Primary prevention from the epidemiology perspective: three examples from the practice

Background: Primary prevention programmes are of increasing importance to reduce the impact of chronic diseases on the individual, institutional and societal level. However, most initiatives that develop and implement primary prevention programmes are not evaluated with scientific rigor. On the basis of three different projects we discuss necessary steps on the road to evidence-based primary prevention. Discussion: We first discuss how to identify suitable target groups exploiting sophisticated statistical methods. This is illustrated using data from a health survey conducted in a federal state of Germany. A literature review is the more typical approach to identify target groups that is demonstrated using a European project on the prevention of childhood obesity. In the next step, modifiable risk factors and realistic targets of the intervention have to be specified. These determine the outcome measures that in turn are used for effect evaluation. Both, the target groups and the outcome measures, lay the ground for the study design and the definition of comparison groups as can be seen in our European project. This project also illustrates the development and implementation of a prevention programme. These may require active involvement of participants which can be achieved by participatory approaches taking into account the socio-cultural and living environment. Evaluation is of utmost importance for any intervention to assess structure, process and outcome according to rigid scientific criteria. Different approaches used for this are discussed and illustrated by a methodological project developed within a health promotion programme in a deprived area. Eventually the challenge of transferring an evidence-based intervention into practice and to achieve its sustainability is addressed. Summary: This article describes a general roadmap to primary prevention comprising (1) the identification of target groups and settings, (2) the identification of modifiable risk factors and endpoints, (3) the development and implementation of an intervention programme, (4) the evaluation of structure, process and outcome and (5) the transfer of an evidence-based intervention into practice

Methylene blue for malaria in Africa: results from a dose-finding study in combination with chloroquine

The development of safe, effective and affordable drug combinations against malaria in Africa is a public health priority. Methylene blue (MB) has a similar mode of action as chloroquine (CQ) and has moreover been shown to selectively inhibit the Plasmodium falciparum glutathione reductase. In 2004, an uncontrolled dose-finding study on the combination MB-CQ was performed in 435 young children with uncomplicated falciparum malaria in Burkina Faso ( CQ monotherapy had a > 50% clinical failure rate in this area in 2003). Three serious adverse events (SAE) occurred of which one was probably attributable to the study medication. In the per protocol safety analysis, there were no dose specific effects. The overall clinical and parasitological failure rates by day 14 were 10% [95% CI (7.5%, 14.0%)] and 24% [ 95% CI (19.4%, 28.3%)], respectively. MB appears to have efficacy against malaria, but the combination of CQ-MB is clearly not effective in the treatment of malaria in Africa

Safety of the methylene blue plus chloroquine combination in the treatment of uncomplicated falciparum malaria in young children of Burkina Faso [ISRCTN27290841]

BACKGROUND: Safe, effective and affordable drug combinations against falciparum malaria are urgently needed for the poor populations in malaria endemic countries. Methylene blue (MB) combined with chloroquine (CQ) has been considered as one promising new regimen. OBJECTIVES: The primary objective of this study was to evaluate the safety of CQ-MB in African children with uncomplicated falciparum malaria. Secondary objectives were to assess the efficacy and the acceptance of CQ-MB in a rural population of West Africa. METHODS: In this hospital-based randomized controlled trial, 226 children (6–59 months) with uncomplicated falciparum malaria were treated in Burkina Faso. The children were 4:1 randomized to CQ-MB (n = 181; 25 mg/kg CQ and 12 mg/kg MB over three days) or CQ (n = 45; 25 mg/kg over three days) respectively. The primary outcome was the incidence of severe haemolysis or other serious adverse events (SAEs). Efficacy outcomes were defined according to the WHO 2003 classification system. Patients were hospitalized for four days and followed up until day 14. RESULTS: No differences in the incidence of SAEs and other adverse events were observed between children treated with CQ-MB (including 24 cases of G6PD deficiency) compared to children treated with CQ. There was no case of severe haemolysis and also no significant difference in mean haemoglobin between study groups. Treatment failure rates were 53.7% (95% CI [37.4%; 69.3%]) in the CQ group compared to 44.0% (95% CI [36.3%; 51.9%]) in the CQ-MB group. CONCLUSION: MB is safe for the treatment of uncomplicated falciparum malaria, even in G6PD deficient African children. However, the efficacy of the CQ-MB combination has not been sufficient at the MB dose used in this study. Future studies need to assess the efficacy of MB at higher doses and in combination with appropriate partner drugs

Frauen als Problemgruppe des Arbeitsmarktes: eine Untersuchung zur Erwerbslosigkeit in Bremen

SIGLEAvailable from Bibliothek des Instituts fuer Weltwirtschaft, ZBW, Duesternbrook Weg 120, D-24105 Kiel A 179750 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Geschlechtersensible Forschung in der Epidemiologie

Schaefer I, Ingeborg J. Geschlechtersensible Forschung in der Epidemiologie. Clio - die Zeitschrift für Frauengesundheit. 2012;74(37):16-18

Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006–2014

BACKGROUND: During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodological requirements were developed but these are rarely translated into research practice. The aim of this study is to provide good practice examples of sex/gender sensitive health research. METHODS: We conducted a systematic search of research articles published in JECH between 2006 and 2014. An instrument was constructed to evaluate sex/gender sensitivity in four stages of the research process (background, study design, statistical analysis, discussion). RESULTS: In total, 37 articles covering diverse topics were included. Thereof, 22 were evaluated as good practice example in at least one stage; two articles achieved highest ratings across all stages. Good examples of the background referred to available knowledge on sex/gender differences and sex/gender informed theoretical frameworks. Related to the study design, good examples calculated sample sizes to be able to detect sex/gender differences, selected sex/gender sensitive outcome/exposure indicators, or chose different cut-off values for male and female participants. Good examples of statistical analyses used interaction terms with sex/gender or different shapes of the estimated relationship for men and women. Examples of good discussions interpreted their findings related to social and biological explanatory models or questioned the statistical methods used to detect sex/gender differences. CONCLUSIONS: The identified good practice examples may inspire researchers to critically reflect on the relevance of sex/gender issues of their studies and help them to translate methodological recommendations of sex/gender sensitivity into research practice

Themenheft 37 "Gebärmuttererkrankungen"

Gebärmuttererkrankungen umfassen verschiedene bösartige und gutartige Erkrankungen der Gebärmutter sowie Krankheitsbilder, an denen die Gebärmutter beteiligt ist. Jährlich erkranken schätzungsweise (Daten aus 2002) rund 28.000 Frauen neu an Krebs unter Beteiligung des Gebärmutterkörpers (ca. 11.500), des Gebärmutterhalses (ca. 6.500) und der Eierstöcke (ca. 9.900). Dies sind ca. 13,5% der geschätzten Krebsneuerkrankungen bei Frauen insgesamt

Occupational life course and lung cancer risk in men. Findings from a socio-epidemiological analysis of job-changing histories in a case-control study

Psychosocial factors in general, and the social and psychological conditions of work and occupation in particular, have attracted little attention to the epidemiological investigation into the occupational-related causes of lung cancer. There is some evidence available concerning the impact of loss events--including job losses--on cancer development. During our research presented in this article, we examined job changes and job transitions in the occupational biography of men with regard to their circumstances in terms of (in-)voluntariness both as individual events and the job-changing histories of individuals. We expected the job-changing histories of lung cancer cases to be more involuntary than those of population controls, and vice versa. Our sample contains 391 male case-control pairs. Cases are defined as newly-diagnosed men of German nationality with a histologically- or cytologically-confirmed diagnosis of primary lung cancer. Population controls were drawn randomly from the municipality records of residents and individuals matched to cases 1:1 by age and region. Occupational histories were reconstructed, and information about other classical and suspected risk factors was collected during standardized interviews by trained interviewers. We categorized the reported reasons for job changes, and classified them with respect to voluntariness on a seven-stepped rating scale from -3 'very involuntary' to +3 'very voluntary', defining relations within the empirically established categories. The job-changing histories of individuals are described by using the average score of voluntariness. We measured the degree of voluntariness for the occupational history: (1) by the rounded average score; and (2) by the quintiles of the average score. On the basis of individuals matched odds ratios (OR) estimates are derived for the score of voluntariness unadjusted and adjusted for smoking, asbestos exposure and socio-economic group by conditional logistic regression. The investigation into job-changing histories using the average score of voluntariness lead to similar results for both measuring methods for the total study group. When the rounded score was used, job-changing histories which were assessed as 'very involuntary' and 'involuntary' (score -3 and -2) showed an elevated odds ratio of adjusted 1.41 (95%-CI: 0.57; 3.48), and when they were assessed as 'moderately involuntary' (score -1) the adjusted odds ratio was 1.59 (95%-CI: 1.02; 2.48), as compared with job-changing histories assessed as neutral (score 0). When the degree of voluntariness was measured by quintiles, the first quintile (score -3- 0.6-3: OR 0.63) were insignificant. The analysis was also conducted for three broad age groups, and for biographies reduced by the five years prior to the interview or the diagnosis of lung cancer respectively. Methodological limitations of the case-control design and methodical implications--missing values and recall-bias in particular--as well as possible explanations for these findings are discussed.psychosocial factors case-control study lung cancer male job-changing history life event approach occupational life course