Combining conventional and participatory approaches to identify and prioritise management and health-related constraints to smallholder pig production in San Simon, Pampanga, Philippines
تلفیق رویکردهای مرسوم و مشارکتی برای شناسایی و اولویت بندی مدیریت و محدودیتهای مرتبط با سلامتی در تولید خوک های خرده فروش در سن سیمون ، پامبانگا ، فیلیپین-2020
Pork is the main meat produced and consumed in the Philippines. The majority of pigs are raised by smallholders who experience a range of constraints to their pig production. This study presents the findings of the first part of an overarching project that used an Ecohealth approach and aimed to improve the production and competitiveness of the smallholder pig system in an area of the Philippines. A participatory approach was embraced, combining conventional and participatory epidemiology methods followed by a stakeholder discussion. The first aim was to identify management and health-related constraints to pig production among smallholder famers in San Simon, Pampanga, Philippines. The second aim was for the project team and stakeholders to jointly prioritise activities for the immediate future to address these constraints. Key management and health-related constraints identified included inadequate water supply to pigs, particularly lactating and gestating sows, and a range of feeding-related issues. Diarrhoea was recognised as the disease syndrome of highest priority and limited record keeping meant that farmers were unable to assess the productivity and profitability of their pig farming enterprises. Actions jointly prioritised by stakeholders and the project team were: the appointment of a project coordinator within each barangay; conduct two sets of seminars, the first covering water and nutrition and the second piglet management and diarrhoea, to be delivered by technical experts but with farmer “trusted sources” also sharing their experiences; development of easily understandable leaflets and posters covering key technical information; promotion of nipple drinkers attached to five-gallon water containers and creep boxes for piglets, and conduct of a record keeping workshop with a small group of innovative farmers to develop a useful and usable tool for record keeping. The use of multiple approaches to data-gathering enabled triangulation of study findings. Without any one of these components the understanding of the pig production system would have been less complete and it is possible that the proposed actions would not have been as well-tailored to the needs of the farmers. The participatory approach, in particular the stakeholder discussion, provided the opportunity to embrace the “deciding together” and “acting together” stances of participation rather than the lower “information giving” stance, thereby giving stakeholders greater ownership of the future activities of the overarching project and beyond.
Keywords: Philippines | Pig | Smallholder | Constraints | Participatory epidemiology | Ecohealth
The harmonizing effect of Smart Snacks on the association between state snack laws and high school students fruit and vegetable consumption, United States—2005–2017
اثر هماهنگ کننده میان وعده های هوشمند در ارتباط بین قوانین میان وعده ایالتی با مصرف میوه و سبزیجات دانش آموزان دبیرستانی ، ایالات متحده — 2005-2017-2020
Despite national guidelines recommending daily fruit and vegetable (FV) consumption, intake of FV among adolescents is low. Over the past 10–15 years, state and federal laws have reduced the availability of junk foods in schools. This study examined the association between state snack laws and high school (HS) student FV consumption. The overall sample included 99,785 HS students (outcome samples ranged from 96,209-97,328) included in the Youth Risk Behavior Survey (YRBS). National Cancer Institute Classification of Laws Associated with School Students data for 2004–2016 were lagged on to 2005–2017 YRBS data. Separate analyses examined the state law-youth FV consumption relationship pre- and post-federal Smart Snacks standards (effective school year 2014–2015). Analyses were conducted between 2018 and 2020. Overall, state laws were associated with any vegetable, salad, and other vegetable consumption. The relationship between state laws and vegetable consumption primarily occurred pre-Smart Snacks. Pre-Smart Snacks, state laws were associated with higher odds of youth consumption of any vegetable, salad, carrots, and other vegetables (all compared to students in states without snack laws). The only association post-Smart Snacks was between strong state laws and salads. This study illustrates the important role that standards restricting the availability of junk foods in schools can have on increasing student vegetable consumption. Given current efforts to roll-back federal school meal standards, findings from this study illustrate how federal standards harmonized the patchwork of state laws that existed prior to Smart Snacks and the important role that consistent national standards can play in supporting student consumption of vegetables.
Keywords: Legal epidemiology | Nutrition | Schools | Fruit | Vegetables
Women in German forensic addiction treatment: Epidemiology and genderrelated decision making in jurisdiction
زنان آلمانی در درمان اعتیاد پزشکی قانونی : اپیدمیولوژی و تصمیم گیری جنسیتی در صلاحیت-2020
Purpose: Within the German legal framework, if an unlawful act is committed by a substance-addicted offender, courts shall make a forensic addiction treatment order (referred to as FAT). In 2010–2015, German courts applied this rule to 14,576 individuals. The article aims to explore the development of FAT sex ratios, its relation to other criminological measures and its regional distribution - and to describe gender-related differences within the FAT population. Methods: Yearly and state-specific sex ratios in FAT orders were calculated and related to general delinquency figures. Women were compared to men on various variables. We computed chi-square, t- and Kruskal-Wallis tests. Results: Compared to registered and sanctioned delinquency, women are steadily underrepresented, but the sex ratio differs largely among German states. Compared to men, women are 1 year older, have a less severe criminal history and a different distribution of addiction-related delinquency. Their average concurrent prison sentence is shorter, indicating less severe offences. Conclusions: Findings largely conform to epidemiological knowledge. However, it is unlikely that these effects explain the extent of womens underrepresentation concerning FAT. Instead, FAT-application seems to be influenced by gender-related decision biases in jurisdiction. Regional differences cannot be explained epidemiologically, they seem to indicate different juridical “cultures”.
Keywords: Forensic psychiatry | Substance abuse | Gender differences | Offender treatment | Epidemiology
What Can We Learn About Drug Safety and Other Effects in the Era of Electronic Health Records and Big Data That We Would Not Be Able to Learn From Classic Epidemiology?
چه چیزی می توانیم درباره ایمنی دارو و سایر تأثیرات در عصر سوابق الکترونیکی سلامت و داده های بزرگی که نمی توانیم از اپیدمیولوژی کلاسیک یاد بگیریم؟-2020
As more and more health systems have converted to the use of electronic health records, the amount of searchable and analyzable data is exploding. This includes not just provider or laboratory created data but also data collected by instruments, personal devices, and patients themselves, among others. This has led to more attention being paid to the analysis of these data to answer previously unaddressed questions. This is especially important given the number of therapies previously found to be beneficial in clinical trials that are currently being re-scrutinized. Because there are orders of magnitude more information contained in these data sets, a fundamentally different approach needs to be taken to their processing and analysis and the generation of knowledge. Health care and medicine are drivers of this phenomenon and will ultimately be the main beneficiaries. Concurrently, many different types of questions can now be asked using these data sets. Research groups have become increasingly active in mining large data sets, including nationwide health care databases, to learn about associations of medication use and various unrelated diseases such as cancer. Given the recent increase in research activity in this area, its promise to radically change clinical research, and the relative lack of widespread knowledge about its potential and advances, we surveyed the available literature to understand the strengths and limitations of these new tools. We also outline new databases and techniques that are available to researchers worldwide, with special focus on work pertaining to the broad and rapid monitoring of drug safety and secondary effects.
Keywords: Electronic health record | Big data | Drug safety | Health care database | Cancer risk
Inequity in California’s Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures
نابرابری قوانین در محل کار و استعمال دخانیات در کالیفرنیا: تجزیه و تحلیل اپیدمیولوژیک قانونی بسته شدن حفره-2020
Introduction: California’s landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among lowincome communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015−2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. Methods: Public health attorneys reviewed current laws for 536 of California’s 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012−2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February−June 2019. Results: Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions’ adult smoking prevalence. State law changes in 2015−2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). Conclusions: Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage. Am J Prev Med 2020;58(3):e71−e78. © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Epidemiological rage: Population, biography, and state responsibility in trans- health activism
خشم اپیدمیولوژیک : جمعیت ، زندگی نامه ، و مسئولیت دولت در فعالیت سلامت دو جنسیتی ها -2020
This article examines how social movements reconceptualized trans-health in Buenos Aires, Argentina. Looking ethnographically to medical and activist practice, the article analyzes “epidemiological biographies”, or activistproduced community-based studies blending quantitative and narrative data. It draws on population health, feminist science studies, transgender studies, and social theory to discuss the circulation and implications of these publications. Specifically, it describes how epidemiological biographies disputed health behavioral models by defining state violence and criminalization as primary conditions endangering health and life expectancy among travestis and trans-people. The article analyzes how activist researchers made state violence legible through logics of population health, even as the concept of “population” also emerged from techniques of state control. In contrast with models that place individual behavior at the locus of health interventions, activists instead advanced interventions that contested state securitization and shifted resource distribution. Epidemiological biographies had a considerable effect on national trans-health politics, providing an evidentiary basis for several regulatory shifts. These studies emerged in part through collective political action that reformulated dominant modes of statistical aggregation. This statistical turn—which I call “statistical collectivization”— produced contradictory effects. At one level, it obscured differential conditions of criminalization and violence. At another, it directed attention to the markedly racialized, sexualized, classed, and gendered forms of subjugation that materialize in landscapes of trans-health, and prioritized materially distributive regulation over and above civil protections. Through these contradictory actions, social movements reformulated dominant notions of health by challenging state securitization and contesting state power.
Keywords: Argentina | Travesti | Transgender health | Epidemiology | Statistics | State violence | Social movements | Science & technology studies
Sexually Transmitted Diseases Among US Adolescents and Young Adults
بیماریهای مقاربتی در بین نوجوانان و بزرگسالان آمریکایی-2019
Although sexually transmitted diseases (STDs) affect individuals of all ages, they take a particularly heavy toll on young people. Expanded, integrated, multilevel approaches are warranted to reverse recent increases in STDs and improve sexual and reproductive health outcomes for adolescents and young adults in the United States. Approaches must reach beyond clinics and school classrooms; capitalize on cuttingedge, youth-friendly technologies; and change social contexts in ways that encourage young people’s healthy sexual decision-making.
KEYWORDS : Adolescents | Young adults | Sexually transmitted diseases | Epidemiology | Clinical practice guidelines | Prevention
Real-World Evidence, Causal Inference, and Machine Learning
شواهد در دنیای واقعی ، استنباط علت و یادگیری ماشین-2019
The current focus on real world evidence (RWE) is occurring at a time when at least two major trends are converging. First, is the progress made in observational research design and methods over the past decade. Second, the development of numerous large observational healthcare databases around the world is creating repositories of improved data assets to support observational research. Objective: This paper examines the implications of the improvements in observational methods and research design, as well as the growing availability of real world data for the quality of RWE. These developments have been very positive. On the other hand, unstructured data, such as medical notes, and the sparcity of data created by merging multiple data assets are not easily handled by traditional health services research statistical methods. In response, machine learning methods are gaining increased traction as potential tools for analyzing massive, complex datasets. Conclusions: Machine learning methods have traditionally been used for classification and prediction, rather than causal inference. The prediction capabilities of machine learning are valuable by themselves. However, using machine learning for causal inference is still evolving. Machine learning can be used for hypothesis generation, followed by the application of traditional causal methods. But relatively recent developments, such as targeted maximum likelihood methods, are directly integrating machine learning with causal inference.
Keywords: big data | causal inference | econometrics | epidemiology | machine learning | real-world evidence | targeted maximum likelihood estimator
انطباق وزنی بهینه مبتنی بر فرد برای شبکه های توزیع ناهمگن جهانی
سال انتشار: 2018 - تعداد صفحات فایل pdf انگلیسی: 17 - تعداد صفحات فایل doc فارسی: 39
مطالعه ما درباره¬ی توزیع اپیدمیک در شبکه های وزنی، جهت دار و ناهمگن است. یک مکانیسم انطباق وزنی مبتنی بر فرد پیشنهاد شد که در آن قدرت تماس افراد با توجه به سطح توزیع شبکه قابل انطباق است. فرمول کنترل بهینه به منظور اشاره به ارتباط بین سطح سرایت جهانی و هزینه انطباق وزنی محلی مطابق با توپولوژي شبکه اتصال زیرزمینی ارائه شده است. وجود راه حل برای مسئله کنترل بهینه، به اثبات رسید و با استفاده از آنالیز ریاضی دقیق به بیان صریح دست یافتیم. علاوه بر این، به طوری تقریبی به راه حل بهینه رسیدیم و بصورت انحصاری آن را با یک تابع هزینه خاص بررسی کردیم. در یک سری از آزمایش های عددی، روش پیاده سازی forward-backward برای واسنجی نتایج تئوری به دست آمده، اتخاذ شد. یافته های ما بینش های جدید راجع به رابطه بین توزیع اپیدمیک در شبکه های پیچیده ناهمگن با دینامیک پاسخ های رفتاری و هزینه های استراتژی کنترل را به همراه پیامدهای مهم توسعه آتی سیاست های بهداشت عمومی تطبیقی مربوطه؛ پوشش نمیدهد.
کلید واژه ها: توزیع جهانی| انطباق وزنی بهینه | شبکه های ناهمگن وزنی | رفتار تطبیقی | مدل ریاضی | اپیدمیولوژی
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دیدگاه های جدید در مورد شیگلا: یکی از عوامل کمکی مهم به بار جهانی بیماری اسهالی
سال انتشار: 2018 - تعداد صفحات فایل pdf انگلیسی: 6 - تعداد صفحات فایل doc فارسی: 9
هدف بررسی اسهال، یکی از مشکلات مهم سلامت جهانی است و مطالعات اخیر، شیگلا را به عنوان یکی از عوامل کمکی اصلی برای این بار، تایید کرده اند. اینجا، ما پیشرفت های اخیر در تحقیقات شیگلا را با تمرکز روی اپیدمیولوژی، بیماری زایی، مقاومت ضد میکروبی و نقش میکروبیوم روده در طی عفونت، مورد بررسی قرار می دهیم. یافته های اخیر افزایش داده های اپیدمیولوژیک، در کنار روش های تشخیصی نسل جدید، بار بیشتری از بیماری شیگلا، نسبت به چیزی که قبلا تخمین زده شده بود را نشان می دهند؛ این بار، محدود به جمعیت های آسیب پذیر در کشورهای با درآمد پایین تا متوسط نیست. از آنجایی که درک ما از مکانیسم های سازگاری (هماهنگی) که شیگلا برای ایجاد عفونت استفاده می کند، بیشتر شده است، می توانیم نقش پیچیده ی میکروبیوم روده در پیشگیری و ایجاد چنین عفونت هایی را نیز درک کنیم. استفاده از ژنومیکس، همراه با داده های اپیدمیولوژیک و بررسی های آزمایشگاهی، باعث کشف تکامل و شیوع گونه های مختلف شده است. چنین اقداماتی، مقاومت در برابر عوامل ضد میکروبی را به عنوان عامل اصلی موفقیت کلون های خاص، شناسایی کرده اند. جمع بندی ما باید یافته های جدید در جهت رویکردهای پایدار برای درمان و پیش گیری از عفونت های شیگلا را اعمال کنیم. واکسن ها و درمان های جایگزین، تحت توسعه هستند و ممکن است فرصتی را برای کاهش بار بیماری شیگلا و محدود کردن تحرک کلون های مقاوم به عوامل ضد میکروبی فراهم کنند.
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