically informed in these ways, and not just data driven. (shrink)

It is estimated that typhoid fever (TF) annually affects more than 12 million persons, worldwide. TF is the result of a generalized infection by the enterobacterium Salmonella typhi. Patients with TF, most of whom live in developing countries have impaired activity for several weeks resulting in an important loss in productivity and welfare. Death may occur, with the single most frequent cause being intestinal perforation. While the first priority must be to develop better methods of disease prevention, there is (...) also an urgent need to devise easy, accurate, and inexpensive diagnostic assays that will allow early routine distinction of TF from other febrile illnesses. Research on TF offers the opportunity to explore many aspects of pathogenesis and the host immune response, as well as to contribute toward the development of new vaccines and diagnostic laboratory tests. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

Contemporary epidemiological methods testing the associations between green space and psychological well-being treat all vegetation cover as equal. However, there is very good reason to expect that variations in ecological "quality" (number of species, integrity of ecological processes) may influence the link between access to green space and benefits to human health and well-being. We test the relationship between green space quality and restorative benefit in an inner city urban population in Bradford, UK. We selected 12 urban parks for (...) study where we carried out botanical and faunal surveys to quantify biodiversity and assessed the site facilities of the green space (cleanliness, provision of amenities). We also conducted 128 surveys with park users to quantify psychological restoration based on four self-reported measure of general restoration, attention-grabbing distractions, being away from everyday life, and site preference. We present three key results. First, there is a positive association between site facilities and biodiversity. Second, restorative benefit is predicted by biodiversity, which explained 43% of the variance in restorative benefit across the parks, with minimal input from other variables. Third, the benefits accrued through access to green space were unrelated to age, gender, and ethnic background. The results add to a small but growing body of evidence that emphasise the role of nature in contributing to the well-being of urban populations and, hence, the need to consider biodiversity in the design of landscapes that enhance multiple ecosystem services. (shrink)

We compared two digital humanities methods in the analysis of a contested scientific term. “Epigenetics” is as enigmatic as it is popular. Some authors argue that its meaning has diluted over time as this term has come to describe a widening range of entities and mechanisms (Haig, International Journal of Epidemiology 41:13–16, 2012). Others propose both a Waddingtonian “broad sense” and a mechanistic “narrow sense” definition to capture its various scientific uses (Stotz and Griffiths, History and Philosophy of the (...) Life Sciences 38:22, 2016). We evaluated these proposals by first replicating a recent analysis by (Linquist and Fullerton, Theoretical Medicine and Bioethics 42:137–154, 2021). We analyzed the 1100 most frequently cited abstracts on epigenetics across four disciplines: proximal biology, biomedicine, general biology, and evolution. Each abstract was coded for its heritability commitments (if any) and functional interpretation. A second study applied LDA topic modelling to the same corpus, thus providing a useful methodological comparison. The two methods converged on a discipline-relative ambiguity. Within such disciplines as biomedicine or molecular biology that focus on proximate mechanisms, “epigenetic(s)” refers to a range of molecular structures while specifying nothing in particular about their heritability. This proximal conception was primarily associated with the functions of gene regulation and disease. In contrast, a second relatively uncommon sense of “epigenetic(s)” is restricted to a small proportion of evolutionary abstracts. It refers to many of the same molecular structures, but regards them as trans-generationally inherited and associated with adaptive phenotypic plasticity. This finding underscores the benefit of digital tools in complementing traditional conceptual analysis. Philosophers should be cautious not to conflate the relatively uncommon evolutionary sense of epigenetics with the more widely used proximal conception. (shrink)

IntroductionThe 2019–2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.Materials and MethodsThis study uses a mixed-method cross-sectional design, including a (...) quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants’ socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi’s phenomenological method.ResultsThe results reveal that 25.7% of patients reported higher level of psychological distress. After controlling the sociodemographic variables, only severity of COVID-19 and uncertainty in illness shown significant effect on psychological distress in the regression model. The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.ConclusionThe 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies. (shrink)

Evidence based medicine has much to offer, but a great deal remains to be done to create a better understanding of what it can and cannot do.The term EBM , as we use it nowadays, was introduced in 1992 by the same group of people who, years before, founded the discipline called “Clinical epidemiology” .1 CE stemmed essentially from the idea of adapting and expanding epidemiological methods to medical and health care decision making; CE was in fact defined as (...) “ the discipline dealing with the study of the occurrence of medical decisions in relation to their determinants”.1CE has been very successful in illustrating new ways of teaching medicine and training health professionals, and has positioned itself around the notion that “critical appraisal skills” are yet another set of essential abilities which—in addition to the interpersonal, diagnostic, and prognostic skills—a good doctor should master. An important by product of CE was documentation which showed that much of the available evidence on diagnosis, prognosis, and treatment of diseases was of poor methodological quality and quite often of dubious transferability to everyday clinical practice.This led to a strong call for improving the scientific basis of clinical practice, which was seen as too often dominated by practices of unproven effectiveness. This was the background for the 1992 Journal of the American Medical Association article that first used the term “evidence based medicine”.2In essence, proponents of EBM said that “all medical action of diagnosis, prognosis, and therapy should rely on solid quantitative evidence based on the best of …. (shrink)

Proponents of evidence-based medicine have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence (...) hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. (shrink)

Epidemiological models of the transmission of SARS-CoV-2 played an important role in guiding the decisions of policy-makers during the pandemic. Such models provide output projections, in the form of time -series of infections, hospitalisations, and deaths, under various different parameter and scenario assumptions. In this paper I caution against handling these outputs uncritically: raw model-outputs should not be presented as direct projections in contexts where modelling results are required to support policy -decisions. I argue that model uncertainty should be handled (...) and communicated transparently. Drawing on methods used by climate scientists in the fifth IPCC report I suggest that this can be done by: attaching confidence judgements to projections based on model results; being transparent about how multi-model ensembles are supposed to deal with such uncertainty; and using expert judgement to ‘translate’ model-outputs into projections about the actual world. In a slogan: tell me what you think (and why), not (just) what your models say. I then diffuse the worry that this approach infects model-based policy advice with some undesirably subjective elements, and explore how my discussion fares if one thinks the role of a scientific advisor is to prompt action, rather than communicate information. (shrink)

November 2009’s announcement of the USPSTF’s recommendations for screening for breast cancer raised a firestorm of objections. Chief among them were that the panel had insufficiently valued patients’ lives or allowed cost considerations to influence recommendations. The publicity about the recommendations, however, often either simplified the actual content of the recommendations or bypassed significant methodological issues, which a philosophical examination of both the science behind screening recommendations and their import reveals. In this article, I discuss two of the leading ethical (...) considerations at issue in screening recommendations: respect for patient autonomy and beneficence and then turn to the most significant methodological issues raised by cancer screening: the potential biases that may infect a trial of screening effectiveness, the problem of base rates in communicating risk, and the trade-offs involved in a judgment of screening effectiveness. These issues reach more broadly, into the use of “evidence-based” medicine generally, and have important implications for informed consent. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

In ontological terms, what can we learn from the current state of the art in Epidemiology? Applying the Quinean criterion of ontological commitment, we can learn that there are several fundamental entities for the theory to work. One is a virus type entity, in which the (in)famous Coronavirus is a particular case. In metaphysical terms, this entity can, in principle, be understood in several ways. One of those ways, apparently, and perhaps intuitively, is the notion of object. Applying the metametaphysical (...) method of Unavailable Metaphysical Stories, we found that Epidemiology is incompatible with an object metaphysics. (shrink)

Biomedical deployments of data science capitalise on vast, heterogeneous data sources. This promotes a diversified understanding of what counts as evidence for health-related interventions, beyond the strictures associated with evidence-based medicine. Focusing on COVID-19 transmission and prevention research, I consider the epistemic implications of this diversification of evidence in relation to: (1) experimental design, especially the revival of natural experiments as sources of reliable epidemiological knowledge; and (2) modelling practices, particularly the recognition of transdisciplinary expertise as crucial to developing and (...) interpreting data models. Acknowledging such shifts in evidential, experimental and modelling practices helps avoid harmful applications of data-intensive methods. (shrink)

ArgumentIn August of 1977, Australian pathologist David W. Buntine delivered a presentation at the Annual Meeting of the Royal College of Pathologists of Australia in Melbourne, Victoria. In this presentation, he used the diagnostic category of “Eskimoma,” to describe a unique set of salivary gland tumors he had observed over the past five years within Winnipeg’s Health Sciences Center. Only found amongst Inuit patients, these tumors were said to have unique histological, clinical, and epidemiological features and were unlike any other (...) disease category that had ever been encountered before. To understand where this nosological category came from, and its long-term impact, this paper traces the historical trajectory of the “Eskimoma.” In addition to discussing the methods and infrastructures that were essential to making the idea of Inuit cancer “visible,” to the pathologist, the epidemiologist, and to society at large, this paper discusses how Inuit tissue samples obtained, stored, and analyzed in Winnipeg, Manitoba, came to be codified into a new, racially based disease category – one that has guided Canadian and international understandings of circumpolar cancer trends and shaped northern healthcare service delivery for the past sixty years. (shrink)

This article traces the history of the Susceptible, Infected, Recovered (SIR) model in early 20th-century epidemiology (1904–27). The aim is to test the hypothesis that the active stance taken by Ross, Hudson, McKendrick, and Kermack represents a turn in the history of modern epidemiology, shifting the classical method of statistical epidemiology from a data-based model to a theory-based model. The article shows that epidemiological modeling is based on a mathematical simplification of epidemics at the time of the microbiological complexification of (...) epidemiology. What were the implications of the mathematical theory of epidemics for the development of modern epidemiology? How can epidemic dynamics be expressed mathematically without compromising the biological representation? This is exactly what is at stake here: from the work of Ross to the standardization of the SIR model by McKendrick and Kermack, modeling has been confronted with the problem of relating its equations to the facts. (shrink)

Causality offers the first comprehensive coverage of causal analysis in many sciences, including recent advances using graphical methods. Pearl presents a unified account of the probabilistic, manipulative, counterfactual and structural approaches to causation, and devises simple mathematical tools for analyzing the relationships between causal connections, statistical associations, actions and observations. The book will open the way for including causal analysis in the standard curriculum of statistics, artificial intelligence, business, epidemiology, social science and economics.