PeerJ Preprints: Public Healthhttps://peerj.com/preprints/index.atom?journal=peerj&subject=6500Public Health articles published in PeerJ PreprintsDesign and reporting considerations for genetic screening testshttps://peerj.com/preprints/279222019-10-232019-10-23Jill HagenkordBirgit FunkeEmily QianMadhuri HegdeKevin B JacobsMatthew FerberMatthew LeboAdam H BuchananDavid Bick
Testing asymptomatic individuals for unsuspected conditions is not new to the medical and public health communities and protocols to develop screening tests are well-established. However, the application of screening principles to inherited diseases presents unique challenges. Unlike most screening tests, the natural history and disease prevalence of most rare inherited diseases in an unselected population are unknown. It is difficult or impossible to obtain a “truth set” cohort for clinical validation studies. As a result, it is not possible to accurately calculate clinical positive and negative predictive values for “likely pathogenic” genetic variants, which are commonly returned in genetic screening assays. In addition, many of the genetic conditions included in screening panels do not have clinical confirmatory tests. All of these elements are typically required to justify the development of a screening test, according to the World Health Organization screening principles. Nevertheless, as the cost of DNA sequencing continues to fall, more individuals are opting to undergo genomic testing in the absence of a clinical indication. Despite the challenges, reasonable estimates can be deduced and used to inform test design strategies. Here, we review test design principles and apply them to genetic screening.
Testing asymptomatic individuals for unsuspected conditions is not new to the medical and public health communities and protocols to develop screening tests are well-established. However, the application of screening principles to inherited diseases presents unique challenges. Unlike most screening tests, the natural history and disease prevalence of most rare inherited diseases in an unselected population are unknown. It is difficult or impossible to obtain a “truth set” cohort for clinical validation studies. As a result, it is not possible to accurately calculate clinical positive and negative predictive values for “likely pathogenic” genetic variants, which are commonly returned in genetic screening assays. In addition, many of the genetic conditions included in screening panels do not have clinical confirmatory tests. All of these elements are typically required to justify the development of a screening test, according to the World Health Organization screening principles. Nevertheless, as the cost of DNA sequencing continues to fall, more individuals are opting to undergo genomic testing in the absence of a clinical indication. Despite the challenges, reasonable estimates can be deduced and used to inform test design strategies. Here, we review test design principles and apply them to genetic screening.Noncommunicable diseases prevention in low- and middle-income countries: an overview of Health in All Policies (HiAP)https://peerj.com/preprints/279622019-09-162019-09-16Ndubuisi Ebele
NCD causes an estimated 35 million deaths annually and accounts for 60% of all deaths globally, of which 80% is in low-and-middle-income countries (LMIC). NCDs will account for 80% of the global burden of disease by 2020. And will be responsible for seven out of every ten deaths in LMIC, more than double the current trend today. NCD is no longer an emerging problem in developing countries, it is assuming an alarming dimension, and it's taking on the proportion of an epidemic. The known risk factors for significant NCDs are well documented. The critical risk factors are tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. To reverse the current trend that leads to an increase in poor dietary pattern, sedentary lifestyle, tobacco use, and harmful alcohol use- will require policies that transcend the health sector and policy change in different areas such as finance, urban planning, education, agriculture, and transportation.
NCD causes an estimated 35 million deaths annually and accounts for 60% of all deaths globally, of which 80% is in low-and-middle-income countries (LMIC). NCDs will account for 80% of the global burden of disease by 2020. And will be responsible for seven out of every ten deaths in LMIC, more than double the current trend today. NCD is no longer an emerging problem in developing countries, it is assuming an alarming dimension, and it's taking on the proportion of an epidemic. The known risk factors for significant NCDs are well documented. The critical risk factors are tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. To reverse the current trend that leads to an increase in poor dietary pattern, sedentary lifestyle, tobacco use, and harmful alcohol use- will require policies that transcend the health sector and policy change in different areas such as finance, urban planning, education, agriculture, and transportation.The occurrence of pharmaceutical waste in different parts of the world: A scoping reviewhttps://peerj.com/preprints/279512019-09-102019-09-10Kim Yun JinMuhammad Shahzad Aslam
Pharmaceutical waste in our ecosystem is the huge burden for our future generations, especially in developing countries. It can be in every place even in drinking water after water treatment. It was observed the presence of over the counter drugs such as ibuprofen, naproxen, acetaminophen and antibiotic such as sulfamethoxazole, trimethoprim, erythromycin the most in the environment. Among all result, Carbamazepine which is known to treat epilepsy was found the most in the environment when the results were compiled from different parts of the world due to its low biodegradable properties. The current article is focused on the occurrence of pharmaceutical waste in the last eight years (January 2010- July 2018) published research work.
Pharmaceutical waste in our ecosystem is the huge burden for our future generations, especially in developing countries. It can be in every place even in drinking water after water treatment. It was observed the presence of over the counter drugs such as ibuprofen, naproxen, acetaminophen and antibiotic such as sulfamethoxazole, trimethoprim, erythromycin the most in the environment. Among all result, Carbamazepine which is known to treat epilepsy was found the most in the environment when the results were compiled from different parts of the world due to its low biodegradable properties. The current article is focused on the occurrence of pharmaceutical waste in the last eight years (January 2010- July 2018) published research work.Injury surveillance in a rural sub-Saharan setting: Results from a pilot surveillance initiative in Nzega District, Tanzaniahttps://peerj.com/preprints/18842019-08-152019-08-15Laura DavisAlyssa BechtoldMarc KaeraaLukas LacavaHamisi A. KigwangallaMichael L. Wilson
Introduction: Ninety percent of all injuries occur in low- and middle-income countries and most of these injuries are largely preventable. Most injury surveillance systems are focused in large urban settings, which largely ignore injury mechanisms in rural contexts which are critical settings for planning future prevention efforts. Methods: Injury event information was collected from July 1 to July 31, 2013 at Nzega District Hospital (NDH) in central Tanzania using an injury questionnaire derived from World Health Organization injury surveillance guidelines. One hundred injured patients were enrolled and surveyed about the location of their injury, cause and other contextual and demographic factors. Results: Seventy-nine percent of participants were males and the most prevalent injury cause for all participants was road traffic collisions, making up 31\% of the injuries. Violence was the second most prevalent cause, accounting for 28\% of the injuries, and the number one cause of injuries for women. Twenty-three percent (n=7) of patients suffering from injuries due to road traffic collisions were given a prognosis of long-term disability of six months or more. Conclusion: Nzega District experienced a large number of injuries in a one-month period, consistent with other studies conducted in low- and middle-income country settings and is higher than several infectious diseases already considered pressing public health problems. More comprehensive data collection is required in order to fully understand the extent of this public health problem.
Introduction: Ninety percent of all injuries occur in low- and middle-income countries and most of these injuries are largely preventable. Most injury surveillance systems are focused in large urban settings, which largely ignore injury mechanisms in rural contexts which are critical settings for planning future prevention efforts. Methods: Injury event information was collected from July 1 to July 31, 2013 at Nzega District Hospital (NDH) in central Tanzania using an injury questionnaire derived from World Health Organization injury surveillance guidelines. One hundred injured patients were enrolled and surveyed about the location of their injury, cause and other contextual and demographic factors. Results: Seventy-nine percent of participants were males and the most prevalent injury cause for all participants was road traffic collisions, making up 31\% of the injuries. Violence was the second most prevalent cause, accounting for 28\% of the injuries, and the number one cause of injuries for women. Twenty-three percent (n=7) of patients suffering from injuries due to road traffic collisions were given a prognosis of long-term disability of six months or more. Conclusion: Nzega District experienced a large number of injuries in a one-month period, consistent with other studies conducted in low- and middle-income country settings and is higher than several infectious diseases already considered pressing public health problems. More comprehensive data collection is required in order to fully understand the extent of this public health problem.Evaluation of the socially evaluated cold-pressor group test (SECPT-G) in the general populationhttps://peerj.com/preprints/276582019-07-162019-07-16Linda BeckerUrsula SchadeNicolas Rohleder
Background. In stress research, economic instruments for introducing acute stress responses are needed. In this study, we investigated whether the socially evaluated cold-pressor group test (SECPT-G) induces salivary alpha-amylase and/or cortisol responses in the general population and whether this is associated with anthropometric, experimental, and lifestyle factors.
Methods. A sample of 91 participants from the general population was recruited. Salivary cortisol and alpha-amylase (sAA) levels were assessed prior to (t0), immediately after (t1), and ten minutes after the SECPT-G (t2).
Results. A robust cortisol increase was found immediately after the SECPT-G, which further increased between t1 and t2. This was independent of most of the control variables. However, men showed a trend towards higher cortisol increases than women (p = .005). No sAA responses were found at all. However, sAA levels were dependent on measurement time point with highest levels between 9 pm and 9:30 pm. Participants who immersed their hands into the ice water for the maximally allowed time of three minutes showed higher sAA levels at all time points than participants who removed their hands from the water earlier.
Conclusions. We conclude that the SECPT-G is a good means of an acute stress test when cortisol – but not necessarily sAA – responses are intended.
Background. In stress research, economic instruments for introducing acute stress responses are needed. In this study, we investigated whether the socially evaluated cold-pressor group test (SECPT-G) induces salivary alpha-amylase and/or cortisol responses in the general population and whether this is associated with anthropometric, experimental, and lifestyle factors.Methods. A sample of 91 participants from the general population was recruited. Salivary cortisol and alpha-amylase (sAA) levels were assessed prior to (t0), immediately after (t1), and ten minutes after the SECPT-G (t2).Results. A robust cortisol increase was found immediately after the SECPT-G, which further increased between t1 and t2. This was independent of most of the control variables. However, men showed a trend towards higher cortisol increases than women (p = .005). No sAA responses were found at all. However, sAA levels were dependent on measurement time point with highest levels between 9 pm and 9:30 pm. Participants who immersed their hands into the ice water for the maximally allowed time of three minutes showed higher sAA levels at all time points than participants who removed their hands from the water earlier.Conclusions. We conclude that the SECPT-G is a good means of an acute stress test when cortisol – but not necessarily sAA – responses are intended.STROBE-MR: Guidelines for strengthening the reporting of Mendelian randomization studieshttps://peerj.com/preprints/278572019-07-152019-07-15George Davey SmithNeil M DaviesNiki DimouMatthias EggerValentina GalloRobert GolubJulian PT HigginsClaudia LangenbergElizabeth W LoderJ Brent RichardsRebecca C RichmondVeronika W SkrivankovaSonja A SwansonNicholas J TimpsonAnne Tybjaerg-HansenTyler J VanderWeeleBenjamin AR WoolfJames Yarmolinsky
While the number of studies using Mendelian randomization (MR) methods has grown exponentially in the last decade, the quality of reporting of these studies often has been poor. Similar to other reporting guidelines such as CONSORT (Consolidated Standards of Reporting Trials) for randomised trials and STROBE (STrenghtening the Reporting of Observational studies in Epidemiology) for observational studies in epidemiology, the STROBE-MR working group aims to provide guidance to authors on how to improve reporting of MR studies and help readers, reviewers, and journal editors to evaluate the quality of the presented evidence.
Empirical evidence indicates that many reports of MR studies do not clearly state or examine the various assumptions of MR methods and report insufficient details on the data sources, which makes it hard to evaluate the quality and reliability of the results. The STROBE-MR guidance covers both one sample and two sample MR studies. At present, the draft checklist consists of 20 items, organized into the title and abstract, introduction, methods, results and discussion sections of articles.
As these guidelines aim to reach the entire MR community, we would like to give everyone the opportunity to contribute their comments. The following draft of the STROBE-MR checklist is open for public discussion and all feedback will be taken into account during its next revision. For feedback, please use the comment section below this post on PeerJ Preprints.
We hope the final guidelines will serve the entire community and contribute to improving the reporting of MR studies in the future.
While the number of studies using Mendelian randomization (MR) methods has grown exponentially in the last decade, the quality of reporting of these studies often has been poor. Similar to other reporting guidelines such as CONSORT (Consolidated Standards of Reporting Trials) for randomised trials and STROBE (STrenghtening the Reporting of Observational studies in Epidemiology)for observational studies in epidemiology, the STROBE-MR working group aims to provide guidance to authors on how to improve reporting of MR studies and help readers, reviewers, and journal editors to evaluate the quality of the presented evidence.Empirical evidence indicates that many reports of MR studies do not clearly state or examine the various assumptions of MR methods and report insufficient details on the data sources, which makes it hard to evaluate the quality and reliability of the results. The STROBE-MR guidance covers both one sample and two sample MR studies. At present, the draft checklist consists of 20 items, organized into the title and abstract, introduction, methods, results and discussion sections of articles.As these guidelines aim to reach the entire MR community, we would like to give everyone the opportunity to contribute their comments. The following draft of the STROBE-MR checklist is open for public discussion and all feedback will be taken into account during its next revision. For feedback, please use the comment section below this post on PeerJ Preprints.We hope the final guidelines will serve the entire community and contribute to improving the reporting of MR studies in the future.Epidemiological scenario of Dengue in the state of Manipur during the last 3 yearshttps://peerj.com/preprints/277862019-06-062019-06-06Leimapokpam Shivadutta SinghRajkumar Manojkumar SinghHuidrom Lokhendro Singh
Background. In recent years, Dengue has been emerging as a global health problem with approximately 2.5 billion people being affected by it .In the last 50 years, the incidence of dengue infection has increased 30-fold, and the World Health Organization (WHO) has estimated that 96 million cases of dengue occur annually. The epidemiology of dengue fever (DF) is complex in the Indian subcontinent as all the four serotypes are circulating. And there is no systematic epidemiological study done on dengue cases in Manipur, a north-eastern state of India. This study is therefore done to report observations on dengue cases from a virus diagnostic and research laboratory of Manipur to present an epidemiological scenario of the state for the last three years. Method. We used the dengue data extracted from the laboratory register of Viral Research and Diagnostic Laboratory (VRDL) from 2016 to 2018. All suspected outpatient and inpatients dengue cases from public and private health services are included in the VRDL database whose informed consent were obtained. We evaluated the overall features of the data for generating seasonal pattern, geographical pattern, gender wise distribution, age wise distribution and seroprevelance pattern of dengue cases for the study period from 2016 to 2018. Results. A total of 1689 cases of suspected patients of dengue virus infection were tested for dengue ELISA test and 272(16.10%) samples were found to be seropositive. The month wise distribution of dengue cases is quite an interesting as the three years of study shows variant pattern in observation. In all the three years dengue seropositive cases were seen higher in male population. But there is no significant value to the positivity of dengue seropositive towards male than female (The chi-square statistic is 2.1314.The p-value is .344481. The result is not significant at p < .05.). Conclusion. Our study presents a comparative epidemiological study on seroprevelance of dengue in the state of Manipur from the year 2016 to 2018. The findings in the present study extend the knowledge of the geographical distribution and seroprevelance of dengue in the state of Manipur for the last three years. This is an attempt to present epidemiological dengue seroprevelance in the state of Manipur which in future would be a reference from public health concerns for taking up necessary action plan to curtail the spread of dengue.
Background. In recent years, Dengue has been emerging as a global health problem with approximately 2.5 billion people being affected by it .In the last 50 years, the incidence of dengue infection has increased 30-fold, and the World Health Organization (WHO) has estimated that 96 million cases of dengue occur annually. The epidemiology of dengue fever (DF) is complex in the Indian subcontinent as all the four serotypes are circulating. And there is no systematic epidemiological study done on dengue cases in Manipur, a north-eastern state of India. This study is therefore done to report observations on dengue cases from a virus diagnostic and research laboratory of Manipur to present an epidemiological scenario of the state for the last three years. Method. We used the dengue data extracted from the laboratory register of Viral Research and Diagnostic Laboratory (VRDL) from 2016 to 2018. All suspected outpatient and inpatients dengue cases from public and private health services are included in the VRDL database whose informed consent were obtained. We evaluated the overall features of the data for generating seasonal pattern, geographical pattern, gender wise distribution, age wise distribution and seroprevelance pattern of dengue cases for the study period from 2016 to 2018. Results. A total of 1689 cases of suspected patients of dengue virus infection were tested for dengue ELISA test and 272(16.10%) samples were found to be seropositive. The month wise distribution of dengue cases is quite an interesting as the three years of study shows variant pattern in observation. In all the three years dengue seropositive cases were seen higher in male population. But there is no significant value to the positivity of dengue seropositive towards male than female (The chi-square statistic is 2.1314.The p-value is .344481. The result is not significant at p < .05.). Conclusion. Our study presents a comparative epidemiological study on seroprevelance of dengue in the state of Manipur from the year 2016 to 2018. The findings in the present study extend the knowledge of the geographical distribution and seroprevelance of dengue in the state of Manipur for the last three years. This is an attempt to present epidemiological dengue seroprevelance in the state of Manipur which in future would be a reference from public health concerns for taking up necessary action plan to curtail the spread of dengue.Bayesian meta-analysis of studies with rare events: Do the choice of prior distributions and the exclusion of studies without events in both arms matter?https://peerj.com/preprints/277322019-05-152019-05-15Soheila AghlmandiPeter JüniJames CarpenterMarcel Zwahlen
Randomized controlled trials (RCTs) analyzing serious adverse events often observe low incidence and might even observe zero events in either or both of the treatment and control arms. In the meta-analysis of RCTs of adverse events, it is unclear whether trials with zero events in both arms provide any information for the summary risk ratio (RR) or odds ratio (OR). Studies with zero events in both arms are usually excluded in both frequentist and Bayesian meta-analysis. We used a fully probabilistic approach—a Bayesian framework—for the meta-analysis of studies with rare events, and systematically assessed whether exclusion of studies with no events in both arms produced different results compared to keeping all studies in the meta-analysis. We did this by conducting a simulation study in which we assessed the bias in the point estimate of the log(OR) and the coverage of the 95% posterior interval for the log(OR) for different analytical decisions and choices in fixed effect and random effects meta-analysis. We used simulated data generated from a known fixed effect or random effects data scenario (each scenario with a 1000 meta-analysis data-set). We found that the uniform and Jeffrey’s prior on the baseline risk in the control group leads to biased results and a reduced coverage, and that setting the prior distribution on the log(odds) scale worked better. We also found nearly identical results regardless of whether studies with no events in both arms were excluded or not.
Randomized controlled trials (RCTs) analyzing serious adverse events often observe low incidence and might even observe zero events in either or both of the treatment and control arms. In the meta-analysis of RCTs of adverse events, it is unclear whether trials with zero events in both arms provide any information for the summary risk ratio (RR) or odds ratio (OR). Studies with zero events in both arms are usually excluded in both frequentist and Bayesian meta-analysis. We used a fully probabilistic approach—a Bayesian framework—for the meta-analysis of studies with rare events, and systematically assessed whether exclusion of studies with no events in both arms produced different results compared to keeping all studies in the meta-analysis. We did this by conducting a simulation study in which we assessed the bias in the point estimate of the log(OR) and the coverage of the 95% posterior interval for the log(OR) for different analytical decisions and choices in fixed effect and random effects meta-analysis. We used simulated data generated from a known fixed effect or random effects data scenario (each scenario with a 1000 meta-analysis data-set). We found that the uniform and Jeffrey’s prior on the baseline risk in the control group leads to biased results and a reduced coverage, and that setting the prior distribution on the log(odds) scale worked better. We also found nearly identical results regardless of whether studies with no events in both arms were excluded or not.Chikungunya: time to change the paradigm of a non-fatal disease.https://peerj.com/preprints/276552019-04-162019-04-16André R R FreitasPatrick Gerardin
Since the initial description of the first human cases the chikungunya has been considered as a non-lethal virus. Since the emergence of the global virus in 2005, it has become increasingly common in the scientific literature to describe many cases of death, including in young people without preexisting diseases. In addition, it has been observed that in settings where, for some reason, death cases are not properly reported for epidemiological surveillance, it is possible to identify mortality due to chikungunya through the excess of deaths occurring during the period of chikungunya epidemics. Even so, international public health bodies still do not recognize in their official documents the importance of chikungunya as the cause of death. We believe it is necessary to review these positions and to increase investment in research to improve knowledge about the pathophysiology of severe forms and to review investment priorities in vaccines and other forms of chikungunya prevention.
Since the initial description of the first human cases the chikungunya has been considered as a non-lethal virus. Since the emergence of the global virus in 2005, it has become increasingly common in the scientific literature to describe many cases of death, including in young people without preexisting diseases. In addition, it has been observed that in settings where, for some reason, death cases are not properly reported for epidemiological surveillance, it is possible to identify mortality due to chikungunya through the excess of deaths occurring during the period of chikungunya epidemics. Even so, international public health bodies still do not recognize in their official documents the importance of chikungunya as the cause of death. We believe it is necessary to review these positions and to increase investment in research to improve knowledge about the pathophysiology of severe forms and to review investment priorities in vaccines and other forms of chikungunya prevention.Exploring the health informatics occupational group in the 2018 Australian health information workforce censushttps://peerj.com/preprints/276262019-04-022019-04-02Kerryn Butler-HendersonKathleen GrayChristopher PearceAnn RitchieJulie BrophyLouise K SchaperVicki BennettAngela Ryan
There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.
There has been no empirical evidence about the health informatics workforce in Australia produced in the last ten years. This study reports the findings from an analysis of a subset of the 2018 Australian Health Informatics Workforce Census data. Analysing 420 responses that were identified as the occupational group Health Informatics, the results indicate that whilst most of the workforce is classified as aged (>45 years), many respondents are still relatively early in their health informatics careers. Furthermore, most do not possess any formal education in health informatics and almost a quarter undertake their health informatics role alongside another health-related role. The broad range of position titles and functions demonstrates the breadth within this workforce. Ongoing monitoring of this occupational group is required to inform workforce reform and renewal.