scholarly journals Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods—Lessons Learnt from Seven Major Norovirus Outbreaks in Finland

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1624
Author(s):  
Aleksandra Polkowska ◽  
Sirpa Räsänen ◽  
Pekka Nuorti ◽  
Leena Maunula ◽  
Katri Jalava
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Mathematical Reasoning ◽  
Meta Analysis ◽  
The Elderly ◽  
Case Definition ◽  
Public Health Approach ◽  
Common Symptom ◽  
Research Collaborations ◽  
Duration Of Illness

Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014–2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.

scholarly journals Epidemiology, public health and the problem of personality disorder

2003 ◽  
Vol 182 (S44) ◽  
pp. s3-s10 ◽  
Author(s):  
Jeremy Coid
Keyword(s):  
Public Health ◽  
Problem Solving ◽  
Personality Disorder ◽  
Public Health Problem ◽  
Population Level ◽  
Case Definition ◽  
Public Health Approach ◽  
Preventive Interventions ◽  
The Public ◽  
Comprehensive Method

BackgroundThe public health problem-solving paradigm is a comprehensive method not previously applied to preventive interventions for personality disorder.AimsTo present an overview for clinical psychiatrists.MethodReview of epidemiological research into DSM–IV Axis II disorders and application to the paradigm.ResultsPersonality disorder affects a substantial proportion of the population. Burdens on health care, social and criminal justice agencies have yet to be accurately quantified. Debates continue over case definition, but there is increasing information on prevalence using ‘broad’ definitions and aetiology. A conceptual framework, based on development, suggests preventive interventions should be targeted in childhood. The public health approach also requires monitoring of risk factors operating at the population level.ConclusionsServices in England and Wales for persons with personality disorder are currently inadequate. The problem-solving paradigm suggests new preventive interventions. Psychiatrists should renegotiate their relationship with policy-makers and reconsider their preventive role.

scholarly journals Measuring the scientific effectiveness of contact tracing: Evidence from a natural experiment

2021 ◽  
Vol 118 (33) ◽  
pp. e2100814118
Author(s):  
Thiemo Fetzer ◽  
Thomas Graeber
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Natural Experiment ◽  
Controlled Trial ◽  
Contact Tracing ◽  
Public Health Approach ◽  
The Public ◽  
Random Breakdown ◽  
Randomized Controlled ◽  
Health Authorities

Contact tracing has for decades been a cornerstone of the public health approach to epidemics, including Ebola, severe acute respiratory syndrome, and now COVID-19. It has not yet been possible, however, to causally assess the method’s effectiveness using a randomized controlled trial of the sort familiar throughout other areas of science. This study provides evidence that comes close to that ideal. It exploits a large-scale natural experiment that occurred by accident in England in late September 2020. Because of a coding error involving spreadsheet data used by the health authorities, a total of 15,841 COVID-19 cases (around 20% of all cases) failed to have timely contact tracing. By chance, some areas of England were much more severely affected than others. This study finds that the random breakdown of contact tracing led to more illness and death. Conservative causal estimates imply that, relative to cases that were initially missed by the contact tracing system, cases subject to proper contact tracing were associated with a reduction in subsequent new infections of 63% and a reduction insubsequent COVID-19–related deaths of 66% across the 6 wk following the data glitch.

scholarly journals Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications

2020 ◽  
Vol 35 (12) ◽  
pp. 1123-1138 ◽  
Author(s):  
Andrew T. Levin ◽  
William P. Hanage ◽  
Nana Owusu-Boaitey ◽  
Kensington B. Cochran ◽  
Seamus P. Walsh ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Meta Analysis ◽  
Age Groups ◽  
The Elderly ◽  
Specific Pattern ◽  
Policy Implications ◽  
Fatality Rate ◽  
Exponential Relationship ◽  
Geographical Locations

AbstractDetermine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.

Epidemiology

2018 ◽  
Author(s):  
Guilherme V. Polanczyk
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Cultural Influences ◽  
Case Definition ◽  
Prevalence Studies ◽  
Adolescents And Adults ◽  
Design Case ◽  
Meta Analyses ◽  
Methodological Aspects ◽  
Cross National

This chapter initially reviews the main methodological aspects of ADHD prevalence studies, specifically study design, case definition, and ascertainment to subsequently address meta-analyses summarizing the prevalence of the disorder on children, adolescents, and adults. Results of meta-regression in the context of meta-analysis have investigated the effect of year of publication, sample location, and methodological characteristics of studies on heterogeneity of results. Studies on the course of the disorder, following up clinical and community samples, are discussed, as well as cultural influences on epidemiological findings. Large-scale cross-national studies and longitudinal studies following non-referred samples are necessary to further advance the knowledge on the epidemiology of ADHD.

scholarly journals Does early surgery improve outcomes for periprosthetic fractures of the hip and knee? A systematic review and meta-analysis

2021 ◽  
Author(s):  
L. Farrow ◽  
A. D. Ablett ◽  
H. W. Sargeant ◽  
T. O. Smith ◽  
A. T. Johnston
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Meta Analysis ◽  
The Elderly ◽  
Outcome Evaluation ◽  
Periprosthetic Fractures ◽  
Early Surgery ◽  
Perioperative Outcomes ◽  
Inclusion Criteria ◽  
Delayed Surgery

Abstract Introduction Previous evidence has established that early surgery is beneficial to improve outcomes for individuals with native hip fractures in the elderly population. Patients who sustain a periprosthetic fracture have been demonstrated to have similar demographics and outcomes as those with native fractures around the hip and knee. We therefore set out to determine if there is a similar difference in perioperative outcomes between early and delayed surgery for periprosthetic fractures of the hip and knee through a systematic review and meta-analysis. Methods Literature search outputs were screened for studies meeting the inclusion criteria. The groups of early surgery and delayed surgery were defined by study authors. The primary outcome measure was 30 day mortality. Where there was sufficient study homogeneity, a random-effects meta-analysis was performed. Individual study risk of bias was assessed using the ROBINS-I criteria, with the GRADE criteria used for independent outcome evaluation. The review protocol was registered on PROSPERO prior to commencement (Registration number CRD42019149360). Results The inclusion criteria was met in 11 studies (n = 3006). Mean time to surgery from admission for reporting studies was 64 h. 59.6% patients underwent early surgery as defined by the study authors. We identified a significantly lower risk of 30 day mortality for those with early surgery versus delayed surgery (RR 0.21; 95% CI 0.05, 0.90; p = 0.04, n = 2022). There were also significantly better outcomes for early versus delayed surgery regarding: medical complications, length of stay, transfusion risk, and reoperation. The quality of evidence for all the individual outcomes was low or very low. Conclusions There is evidence that delaying surgery in those with periprosthetic fractures of the hip and knee has a deleterious impact on mortality and other important patient outcomes. There are, however, notable limitations to the existing available literature, with further appropriately designed large-scale studies required to confirm these findings.

scholarly journals Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications

2020 ◽  
Author(s):  
Andrew T. Levin ◽  
William P. Hanage ◽  
Nana Owusu-Boaitey ◽  
Kensington B. Cochran ◽  
Seamus P. Walsh ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Meta Analysis ◽  
Age Groups ◽  
The Elderly ◽  
Specific Pattern ◽  
Policy Implications ◽  
Fatality Rate ◽  
Exponential Relationship ◽  
Geographical Locations

Structured AbstractObjectiveDetermine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups.MethodsStudies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities four weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age.ResultsOur analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus.DiscussionThese results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.

scholarly journals Meta-analysis of diagnostic performance of serological tests for SARS-CoV-2 antibodies and public health implications

2020 ◽  
Author(s):  
Saverio Caini ◽  
Federica Bellerba ◽  
Federica Corso ◽  
Angelica Diaz-Basabe ◽  
Gioacchino Natoli ◽  
...  
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Quantitative Methods ◽  
Meta Analysis ◽  
Herd Immunity ◽  
Antibody Detection ◽  
Serological Tests ◽  
Random Effects Models ◽  
Low Prevalence ◽  
Very High

Serology-based tests have become a key public health element in the COVID-19 pandemic to assess the degree of herd immunity that has been achieved in the population. These tests differ between one another in several ways. Here, we conducted a systematic review and meta-analysis of the diagnostic accuracy of currently available SARS-CoV-2 serological tests, and assessed their real-world performance under scenarios of varying proportion of infected individuals. We included independent studies that specified the antigen used for antibody detection and used quantitative methods. We identified nine independent studies, of which six were based on commercial ELISA or CMIA/CLIA assays, and three on in-house tests. Test sensitivity ranged from 68% to 93% for IgM, from 65% to 100% for IgG, and from 83% to 98% for total antibodies. Random-effects models yielded a summary sensitivity of 82% (95%CI 75-88%) for IgM, and 85% for both IgG (95%CI 73-93%) and total antibodies (95%CI 74-94%). Specificity was very high for most tests, and its pooled estimate was 98% (95%CI 92-100%) for IgM and 99% (95%CI 98-100%) for both IgG and total antibodies. The heterogeneity of sensitivity and specificity across tests was generally high (I2≤50%). In populations with a low prevalence (≤5%) of seroconverted individuals, the positive predictive value would be ≤88% for most assays, except those reporting perfect specificity. Our data suggest that the use of serological tests for large-scale prevalence surveys (or to grant "immunity passports") are currently only justified in hard-hit regions, while they should be used with caution elsewhere.

A Public Health Approach to Child Protection: Why Data Matter

2014 ◽  
Vol 40 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Karen Broadley ◽  
Chris Goddard
Keyword(s):  
Public Health ◽  
Child Protection ◽  
Large Scale ◽  
Surveillance Data ◽  
Public Health Approach ◽  
Data Recording ◽  
Policy Makers ◽  
Health Community ◽  
Protection Legislation ◽  
Health Model

In Australia, many researchers and policy makers believe that statutory child protection systems are overburdened and ineffective. The way forward, they suggest, is a public health model of child protection. A public health approach comprises four steps: (1) collecting surveillance data; (2) establishing causes and correlations; (3) developing and evaluating interventions; and (4) disseminating information about the effectiveness of intervention activities to the public health community. However, in Australia there are no reliable surveillance data. There is no information about ‘person’. Information is not collected about the characteristics of children (e.g., ethnicity) and parents (e.g., mental illness) reported to child protection services. Data are not comparable across place. This is because the states and territories have their own child protection legislation, definitions and data recording methods. Data are not comparable over time. This is because many jurisdictions have introduced new data recording systems over recent years. This paper concludes that it is essential to develop an effective child protection surveillance data system. This will ensure that services are located in areas and targeted towards populations in greatest need. It will enable large-scale evaluation of the effectiveness of prevention and intervention activities.

scholarly journals Managing outbreaks of highly contagious diseases in prisons: a systematic review

2020 ◽  
Vol 5 (11) ◽  
pp. e003201
Author(s):  
Gabrielle Beaudry ◽  
Shaoling Zhong ◽  
Daniel Whiting ◽  
Babak Javid ◽  
John Frater ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Meta Analysis ◽  
Correctional Facility ◽  
Disease Outbreaks ◽  
Epidemiological Surveillance ◽  
Contact Tracing ◽  
Public Health Approach ◽  
Contagious Diseases ◽  
Registration Number

BackgroundThere are reports of outbreaks of COVID-19 in prisons in many countries. Responses to date have been highly variable and it is not clear whether public health guidance has been informed by the best available evidence. We conducted a systematic review to synthesise the evidence on outbreaks of highly contagious diseases in prison.MethodsWe searched seven electronic databases for peer-reviewed articles and official reports published between 1 January 2000 and 28 July 2020. We included quantitative primary research that reported an outbreak of a given contagious disease in a correctional facility and examined the effects of interventions. We excluded studies that did not provide detail on interventions. We synthesised common themes using the Synthesis Without Meta-analysis (SWiM) guideline, identified gaps in the literature and critically appraised the effectiveness of various containment approaches.ResultsWe identified 28 relevant studies. Investigations were all based in high-income countries and documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, adenovirus and COVID-19. Several themes were common to these reports, including the public health implications of infectious disease outbreaks in prison, and the role of interagency collaboration, health communication, screening for contagious diseases, restriction, isolation and quarantine, contact tracing, immunisation programmes, epidemiological surveillance and prison-specific guidelines in addressing any outbreaks.DiscussionPrisons are high-risk settings for the transmission of contagious diseases and there are considerable challenges in managing outbreaks in them. A public health approach to managing COVID-19 in prisons is required.PROSPERO registration numberCRD42020178827

scholarly journals Epidemic size of novel coronavirus-infected pneumonia in the Epicenter Wuhan: using data of five-countries’ evacuation action

2020 ◽  
Author(s):  
Hongxin Zhao ◽  
Sailimai Man ◽  
Bo Wang ◽  
Yi Ning
Keyword(s):  
Public Health ◽  
Infection Rate ◽  
Large Scale ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Population Mobility ◽  
Epidemic Size ◽  
Using Data ◽  
Novel Coronavirus

AbstractBackgroundSince late December 2019, novel coronavirus–infected pneumonia (NCP) emerged in Wuhan, Hubei province, China. Meanwhile, NCP rapidly spread from China to other countries, and several countries’ government rush to evacuate their citizens from Wuhan. We analyzed the infection rate of the evacuees and extrapolated the results in Wuhan’s NCP incidence estimation.MethodsWe collected the total number and confirmed cases of 2019-nCov infection in the evacuation of Korea, Japan, Germany, Singapore, and France and estimated the infection rate of the 2019 novel coronavirus (2019-nCov) among people who were evacuated from Wuhan with a meta-analysis. NCP incidence of Wuhan was indirectly estimated based on data of evacuation.ResultsFrom Jan 29 to Feb 2, 2020, 1916 people have been evacuated from Wuhan, among them 17 have been confirmed 2019-nCov infected. The infection rate is estimated to be 1.1% (95% CI 0.4%-3.1%) using one group meta-analysis method with random effect model. We then estimated that almost 110,000 (95% CI: 40,000-310,000) people were infected with 2019-nCov in Wuhan around Feb 2, 2020, assuming the infection risk of evacuees is close to Chinese citizens in Wuhan.ConclusionsAt the beginning of the outbreak, incidence of NCP may be vastly underestimated. Our result emphasizes that 2019-nCov has proposed a huge public health threats in Wuhan. We need to respond more rapidly, take large-scale public health interventions and draconian measures to limiting population mobility and control the epidemic.

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