Epidemiology
Each of the following paragraphs presents a study objective and the methodology that will be used to evaluate the types of epidemiologic study design. State what is the study design for each study? (24 points â 4 each) (Note: For study design, try to have as detailed design as possible and avoid simply âexperimental studyâ or âobservational studyâ)
c) The following abstract was obtained from PubMed (with modification by XLD).
Lishman H, et al. Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antibiotic resistance. Int J Antimicrob Agents. 2018 Aug 23. [Epub ahead of print].
This study aimed to quantify the association between antibiotic prescribing for urinary tract infections (UTIs) and the incidence/antibiotic susceptibility of UTI-related Escherichia coli bacteraemia in adult women in England. A national study was conducted with data aggregated at the GP practice level. The study population was all adult female patients (18+) with a reported UTI-related E. coli bacteraemia in England (2012-2014). Reports of bacteraemia from the national mandatory surveillance scheme were linked with E. coli blood culture susceptibility data (where available) and the correlation with primary care exposure to trimethoprim and nitrofurantoin was quantified using longitudinal multi-level models. There were 20,274 patients in the study from 5,916 practices. Between 2012-2014, the overall incidence of UTI-related E. coli bacteraemia in the study group did not change significantly (1.3% increase, 95% CI 0.1%-2.7%, p=0.074). However, after adjusting for practice characteristics, UTI-related E. coli bacteraemia incidence increased by 3.0% and 1.5% with each increasing quintile in trimethoprim and nitrofurantoin prescribing, respectively. The incidence of trimethoprim-resistant bacteraemia increased by 4.5% (p=0.032) with each increasing quintile in trimethoprim prescribing and was not associated with nitrofurantoin prescribing. This study demonstrates an association between GP prescribing for UTIs and UTI-related E. coli bacteraemia incidence at the practice level and shows that higher prescribing of trimethoprim is associated with higher incidence of trimethoprim-resistant bacteraemia. Evidence is provided of the importance of prudent antibiotic prescribing in primary care to prevent the development of antibiotic resistance which can put patients at risk of subsequent severe infections.
Study Design: ___________________________
d. The following abstract was obtained from PubMed (with modification by XLD).
Mubarak MY, et al. Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan. BMC Infect Dis. 2016 Aug 31;16(1):459.
BACKGROUND: Sustained civil and military conflict, resulting in large numbers of internally displaced persons (IDP), in combination with rapid urbanization has strained public health and sanitation within cities in Afghanistan. In order to examine the association between preventive sanitary behaviors and diarrhea within two high risk settings located within Kabul, Afghanistan, this study aimed to evaluate the prevalence of hygienic practices and diarrheal illness in an IDP camp and an urban slum.
METHODS: In this study, a convenience sample of residents of an IDP camp and an urban slum in Kabul, Afghanistan, was used. Participants were asked to describe their hygienic practices and interviewers independently documented household sanitation. The knowledge and attitudes about and practice of hygienic activities to prevent diarrhea were compared between the two settings.
RESULTS: Two hundred participants, 100 from each setting, were enrolled. Knowledge, attitudes, and practices regarding hygienic activities to prevent diarrhea were greater among the slum dwellers than the IDP. Fewer than half of participants washed their hands with soap before eating or after eating: 31 % of slum dwellers washed before eating compared to 11 % of IDPs (Pâ=â0.0050), and 25 % of slum dwellers washed after defecating compared to 4 % of IDPs (Pâ=â0.0020). The IDPs were more likely to share a latrine (Pâ=â0.0144) and less likely to disinfect their latrine than slum dwellers. Diarrhea in the household within the past 3 months was more common in the IDP camp (54 %) than the slum (20 %) (Pâ=â0.0020).
CONCLUSIONS: Even though certain sanitary and hygienic practices were more common among slum dwellers than IDPs, the lack of hygienic activities in both setting indicates that interventions to change behavior, like increasing the availability of soap and encouraging hand washing, are needed. Any initiative will have to be developed in the context of pervasive illiteracy among persons in these settings.
Study Design: ___________________________
