ANSWER
Background: This study used bibliometric methods to investigate infectious disease prevention and control (IDs). As part of the collaborative study SPHERE, the goal was to gain an overall view of published ID research in Europe (Strengthening Public Health Research in Europe). Methods: A framework for ID and public health research was created, complete with definitions, keywords, and inclusion and exclusion criteria. Based on the framework, a detailed web search strategy was designed, piloted, and refined. Between July 1995 and June 2005, the PubMed electronic database was searched for ‘infectious diseases as a whole, as well as several subtopic areas. The number of publications was calculated by year, country, population, and GDP. Results: Nearly 21 000 publications on the main topic and sub-topics were discovered, with a steady increase since 2000. There was significant variation between countries. France, Italy, the Netherlands, Spain, Germany, Switzerland, Sweden, the United Kingdom, and Belgium were prolific, with Eastern European countries faring the worst. Vaccine-preventable diseases, sexually transmitted diseases, drug-resistant infections, insect-arthropod-related diseases, and childhood diseases were the primary areas of scientific research. In general, ‘Epidemiology and Surveillance’ research appeared to be better represented than ‘Prevention and Control’ research. Discussion: This is the first time in Europe that such a broad approach has been used to describe public health research on IDs. Cooperation between European countries with little or no scientific production should be prioritized. Bibliometrics has limitations, but it helps identify a general pattern.
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Infectious diseases, public health, scientific research, Europe
The topic is epidemiology.
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infectious diseases in Belgium
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Medicine in the public interest
pediatric disorders, medical surveillance
Articles in the Issue Section
Some of the most significant advances in medicine over the last few decades have been in preventing and controlling infectious diseases (IDs), to which both vaccines and antibiotics have contributed. 1,2 Some necessary IDs, such as smallpox, have been eradicated globally, and for others, such as polio, diphtheria, measles, and tetanus, 3-5, there is a clear possibility of eradication or optimal control. The health of children has improved, owing primarily to well-planned vaccination strategies and targeted national immunization schedules. 6
Many issues, however, remain. Public health policymakers are concerned about HIV infection, microorganism multi-resistance to antibiotics and anti-virals, and the possibility of the next pandemic. 7-9 Because of mass migration, changing work relationships, tourism, and ‘globalization,’ dramatic changes in population demographic composition have impacted social and cultural values and ID epidemiology. 10 Inequality within and between countries has increased, as has the use and cost of health care. 11,12 Improving population health can result in significant economic benefits, 13 and a more dynamic approach to ID prevention and control will contribute to overall health improvement.
Recent advancements have resulted in practical new tools for prevention, such as meningitis vaccines, chicken pox vaccines, HPV and rotavirus infections, and diagnosis and treatment, such as HAART for HIV infection and antibiotics for non-susceptible strains. 14–16 As part of the collaborative study SPHERE, this study was conducted to gain an overview of research on ID control and prevention (Strengthening Public Health Research in Europe). We examined the published public health research literature about the European Economic Area (EEA). Our goals were to describe scientific article production and the temporal trend over the last ten years, define the main research areas, and compare scientific production across European countries.
Methods
We searched PubMed from 1 July 1995 to 6 March 2005 17 for papers by authors from the EEA, both collectively and individually. The address or affiliation of the author was used as a proxy for the country of production. We chose the search term “infectious diseases” as our broad topic, as well as subtopics and two major research areas (see diagram, Appendix 1 ).
‘Infectious diseases’ was the general topic keyword. Subtopics were chosen from the Centres for Disease Control and Prevention classification 18 and organized into nine groups: ‘Sexually transmitted diseases,’ ‘Animal-related diseases,’ ‘Bioterrorism agents and Diseases,’ ‘Childhood diseases,’ ‘Drug-resistant infections,’ ‘Emerging infectious diseases,’ ‘Food-related diseases,’ ‘Occupational risk in healthcare,’ and ‘Insects or arthropod-related diseases. Another subtopic was ‘Vaccine-preventable diseases’ (with ‘Vaccine’ as a keyword). In addition, a PubMed search for one’specific disease’ within a main subtopic was conducted (i.e. HIV for the subtopic STDs).
All results for topics and subtopics were assigned to the research areas ‘Epidemiology and Surveillance’ or ‘Prevention and Control,’ and the sexually transmitted diseases subtopic was described as the number of published articles for Europe as a whole and by a single state. Crude rates were also calculated about each Member State’s population and GDP.
Results
In our research, we discovered approximately 21 000 published articles. Figure 1 depicts their country distribution: France, Italy, the Netherlands, Spain, Germany, Switzerland, Sweden, the United Kingdom, and Belgium were the most prolific, with total production ranging from 3898 to 899 articles.
Figure 1 depicts the overall scientific production (raw number of published papers) by EU countries on selected topics and subtopics during the study period.
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Overall scientific output (raw number of published papers) by EU countries on selected topics and subtopics during the study period
Our broad keyword ‘infectious diseases’ yielded only a few results. In 1995, 64 articles were discovered, increasing to 228 in 2005. Over the entire period monitored, the yearly production of these ‘Infectious diseases’ articles was always more for ‘Epidemiology and Surveillance’ than ‘Prevention and Control’: 46 vs 18, 72 vs 32, and 161 vs 67 published articles per year in 1995, 2000, and 2005, respectively.
Table 1 shows the total number of articles for all subtopics. ‘Vaccine-preventable diseases’ had the most, followed by ‘Sexually transmitted diseases. Except for ‘Vaccine-preventable diseases,’ the crude number of articles in the ‘Epidemiology and Surveillance’ area was greater than that in the ‘Prevention and Control’ area for all subtopics.
Table 1Published papers on “Epidemiology and Surveillance” and “Prevention and Control” AND subtopics investigated in “overall Europe” during the study period
Subtopics
Sexually transmitted diseases
Drug-resistant infections
Bioterrorism
Occupational hazards in healthcare
Animalborne-diseases
Food-related diseases
Childhood diseases
EmergingInfectiousdiseases
Diseases caused by insects and arthropods
Vaccine-preventable diseases
Prevention and Control 1499 349 61 77 55 135 139 47 383 4433 Epidemiology and Surveillance 3114 1184 36 102 181 222 555 113 561 1810
Total number of papers published: 4613 1533 97 179 236 357 694 160 944 6243
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‘Sexually transmitted diseases,’ ‘Drug-resistant infections,’ ‘Insects or arthropod-related diseases,’ and ‘Childhood diseases’ emerged as the main fields of scientific production over the ten years.
We calculated totals for each country, as well as population and GDP. Figures 2 and 3 show data from the search ‘Epidemiology and Surveillance’. Switzerland, Iceland, Luxemburg, Denmark, The Netherlands, Sweden, Norway, Finland, Belgium, France, and Ireland had the highest population-based research output, with 50 or more articles produced per million inhabitants. In addition, the general category of ‘Infectious Diseases’ had a similar country distribution (data not shown).
Figure 2: Overall scientific output by EU countries based on population size (number of published papers per 100,000 inhabitants).
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Overall scientific output by EU countries based on population size (number of published papers per 100,000 inhabitants)
Figure 3: Total scientific output by EU countries as a percentage of GDP (number of published papers/trillion US dollars of GDP).
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Overall scientific production by EU countries as a percentage of GDP (number of published papers/trillion US dollars of GDP)
Estonia, Switzerland, the Netherlands, Iceland, Sweden, Finland, and Denmark had the highest production for variable GDP, publishing 4000 or more articles per trillion US dollars.
Our HIV-specific disease-based search yielded 4881 articles, with 3327 and 1554 related to ‘Epidemiology and Surveillance’ and ‘Prevention and Control,’ respectively. Switzerland, Luxemburg, Denmark, The Netherlands, Norway, Spain, France, Sweden, Italy, and Belgium produced ten or more articles per million inhabitants on ‘Epidemiology and Surveillance’ and ‘HIV,’ while Estonia, Switzerland, Spain, The Netherlands, Denmark, Lithuania, Italy, France, and Luxemburg produced more than 500 articles per trillion US dollars of GDP on ‘STDs’.
Discussion
Before analyzing our data, it is worth noting some limitations of our methodological approach to the current study: the use of a single web search engine (PubMed), the difference in sensitivity of the selected keywords, and the fact that articles were chosen only for ‘all type’ publications, with no stratification of results based on impact factor. Despite these flaws, some of the findings of our study are interesting and worth further investigation.
The EEA is a significant producer of public health research on IDs. Since 1995, the production of literature has steadily increased, particularly since 2000, reaching a peak in the final year of the study period. This trend is real because the aforementioned methodological constraints were present throughout the study. This trend could be explained by advances in basic and applied research, particularly in biotechnology, molecular epidemiology, and genetics. We are aware that numerous new vaccines, pharmacological molecules, and diagnostic tests for IDs have recently been studied: their availability and routine use in healthcare practices have significantly changed the natural history and general epidemiology of several diseases. In the field of prevention, conjugate pneumococcal and meningococcal vaccines, as well as those against chicken pox, anti-virals and antibiotics for multi-resistant microorganisms, and new molecular techniques, such as polymerase chain reaction and genetic sequencing, are actual examples of advancements. 16,19–22
In Europe, we found a wide range of scientific production on IDs. This was immediately apparent from our initial web searches: when we analyzed data both broadly and by specific subtopic, significant differences in country article production emerged. This is consistent with the findings of other SPHERE research groups: public health research is proportionate to local health needs.
However, the situation is more complicated than a simple count of published articles would suggest. Analyzing our findings using both state population and GDP yields a different picture, particularly for the variable GDP: Eastern European countries appear to gain importance.
About our subtopics, we found 4613 published articles for ‘Sexually transmitted diseases’, 4881 for ‘HIV’ and 6243 for ‘Vaccine’ subtopics, respectively: far more than that obtained through the first web search using ‘Infectious diseases’ when 1201 articles were collected. As previously stated, this confirms methodological limitations in our research, which vary depending on the sensitivity of each keyword used. However, the balance of scientific production by country for this subtopic is similar to that found for ‘Infectious diseases’: France, Italy, Spain, The Netherlands, Switzerland, Germany, Sweden, Belgium, and the United Kingdom remain the most prominent European producers. The comments on data from the country’s population size and GDP analysis are consistent with those previously stated.
There are no definite conclusions to be drawn from the observed heterogeneity of production across Europe, with different results emerging from the analysis for each specific item. Cooperation to assist Member States with no scientific output, as well as the need to harmonize research in Europe, should be the priority.
Another general trend emerges: the research area ‘Epidemiology and Surveillance’ seems to be more frequent than ‘Prevention and Control’. This could reflect a recent need by developed-country governments to establish the frequency of essential IDs to plan better and organize healthcare policies. The lack of a deeper analysis of the contents of our articles and the separation of observational from experimental studies in our search prevents us from drawing definitive conclusions on this item at this time.
On the other hand, public health research may prioritize descriptive analysis over active-interventional approaches. In this regard, European public health policymakers need to focus their attention and efforts in the future on optimizing research production in the ‘Prevention and Control setting. The only exception was the subtopic ‘Vaccine-preventable diseases,’ where ‘Prevention and Control’ outnumbered ‘Epidemiology and Surveillance’. This is not surprising, given the importance of vaccines in preventing many infectious diseases.
Finally, some observations on the results of the subtopics were investigated.
‘Vaccine-preventable diseases,’ ‘Sexually transmitted diseases,’ ‘Drug-resistant infections,’ ‘Insects or arthropod-related diseases,’ and ‘Childhood diseases’ emerged as the most critical areas of scientific research. These disease groups focus on the significant public health issues in EU countries, with promising results in prevention, diagnosis, and treatment in recent years.
Our search revealed that some subtopics, such as ‘Bioterrorism,’ ‘Emerging infectious diseases,’ and ‘Occupational risk in healthcare,’ should significantly increase public health research output. We must respond to the effects of globalization and the changing global political landscape and provide more excellent infection protection to healthcare workers. The experience of SARS, the potential next influenza pandemic, and old diseases re-emerging (e.g. tuberculosis) justify more attention focused on the subtopic ‘Emerging infectious diseases’. ‘Animal-borne infections’ was not a particularly sensitive keyword for our purposes, but because this is an area of scientific concern, more research should be conducted.
In balancing these demands, public health research must also ensure that existing problems are addressed without being ‘distracted’ by potential threats.
Conclusions
It is now recognized that designing effective public health interventions requires a well-structured scientific approach in evidence-based medicine and prevention. 23 To our knowledge, this is the first study to describe the state of public health research on IDs in Europe in a broad sense. Even though the bibliometric methodology used has limitations and the results may be biased in some ways, we believe that SPHERE is a valuable tool for both scientists and public health policymakers to plan and organize research on IDs, with clear implications for future EU (and other) funded programs in Europe.
QUESTION
In this assessment, you will analyze communicable diseases within the community, state, and nation. You will evaluate the epidemiology and the nurse’s role in using evidence-based data to develop methods to mitigate disease in the community. You will also develop the teaching materials for and deliver the educational program you developed in Part II of the CSLO 1 assessment.
Part 1: Nursing Student Presentation on Infection Control
Understanding diseases present within the community allows public health nurses to prioritize health promotion and disease prevention strategies.
Explore the Healthy People 2030 website.
Review the Healthy People 2030 Objectives and Measures.
Review the Healthy People 2030 Leading Health Indicators.
Assume you have been asked by the nursing supervisor at the community health clinic at which you work to research infectious disease trends as they relate to public health program planning and promotion. She wants you to prepare a presentation that will be presented to nursing students at the local branch of the statewide university system. The presentation will focus on infection control.
Develop an 18- to 20-slide Microsoft® PowerPoint® presentation, with speaker notes, that analyzes infectious diseases by:
Defining epidemiology, outbreak, incidence, and prevalence
Evaluating the role of nursing within epidemiology
Evaluating current infectious diseases locally, statewide, and nationally
Associating 3 of the most current infectious diseases with Healthy People 2030 objectives
Analyzing evidence-based practices aimed at reducing infectious diseases
Explaining health promotion techniques that can be used to manage infectious and communicable diseases in populations
Note: The slides themselves should only contain essential information and as little text as possible. Do not design a slide presentation made up of long bullet points. Your speaker notes convey the details you would give if you were presenting. See the Create Speaker Notes video from Microsoft for more help.
Cite a minimum of 3 scholarly sources.
Include an APA-formatted reference slide.
Part II: Teaching Project
In this assignment, you will develop a teaching project identified in the CSLO 1 Part II Assessment. Follow the steps delineated below.
Step 1:
Develop your teaching project identified in the CSLO 1 Part II Assessment into a community education curriculum.
Determine which variables should be included in your curriculum to address the identified public health conditions.
Determine which resources and materials you will need for teaching the curriculum.
Determine which communication method and health promotion technique should be used to deliver your curriculum.
Step 2:
Develop and prepare the curriculum and identify all elements you would use.
Develop all materials needed to properly educate the identified agency population regarding the identified public health or communicable disease issue.
Develop a method for assessment of the success of the educational curriculum with the identified population.
Step 3:
Write a 500-word summary of the educational curriculum.
Submit your assignment.