Marguerite Pappaioanou

Data collection instrument and procedure for systematic reviews in the guide to community preventive services1

INTRODUCTION A standardized abstraction form and procedure was developed to provide consistency, reduce bias, and improve validity and reliability in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide). DATA COLLECTION INSTRUMENT The content of the abstraction form was based on methodologies used in other systematic reviews; reporting standards established by major health and social science journals; the evaluation, statistical and meta-analytic literature; expert opinion and review; and pilot-testing. The form is used to classify and describe key characteristics of the intervention and evaluation (26 questions) and assess the quality of the studys execution (23 questions). Study procedures and results are collected and specific threats to the validity of the study are assessed across six categories (intervention and study descriptions, sampling, measurement, analysis, interpretation of results and other execution issues). DATA COLLECTION PROCEDURES Each study is abstracted by two independent reviewers and reconciled by the chapter development team. Reviewers are trained and provided with feedback. DISCUSSION What to abstract and how to summarize the data are discretionary choices that influence conclusions drawn on the quality of execution of the study and its effectiveness. The form balances flexibility for the evaluation of papers with different study designs and intervention types with the need to ask specific questions to maximize validity and reliability. It provides a structured format that researchers and others can use to review the content and quality of papers, conduct systematic reviews, or develop manuscripts. A systematic approach to developing and evaluating manuscripts will help to promote overall improvement of the scientific literature.

Methods for Systematic Reviews of Economic Evaluations for the Guide to Community Preventive Services

OBJECTIVES This paper describes the methods used in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) for conducting systematic reviews of economic evaluations across community health-promotion and disease-prevention interventions. The lack of standardized methods to improve the comparability of results from economic evaluations has hampered the use of data on costs and financial benefits in evidence-based reviews of effectiveness. The methods and instruments developed for the Guide provide an explicit and systematic approach for abstracting economic evaluation data and increase the usefulness of economic information for policy making in health care and public health. METHODS The following steps were taken for systematic reviews of economic evaluations: (1) systematic searches were conducted; (2) studies using economic analytic methods, such as cost analysis or cost-effectiveness, cost-benefit or cost-utility analysis, were selected according to explicit inclusion criteria; (3) economic data were abstracted and adjusted using a standardized abstraction form; and (4) adjusted summary measures were listed in summary tables. RESULTS These methods were used in a review of 10 interventions designed to improve vaccination coverage in children, adolescents and adults. Ten average costs and 14 cost-effectiveness ratios were abstracted or calculated from data reported in 24 studies and expressed in 1997 USD. The types of costs included in the analysis and intervention definitions varied extensively. Gaps in data were found for many interventions.

Developing the guide to community preventive services—overview and rationale

When the GUIDE TO COMMUNITY PREVENTIVE SERVICES: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will make recommendations regarding public health interventions to reduce illness, disability, premature death, and environmental hazards that impair community health and quality of life. The Guide is being developed under the guidance of the Task Force on Community Preventive Services (the Task Force)-a 15-member, nonfederal, independent panel of experts. Subject matter experts, methodologists, and scientific staff are supporting the Task Force in using explicit rules to conduct systematic literature reviews of evidence of effectiveness, economic efficiency, and feasibility on which to base recommendations for community action. Contributors to the Guide are building on the experience of others to confront methodologic challenges unique to the assessment of complex multicomponent intervention studies with nonexperimental or nonrandomized designs and diverse measures of outcome and effectiveness. Persons who plan, fund, and implement population-based services and policies to improve health at the state and local levels are invited to scrutinize the work in progress and to communicate with contributors. When the Guide is complete, readers are encouraged to consider critically the value and relevance of its contents, the implementation of interventions the Task Force recommends, the abandonment of interventions the Task Force does not recommend, and the need for rigorous evaluation of the benefits and harms of promising interventions of unknown effectiveness.

Antibody Response to Preexposure Human Diploid-Cell Rabies Vaccine Given Concurrently with Chloroquine

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.

Prevalence of HIV infection in childbearing women in the United States

CD4 T-lymphocyte counts and Pneumocystis carinii pneumonia in pediatric HIV infection Kovacs A; Frederick T: Church J; Eller A; Oxtoby M; Mascola L University of Southern California Medical Cenier, 1129 N State St, Los Angeles. CA 90033, USA J AM MED ASSOC 1991 265113 (1698-1703) The relationship between CD4 T-lymphocyte counts and infection with the human immunodeficiency virus (HIV) is retrospectively investigated for 266 HIV-infected and uninfected children who were born to infected women, including 39 with Pneumocystis carinii pneumonia (PCP), in a population-based surveillance study. Of 21 perinatally HIVinfected children with PCP only 10 (48”/u) had CD4 Tlymphocyte counts that were less than 500 x IO6 cells/L (500 cells/mm3), compared with all 18 who were infected via blood transfusions or clotting factors. Among 88 children who were 1 year or younger, 18 (90%) of 20 PCP cases had CD4 Tlymphocyte counts that were less than 1500 x IO6 cells/L (1500 cells/mm3) compared with only five (IO%) of 48 children who did not have the acquired immunodeficiency syndrome (odds ratio, 77.4; 95% confidence interval, 19.7 to 313.4). The mean CD4 T-lymphocyte count was lower for the 39 PCP cases when compared with the 188 children who were at different stages of HIV infection and did not have the acquired immunodeficiency syndrome (AIDS) independent of age. The majority of perinatally HIV-infected children with PCP were 8 months or younger and 5O”/u were previously unknown to be infected. Thus, HIV-positive children should be identified early and followed closely. CD4 T-lymphocyte counts may be useful in monitoring HIV-positive children and determining when to begin PCP prophylaxis.

Strengthening capacity in developing countries for evidence-based public health:: the data for decision-making project

Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.

Executive summary of the AVMA One Health Initiative Task Force report

Lonnie J. King, dvm, ms, mpa, dacvpm; Larry R. Anderson, dvm, md; Carina G. Blackmore, dvm, phd; Michael J. Blackwell, dvm, mph; Elizabeth A. Lautner, dvm, ms; Leonard C. Marcus, vmd, md; Travis E. Meyer, bs; Thomas P. Monath, md; James E. Nave, dvm; Joerg Ohle; Marguerite Pappaioanou, dvm, mpvm, phd, dacvpm; Justin Sobota, ms, dvm; William S. Stokes, dvm, daclam; Ronald M. Davis, md; Jay H. Glasser, phd; Roger K. Mahr, dvm

Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases

Outbreaks in the past decade of avian influenza H5N1 (“bird flu”), severe acute respiratory syndrome (SARS), and pandemic H1N1 2009 (so called “swine flu”) are examples of how zoonotic diseases—those caused by bacteria, viruses, parasites, or unconventional agents and are transmissible between humans and animals—can threaten health and economies around the world. Unfortunately, for several reasons, disease surveillance in the United States and abroad is not very effective in alerting officials to emerging zoonotic diseases. This report calls for the United States to take the lead, working with global health organizations, to establish a global zoonotic disease surveillance system that better integrates the human and animal health sectors for improved early detection and response. Zoonotic pathogens have caused more than 65 percent of emerging infectious disease events in the past six decades. Zoonotic diseases are often novel and ones societies are medically unprepared to treat, as was the case when HIV/AIDS and variant Creutzfeldt-Jakob Disease (the human form of “mad cow disease”) emerged. Moreover, the severity of illness in different species is unpredictable and widely variable. For example, the 1918 influenza pandemic (“Spanish flu”) was a particularly virulent strain of H1N1 that killed millions of people worldwide. Although mortality from recent human avian influenza outbreaks has been relatively low—notably just 257 reported deaths worldwide from the ongoing highly pathogenic avian influenza H5N1(HPAI H5N1) outbreak—there is still much cause for concern. In response to this concern, the U.S. Agency for International Development (USAID) approached the Institute of Medicine and the National Research Council for advice about how to achieve more sustainable global capacity for surveillance and response to emerging zoonotic diseases. A committee was convened to examine several infectious disease surveillance systems already in operation, identify effective systems, uncover gaps in efforts, and recommend improvements toward the goal of an effective global disease surveillance system. Experts in human and animal disease surveillance provided input to the committee at a workshop held in June 2008 in Washington, D.C. In addition to human and animal illness and potential loss of lives, the economic losses due to zoonotic disease outbreaks can be staggering. Economic consequences can include trade sanctions, travel warnings or restrictions, animal disease control efforts such as animal culling (intentional slaughter), and declining public confidence in animals products, as was the case with pork

Impact of globalization and animal trade on infectious disease ecology.

The articles on rabies and Marburg virus featured in this months Emerging Infectious Diseases (EID) zoonoses issue illustrate common themes. Both discuss zoonotic diseases with serious health implications for humans, and both have a common reservoir, the bat. These articles, and the excitement generated by this years recognition of World Rabies Day on September 8, also described in this issue, remind us how globalization has had an impact on the worldwide animal trade. This worldwide movement of animals has increased the potential for the translocation of zoonotic diseases, which pose serious risks to human and animal health.

Scope and organization of the guide to community preventive services

BACKGROUND The diverse nature of the target audience (i.e., public health decision-makers) for the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) dictates that it must be broad in scope. In addition, for the Guide to be most useful for its target audience, its organization and format must be carefully considered. DETERMINING THE SCOPE OF THE GUIDE Healthy People objectives and actual causes of death were used to determine the contents of the Guide. A priority setting exercise resulted in the selection of 15 topics for systematic reviews using the following criteria: burden of the problem, preventability, relationship to other public health initiatives, usefulness of the package of topics selected and level of current research and intervention activity in public and private sectors. Interventions within each topic target state and local levels and include population-based strategies, individual strategies in other than clinical settings and group strategies. ORGANIZATION OF THE GUIDE The Guide is organized into: Introduction, Reviews and Recommendations (three sections: Changing Risk Behaviors, Reducing Diseases, Injuries, or Impairments, and Addressing Environmental and Ecosystem Challenges), Appendixes, and Indexes. DISCUSSION The scope and organization of the Guide were determined using relevant public health criteria and expert opinion to provide a useful and accessible document to a broad target audience. While the final contents of the Guide may change during development, the working table of contents described in this paper provides a framework for development of the Guide and conveys its scope and intention.