Obesity versus Physical Activity In Predicting CHD and Mortality: Epi Inquiry Accolade 02/5/2006

[Epidemiologic Inquiry 2006, 1: 12]

In the past few years, some researchers have suggested that adiposity is not an important risk factor of disease and mortality as long as individuals maintain high levels of physical activity (in other words," it is okay to be fat as long as you're active"). However, such assertion has been refuted by many other epidemiologists as highly inaccurate and woefully irresponsible for public health.

Notably, in December 2004 in the New England Journal of Medicine, investigators from the Nurse's Health Study jointly stratified by levels of adiposity and physical activity. Results indicated that adiposity and physical activity were clearly independent risk factors for overall mortality (in fact, opposite of the refuted theory, those lean and inactive were at relatively lower risk compared to those obese and active).

Moreover, a similar analysis was published this past week in the journal Circulation, to assess the independence of adiposity and physical activity for risk of coronary heart disease (CHD). As found in the mortality analysis, increasing adiposity and decreasing physical activity again independently predicted CHD risk. The authors noted that most studies in the literature supported such independent results, and the few dissensing studies were often conducted among those with very short follow-up, relatively fewer number of cases, and among those with pre-existing cardiovascular disease.

Thus, for clearly highlighting such important issues, the editors select as the Epidemiologic Inquiry Accolade: Investigation of the Week...

Obesity as compared with physical activity in predicting risk of coronary heart disease in women.
Li TY, Rana JS, Manson JE, Willett WC, Stampfer MJ, Colditz GA, Rexrode KM, Hu FB.
Circulation. 2006 Jan 31;113(4):499-506.

and also recognize...
Adiposity as compared with physical activity in predicting mortality among women.
Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE.
N Engl J Med. 2004 Dec 23;351(26):2694-703.

If not saturated fat, then eat what?: Epi Inquiry Accolade- RCT 01/2006

[Epidemiologic Inquiry 2006, 1: 11]

Excess dietary intake of saturated fat has long been recognized an a major culprit in contributing to heart disease, and virtually all dietary recommendations urge people to reduce its intake. However, given that people have daily caloric energy requirements below any excesses, the key questions is -- if one reduces saturated fat intake, then one should replace such intake with what for optimal cardiovascular health? Carbohydrate? Protein? Unsaturated fat?

This key question was the impetus behind the recent OMNIHEART randomized crossover trial by Appel et al. Based on the healthy DASH diet, the investigators isocalorically replaced saturated fat with calories from carbohydrates (mix of refined and whole grain), proteins (mix of vegetable and animal), and unsaturated fat (mix of mono- and polyunsaturated). Based on changes in a series cardiovascular risk factors (blood pressure, LDL, HDL, triglycerides), they determined all 3 replacements are indeed better than saturated fat in reducing Framingham risk factors, with particuarly protein and unsaturated fat being better than carbohydrate replacement. While future studies will attempt to further examine protein sources and types of dietary fat in a randomized setting-- this current trial significantly establishes current understanding in nutritional epidemiology of the more optimal macronutrient to substitute for saturated fat.

Therefore, for these important contributions, the editors select as the Epidemiologic Inquiry Accolade: Randomized Trial of the Month ...

Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.
Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM; OmniHeart Collaborative Research Group.
JAMA. 2005 Nov 16;294(19):2455-64.

Click here to learn more information about the Epidemiologic Inquiry award series

Advancing sex-based medicine via meta-analysis: Epi Inquiry Accolade- Meta Analysis 01/2006

[Epidemiologic Inquiry 2006, 1: 10]

An important role of epidemiology is to advance medicine and clinical practice. Typically, meta-analyses can be helpful in summarizing study results to guide clinical practice and disease prevention. However, meta-analyses can ascend beyond fulfilling that simple role, as the truly outstanding meta-analyses can also advance scientific thinking beyond simple exposure-outcome relationships.

Such was the unique contribution of the sex-specific meta-analysis of diabetes and risk of CHD mortality by Huxley et al., demonstrating that sex is an important factor in determining the etiologic relationship between these two conditions. While the diabetes-heart disease relationship has long been recognized and sex differences have been suggested, this study was the first to formally document this important sex difference, as it ever more emphasizes the need for sex-based medicine and studying epidemiology in diverse populations.

Therfore, for making this important contribution, the editors select as the Epidemiologic Inquiry Accolade: Meta-Analysis of the Month 01/2006...

Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies
BMJ 2006;332:73-78
Rachel Huxley, Federica Barzi, Mark Woodward

Click here to learn more information about the Epidemiologic Inquiry award series

Scientific Integrity of Publications? Epi Inquiry Accolade 01/29/2006

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Given the recent rash of scientific scandals regarding fabricated stem cell research, concealment of adverse events in the rofecoxib VIGOR trial, and other incidents this past month alone... studies examining the quality of scientific publications and review process are becoming ever more important. This week, two interesting studies (one in JAMA, one in BMJ) explored such issues.

The article by Biondi-Zoccai et al. in the BMJ studied the degree of scientific agreement between the findings and conclusions of overlapping meta-analyses of the same clinical topic. Interestingly, they found that the the same meta-analysis topic-- longer manuscripts and articles published by those with non-profit funding scored higher in quality. This attests to potential biases due to funding, and potential adverse consequences of tight word lengths of scientific journals (this is most ironic for the BMJ, as the BMJ has the reputation to be the most restrictive in word length of articles).

Meanwhile, BMJ investigators also published in JAMA that for the peer review process, the practice of requesting author-suggested reviewers and/or having open-reviews (revealing the reviewer's identity) led to more favorable reviews. Though this is an intuitive bias of human-nature, journal editors fortunately were not swayed by differences in such peer review practices, which is reassuring for scientific integrity.

Therefore, for these important contributions to investigate the integrity of the scientific process, the editors this week select as the Epidemiologic Inquiry Accolade: Investigation of the Week (co-winners)...

Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study
Biondi-Zoccai GG, Lotrionte M, Abbate A, Testa L, Remigi E, Burzotta F, Valgimigli M, Romagnoli E, Crea F, Agostoni P.
BMJ. 2006 Jan 28;332(7535):202-9.

Differences in review quality and recommendations for publication between peer reviewers suggested by authors or by editors.
Schroter S, Tite L, Hutchings A, Black N. (of the BMJ Editorial Office)
JAMA. 2006 Jan 18;295(3):314-7.

Click here to learn more information about the Epidemiologic Inquiry award series

Epidemiologists Lead Among Top Scientists in Clinical Medicine

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Thomson Scientific recently released the list of the top cited scientists in Clinical Medicine. Among the Top 10- epidemiologists garner 5/10, and lead with the top 3. Truly, nobody can still doubt the value and intermarriage of epidemiology and medicine anymore...

Most-Cited Scientists in Clinical Medicine
(Ranked by total citations, based on papers published and cited in Thomson-indexed journals between January 1995 and August 2005)
Rank -- Name -- Field -- Citations

1 Meir J. Stampfer -- Epidemiology, Citations: 34,872
2 Walter C. Willett -- Epidemiology, Citations: 33,724
3 Charles H. Hennekens -- Epidemiology, Citations: 27,629
6 Graham A. Colditz -- Epidemiology, Citations: 25,702
10 JoAnn E. Manson -- Epidemiology, Citations: 19,141

Source: Thomson Scientific, of The Thomson Corporation. The Thomson Corporation (http://www.thomson.com), with 2004 revenues of US$8.10 billion, is a global leader in providing integrated information solutions to business and professional customers. Thomson provides value-added information, software tools and applications to more than 20 million users in the fields of law, tax, accounting, financial services, higher education, reference information, corporate e-learning and assessment, scientific research and healthcare. With operational headquarters in Stamford, Conn., Thomson has approximately 38,000 employees and provides services in approximately 130 countries. The Corporation's common shares are listed on the New York and Toronto stock exchanges (NYSE: TOC; TSX: TOC). Web site: http://www.scientific.thomson.com

Relevant causal question - Epi Inquiry Accolade 01/22/2006: Kurth et al.

[Epidemiologic Inquiry 2006, 1: 8]

In epidemiology, we often launch an investigation to examine the simple causal association between exposure and disease outcome. However, too often, we can lose sight of the more important purpose- to determine "the relevant causal question"...

This week in AJE, Kurth et al. investigates the comparative results between multivariable adjustment of confounders via various methods of propensity score adjustment and propensity score weighting (inverse probability weighting standardization, aka marginal structural model), in the observational setting studying the use of a pharmacologic agent and risk of death.They found the overall results varied dramatically between the method of adjustment, ranging from RR=1 (conventional propensity adjustment) to RR=10 (IPW) for the same disease association. However, they discovered that IPW did report consistent RR=1 among those with propensity greater than 5% probability of treatment...

This article demonstrates the importance of the "relevant causal question" in epidemiology and clinical medicine, as those contraindicated with probability of drug treament less than 5% would not likely receive treatment in a realistic population. Thus, forcing every individual to take the drug in an entire population, regardless of clinical contraindications, would not be the relevant causal question in epidemiology, nor relevant to clinical practice. (That said, there are also important advantages of IPW standardization for time-dependent confounding, not discussed here.)

Thus, for clearly highlighting such key methodologic issues in epidemiologic research, the editors select as the Epidemiologic Inquiry Accolade: Investigation of the Week...

Results of Multivariable Logistic Regression, Propensity Matching, Propensity Adjustment, and Propensity-based Weighting under Conditions of Nonuniform Effect
Tobias Kurth, Alexander M. Walker, Robert J. Glynn, K. Arnold Chan, J. Michael Gaziano, Klaus Berger, and James M. Robins
American Journal of Epidemiology 2006 163(3):262-270

Sex-Specific Investigations into Etiology

Recently, epidemiology and medicine have begun to focus more and more on sex-specific etiologies for disease. Men and women may not necessarily be as far apart as Mars and Venus... however, it is becoming more and more clear that not all drugs act the same in men and women, and not all conditions lead to other diseases with the same rate in both sexes.

Simultaneously this week, two large meta-analyses clearly demonstrate that the above is likely true. Notably, the study by Berger et al. showed that aspirin has different effects on the primary prevention of stroke and myocardial infarction between the sexes. Additionally, the study by Huxley showed that diabetes is more adverse in women than men for CHD mortality-- diabetes may be considered a "CHD equivalent", but likely more so in women. Additionally, another study in AJE this week shows that fetal sex differentially influences maternal asthma.

These studies highlight the need for sex-based medicine. These studies also show that epidemiologic research likely always requires a synthesis of knowledge from a variety of populations-- one study cannot prove a disease pattern, and one diesease pattern cannot be generalized to all populations.


Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials
JAMA. 2006;295:306-313
Jeffrey S. Berger; Maria C. Roncaglioni; Fausto Avanzini; Ierta Pangrazzi; Gianni Tognoni; David L. Brown

Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies
BMJ 2006;332:73-78
Rachel Huxley, Federica Barzi, Mark Woodward

Effect of Fetal Sex on Airway Lability in Pregnant Women with Asthma
American Journal of Epidemiology 2006 163(3):217-221
Helen L. Kwon, Kathleen Belanger, Theodore R. Holford and Michael B. Bracken

Better Drug Combo Treatment for HIV

Always in search of a better treatment... it has been a long since new drug combination has proven itself to be more effective and safer above and beyond the current standard treatment regimen for HIV..

"Tenofovir DF and emtricitabine plus efavirenz"
--> proves superior in terms of virologic suppression, CD4 response, and adverse events

Tenofovir DF, Emtricitabine, and Efavirenz vs. Zidovudine, Lamivudine, and Efavirenz for HIV
NEJM Volume 354:251-260
Joel E. Gallant, M.D., M.P.H., Edwin DeJesus, M.D., José R. Arribas, M.D., Anton L. Pozniak, M.D., Brian Gazzard, M.D., Rafael E. Campo, M.D., Biao Lu, Ph.D., Damian McColl, Ph.D., Steven Chuck, M.D., Jeffrey Enejosa, M.D., John J. Toole, M.D., Ph.D., Andrew K. Cheng, M.D., Ph.D., for the Study 934 Group

International geosentinal surveillance... Epi Inquiry Accolade 01/15/2006: Freedman et al.

[Epidemiologic Inquiry 2006, 1: 4]

For the inaugural Epi Inquiry award, it is fitting to recognize an outstanding investigation that simultaneously pays homage to the historical foundations of epidemiology...

From a large international surveillance network data on 17,353 patients , this analysis is an eminent example of geosentinel surveillance applied in classic epidemiology, to predict the probability of travelers contracting a region-specific disease. In addition to being poorly understood previously, it also has important clinical impact on helping guide diagnosis and treatment for diseases suffered by returning international travelers. This study also reminds epidemiology of the important historical roots of the field in studying the distribution of disease. In addition, this study again emphasizes that population disease transmission, today, truly occurs on a global scale.

Therefore, the editors select...
Freedman et al. NEJM Volume 354:119-130 Number 2
Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers

for Epidemiologic Inquiry Accolade: Investigation of the Week.


Click here to learn more information about the Epidemiologic Inquiry award series

EPIDEMIOLOGIC INQUIRY AWARD Series

Beginning January 2006, The Journal will regularly announce a series of "Epidemiologic Inquiry Awards" for best original investigations in epidemiology and clinical medicine from among new published papers in each award period. The award categories are:

"Epidemiologic Inquiry Accolade: Original Investigation of the Month"
Eligible papers are original epidemiologic studies of observational design, excluding reviews.

"Epidemiologic Inquiry Accolade: Meta-Analysis of the Month"
Eligible papers are original systematic reviews with a meta-analytic component. A systematic search of at least one major biomedical database is required. Meta-analyses of either randomized or observational studies are eligible. Pooling projects are not eligible.

"Epidemiologic Inquiry Accolade: Randomized Trial of the Month"
Eligible papers are original investigations of randomized interventions. Trials must be of sufficient size and duration to have significant impact on clinical medicine and public health.

top-awards:
"Epidemiologic Inquiry Award: Best Original Investigation" (annual)
Eligible papers are original investigations of any study design. The winning paper may be selected from among previous weekly/monthly winning papers or from any new paper published during the eligible semi-annual time period (January-June).

"Epidemiologic Inquiry Award: Best Methodologic Innovation" (annual)
Eligible papers must contribute a novel method or an innovative approach to epidemiologic investigation.

Papers are judged overall based on the following criteria:
1) quality of study design and analysis
2) clinical and public health significance
3) innovation in understanding disease etiology
4) innovation and novel approaches in analysis

The body of journals from which articles are selected is comprised of leading epidemiology journals, leading general medicine journals (e.g. NEJM, JAMA, BMJ, etc), as well as leading journals in substantive fields (e.g. J Nat'l Cancer Institute, Diabetes / Diabetes Care, Circulation, Am J Clinical Nutr, etc).

No monetary prizes are bestowed. Each winning paper will be featured in the newest issue of the Journal. Press releases for the paper named "Best Methodologic Innovation" will be distributed to schools of public health and the journal in which the article appears. Press releases for the paper named "Best Original Investigation" will be distributed to media outlets, schools of public health, and the journal in which the article appears.

With exception of "Epidemiologic Inquiry Prize" top-awards, decisions are made by the editorial board of the Journal. The Prizes for top investigation are decided after peer consultation with editors of leading epidemiology and clinical journals and experts in epidemiology methods and biostatistics, for respective prizes.

Nominations. Nominations from readers are considered, though self-nomination of an article on which one is a co-author is prohibited. However, official press releases sent from institutions' communications offices are acceptable. All nominations must be accompanied by the nominator's name, contact informations, URL to the nominated article's webpage, and a brief letter (or press release) describing the significance of the article's contribution to epidemiology and/or medicine. Nominations may be emailed to epidemiologic@gmail.com.

FAQ

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A few responses to FAQ:

-- Is the Journal professional and genuine to its described purpose? Are we "just a blog"?
On our honor, we assure the audience that the efforts of the editors are whole-heartedly genuine and sincere to the mission of the Journal. We are not "just a blog", as we uphold the professionalism expected in science. In any case, even blogs are now a new category eligible for the famed Pulitzer Prize.

-- Why is there a need for another epidemiology publication?
As stated in the Journal's mission...
In a world with ever increasing pace of scientific investigations, important research findings are often disseminated too slowly through the general scientific community-- slowly as in weeks or months, instead of hours and days. Furthermore, methodologic controversies are usually discussed via word of mouth soon after the publication, and written responses to journals often appear months after publication -- too slow to engage readers, too long of a lag to maintain relevance, and too long a period of time for potentially flawed study results to propagate uninhibited. Finally, outstanding investigations are too often under- or unrecognized in epidemiology and medicine...

Additionally, the Journal supports rapid dissemination and discussion of the latest significant findings in epidemiology in an open-access format, which, unlike Journal Watch, is by paid subscription only, does not necessarily focus on epidemiology, and does not allow a forum for discussion. Moreover, the BMC journals EP&I and ETE do not allow for a rapid forum for discussion of the latest breaking study results, nor are other journals free in the first 6 months in which open discussions of latest results are most critical.

-- Are articles in the Journal peer-reviewed?
For purposes of rapid dissemination and opening a rapid forum for scientific discussion, alerts for top articles, articles of the week/month, and brief commentaries are reviewed by our editorial board. For longer reviews and external editorials, we seek at least another external review in addition to our editorial board. For the top Epidemiologic Inquiry Awards, all candidate articles are requested from editors of leading epidemiology and clinical journals, as well as experts in epidemiology relevant to the field. Finally, because the Journal is a rapid-response publication for a body of epidemiologists about the latest studies in epidemiology, we feel a purpose of the Journal is to theorectically provide the ultimate in peer-review.

-- Who are the editors, and why the anonymity?
We expect readers to notice the obvious enigma. We would first like to say that our editorial board indeed consists of editors with doctoral-qualifications and degrees in epidemiology and public health, and who have previously first-author published in leading journals, including JAMA. However, after careful consideration - due to the often controversial nature of decisions on what articles are worthy of recognizing and awarding, the editors have decided to not only remain anonymous to prevent personal attacks, but more importantly to allow editors to remain objective and humble in their daily personal lives. Finally, as an aside to the philosophy of anonymity in epidemiology -- it is also the policy of the secretive American Epidemiology Society (AES) to not officially divulge the entire membership of the society, nor publish any online site describing the nature of the organization. That said, we are not members of AES. However, in light of anonymity in other epidemiology organizations, and for our unique reasons discussed, we feel it is justified and appropriate to not disclose the identity of our editors, who volunteer our personal time and efforts and remain objective to the purposes of the Journal.

-- Will editors ever select their own article for an award?
No. We assure our readership that there will never be any personal conflicts-of-interest in recognizing and awarding any articles. Even if qualified, we swear an oath that no articles winning any awards will ever be personal works of the editors. That said, if sufficient external nominations are received for an editor's own article by chance, the article may be listed in the simple feature-list, without eligibility for any award.

-- Who retains copyright?
As described in the "about", Journal is open-access and the original author(s) retains original copyright of all works, consistent with BMC open-access policies.

-- Is the Journal indexed or have an ISSN?
We are also in the process of obtaining an ISSN, as well as negotiating with Pubmed Central, Medline, and Google Scholar. In the interim period, all articles will be cache-archived in Google, as well as the website server, owned by Google.

[Others to be added as they arise]

About the Journal

[Epidemiologic Inquiry 2006, 1: 1]

UPDATE: As of September 2006, Epidemiologic Inquiry will be revamped as an online weblog for epidemiology and clinical medicine related content, rather than a formal online journal. After feedback from readers, the editors have decided to adopt a blog format to better serve interested readers. However, we still believe in the original principles to not only bring news, but also insightful analysis on occassions. Thank you for your continued readership.

~Editors


================================

In a world with ever increasing pace of scientific investigations, important research findings are often disseminated too slowly through the general scientific community-- slowly as in weeks or months, instead of hours and days. Furthermore, methodologic controversies are usually discussed via word of mouth soon after the publication, and written responses to journals often appear months after publication -- too slow to engage readers, too long of a lag to maintain relevance, and too long a period of time for potentially flawed study results to propagate uninhibited. Finally, outstanding investigations are too often under- or unrecognized in epidemiology and medicine...


PURPOSE: The Journal is a fresh and innovative online weblog exploring the most outstanding, fascinating, and controversial. The Journal highlights and examines important epidemiologic contributions to medicine and public health - the latest controversies in contemporary epidemiology and medicine - as well as critiques of the occassional flawed study. The Journal also seek to discuss the need for new methods and analytic approaches in epidemiology whenever appropriate.

Another innovative approach of the Journal is in highlighting the most important latest research in epidemiology and medicine at breaking-news speed of traditional mass-media-- all while maintaining depth of content and not sacrificing the sine-qua-non essense of a scientific publication.

The Journal publishes brief commentaries and editorials, from both readers and editors, on the latest in epidemiology and clinical medicine by editors and submitting authors. The Journal also sponsors a series of prizes titled the "Epidemiologic Inquiry Awards" to recognize outstanding scientific investigations. The editorial board consists of a group of researchers who recognize the importance of highlighting important contemporary advances and critical achievements in epidemiology and medicine.

SUBMISSIONS: Readers to highly encouraget to contribute your thoughts and insights to the Journal. To contribute your brief letter/commentary (less than 300 words) or carefully composed editorial review (less than 1200 words), please submit your article and figures in email format (no PDF) to epidemiologic@gmail.com, along with your contact information. Any references should be listed in AMA format. All submissions are reviewed by the editorial board, although commentaries are frequently accepted to open forum for discussion.

Rapid Response submissions: Rapid responses to online articles may be freely posted via the 'comment' box under each posting. References only need to cite the URL of an article abstract for such responses. All responses must be professional and courteous, slander is prohibited.

OPEN ACCESS: All published material become open-access without charge to the public. However, the Journal and the original author(s) retain copyright of original content materials, unless otherwise declared. Distribution and reproduction of the Journal's content for commercial purposes without expressed permission is prohibited. The Journal remains independent to avoid all article processing and access charges, and is supported by time donated by the editorial board. Publicity support and donations are both welcome and appreciated. Advertisers of relevant job postings are welcome to contact the Journal.

Citatations: Articles and awards published by the Journal are citable as [Epidemiologic Inquiry 2006, 1: 1 ], consistent with BIOMED CENTRAL format for online publications.

Please also read FAQ to understand more about the Journal.