May 2014 the epidemiology monitor final

Epidemiologic Mysteries Still Surround MERS-CoV Outbreak In The Middle East Why More Cases Recently Than In All Of The Previous 2 Years ?

Worrisome or even frightening outbreaks of mysterious infectious diseases are not new. Two such outbreaks, one of Ebola and one of MERS-CoV now underway in Africa and the Middle East respectively are of special concern.

Upsurge in Cases The mysteries surrounding MERSCoV have only deepened in the past few weeks as the cases have increased dramatically. There is no convincing

explanation yet for the sudden increase in cases. According to Marjorie Pollack, Deputy Editor of ProMED, a listserv used as an informal surveillance system, “Two years since the first news reports, MERS remains a mystery. With more cases reported in a single month than in the two years combined, no one is certain how people become infected.”

ProMED has been instrumental in - MERS continues on page 2

Top 25 Entries Selected in Marriage Vow Contest Readers Being Polled To Help Select The Winning Entry More than 100 entries have been submitted since late last year to the Epidemiology Monitor contest to create the best marriage vow for epidemiologists. The contest was inspired by a humorous vow penned by the University of North Florida’s Tammie Johnson in thinking about vows she might exchange with her new husband. She came up with “I promise I will always fail to reject you” and her humor has inspired

scores of readers to be creative.

In collaboration with Johnson, The Epidemiology Monitor will give a $500 prize for the best slogan submitted to the newsletter. The deadline was extended to April 30, 2014.

We received so many clever entries - Vows continues on page 13

In This Issue -3List of "Public Health Issues" Growing -8Oath of Public Health Professionals -9Gains in Life Expectancy - 11 Health Status of the World Today - 12 IEA Conference Update - 14 Marketplace

May 2014 Volume Thirty Five Number Four

-MERS continued from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly (except August) by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA. All rights reserved.

Reproduction, distribution, or translation without written permission of the publisher is strictly prohibited.

Advertising Rates Full Page $995 7.5”w x 10” h Half Page $595 7.5”w x 5” h Quarter Page $295 3.75”w x 5” h Typesetting: $50 Online Ads $395 / mo.

Ad Discounts: 10% off ads run 2 consecutive months 20% off ads run 3 or more consecutive months.

Advertising Sales Ron Aron 770.670.1946 ron.aron@epimonitor.net

All checks must be in U.S.D, drawn on a bank with a U.S. address on the check.

Contact Us The Epidemiology Monitor 33 Indigo Plantation Rd, Okatie, SC, 29909 USA 678.361.5170 / Phone call or email for Fax# office@epiMonitor.net

bringing new infections to public attention since 1994, notably both SARS in the early 2000’s and most recently the first MERS notices were posted to ProMED. Case Count The latest report from the World Health Organization on May 23 describes 635 laboratory-confirmed cases of infection with MERS-CoV, including 193 deaths for a casefatality rate of 30%. The WHO notes that 41 laboratory confirmed cases were reported just between May 1015 from Saudi Arabia.

International Concern International concern about the seriousness and urgency of the situation is high, but not high enough at the moment to convince an International Panel advising WHO to declare a state of emergency. This judgment is likely to persist as long as evidence of limited person to person spread holds up.

Not everyone agrees with the WHO panel, Preben Aavitsland, a Norwegian epidemiologist who helped draft the regulations about outbreaks told Science Insider, “I personally think from the information publicly available that the event should be declared a PHEIC (Public Health Emergency of International Concern).

There are certainly multiple reasons to be concerned. There is a potential threat posed by the large number of pilgrims estimated at 6 million per

year who make their way to Saudi Arabia from all over the world. It is possible that some infected pilgrims could return to less developed countries where detection of importations might be delayed and infection control procedures might be too limited to snuff out the cases before transmission becomes widespread. According to sources who spoke with The Epidemiology Monitor, public health officials may be more worried than they are admitting to publicly.

The long list of unknowns about MERS transmission coupled with any new evidence of enhanced spread would likely trigger an emergency declaration. For now, the international advisors are calling for more studies on how the virus spreads. For example, there has been no case-control study to identify risk factors of transmission.

Criticisms The Saudis have been criticized in many quarters for not being as forthcoming as possible about the epidemiologic facts surrounding each of the cases. As noted in a WIRED magazine article, “Restrictive government can still put the whole world in danger by clamming up.

That’s because the most important factor in controlling epidemics isn’t the quality of our medicines. It’s the quality of our information.”

Scientific Competition In addition to the lack of cooperation from Saudi officials, there has been the lack of collaboration among - MERS continues on page 7

2

List of “Public Health Issues” Appears To Be Growing What Makes An Issue A “Public Health Issue”?

Judging from recent articles which have appeared in the mass media and medical literature on topics as diverse as bullying and hoarding, it appears that seeing social phenomena through the lens of public health offers benefits that many advocates seek. This raises questions about what the benefits of earning the "public health issue" label are, and what criteria must be fulfilled by a social phenomenon to be legitimately classified as a "public health issue".

Quick quiz: As readers of The Epidemiology Monitor and public health scientists, which of the following phenomena do you think are a public health issue? You may wish to revisit your answers after reading this article.

Racism Computer Security Bullying Harmful Alcohol Use Online Pornography Adolescence Child Obesity Infertility The Size of Soda Servings Injury Violence Marijuana Use Hoarding

Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No

HIV in Fishing Towns Trauma Depression Teen age Pregnancy Child Labor Adult Obesity All Season Tires Active, non-motorized transportation Guns Gang Violence Climate Change Achieving a "Good" Death

Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No

A case has been made in various publications for all of these phenomena to be considered public health issues. Among the recent cited reasons for positing a phenomenon as a public health issue are those listed below. Read these reasons and consider whether or not to change your view about what is or is not a public health issue.

Issue Racism

Reasons Cited • • • • •

Computer security

•

Psychological toll on black Americans causes stress related health issues causing them to die younger than white Americans.

Black Americans receive poorer health care Research on Black Americans is underfunded.

People of color are underrepresented in clinical trials.

Poor Black Americans are being hit hardest by political resistance to implement the Affordable Care Act Individual action to protect yourself only gets you so far. You need a group response.

- Issues continues on page 4

3

Issue Bullying

Alcohol Use

Adolescence

Injury

Size of Soda Servings

Infertility

Reasons Cited • • • • • • • • • • • • • • • • • • • • • • • • •

Violence Gun Violence

• • • • •

Marijuana Use Legalization

4

• • •

It is widespread in the US It is a multifaceted form of maltreatment It is linked to a wide range of health issues and can result in injury, distress, or death.

There are risk factors for bullying or being a victim of bullying It may be preventable.

It is a causal factor in more than 200 diseases and injuries.

It causes deaths.

It is harmful for others besides the drinker We pay little attention to the health of 10-19 year olds.

Almost all adolescent deaths are preventable Mental health challenges are the overwhelming problem for adolescents Teenagers need adequate consideration and a voice in public policy They are preventable We want to approach problems in the community as a whole and not focus on individuals Want to focus on prevention not treatment Want to use many solutions Sodas are bad for health. If you are ill, your illness has consequences for others.

Public health measures make life healthier and safer for everyone.

Makes the default choice the healthier choice.

The intervention is broadly inclusive and democratic.

Unwanted childlessness causes significant sometimes life threatening consequences.

Prevalence is significant.

Often linked to preventable infections.

Recognition and treatment are neglected now.

Discipline of public health could contribute significantly to policy and programs It is transmitted like a disease.

The US has one of the highest rates of homicides in the developed world.

The US has an average of 88 gun deaths per day.

Every time a gun is used in self-defense, there are 4 accidental shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides.

The National Rifle Association specifically targets the public health approach.

Promoting reasonable gun policies does not make public health professionals anti-gun It produces second hand smoke It leads to schizophrenia, especially in teen boys Driving while high should be discouraged.

- Issues continues on page 5

Issue Achieving a “Good” Death

Trauma

Reasons Cited • • • • •

Public health addresses the distribution of limited resources.

We can achieve better care with lower costs by avoiding unwanted aggressive care.

It is the number one health public health issue of our time.

Unrelenting stress is linked to obesity, diabetes, depression, and suicide.

Teaching resilience can transform trauma.

HIV/AIDS in Fishing Communities

•

AIDS related illness and mortality are devastatingly high in some fishing communities.

Hoarding

• • • •

All Season Tires

• • • •

A growing problem.

Epi studies suggest prevalence is 2-5 percent of the population.

It spreads pests and possible health dangers to the community.

Social service or other agencies have to use resources to clean houses people cannot afford to clean.

Cold hardens the rubber in all season tires They are unsafe in cold weather and dangerous in snow.

People are dying because of these tires.

Manufacturers are allowed to market tires as all season knowing they are unsuitable in cold weather It has a significant long term health impact We do not have universally accepted definitions We need to prevent it before it happens.

We need to create lasting change by making the healthy choices the easiest choices.

Childhood Obesity

Adult Obesity

Child Labor

Active (nonmotorized) transportation

• • • •

• •

It is a global practice It has many negative outcomes

• • •

Everyone travels.

Transportation systems impact health.

Health should be considered in transportation and land use planning and decision making It can produce health benefits and curb health care spending It is harmful in many ways—preventing healthy sexuality, disempowering women, leading to sexual violence and nonconsensual sex.

It is so widespread as to be considered a crisis If CDC got interested, we could have success in the way we had success with cigarette smoking

• •

Online Pornography

• •

- Issues continues on page 6

5

Issue

Reasons Cited •

•

Climate Change

• • •

Gang Violence

• • • •

Rebranding this issue as a health issue rather than an environmental or national security issue might have more resonance for the average citizen.

It fosters a more emotionally compelling response since it focuses on the immediate implications a warmer climate could have on people's lives.

It provides a sense of hope that problems can be addressed and avoided.

Invoking health helps to bypass the political quagmire.

Doctors can have a potential impact scientists may not have because they can transcend political differences and we really care about what they say.

It can change the type of dialogue people have about climate change.

It has a distressing impact on individuals, families, and communities.

The wider social-economic costs can be equally damaging.

It provides communities with the opportunity to rethink how services for young people are delivered and how public health funding can be used in a more flexible way.

A question posted on Researchgate last year resulted in the following criteria being offered for what makes an issue a "public health issue". Read these criteria and see if they change your view about what is or is not a public health issue.

1.

2.

3.

4.

5.

6.

7.

8.

The concept of preventability—there are conceivable ways to prevent the phenomenon.

High prevalence of a risk factor or disease.

A rapid increase in incidence and prevalence.

Cost of the disease Burden of disease Has the capability of affecting the population as a whole Will require group action to solve.

Ability to recognize the problem unhindered by obstacles posed by culture, politics, lack of resources, or lack of effective measures. This set of criteria effectively requires that a phenomenon must be seen as culturally appropriate, politically acceptable, technically feasible, and financially possible in order to be or become a true “public health issue”. ■

Note to Readers Send your views about what constitutes the best set of criteria to use in establishing an issue as a "public health issue". We will publish your views on the topic.

Email to: epimon@aol.com

6

Number of confirmed cases of Middle East respiratory syndrome coronavirus infection (145 fatal and 391 nonfatal) reported by the World Health Organization (WHO) as of May 12, 2014, by month of illness onset — worldwide, 2012–2014

* Reprinted from MMWR - MERS continued from page 2 scientists and other investigators.

In an article entitled “Triumphs, Trials, and Tribulations of the Global Response to MERS Coronavirus, Scott McNab and colleagues note that the “…meaningful collaboration that helped the scientific community to rapidly identify the SARS coronavirus has not been seen recently.

Collaborative research into MERS coronavirus has been scarce, with investigations marked by bitter disagreements between public health authorities and scientists about the virus’ discovery and the ensuing publications, processes, and patenting of products.”

Unsolved Mysteries Among some of the key unsolved mysteries surrounding the Saudi outbreak are the following:

1. The current increase in reported cases is partially related to nosocomial transmission, according to Pollack, but not all of the cases can be explained through this route of transmission.

And even for the nosocomial cases, it is unclear if transmission is occurring through droplet spread, aerosolization, or perhaps fomites.

2. Camels are considered the most likely intermediary host and fruit bats (Egyptian tomb bat: the possible reservoir, yet many case have occurred in city dwellers. How can one explain this discrepancy ?

"Collaborative research into MERS coronavirus has been scarce..."

3. Camels have antibodies to MERS, but came handlers, butchers, and other with close contact with the animals are not a higher risk than persons with no contact.

4. The dramatic increase in reported cases suggests that genetic changes -MERS continues on page 10

7

Ethics Forum University of Georgia Public Health Graduates Commit To The Oath Of Public Health Professionals How Strongly Does The Oath Resonate With Public Health Scientists Today?

Note to Readers: We invite our readers to comment on this oath. We are interested in learning to what extent the oath is used at other schools, and to what extent the principles articulated are accepted and adhered to by epidemiologists in public health today.

Your opinion counts.

Send your comments to epimon@aol.com

As public health scientists, epidemiologists presumably share a set of disease prevention and health promotion values with other public health colleagues. This set of values was highlighted at the graduation ceremonies for public health graduates at the University of Georgia in early May 2014.

The Public Health Professional’s Oath As a public health professional, I hold sacred my duty to protect and promote the health of the public. I believe that working for the public’s health is more than a job, it is a calling to public service. Success in this calling requires integrity, clarity of purpose and, above all, the trust of the public.

Whenever threats to trust in my profession arise, I will counter them with bold actions and clear statements of my professional ethical responsibilities.

I do hereby swear and affirm to my colleagues and to the public I serve that I commit myself to the following professional obligations.

In my work as a public health professional:

8

• I will strive to understand the fundamental causes of disease and good health and work both to prevent disease and promote good health.

• I will respect individual rights while promoting the health of the public.

• I will work to protect and empower disenfranchised persons to ensure that

basic resources and conditions for health are available to all.

• I will seek out information and use the best available evidence to guide my work.

• I will work with the public to ensure that my work is timely, open to review, and responsive to the public’s needs, values, and priorities.

• I will anticipate and respect diverse values, beliefs, and cultures.

• I will promote public health in ways that most protect and enhance both the physical and social environments.

• I will always respect and strive to protect confidential information.

• I will maintain and improve my own competence and effectiveness.

• I will promote the education of students of public health, other public health professionals, and the public in general, and work to ensure the competence of my colleagues.

• I will respect the collaborative nature of public health, working with all health professionals who labor to protect and promote health.

• I will respectfully challenge decisions that are contrary to supporting and protecting the public’s health.

• In all that I do I will put the health of the public first, even when doing so may threaten my own interest or those of my employer.

In dedication to these high goals, on my honor, and with a clear understanding of these obligations that I as a public health professional have accepted, I do, this day, commit myself. ■

Large Gains In Life Expectancy Reported By WHO People everywhere are living longer, according to the "World Health Statistics 2014" just published by WHO. Based on global averages, a girl who was born in 2012 can expect to live to around 73 years, and a boy to the age of 68. This is six years longer than the average global life expectancy for a child born in 1990.

“An important reason why global life expectancy has improved so much is that fewer children are dying before their fifth birthday,” says Dr Margaret Chan, WHO Director-General. “But there is still a major epidemiology. rich-poor divide: people in high-income countries continue to have a much better chance of living longer than people in lowincome countries.”

Gaps between rich and poor countries A boy born in 2012 in a high-income country can expect to live to the age of around 76 – 16 years longer than a boy born in a low-income country (age 60). For girls, the difference is even wider; a gap of 19 years separates life

expectancy in high-income (82 years) and low-income countries (63 years).

Wherever they live in the world, women live longer than men. Women in Japan have the longest life expectancy in the world at 87 years.

“In high-income countries, much of the gain in life expectancy is due to success in tackling non-communicable diseases,” says Dr Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “Fewer men and women are dying before they get to their 60th birthday from heart disease and stroke. Richer countries have become better at monitoring and managing high blood pressure for example.” Declining tobacco use is also a key factor in helping people live longer in several countries.

At the other end of the scale, life expectancy for both men and women is still less than 55 years in nine sub-Saharan African countries. ■

Life expectancy at birth among men and women in 2012 in the 10 top-ranked countries* Men Women Rank Country

Life expectancy

Rank Country

Life expectancy

1 Iceland

81.2

1 Japan

87

2 Switzerland

80.7

2 Spain

85.1

3 Australia

80.5

3 Switzerland

85.1

4 Israel

80.2

4 Singapore

85.1

5 Singapore

80.2

5 Italy

6 New Zealand

80.2

6 France

84.9

7 Italy

80.2

7 Australia

84.6

8 Japan

80

8 Republic of Korea

84.6

9 Sweden

80

9 Luxembourg

84.1

10 Luxembourg

79.7

10 Portugal * Reprinted from WHO

85

84

-MERS continued from page 7 may have made the virus spread more easily, however experts in genetics disagree saying there is no evidence of genetic change or that the genome is too complex to know what mutations to look for.

5. There are almost 50 times more camels in Africa than in the Middle East according to one estimate from the Food and Agriculture Organization and camels from Africa have tested positive for MERS-CoV. However, there have been no reported cases from Africa. A report that the virus was detected in camels as far back as 1992 only deepens the mystery of why the outbreak is occurring now.

As reported in Science, several potential explanations for the upsurge have been put forth such as increased testing for MERS, genetic changes to make the virus more transmissible, poor infection control with an accompanying seasonality in case reports.

According to Ian Lipkin, John Snow professor of epidemiology at Columbia University, an

increase in the number of reported cases is not equivalent to an increase in the number of actual cases. It may reflect better case ascertainment, he noted in an article for CNN. This is basically the argument that increased testing accounts for the recent upsurge.

Ebola Virus Outbreak The Ebola virus outbreak has been focused in Guinea which has reported 258 clinical cases including 174 deaths representing a case fatality rate of 67% for reported clinical cases as of May 24. Suspect cases have occurred in neighboring Sierra Leone and in Liberia where 11 of 12 reported cases have died. Much is known about Ebola. It is transmitted via direct contact with bodily fluids from an infected person. This happens most readily for hospital caretakers of infected persons or from exposure to fluids during medical procedures. However, this is the first time Ebola has been reported in West Africa and the mystery of why it is occurring or being reported now is unsolved. â–

Advertise with The Epidemiology Monitor Do you have a job, course, conference, book or other resource of interest to the epidemiology community ?

Advertise with The Epidemiology Monitor and reach 20,000 epidemiologists, biostatisticians, and public health professionals monthly.

Advertising opportunities exist both in this digital publication, on our website and Facebook page, and in our Epi-Gram emails.

For more information please contact: Ron Aron, Director of Advertising 770.670.1946 ron.aron@epimonitor.net

10

WHO Director Speaks Pointedly About Accomplishments And Challenges At World Health Assembly Margaret Chan, Director General of the World Health Organization, addressed the World Health Assembly in Geneva in May and provided a frank and wide-ranging discussion of the health status of the world today.

Polio Setbacks She began her talk by noting the dramatic setback in polio eradication.

“Two years ago, polio was on its knees,” she said. However, armed conflicts, civil unrest, migrant populations, weak border controls, low routine immunization coverage, bans of immunization by militant groups, and the targeted killing of polio workers have all contributed to increasing international spread of the virus.

The Good News On the positive side of the world health situation, she noted that pursuit of the Millenium Development Goals has saved many millions of lives, and has placed 12 million people on retroviral therapy for AIDS. “We learned that high ambitions pay off,” she said and noted that India’s eradication of polio tells us there is no such thing as impossible.

Health and Progress Index She described rising inequality and economic exclusion, saying that it threatens social cohesion and stability, and added “Wealth does not trickle down,” and using GDP as the best index of overall progress is outmoded.

As she noted later in her talk, “Better health is a good way to track the

world’s true progress in poverty elimination, inclusive growth, and equity.”

More Problems She focused some of her remarks on the latest report from the Intergovernmental Panel on Climate Change and said “our planet is losing its capacity to sustain human life in good health.”

“Two years ago, polio was on its knees,”

Another notable concern is WHO’s estimate that exposure to air pollution killed approximately 7 million persons worldwide in 2012, making it the world’s largest single environmental health risk.

In an attention grabbing statement, she stated that “parts of the world are quite literally eating themselves to death” without any evidence that obesity and diet-related noncommunicable diseases are decreasing anywhere. In contrast, other parts of the world are starving with equally few signs of progress.

Chan noted that the 2014 World Cancer Report states the number of new cancer cases has reached an all time high and is projected to increase.

“No country anywhere, no matter how rich, can treat its way out of the cancer crisis,” she warned. She called for a much greater commitment to prevention to tackle not only cancer, but also heart disease, diabetes, and chronic lung diseases.

“parts of the world are quite literally eating themselves to death”

-WHO continues on page 12

11

More Than 700 Register For Alaska Epidemiology Congress Japanese and Cameroonian Colleagues Win Free Registration Norwegian Epidemiologist Wins Free Airfare

“...we are investing in black holes.”

Preparations for the upcoming 20th IEA World Congress of Epidemiology in Anchorage Alaska in August 2014 are well underway, according to Tina Day, one of the conference organizers. More than 700 persons have registered to date and an expected 1200 will register before the time of the meeting. A series of raffles in April, May and June are being held to encourage early registration. So far, a Norweigian colleague Bente Morseth has been the lucky winner of a free airfare, and Seidou Moulah from Cameroon and Shizukiyo Ishikawa from Japan are the winners of free registrations. Hotel accommodations are being raffled in June for those who register prior to May 31.

-WHO continues from page 11 Black Holes in Epidemiology Of special note for epidemiologists, she said that “overall, only about one third of all deaths worldwide are recorded in civil registries along with cause of death information.

“Think about what this means,” she added, “we are investing in black holes.” She called closing this data gap a top priority. ■

12

A total of 75 persons from 22 different countries have been selected as bursary recipients and will attend the international conference.

Registrations for the pre-conference short courses entitled Emerging Issues in Epidemiology, Epidemiology for the Non-Initiated, and Best Practices in Publishing Clinical and Public Health Research are increasing briskly, according to Day. The conference at-a-glance schedule is presented in another section of this month’s issue. ■

-VOWs continued from page 1 that we have decided to consult our readers in making the final selection of the winning slogan and two top runner ups. To help guide you, we selected the top 25 slogans received. We ask our readers to submit their votes for the best three slogans. Slogans receiving the most votes will be selected for the top and runner up prizes. The winner of the top prize will also receive a free t-shirt with the winning slogan.

Send an email with your votes for your 3 favorite slogans in order of preference to epimon@aol.com before June 15. We reserve the right to make the final selection based on the overall results.

Also, we welcome suggestions for a follow up contest. We could ask readers to submit their favorite epidemiology related cartoon or humorous quotes. Alternatively, we might rerun a contest from years past. Readers who suggest an idea for a contest or competition that we use will receive a prize from The Epidemiology Monitor.

The link below will take you to our online voting. In addition to voting online you may also submit your vote via email to epimon@aol.com Below, in no particular order, are the top 25 candidate slogans for you to vote on. Vote for ONLY 3 slogans and remember to specify your favorites for the winning and 2 runner up slogans.

Top 25 Vows 1.

I vow to you that my love for you will have a 100% survival rate over a lifetime

2.

I vow to never let the posterior distribution change your prior beliefs

3.

I promise that all other relationships are spurious

4.

I vow to be reliable and valid, sensitive and specific, and unbiased and efficient

5.

I promise that you’ll always have the power to rule out all my explanations

6.

Like a citizen of Framingham, I will voluntarily consent to your study of my heart.

7.

I promise not to egregiously violate your assumption of normality.

8.

I promise our interactions will always be significant and meaningful

9.

I vow not to over control

10. I probably do, within certain limits 11. I vow that I'll never use you as my placebo control 12. I promise you will always be my dependent variable 13. I vow that even when I don't feel normal and a little skewed, I will never be "mean" to you 14. I vow to never adjust or modify myself just to follow the latest trend 15. I promise that my love is like a perfect trial: 100% adherence and no lost to follow up 16. I vow there will be no variance in my love for you ever.

17. These vows cause us to be correlated until mortality disperses us 18. I vow my love for you will be cumulative 19. I promise never to be mean, and the average person could never say that 20. I promise that you will be my perfect concordant pair 21. I vow to never leave you with residual confounding 22. I promise that our interactions will always be synergistic 23. I promise to always see you as significant, but maybe I am just biased 24. I promise that when life is variable, you can be dependent on me 25. I promise that no matter how many times we are tested, that I will never adjust our level of significance.

Sunday, 17 August 2014 Sunday | Monday | Tuesday | Wednesday | Thursday | top 1:00 PM-3:00 PM Cruickshank Lecture – Anthony J. McMichael, MBBS, PhD 3:30 PM-5:00 PM Autism: Free Papers Cancer: Free Papers Climate Change, International Adaptation to Climate Change Influenza Innovative Strategies with Hard-to-Reach Populations Nutrition and Diet, 1 Occupational Health: Free Papers Suicide in the Arctic: Free papers 6:00 PM-8:00 PM Sunday Poster Session

Monday, 18 August 2014 Sunday | Monday | Tuesday | Wednesday | Thursday | top 8:30 AM-10:00 AM Circumpolar Health 10:30 AM-12:00 PM Alcohol Epidemiology Cardiovascular Disease Risk: Free Papers

Child Health Epigenetic Epidemiology IPCC Perspectives on Enhancing the use of Science Mental Health and Suicide in Circumpolar Region Pharmacoepidemiology Selected Global Health Issues in Latin America Viral Hepatitis: Free Papers 1:30 PM-3:00 PM Climate Change and Health 3:00 PM-4:30 PM Monday Poster Session 4:30 PM-5:45 PM Early Career Epidemiologist Track: Authors Panel 4:30 PM-6:00 PM Circumpolar Surveillance of Tuberculosis Climate Change, Healthy and Resilient Arctic Communities Epidemiology of Aging HIV/AIDS: Free Papers Measuring Intervention Coverage in Low Income Countries (BMGF potential funder) No Global Health without Mental Health Oral Health, Ethics and Equity - I

Smoking: Free Papers 2 6:00 PM-8:00 PM IEA Business Meeting

Tuesday, 19 August 2014 Sunday | Monday | Tuesday | Wednesday | Thursday | top 8:30 AM-10:00 AM Health Disparities, Ethics of Human Rights, and Social Justice 10:30 AM-12:00 PM Advances In Family Planning Measurement Disease Surveillance Early Career Epidemiologist Track: Teaching Epidemiology Ethics in Epidemiologic Research (data sharing revisited) Life-course Epidemiology Nutrition and Diet, 2 Risky Behaviors: Free Papers Social Epidemiology, 1 Water Security, Sanitation and Health in the Arctic 1:30 PM-3:00 PM IEA Regional Workshops 3:00 PM-4:30 PM Tuesday Poster Session

4:30 PM-6:00 PM Infectious Disease

Wednesday, 20 August 2014 Sunday | Monday | Tuesday | Wednesday | Thursday | top 8:30 AM-10:00 AM Hot Topics in Epidemiology: Autism and Other Neurodevelopmental Disorders 10:30 AM-12:00 PM Horizons in Cancer Epidemiology Climate Change and Infectious Diseases Epidemiology and Public Health: A joint Approach to Health in the Post-2015 Development Agenda Ethics and Equity in Maternal and Child Health Mental Health Methods and Techniques in Epidemiology - Model Issues Progress in Polio Eradication Public Engagement and Translation Women's Health 1:30 PM-3:00 PM Innovations in Epidemiologic Methods: Epidemiologic Theory and Causation 3:00 PM-4:30 PM Wednesday Poster Session

4:30 PM-6:00 PM Cancer Risk: Free Papers Circumpolar Health: Injury Circumpolar Infectious Diseases Climate Change and Environmental Health Early Career Epidemiologist Track Grant Writing Health, Mental Health and Civil Conflicts Issues in Measuring Health Disparities Life-course Epidemiology, 2 Wrapping up the Birth Weight Paradox

Thursday, 21 August 2014 Sunday | Monday | Tuesday | Wednesday | Thursday | top 8:30 AM-10:00 AM A World Council on Epidemiology and Causation Climate Change and Extreme Weather Events Dictionary of Epidemiology Gun Violence in the US and Violence Prevention Methods and Techniques in Epidemiology - II Methods, Global Burden of Disease Polio: Free Papers Smoking: Free Papers

Women's Health, 2 10:30 AM-12:00 PM Emergence of Haemophilus Influenza Type A In Arctic Indigenous Populations Conflict-of-Interest: an IEA-sponsored Session on Evidence, Issues and Integrity- New Insights and Best Practices for Epidemiology Countdown to 2015 Hypertension Free Papers Maternal and Child Health - II: Free Papers Oral Health - II: Free Papers Overweight and Obesity Social Epidemiology, 2 Youth Alcohol and Substance Abuse Studies 2:30 PM-4:00 PM Richard Doll Lecture

Cancer Survivorship Research at Kaiser Permanente Southern California Kaiser Permanente Southern California is searching for a cancer survivorship researcher to join the Department of Research & Evaluation in Pasadena, California. This is an openrank position for a doctorally prepared implementation scientist, health service researcher, epidemiologist, or clinical researcher with expertise and experience in cancer survivorship. Specialized focus may include palliative care, end-of-life care, geriatric research, or research methodologies.

Interested candidates should submit their letter of interest, CV and references to Dr. Steven J. Jacobsen (c/o mailto:Jennifer.X.Wong@kp.org). Please visit http://jobs.kp.org for job submission details, referencing job number 244910. Principals only. EEO/AA Employer.

Postdoctoral Fellowship in Cardiovascular Disease Epidemiology One NIH-sponsored two- to three-year fellowship is available for Summer/Fall 2014 at the University of Minnesota emphasizing research methods in the epidemiology of cardiovascular disease (http://z.umn.edu/cvdepitraining). Fellows contribute to and gain competency in designing, administering, and analyzing cardiovascular population studies and can seek an MPH degree. The program also intends to enhance the diversity of the research workforce in cardiovascular disease epidemiology by recruiting individuals from underrepresented/disadvantaged populations.

Candidates must have a doctoral degree and permanent U.S. residency status.

Inquiries: Aaron R. Folsom, MD, MPH Division of Epidemiology & Community Health, School of Public Health University of Minnesota email: folso001@umn.edu The University of Minnesota is an equal opportunity educator and employer.

Chair, Division of Epidemiology The Ohio State University College of Public Health is seeking an innova- tive leader and scholar to chair its Division of Epidemiology. The success- ful candidate will provide senior leadership and vision in the expansion and application of epidemiology within the College of Public Health and other colleges at Ohio State, communities in Ohio, and internationally.

This position requires academic credentials consistent with appointment as a tenured professor in the Division of Epidemiology. The candidate is expected to provide active leadership for the division’s diverse and expanding research program, recruit and mentor faculty, direct an innovative epidemiology training program for undergraduate and graduate students, collaborate in research initiatives with other investigators both within and outside the College of Public Health, and manage the division’s resources. Candidates should have a demonstrated record of administrative experience and have a strong and distinguished record of scholarly research, teaching, and mentoring. Applications will be accepted immediately, and will be considered until the search has concluded. Applicants are asked to prepare a single pdf file that contains a cover letter including a statement of research and teaching interests, a current curriculum vitae, and copies of five recent publications.

Send the pdf file by email to epichairsearch@cph.osu.edu.

Questions about the position can be directed to Dr. Michael Bisesi, Senior Associate Dean of Academic Afairs, College of Public Health, The Ohio State University, 614-247-8196.

For more information, please visit our website at: http://www.cph.osu.edu.

BIOSTATISTICS National Academy of Sciences/Radiation Effects Research Foundation The National Academy of Sciences (NAS) seeks a scientist to fill a biostatistics position at the Radiation Effects Research Foundation (RERF) in Hiroshima, Japan. Candidates must be U.S. citizens; hold an earned M.S. or Ph.D. degree in biostatistics, bioinformatics, or statistics; have a demonstrated record of productivity in a relevant research field commensurate with the level of appointment; and have the ability to relocate to Japan. The appointment can be made at the early to senior career levels for a minimum of two years with the possibility for renewals. Position level, salary, and responsibilities will be commensurate with earned degrees and experience.

Please visit http://ch.tbe.taleo.net/CH04/ats/careers/requisition.jsp?org=NAS&cws=1&rid=7343 for additional information about and to apply for this position or contact: Dr. Kevin Crowley at NAS ( kcrowley@nas.edu ) or Dr. Harry Cullings at RERF ( cullings@rerf.or.jp ) for additional information.

EOE, M/F/D/V

The Epidemiology Monitor in a Digital Version is now available FREE to subscribers The Epidemiology Monitor is now available exclusively online in the same familiar print format subscribers are accustomed to, and they can read through the publication on their electronic devices in the same manner they did with the print version. In addition, you’ll be able to download and save copies of The Epidemiology Monitor for easy future access. Over the next year we’ll be exploring ways to make this publication available on additional mobile devices.

This new publication format provides: ► ► ► ► ►

Easier access to information that is more timely Publication alerts via email Embedded hot links in articles Full color advertising Wider circulation for advertisers

One thing that has not changed is our commitment to meet the news and information needs of the epidemiology community. We hope that you will share this notice about free access with your friends and colleagues in epidemiology and public health. We invite you to send us your comments and suggestions on how we can continue to serve most effectively as “the voice of epidemiology” in the digital age.

SUBSCRIBE FOR FREE TODAY AT: http://epimonitor.net/Subscribe.htm