Epidemiology of Hajj pilgrimage mortality: Analysis for potential intervention.

Background: The Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Little is known about the impact of the existing chronic diseases on morbidity and mortality during the Hajj.

The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study.

There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012.

Perspectives on the Future of Epidemiology: A Framework for Training.

Over the past century, the field of epidemiology has evolved and adapted to changing public health needs. Challenges include newly emerging public health concerns across broad and diverse content areas, new methods, and vast data sources. We recognize the need to engage and educate the next generation of epidemiologists and prepare them to tackle these issues of the 21st century.

Posttraumatic Stress Disorder 23 Years After the 1988 Spitak Earthquake in Armenia.

This population-based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM-5 criteria), and a variety of potential risk and protective factors.

A post-earthquake psychopathological investigation in Armenia: methodology, summary of findings, and follow-up.

The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes.

Prospective study of predictors of poor self-rated health in a 23-year cohort of earthquake survivors in Armenia.

Long-term prospective studies exploring general health outcomes among disaster survivors are rare. Self-rated health (SRH) - a proven correlate of morbidity and mortality prognosis - was used to investigate predictors of perceived health status among a 23-year cohort of survivors of 1988 Spitak earthquake in Armenia. A geographically-stratified subsample of 725 adults from a larger initial cohort was followed during the period of 1990-2012.

Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors.

Background: Despite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes.

Methods: 23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants.

Rate and predictors of postpartum depression in a 22-year follow-up of a cohort of earthquake survivors in Armenia.

Disasters have serious long-term impact on mental health for those exposed. The aim of this study was to identify predictors of postpartum depression among survivors of the 1988 devastating earthquake in Armenia. A nested case-control design was applied to investigate postpartum depression in a large-scale cohort of survivors followed between 1990 and 2012.

Interbirth interval and history of previous preeclampsia: a case-control study among multiparous women.

Background: Preeclampsia is a disorder with a reported incidence of 2%-8% among all pregnancies, accounting for more than 50,000 deaths worldwide each year. In low- and middle- income countries maternal/perinatal morbidity and mortality associated with preeclampsia are high due to the lack of proper prenatal and hospital care and limited access to neonatal intensive care. The objectives of our study were to determine the association of long interbirth interval (IBI) and preeclampsia and to investigate the interactions between long IBI and other risk factors among multiparous women in Yerevan, Armenia.

Short and long term determinants of incident multimorbidity in a cohort of 1988 earthquake survivors in Armenia.

Background: Multimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations' health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time.

Triggers for attacks in familial Mediterranean fever: application of the case-crossover design.

The etiology of recurrent attacks of serositis in familial Mediterranean fever (FMF) is not completely understood. Uncontrolled clinical case series have reported that factors associated with emotional, physiological, or physical stress precede and might trigger the attacks. This case-crossover study, conducted between July 2007 and May 2008, aimed to estimate the role of precipitating factors in attacks in a sample of Armenian FMF patients in Yerevan, Armenia, where 104 patients contributed 55 case and 189 control time periods.

Interaction of maternal age and mode of delivery in the development of postpartum depression in Yerevan, Armenia.

Background: To investigate determinants of development of postpartum depression among women in Yerevan, Armenia.

Method: A case-control study of all reproductive age (18-45) women having 1-3 months old children registered in 7 Primary Health Care (PHC) facilities, in Yerevan. We used Edinburgh Postnatal Depression Scale (EPDS) and a structured questionnaire to assess possible postpartum depression status of mothers and exposure status through telephone interviews.

Prevention of amyloidosis in familial Mediterranean fever with colchicine: a case-control study in Armenia.

Objective: To determine whether or not the use of colchicine decreases the risk of amyloidosis among Armenian patients with familial Mediterranean fever (FMF).

Subjects And Methods: The study included 99 Armenian patients from the Center of Medical Genetics database with genetically ascertained FMF; 33 had renal amyloidosis and 66 were randomly selected control patients without renal amyloidosis. Self- reported colchicine use was assessed by interviewer-based questionnaire.

Epidemiology: a problem-solving journey.

As a scientific discipline, epidemiology has helped liberate the practice of public health and medicine from dogmatic thinking over the past century. This commentary highlights some integrating principles to explain why epidemiology is a problem-solving discipline. The first of these is that epidemiology is an information science.

Effect of HAART on incident cancer and noncancer AIDS events among male HIV seroconverters.

Objective: To explore the impact of highly active antiretroviral therapy (HAART) on the prevention of AIDS-defining cancers relative to other AIDS-defining events.

Design: Prospective cohort study using 2,121 HIV+ male seroconverters (median age: 28 years, 51% white/non-Hispanic) in the Tri-Service AIDS Clinical Consortium (n = 1694) and the Multicenter AIDS Cohort Study (n = 427).

Methods: Poisson regression models, with calendar periods to represent antiretroviral therapy, were extended to analyze first incident AIDS-defining cancers and other first AIDS-defining events as competing risks.

Low bone mineral density, coronary heart disease, and stroke mortality in men and women: the Third National Health and Nutrition Examination Survey.

Purpose: The aim of this study is to determine the long-term association of bone mineral density and cardiovascular disease mortality.

Methods: The data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of noninstitutionalized civilians. A cohort of white, black, and Mexican-American persons ages 50 years and older at baseline (1988-1994) was followed through 2000 for coronary heart disease (CHD; n = 4690) and stroke mortality (n = 5272) using the NHANES III Linked Mortality File.

Latency and exposure-health associations in Gulf War veterans with early fatigue onsets: a case-control study.

Purpose: To see if self-reported exposures were associated with health in early-onset Gulf War illnesses (GWIs) cases and healthy Gulf War veteran controls.

Methods: Forty-nine cases and 44 controls completed questionnaires about wartime exposures and symptoms experienced. Odds ratios were calculated using 2 x 2 tables and logistic regression.

Feeding practices of babies and the development of atopic dermatitis in children after 12 months of age in Armenia: is there a signal?

We investigated the influence of feeding practices on development of atopic dermatitis (AD) in Armenian children (n = 240). In multivariate models early introduction to solids, family history of atopy, and breastfeeding by a mother with atopic condition were associated with the development of AD after 12 months post-term. A prospective study in Armenia is recommended to confirm our findings.

Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue.

Aims: We hypothesized that family history of fainting is a risk factor for adult-onset neurally mediated hypotension (NMH) in patients who present with chronic fatigue rather than fainting.

Methods And Results: A nested case-control study of Gulf War veterans gathered fainting histories directly from 197 first-degree relatives of 16 fatigued NMH cases, 26 fatigued controls, and 17 healthy controls. NMH status was determined by tilt testing.

A positive or a negative confounding variable? A simple teaching aid for clinicians and students.

Anticipating the direction of a confounding variable can be problematic especially to introductory students. Using elementary rules of mathematics, we describe below a simple instructional tool for deriving the direction of confounding bias. The tool is illustrated with examples and a heuristic mathematical justification is also described.

Application of case-crossover and case-time-control study designs in analyses of time-varying predictors of T-cell homeostasis failure.

Purpose: To evaluate the association of sexual behavior and recreational drug exposures with T-cell homeostasis failure (TCHF), which corresponds to the onset of a rapid decline in an individual's T lymphocyte count, which occurs on average approximately 1.75 years prior to an initial diagnosis of acquired immunodeficiency syndrome (AIDS).

Methods: A case-crossover design and a case-time-control design, both nested within the Multicenter AIDS Cohort Study of 4954 homosexual and bisexual men initiated in 1983.

Incident hypertension associated with depression in the Baltimore Epidemiologic Catchment area follow-up study.

Background: This study evaluates the role of depression as a specific risk factor for hypertension.

Methods: This study analyzed the prospective data in the Baltimore Epidemiologic Catchment Area (ECA) Follow-up Study (n=1920), a longitudinal population-based study of mental illness in East Baltimore. Incident cases of hypertension as assessed by self-report (n=148) in 1993 were compared to the remaining cohort without hypertension (n=901) across three waves of ECA interviews (1981, 1982, 1993).

Predictors of cause-specific hospital readmission in patients with heart failure.

Background: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The predictors for readmission in patients with HF are not completely understood.

Hypothesis: The study was undertaken to investigate the time course of readmission by specific cause in patients with HF, and to examine the independent effects of HF etiology and left ventricular (LV) function on cause-specific readmissions.