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Title: Journal of Epidemiology and Community Health
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Title: Journal of Epidemiology and Community HealthFull Journal Title: Journal of Epidemiology and Community Health ISO Abbreviated Title: J. Epidemiol. Community Health JCR Abbreviated Title: J Epidemiol Commun H ISSN: 0143-005X Issues/Year: 4 Journal Country/Territory: England Language: English Publisher: British Med Journal Publ Group Publisher Address: British Med Assoc House, Tavistock Square, London WC1H 9JR, England Subject Categories: Public, Environmental & Occupational Health: Impact Factor 1.698, 27/85 ? Patel, M. (1980), Effects of the health service and environmental factors on infant mortality: The case of Sri Lanka. Journal of Epidemiology and Community Health, 34 (2), 76-82. Abstract: One of the findings of this study is that regional variations in the infant mortality rates of Sri Lanka are large, ranging from 26 per 1000 live births in Jaffna to 91 per 1000 in Nuwara Eliya, a tea estate district. These differences are more strongly associated with regional variations in environmental determinants of mortality than with regional variations in public health expenditure. The most significant environmental factor associated with interregional infant mortality rates was to be the nature of the water supply (r = -0.82, significant at the 99% level). Regional government expenditure on health had only a weak association with infant mortality rates (r = 0.08). ? Dolk, H., Mertens, B., Kleinschmidt, I., Walls, P., Shaddick, G. and Elliott, P. (1995), A standardization approach to the control of socioeconomic confounding in small area studies of environment and health. Journal of Epidemiology and Community Health, 49, S9-S14. Abstract: Objective-To assess how effectively a routine adjustment can be made for socioeconomic confounding in small area studies of environment and health using indirect standardisation and small area deprivation indices, including analysis of the appropriate size of population unit on which to base the deprivation index and the importance of region and urban/rural status as axes of stratification. Method-Standardised morbidity ratios were calculated for cancers in Great Britain for 1981 and standardised mortality ratios for all cause mortality in Great Britain between 1982 and 1985. Deprivation indices were calculated for enumeration districts and wards from 1981 small area census statistics. Cancers and deaths were allocated to enumeration districts via their postcode. Standardised morbidity and mortality ratios were calculated by quintile of enumeration district according to the deprivation index. Standardised mortality ratios were further analysed by deprivation of ward, region and urban/rural status. Results-Strong relationships were found between all cause mortality and the incidence of selected cancers and deprivation quintile-there was up to a twofold difference in lung cancer incidence between the highest and lowest quintile. The deprivation index can be used to measure gradients of deprivation according to the distance from industrial sites. The deprivation index for enumeration districts showed similar discrimination of mortality as the index for wards. There is some interaction between deprivation and region in their effect on the standardised mortality ratios, leading to a small bias in the estimation of expected numbers if this is not taken into account. The relationship between deprivation, urban/rural status and mortality is complex and confounded by region, but mortality tends to be higher in urban than in rural areas within quintiles of deprivation. Discussion-Whether calculated for enumeration districts or wards, the main problems in the interpretation of the deprivation index may be its limited correlation with the risk factors of interest and its concentration on present rather than past socioeconomic status. Indirect standardisation based on stratification for deprivation and other variables involves a trade off between bias and precision in determining the fineness and the number of axes of stratification. Some bias may occur due to interaction between region and deprivation and the effects of urban/rural status. Complementary approaches including modelling and proportional mortality or morbidity analyses may be needed and the possibility of residual socioeconomic confounding must always be considered. Conclusion-There is potential for important socioeconomic confounding in small area studies of environmental pollution and health where the health outcome under examination has a strong relationship to socioeconomic status and where the putative excess risk due to pollution may be small. One method of controlling for confounding is to use an ecological measurement of deprivation in small areas and to adjust for deprivation by indirect standardisation. However, residual socioeconomic confounding can be expected, which may seriously complicate the interpretation of small area studies. ? Fowle, S.E., Constantine, C.E., Fone, D. and Mccloskey, B. (1996), An epidemiologic study after a water contamination incident near Worcester, England in April 1994. Journal of Epidemiology and Community Health, 50, 18-23. Abstract: Study objectives-To investigate whether exposure to tap water contaminated in a major river pollution incident with 2 ethyl 5, 5 dimethyl 1, 3 dioxane (EDD) and 2 ethyl 4 methyl 1, 3 dioxolane (EMD) was associated with an increase of self reported symptoms. To assess the extent of association between noticing the water had an unusual taste or odour and self reported symptoms. Design-Retrospective cohort study. Setting-A city and two nearby towns in a semi-rural area of England, UK. Participants-A total of 3861 people who replied to a postal questionnaire asking about symptoms and water consumption sent to a sample of 1000 households in each of three areas-one area supplied with contaminated water (study group) and two control areas that were unaffected (control groups). Main results-The household response rates were 65% for the study group and 56% and 57% for the two control groups. Self reporting of 10 individual symptoms was significantly increased in the study group compared with controls. Within the study group, reporting of one or more symptoms was significantly higher in subjects who consumed contaminated water but not among subjects who used it to wash or cook. Subjects who drank contaminated water showed a dose-response relationship for self reporting of one or more symptoms and for seven individual symptoms. Within the study group, however, only 62% (867 of 1398 subjects) noticed that the water had an unusual taste or odour. Among subjects who did not notice that the water had an unusual taste or odour, no association was found between drinking contaminated water and reporting one or more symptoms, or between drinking contaminated water and reporting of individual symptoms, although a dose-response relationship was shown between the amount of water consumed and self reporting of nausea. Among subjects who noticed the water had an unusual taste or odour, both an association and a dose-response relationship were found between consumption of contaminated water and the self reporting of six symptoms-diarrhoea, nausea, headache, stomach pains, skin irritation and itchy eyes. Retrospective cohort study. Conclusions-Higher rates of symptom reporting were associated with the water contamination incident. Reported symptoms seemed, however, to be associated with the ability to detect an unusual taste or odour in the water. Because concentrations of the contaminants would be expected to be evenly distributed in the tap water in the affected area, irrespective of taste or odour and because of the known toxicity of the parent compounds of EMD and EDD, it is concluded that the increase in self reported symptoms in the study group respondents was associated with noticing the unpleasant taste or odour of the tap water and not with the chemical contamination. It is concluded that the observed increase in reporting of nausea with increasing water consumption was due to public anxiety caused by the incident but did not pose a serious risk to the public’s health, The increase in self reported symptoms in the area affected by the contamination was an important reminder of the wider health implications of “health scares”. Ginns, S.E. and Gatrell, A.C. (1996), Respiratory health effects of industrial air pollution: A Study in East Lancashire, UK. Journal of Epidemiology and Community Health, 50, 631-635. Abstract: Study objective-To determine whether there was a higher incidence of respiratory ill health in children living near to a cement works than in those from a different area and if so whether the higher incidence was due to the use of a hazardous waste-derived fuel at the works. Study design-A sample of the population of children Living near the cement works (the study area) was compared with a sample of children living between 9 and 19 km away from the site (the control area). Setting-The cement works is Located on the north eastern edge of a small rural town in east Lancashire. Methods-Data were collected via the use of a health questionnaire. This was distributed through selected primary schools to families who had one or more children of primary school age (5-11 years). Main results-The study and control populations were comparable in terms of response rates, gender and socioeconomic indicators. There was no significant difference in the incidence of asthma (as diagnosed by a general practitioner) between the two areas when adjustment for hayfever was made. The incidence of sore throat was significantly higher in the case area, a difference not explained by other factors. For two other non-specific indicators of respiratory health (blocked nose and sore eyes) there was a significantly higher incidence in the study area, although hayfever and mould were also significant influences. Conclusions-The results indicated that certain non-specific health indicators were more common in the children living near a cement works. This excess may be due to exposure to emissions from the site. However, it is not possible to draw firm conclusions because there are no epidemiological data predating the use of the hazardous waste derived fuel. James, W.H. (1996), The decline in sex ratios at birth, England and Wales, 1973-90. Journal of Epidemiology and Community Health, 50, 690-691. Ballester, F. and Sunyer, J. (2000), Drinking water and gastrointestinal disease: Need of better understanding and an improvement in public health surveillance [editorial; comment]. Journal of Epidemiology and Community Health, 54 (1), 3-5. Schwartz, J., Levin, R. and Goldstein, R. (2000), Drinking water turbidity and gastrointestinal illness in the elderly of Philadelphia [see comments]. Journal of Epidemiology and Community Health, 54 (1), 45-51. Abstract: STUDY OBJECTIVE: To investigate the association between drinking water quality and gastrointestinal illness in the elderly of Philadelphia. DESIGN: Within the general population, children and the elderly are at highest risk for gastrointestinal disease. This study investigates the potential association between daily fluctuations in drinking water turbidity and subsequent hospital admissions for gastrointestinal illness of elderly persons, controlling for time trends, seasonal patterns, and temperature using Poisson regression analysis. SETTING and PARTICIPANTS: All residents of Philadelphia aged 65 and older in 1992-1993 were studied through their MEDICARE records. MAIN RESULTS: For Philadelphia’s population aged 65 and older, we found water quality 9 to 11 days before the visit was associated with hospital admissions for gastrointestinal illness, with an interquartile range increase in turbidity being associated with a 9% increase (95% CI 5.3%, 12.7%). In the Belmont service area, there was also an association evident at a lag of 4 to 6 days (9.1% increase, 95% CI 5.2, 13.3). Both associations were stronger in those over 75 than in the population aged 65-74. This association occurred in a filtered water supply in compliance with US standards. CONCLUSIONS: Elderly residents of Philadelphia remain at risk of waterborne gastrointestinal illness under current water treatment practices. Hospitalisations represent a very small percentage of total morbidity. ? Vlassov, V. (2000), Is there epidemiology in Russia? Journal of Epidemiology and Community Health, 54, 740-744. Full Tex: 2000\J Epi Com Hea54, 740.pdf Abstract: OBJECTIVE-To examine the current state of epidemiology in Russia. DESIGN-The structure of clinical research and statistical methods was used to shed light on the epidemiology in Russia. The frequencies of specific study designs were evaluated using Medline data for 1970-1997. To determine the proportion of advanced design clinical studies the frequency of cohort, prospective, follow up, or longitudinal studies, and controlled trials was evaluated. All diagnosis related studies were found to determine the usage of advanced statistical technique (ROC analysis). The adequacy of Medline information was checked by hand search of journals. All dissertations in epidemiology defended in Russia in 1995 and 1996 were evaluated for their methodology. The curriculum recommended by Ministry of Health to Medical Universities was evaluated. Available literature and library indexing of epidemiological terms examined. MAIN RESULTS-Russian medical research uses less frequently advanced study designs and methods of data analysis. Medical students are taught epidemiology as a science of spread of infectious diseases. There is no department of epidemiology in Russian universities where epidemiology is taught in the modern sense and no epidemiological and biostatistical periodicals available in Russia. CONCLUSION-Epidemiology in Russia remains in an archaic state of science of the spread of infectious diseases and it is detrimental to methodology of medical research in Russia. Keywords: Soviet Union, Russia, Study Design, Comparative Studies Hjern, A. and Bremberg, S. (2002), Social aetiology of violent deaths in Swedish children and youth. Journal of Epidemiology and Community Health, 56 (9), 688-692. Abstract: Study objective: To describe the contribution of social conditions for the main causes of injury deaths in Swedish children and youth aged 5-25 years. Design: Cohort study. All children below 15 years of age that resided in Sweden 1985 were followed up during 1991-1995. Injury deaths were recorded from The National Cause of Death Register. Information on parental social determinants were collected from various national registers. Connections between the social determinants and an injury death outcome were analysed in multivariate, Cox regression models. Main results: In total 1474 injury deaths were recorded during approximately 8 million person years. In a regression model, with control for sex, year of birth, and residency (urban/rural), the aetiological fraction for parental SES, maternal country of birth, family situation, parental risk factors, and all these factors combined were 13%, 6%, 1.4%, 1.3%, and 19%, respectively. Similar regression models were studied separately for each of the main causes of injury death. The parental social determinants explained 58% of all homicides, 47% of all motor traffic injuries, and 30% of all other traffic injuries while the suicide rate was not affected by these determinants. Parental socioeconomic status was the single most important parental determinant for all major causes of injury. Conclusions: There was a wide variation of the aetiological fractions of parental social determinants for different causes of injury death. This variation might be used to further investigate the social aetiology of injuries. Keywords: Injury Mortality, Area Analysis, Health, Income, Risk ? Porta, M., Malats, N., Vioque, J., Carrato, A., Soler, M., Ruiz, L., Barbera, V., Ayude, D. and Real, F.X. (2002), Incomplete overlapping of biological, clinical, and environmental information in molecular epidemiological studies: A variety of causes and a cascade of consequences. Journal of Epidemiology and Community Health, 56 (10), 734-738. Full Tex: 2002\J Epi Com Hea56, 734.pdf Keywords: Biological, Clinical, Environmental, Information, Overlapping ? Cohen, J.M., Wilson, M.L. and Aiello, A.E. (2007), Analysis of social epidemiology research on infectious diseases: Historical patterns and future opportunities. Journal of Epidemiology and Community Health, 61 (12), 1021-1027. Full Tex: 2007\J Epi Com Hea61, 1021.pdf Abstract: Background: Despite the many triumphs of biomedical research over infectious diseases, human pathogens continue to impact profoundly populations deprived of social resources. Correspondingly, health researchers have advocated a social determinants approach to the study and prevention of infectious diseases. However, it is unknown whether this call has resulted in an increase in the number of studies examining social determinants of infectious outcomes. Methods: Research on social determinants of infectious diseases was systematically quantified by assessing temporal trends in the published literature using MEDLINE, PsycINFO and ISI Web of Science. Results: Results of the literature review spanning 1966-2005 show that socially related citations increased an annual average of 180.3 for neuropsychiatric conditions, 81.9 for chronic conditions, 44.7 for sexually transmitted diseases and 18.9 for non-sexually transmitted infectious diseases (p < 0.0001). of the 279 publications found to employ the term “socialepidemiology’’, 15 (5.4%) investigated infectious outcomes. Conclusions: The results of the literature review suggest a paucity of social research on infectious diseases. There is a need for increased dialogue and collaboration between infectious disease epidemiologists and social epidemiologists. Keywords: AIDS, Biomedical, Biomedical Research, Citations, Collaboration, Common Cold, Determinants, Disease, Epidemiology, Heterosexual Gonorrhea, HIV Prevention, Human, Impact, Infectious Diseases, Injecting Drug-Users, ISI, Literature, Literature Review, Malaria, Medline, Methods, Outcomes, Poverty, Prevention, Public-Health, Publications, Research, Researchers, Review, Science, Sexually Transmitted Diseases, Social, St Thomas, Systematic Reviews, Trends, Web of Science
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