Epidemiology and Health

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Original Article

March 13, 2018


The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran
Shahrzad Nematollahi, Mohammad Ali Mansournia, Abbas Rahimi Foroushani, Mahmood Mahmoodi, Azin Alavi, Mohammad Shekari, Kourosh Holakouie-Naieni
Epidemiol Health. 2018;40:e2018008.

OBJECTIVES: Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim...

Original Article

March 10, 2018


Application of an artificial neural network model for diagnosing type 2 diabetes mellitus and determining the relative importance of risk factors
Shiva Borzouei, Ali Reza Soltanian
Epidemiol Health. 2018;40:e2018007.

OBJECTIVES: To identify the most important demographic risk factors for a diagnosis of type 2 diabetes mellitus (T2DM) using a neural network model. METHODS: This study was conducted on a sample...

Perspective

March 10, 2018


Interpretation of the hygiene and microflora hypothesis for allergic diseases through epigenetic epidemiology
Jong-Myon Bae
Epidemiol Health. 2018;40:e2018006.

The hygiene hypothesis (HH) proposed by Strachan in 1989 was expanded to explain the inverse association between the occurrence of allergy disorders and the risk of infectious diseases and parasite...

Review

February 4, 2018


Registry-based stroke research in Taiwan: past and future
Cheng-Yang Hsieh, Darren Philbert Wu, Sheng-Feng Sung
Epidemiol Health. 2018;40:e2018004.

Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected...

Review

January 23, 2018


Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks
Patrik Hummel, Abha Saxena, Corinna Klingler
Epidemiol Health. 2018;40:e2018003.

This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks....
Current Issue
Volume 40; 2018
Original Article The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran
Shahrzad Nematollahi, Mohammad Ali Mansournia, Abbas Rahimi Foroushani, Mahmood Mahmoodi, et al. Epidemiol Health. 2018;40:e2018008.
  • Abstract
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Original Article Application of an artificial neural network model for diagnosing type 2 diabetes mellitus and determining the relative importance of risk factors
Shiva Borzouei, Ali Reza Soltanian Epidemiol Health. 2018;40:e2018007.
  • Abstract
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Abstract
OBJECTIVES:
Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight.
METHODS:
Data from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016-2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI).
RESULTS:
Fifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05).
CONCLUSIONS:
Our results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women’s knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.
Abstract
OBJECTIVES:
To identify the most important demographic risk factors for a diagnosis of type 2 diabetes mellitus (T2DM) using a neural network model.
METHODS:
This study was conducted on a sample of 234 individuals, in whom T2DM was diagnosed using hemoglobin A1c levels. A multilayer perceptron artificial neural network was used to identify demographic risk factors for T2DM and their importance. The DeLong method was used to compare the models by fitting in sequential steps.
RESULTS:
Variables found to be significant at a level of p<0.2 in a univariate logistic regression analysis (age, hypertension, waist circumference, body mass index [BMI], sedentary lifestyle, smoking, vegetable consumption, family history of T2DM, stress, walking, fruit consumption, and sex) were entered into the model. After 7 stages of neural network modeling, only waist circumference (100.0%), age (78.5%), BMI (78.2%), hypertension (69.4%), stress (54.2%), smoking (49.3%), and a family history of T2DM (37.2%) were identified as predictors of the diagnosis of T2DM.
CONCLUSIONS:
In this study, waist circumference and age were the most important predictors of T2DM. Due to the sensitivity, specificity, and accuracy of the final model, it is suggested that these variables should be used for T2DM risk assessment in screening tests.
Perspective Interpretation of the hygiene and microflora hypothesis for allergic diseases through epigenetic epidemiology
Jong-Myon Bae Epidemiol Health. 2018;40:e2018006.
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  • Korean summary
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Review Registry-based stroke research in Taiwan: past and future
Cheng-Yang Hsieh, Darren Philbert Wu, Sheng-Feng Sung Epidemiol Health. 2018;40:e2018004.
  • Abstract
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Abstract
The hygiene hypothesis (HH) proposed by Strachan in 1989 was expanded to explain the inverse association between the occurrence of allergy disorders and the risk of infectious diseases and parasite infestation. The microflora hypothesis (MH) suggests that gut microbial dysbiosis in early life might trigger hypersensitivity disorders. The sharing concept of both HH and MH is gene-environment interaction, which is also a key concept in epigenetics. The amalgamation of epidemiology and epigenetics has created a scientific discipline termed epigenetic epidemiology. To accomplish an era of gene-environment-wide interaction studies, it is necessary to launch a national human epigenome project.
Abstract
Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.
Review Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks
Patrik Hummel, Abha Saxena, Corinna Klingler Epidemiol Health. 2018;40:e2018003.
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  • Supplementary data
Original Article Physician’s awareness of lung cancer screening and its related medical radiation exposure in Korea
Seri Hong, Suyeon Kim, Mina Suh, Boyoung Park, et al. Epidemiol Health. 2018;40:e2018002.
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Abstract
This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks. The review was commissioned by the World Health Organization to inform responses to the Zika outbreak that began in 2015. Due to the urgency of the response efforts that needed to be informed by the literature search, a rapid qualitative review of the literature published in PubMed was conducted. The search and analysis were based on the operationalization of 3 key concepts: ethics, pregnancy, and epidemic outbreak. Ethical issues and solutions were interpreted within a principlist framework. The data were analyzed using qualitative content analysis. The search identified 259 publications, of which the full text of 23 papers was read. Of those, 20 papers contained a substantive part devoted to the topic of interest and were therefore analyzed further. We clustered the ethical issues and solutions around 4 themes: uncertainty, harms, autonomy/liberty, and effectiveness. Recognition of the identified ethical issues and corresponding solutions can inform and improve response efforts, public health planning, policies, and decision-making, as well as the activities of medical staff and counselors who practice before, during, or after an epidemic outbreak that affects pregnant women or those of reproductive age. The rapid review format proved to be useful despite its limited data basis and expedited review process.
Abstract
OBJECTIVES:
Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements.
METHODS:
Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians’ perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis.
RESULTS:
Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk.
CONCLUSIONS:
It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.

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