Getting to the why.

BACKGROUND: Recently, specific policy statements have been published in pediatric journals that question the use of race and ethnicity (R/E) in health care research. OBJECTIVES: To determine why researchers may or may not collect R/E data and to find out their opinion on the importance of R/E and SMs to their research. METHODS: All full-length articles published in the print edition of 3 general pediatric journals published between July 1, 1999, through June 30, 2000, were collected and reviewed. Articles were excluded if they did not include at least 1 US researcher, all subjects at US institutions, some prospective data collection, or enrolled less than 8 or more than 10 000 subjects. We recorded whether the articles documented R/E, socioeconomic markers (SMs), or both in the "Results" section and whether they discussed their significance. Corresponding authors (or researchers) were surveyed to clarify the R/E data, to determine why they had or had not collected R/E data, and to elicit their opinion on the importance of R/E and SMs to their research. RESULTS: One hundred ninety-two studies qualified for further review. One hundred fourteen (59%) reported R/E but only 44 (23%) discussed it. Even fewer 74 (39%) reported both R/E and SMs, and only 33 (17%) discussed both. Researchers collected R/E data because they thought it was relevant and because it described the subject population. Seventy-five percent of the researchers who responded to the survey thought R/E and 63% thought SMs were relevant to their research, and this influenced whether they reported and discussed R/E (P<.001, chi2 test) and whether they discussed SMs (P<.001, chi2 test). CONCLUSIONS: Pediatric statements will require that researchers not mention R/E or explore the extent to which R/E disparities are confounded by other SMs. This will require a cultural shift because many researchers believe that R/E is relevant to their research, and yet, they infrequently report SMs.

Epidemiologic Factors↗

PubMed2003

Vaccination priorities.

Selection of immunizations should be based on requirements and on risk of infection. According to the International Health Regulations, many countries require yellow fever vaccination and proof thereof as the International Certificate of vaccination. Additionally selected countries require proof of vaccination against cholera and meningococcal disease. A consultation for travel health advice is always an opportunity to ascertain that routine immunizations have been performed. Recommended immunizations often are more important for traveller's health than the required or routine ones. The most frequent vaccine preventable infection in non-immune travellers to developing countries is hepatitis A with an average incidence rate of 0.3% per month; in high risk backpackers or foreign-aid-volunteers this rate is 2.0%. Many immunizations are recommended for special risk groups only: there is a growing tendency in many countries to immunize all young travellers to developing countries against hepatitis B, as it is uncertain who will voluntarily or involuntarily get exposed. The attack rate of influenza in intercontinental travel is estimated to be 1%. Immunity against poliomyelitis remains essential for travel to Africa and parts of Asia. Many of the 0.2-0.4% who experience an animal bite are at risk of rabies. Typhoid fever is diagnosed with an incidence rate of 0.03% per month among travellers to the Indian subcontinent, North and West Africa (except Tunisia), and Peru, elsewhere this rate is 10-fold lower. Meningococcal disease, Japanese encephalitis, cholera and tuberculosis have been reported in travellers, but these infections are rare in this population. Although no travel health vaccine is cost beneficial, most professionals will offer protection against the frequent risks, while most would find it ridiculous to use all available vaccines in every traveller. It is essentially an arbitrary decision made on the risk level one wishes to recommend protection--but the priorities need to be set correctly.

Epidemiologic Factors↗