Developing surveillance for HIV transmission and risk behaviours among high-risk groups in a central London health district.
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BACKGROUND: Our aim was to describe surveillance data on HIV transmission and risk behaviours in Camden and Islington, an inner London health district (population 360 000). This information is required to assess the effectiveness of HIV-AIDS prevention. METHODS: We focused on two groups in the local population most severely affected by the HIV epidemic: homosexual and bisexual men, and injecting drug users. Data were drawn from routine and survey data, national and local sources, and a special local survey. RESULTS: There were estimated to be 9250 homosexual men, with an estimated prevalence of 7.7 per cent (confidence interval (CI) 5.9-11.0) diagnosed with HIV infection resident within the health district, and 9900 injecting drug users, with an estimated prevalence of 0.8 per cent (CI 0.6-1.1), diagnosed with HIV infection. New HIV infections diagnosed amongst homosexual men having a named test in HIV testing services averaged 281 and was unchanged between 1992 and 1996. However, unlinked anonymous seroprevalence surveys showed a decline in HIV prevalence for both homosexual men attending a genito-urinary medicine clinic and for injecting drug users attending services. Local surveys indicated that, in the preceeding year, one in three homosexual men had had unprotected anal intercourse with a man, and 13 per cent of intravenous drug users had shared equipment. There appeared to be no change in these levels over the years studied. CONCLUSION: Population-based information on HIV is available at local level in England. It can be used for surveillance of HIV transmission and behaviour in high-risk groups, especially homosexual and bisexual men and intravenous drug users. Resources for HIV prevention are provided to all NHS districts, and surveillance is a cost-effective measure of the outcome of HIV prevention. (+info)
Reassessing the role of epidemiology in public health.
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This commentary examines the scope of epidemiology and delineates the role of epidemiology in relation to public health. Epidemiology is a science; public health is a mission that is implemented through societal action. The implications of this difference are considered, and the sufficiency of epidemiology for guiding public health is evaluated in relation to other scientific disciplines and nonscientific considerations. The authors conclude that epidemiology is not the basic science of public health but one of many contributors to guiding action. The need for public health decisions despite scientific uncertainty and the potential for epidemiologic certainty's failing to provide clear guidance to public health action emphasize the distinctiveness of these endeavors. Criticisms that epidemiology fails to solve major public health problems, such as tobacco use; that it overemphasizes methods; that it fails to meet the needs of public health practitioners; and that it isolates itself from public health ethics are unwarranted. However, epidemiology should focus on addressing issues that directly affect public health decisions and should clearly communicate information about such issues to public health workers. Public health is far more complex than merely applying epidemiology. (+info)
Paradigms in epidemiology textbooks: in the footsteps of Thomas Kuhn.
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This article attempts to contribute to the debate on the future of epidemiology by combining Thomas Kuhn's ideas on scientific paradigms with the author's observations on some epidemiology textbooks. The author's interpretations were based on his readings of Kuhn's The Structure of Scientific Revolutions, epidemiology textbooks, and papers on the future of epidemiology. Thomas Kuhn's view is that sciences mostly work with a single paradigm driven by exemplars of successful work, and that proposals for paradigm change are resisted. Sciences that are maturing or changing do not have a dominant paradigm. Epidemiology textbooks showed diversity in their concepts, content, and approach. Most exemplars related to etiologic research rather than public health practice. One key focus of the recent controversy regarding the role of epidemiology has been the increasing inability of epidemiology to solve socially based public health problems. Kuhn's views help explain the polarization of views expressed. Kuhn's philosophy of science offers insights into controversies such as whether a paradigm shift is needed or imminent and the gap between epidemiology and public health practice. Interaction between science philosophers, epidemiologists, and public health practitioners may be valuable. (+info)
Frequency of policy recommendations in epidemiologic publications.
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OBJECTIVES: The purpose of this study was to determine the frequency and character of policy statements in epidemiologic reports. METHODS: The first author followed a standardized protocol and reviewed a random sample of articles selected from the American Journal of Epidemiology, Annals of Epidemiology, and Epidemiology. The second author reviewed all articles with policy statements and a 10% sample without such statements. RESULTS: Overall, 23.8% of the articles contained policy statements. Annals of Epidemiology and the American Journal of Epidemiology had similar frequencies of articles with policy statements (30% and 26.7%, respectively), while Epidemiology evidenced the lowest frequency (8.3%). The majority of policy statements (55%) pertained to public health practice; 27.5% involved clinical practice, and the remainder (17.5%) focused on corporate policies, regulatory actions, or undefined arenas. The frequency of policy statements differed according to first author's affiliation, type of publication, area of research, research design, and study population. CONCLUSIONS: Although a minority of publications included policy statements, the inclusion of a statement seemed to be influenced by specific study characteristics. (+info)
Health inequalities and social group differences: what should we measure?
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Both health inequalities and social group health differences are important aspects of measuring population health. Despite widespread recognition of their magnitude in many high- and low-income countries, there is considerable debate about the meaning and measurement of health inequalities, social group health differences and inequities. The lack of standard definitions, measurement strategies and indicators has and will continue to limit comparisons--between and within countries, and over time--of health inequalities, and perhaps more importantly comparative analyses of their determinants. Such comparative work, however, will be essential to find effective policies for governments to reduce health inequalities. This article addresses the question of whether we should be measuring health inequalities or social group health differences. To help clarify the strengths and weaknesses of these two approaches, we review some of the major arguments for and against each of them. (+info)
From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.
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OBJECTIVES: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and STD prevention policy and practice. METHODS: Articles were selected from a review of Medline, accessed with the OVID search engine. The search covered articles from January 1987 to September 1998 and yielded 2101 articles. Methods used to uncover articles which might have been missed included searching for related articles by author, and combing literature reviews. In addition, all abstracts under the category "sexually transmitted diseases" from the XI and XII International Conferences on AIDS (Vancouver 1996 and Geneva 1998) and other relevant scientific meetings were reviewed. Efforts were made to locate journal articles which resulted from the research reported in the identified abstracts. All original journal articles and abstracts which met one of the following criteria were included: (1) studies of the biological plausibility or mechanism of facilitation of HIV infectiousness or susceptibility by STDs, (2) prospective cohort studies (longitudinal or nested case-control) which estimate the risk of HIV infection associated with specific STDs or STD syndromes, or (3) intervention studies which quantitate the effect which STD treatment can have on HIV incidence. RESULTS: Strong evidence indicates that both ulcerative and non-ulcerative STDs promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms. These effects are reflected in the risk estimates found in numerous prospective studies from four continents which range from 2.0 to 23.5, with most clustering between 2 and 5. The relative importance of ulcerative and non-ulcerative STDs appears to be complex. Owing to the greater frequency of non-ulcerative STDs in many populations, these infections may be responsible for more HIV transmission than genital ulcers. However, the limited reciprocal impact of HIV infection on non-ulcerative STDs and the evidence that non-ulcerative STDs may increase risk primarily for the receptive partner (rather than bidirectionally) may modulate the impact of these diseases. The results of two community level randomised, controlled intervention trials conducted in Africa suggest that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission. CONCLUSIONS: Available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy. Policy makers, HIV prevention programme managers, and providers should focus initial implementation efforts on three key areas: (i) improving access to and quality of STD clinical services; (ii) promoting early and effective STD related healthcare behaviours; and (iii) establishing surveillance systems to monitor STD and HIV trends and their interrelations. (+info)
Outbreaks of salmonellosis associated with eating uncooked tomatoes: implications for public health. The Investigation Team.
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Laboratory-based surveillance of salmonella isolates serotyped at four state health departments (Illinois, Michigan, Minnesota and Wisconsin) led to the identification of multistate outbreaks of salmonella infections during 1990 (176 cases of S. javiana) and 1993 (100 cases of S. montevideo). Community-based case-control studies and product traceback implicated consumption of tomatoes from a single South Carolina tomato packer (Packer A) MOR 16.0; 95% CI2.1, 120.6; P < 0.0001 in 1990 and again in 1993 (MOR 5.7; 95 % CI 1.5, 21.9; P = 0.01) as the likely vehicle. Contamination likely occurred at the packing shed, where field grown tomatoes were dumped into a common water bath. These outbreaks represent part of a growing trend of large geographically dispersed outbreaks caused by sporadic or low-level contamination of widely distributed food items. Controlling contamination of agricultural commodities that are also ready-to-eat foods, particularly fruits and vegetables, presents a major challenge to industry, regulators and public health officials. (+info)
Prevalence and determinants of smoking in three regions of Saudi Arabia.
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OBJECTIVES: To study the prevalence and determinants of cigarette smoking among Saudi nationals in three regions of Saudi Arabia. PARTICIPANTS: A sample of 8310 individuals aged 15 years and above from both sexes, randomly selected from the three regions, using a stratified cluster sampling technique. DESIGN: A cross-sectional, household, community-based survey. Using a predesigned and tested questionnaire, the participants were interviewed by primary care physicians. The interview covered personal, social, and educational characteristics of the respondents, and also included questions about their smoking status, duration of smoking, and daily cigarette consumption. MAIN OUTCOME MEASURES: Association between current smoking and sociodemographic variables, in univariate and multivariate analysis. Degree of interaction between the different determinants of cigarette smoking. RESULTS: The overall prevalence of current smoking was 21.1% for males and 0.9% for females. Most smokers (78%) were young to middle-aged (21-50 years old). Smoking prevalence was higher among married people, among uneducated people, and among those in certain occupations: manual workers, businessmen, army officers, and office workers. CONCLUSIONS: Cigarette smoking is an important public health problem in Saudi Arabia. A more intense and comprehensive tobacco control effort is needed. (+info)