Reaping the benefits of Open Data in public health.

Open Data is part of a broad global movement that is not only advancing science and scientific communication but also transforming modern society and how decisions are made. What began with a call for Open Science and the rise of online journals has extended to Open Data, based on the premise that if reports on data are open, then the generated or supporting data should be open as well. There have been a number of advances in Open Data over the last decade, spearheaded largely by governments. A real benefit of Open Data is not simply that single databases can be used more widely; it is that these data can also be leveraged, shared and combined with other data. Open Data facilitates scientific collaboration, enriches research and advances analytical capacity to inform decisions. In the human and environmental health realms, for example, the ability to access and combine diverse data can advance early signal detection, improve analysis and evaluation, inform program and policy development, increase capacity for public participation, enable transparency and improve accountability. However, challenges remain. Enormous resources are needed to make the technological shift to open and interoperable databases accessible with common protocols and terminology. Amongst data generators and users, this shift also involves a cultural change: from regarding databases as restricted intellectual property, to considering data as a common good. There is a need to address legal and ethical considerations in making this shift. Finally, along with efforts to modify infrastructure and address the cultural, legal and ethical issues, it is important to share the information equitably and effectively. While there is great potential of the open, timely, equitable and straightforward sharing of data, fully realizing the myriad of benefits of Open Data will depend on how effectively these challenges are addressed.

Acute gastrointestinal illness in two Inuit communities: burden of illness in Rigolet and Iqaluit, Canada.

Food- and waterborne disease is thought to be high in some Canadian Indigenous communities; however, the burden of acute gastrointestinal illness (AGI) is not well understood due to limited availability and quality of surveillance data. This study estimated the burden of community-level self-reported AGI in the Inuit communities of Rigolet, Nunatsiavut, and Iqaluit, Nunavut, Canada. Cross-sectional retrospective surveys captured information on AGI and potential environmental risk factors. Multivariable logistic regression models identified potential AGI risk factors. The annual incidence of AGI ranged from 2·9-3·9 cases/person per year in Rigolet and Iqaluit. In Rigolet, increased spending on obtaining country foods, a homeless person in the house, not visiting a cabin recently, exposure to puppies, and alternative sources of drinking water were associated with increased odds of AGI. In Iqaluit, eating country fish often, exposure to cats, employment status of the person responsible for food preparation, not washing the countertop with soap after preparing meat, a homeless person in the house, and overcrowding were associated with increased odds of AGI. The results highlight the need for systematic data collection to better understand and support previously anecdotal indications of high AGI incidence, as well as insights into unique AGI environmental risk factors in Indigenous populations.

The burden and determinants of self-reported acute gastrointestinal illness in an Indigenous Batwa Pygmy population in southwestern Uganda.

Acute gastrointestinal illness (AGI) is an important public health priority worldwide. Few studies have captured the burden of AGI in developing countries, and even fewer have focused on Indigenous populations. This study aimed to estimate the incidence and determinants of AGI within a Batwa Pygmy Indigenous population in southwestern Uganda. A retrospective cross-sectional survey was conducted in January 2013 via a census of 10 Batwa communities (n = 583 participants). The AGI case definition included any self-reported symptoms of diarrhoea or vomiting in the past 2 weeks. The 14-day prevalence of AGI was 6·17% [95% confidence interval (CI) 4·2-8·1], corresponding to an annual incidence rate of 1·66 (95% CI 1·1-2·2) episodes of AGI per person-year. AGI prevalence was greatest in children aged <3 years (11·3%). A multivariable mixed-effects logistic regression model controlling for clustering at the community level indicated that exposure to goats [odds ratio (OR) 2·6, 95% CI 1·0-6·8], being a child aged <3 years (OR 4·8, 95% CI 1·2-18·9), and being a child, adolescent or senior Batwa in the higher median of wealth (OR 7·0, 95% CI 3·9-9·2) were significantly associated with having AGI. This research represents the first Indigenous community-census level study of AGI in Uganda, and highlights the substantial burden of AGI within this population.

'Changing climate, changing health, changing stories' profile: using an EcoHealth approach to explore impacts of climate change on inuit health.

Global climate change and its impact on public health exemplify the challenge of managing complexity and uncertainty in health research. The Canadian North is currently experiencing dramatic shifts in climate, resulting in environmental changes which impact Inuit livelihoods, cultural practices, and health. For researchers investigating potential climate change impacts on Inuit health, it has become clear that comprehensive and meaningful research outcomes depend on taking a systemic and transdisciplinary approach that engages local citizens in project design, data collection, and analysis. While it is increasingly recognised that using approaches that embrace complexity is a necessity in public health, mobilizing such approaches from theory into practice can be challenging. In 2009, the Rigolet Inuit Community Government in Rigolet, Nunatsiavut, Canada partnered with a transdisciplinary team of researchers, health practitioners, and community storytelling facilitators to create the Changing Climate, Changing Health, Changing Stories project, aimed at developing a multi-media participatory, community-run methodological strategy to gather locally appropriate and meaningful data to explore climate-health relationships. The goal of this profile paper is to describe how an EcoHealth approach guided by principles of transdisciplinarity, community participation, and social equity was used to plan and implement this climate-health research project. An overview of the project, including project development, research methods, project outcomes to date, and challenges encountered, is presented. Though introduced in this one case study, the processes, methods, and lessons learned are broadly applicable to researchers and communities interested in implementing EcoHealth approaches in community-based research.

Improving Aboriginal health data capture: evidence from a health registry evaluation.

The lack of high-quality health information for accurately estimating burdens of disease in some Aboriginal populations is a challenge for developing effective and relevant public health programmes and for health research. We evaluated data from a health registry system that captured patient consultations, provided by Labrador Grenfell Health (Labrador, Canada). The goal was to evaluate the registry's utility and attributes using modified CDC guidelines for evaluating surveillance systems. Infectious gastrointestinal illness data were used as a reference syndrome to determine various aspects of data collection and quality. Key-informant interviews were conducted to provide information about system utility. The study uncovered limitations in data quality and accessibility, resulting in region-specific recommendations including conversion to an electronic system. More generally, this study emphasized how a systematic and standardized evaluation of health registry systems can help address challenges to obtaining quality health data in often remote areas where many Aboriginal communities are found.

Perceptions of risk and optimistic bias for acute gastrointestinal illness: a population survey.

Optimistic bias refers to the tendency of individuals to believe that they are less likely to experience negative events compared with other people. Individuals who perceive their risk of an adverse health event to be low may not be as receptive to informational messages aimed at disease prevention. Our objective was to estimate the magnitude of optimistic bias for acute gastrointestinal illness, and to describe demographic associations with, and reasons for, individuals' perception of personal risk. Data were obtained by a retrospective, cross-sectional telephone survey of 2057 randomly selected English-speaking residents of Ontario, Canada conducted between May 2005 and April 2006. Data were collected on the occurrence of acute gastrointestinal illness during the 28 days prior to the survey, demographics, respondents' perception of their personal risk of acute gastrointestinal illness compared with the average person, and the reasons for this perception. Associations with perception of illness were evaluated using ordinal logistic regression and reasons for perception of risk were explored qualitatively. Optimistic bias was present among all respondents, but was not statistically significant within the group that had experienced acute gastrointestinal illness in the previous 28 days. Rural residency and not having experienced acute gastrointestinal illness in the previous 28 days were associated with a lower perception of risk compared with the average person. Proportionally fewer individuals who had not completed secondary education saw themselves as at less than average risk. The most common reason given for the perception of lower risk was that the respondent was healthier than the average person, although personal lifestyle choices also were provided as reasons. The presence of optimistic bias may negatively impact compliance with public health initiatives to reduce acute gastrointestinal illness. Therefore, recognizing the demographic characteristics associated with a perception of lower risk and understanding the reasons for this perception may help with targeting effective preventive messaging.

Estimation of the costs of acute gastrointestinal illness in British Columbia, Canada.

The costs associated with gastrointestinal infection (GI) in the province of British Columbia, Canada, were estimated using data from a population-based survey in three health service delivery areas, namely Vancouver, East Kootenay and Northern Interior. The number of cases of disease, consequent expenditure of resources and associated economic costs were modeled as probability distributions in a stochastic model. Using 2004 prices, the estimated mean annual cost per capita of gastrointestinal infection was CAN$128.61 (207.96 euros), with a mean annual cost per case of CAN$1,342.57 (2,170.99 euros). The mean estimate of the overall economic burden to British Columbia was CAN$514.2 million (831.5 million euros) (95% CFI CAN$161.0 million to CAN$5.8 billion; 260.3 million euros to 9.38 billion euros). The major element of this cost was the loss of productivity associated with time away from paid employment by both the sick and their caregivers. Sensitivity analysis suggested that the uncertainty associated with the base model assumptions did not significantly affect the estimates. The results are comparable to those obtained in an earlier study using a similar analytical framework and data from the city of Hamilton, Ontario, Canada.

Drinking water consumption patterns in British Columbia: an investigation of associations with demographic factors and acute gastrointestinal illness.

A cross-sectional telephone survey was performed in the province of British Columbia, Canada, to investigate drinking water consumption patterns and their associations with various demographic characteristics and acute gastrointestinal illness (AGI). Water consumption included plain water and water used in the preparation of cold beverages. The median amount of water consumed daily was four-250 mL servings (1.0 L), although responses were highly variable (0 to 9.0 L). Alternative water use was common: bottled water was the primary source of drinking water (i.e. >or=75% of the total daily water intake) for 23% of respondents and 47% of households used in-home water treatment methods. Approximately 10% of respondents reported an episode of AGI (vomiting or diarrhea) in the previous 4-week period. Such illness was associated with age (continuous variable in years, OR=-0.98), sex (male vs. female, OR=0.8) and the amount of water consumed (continuous variable in 250-mL servings, OR=1.06); however, a causal relationship with water consumption cannot be established based on this study alone. Overall, the associations of drinking water patterns with age, sex, education, and household income serve as important reminders to researchers and public health professionals of the non-uniform nature of drinking water consumption, and indicate potential differences in exposure to waterborne hazards in this population.

Burden and cost of gastroenteritis in a Canadian community.

This study estimated the health burden and costs associated with gastroenteritis in the City of Hamilton (Ontario, Canada). The number of cases, number of different resource units used, and cost per resource unit were represented by probability distributions and point estimates. These were subsequently integrated in a stochastic model to estimate the overall burden and cost in the population and to depict the uncertainty of the estimates. The estimated mean annual cost per capita was Can dollar 115. The estimated mean annual cost per case was Can dollar 1,089 and was similar to other published figures. Gastroenteritis represented a significant burden in the study population, with costs high enough to justify prevention efforts. These results, currently the most accurate available estimates for a Canadian population, can inform future economic evaluations to determine the most cost effective measures for reducing the burden and cost of gastroenteritis in the community.

Magnitude and distribution of acute, self-reported gastrointestinal illness in a Canadian community.

To estimate the magnitude and distribution of self-reported, acute gastrointestinal illness in a Canadian-based population, we conducted a retrospective, cross-sectional telephone survey of approximately 3500 randomly selected residents of the city of Hamilton (Ontario, Canada) from February 2001 to February 2002. The observed monthly prevalence was 10% (95 % CI 9.94-10.14) and the incidence rate was 1.3 (95 % CI 1.1-1.4) episodes per person-year; this is within the range of estimates from other developed countries. The prevalence was higher in females and in those aged < 10 years and 20-24 years. Overall, prevalence peaked in April and October, but a different temporal distribution was observed for those aged < 10 years. Although these data were derived from one community, they demonstrate that the epidemiology of acute gastrointestinal illness in a Canadian-based population is similar to that reported for other developed countries.

A comparison of two pre-enrichment media prior to immunomagnetic separation for the isolation of E. coli O157 from bovine faeces.

AIMS: To compare the sensitivity of two pre-enrichment broth media prior to immunomagnetic separation for the isolation of Escherichia coli O157 from cattle faeces. METHODS AND RESULTS: One-gram portions of 721 cattle faeces collected from 43 farms were pre-enriched in buffered peptone water containing vancomycin, cefixime and cefsulodin (BPW-VCC) and buffered peptone water without additives (BPW-WOA), respectively. A total of 137 samples were positive for E. coli O157: 127 pre-enriched with BPW-WOA and 89 pre-enriched in BPW-VCC. Representative isolates were tested for phage type, verotoxin and eae (E. coli attaching and effacing) gene sequences, resulting in the recognition of eight different types. All the E. coli O157 types recognized were isolated by both methods except for three different strains, each of which were isolated only on a single occasion: two by BPW-WOA and another by BPW-VCC. CONCLUSIONS: The results clearly demonstrate, under the conditions of this study, that BPW without antibiotics was the superior pre-enrichment medium for the isolation of E. coli O157 from cattle faeces. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of BPW-WOA in preference to BPW-VCC for the isolation of E. coli O157 from cattle faeces in future research and outbreak studies should lead to a higher number of positive isolates.

The effect of an outbreak of respiratory disease on herd-level milk production of Norwegian dairy farms.

This study was done to evaluate the effect of an outbreak of acute respiratory disease associated with bovine respiratory syncytial virus (BRSV) on the daily milk yield per cow in Norwegian dairy-cattle farms. Retrospective data from 184 dairy herds located in two neighbouring veterinary districts during the study period (December 1994-May 1995, during which an epidemic of acute respiratory disease associated with BRSV occurred in this area) were analysed. Data on the bulk-milk deliveries and the date of the outbreak were collected at herd level, whereas information on calving dates and parity was collected at cow-level. The effect of the herd outbreaks on the daily milk yield was analysed with a repeated-measurement approach. The average daily milk loss was estimated to be 0.70kg per cow for 7 days after a herd outbreak (compared with the period >1 week prior to an outbreak), adjusted for the herd-level lactation stage, parity and their interaction term. We consider the estimated milk loss associated with a herd outbreak of epidemic respiratory disease to be of minor importance.

Endosulfan transport: I. Integrative assessment of airborne and waterborne pathways.

To reduce endosulfan (C9H6O3Cl6S; 6,7,8,9,10,10-hexachloro-1,5, 5a,6,9,9a-hexahydro-6,9-methano-2,4,3-benzodioxathiepin 3-oxide) contamination in rivers and waterways, it is important to know the relative significances of airborne transport pathways (including spray drift, vapor transport, and dust transport) and waterborne transport pathways (including overland and stream runoff). This work uses an integrated modeling approach to assess the absolute and relative contributions of these pathways to riverine endosulfan concentrations. The modeling framework involves two parts: a set of simple models for each transport pathway, and a model for the physical and chemical processes acting on endosulfan in river water. An averaging process is used to calculate the effects of transport pathways at the regional scale. The results show that spray drift, vapor transport, and runoff are all significant pathways. Dust transport is found to be insignificant. Spray drift and vapor transport both contribute low-level but nearly continuous inputs to the riverine endosulfan load during spraying season in a large cotton (Gossypium hirsutum L.)-growing area, whereas runoff provides occasional but higher inputs. These findings are supported by broad agreement between model predictions and observed typical riverine endosulfan concentrations in two rivers.

Endosulfan transport: II. Modeling airborne dispersal and deposition by spray and vapor.

Endosulfan (C9H6O3Cl6S; 6,7,8,9,10,10-hexachloro-1,5,5a,6,9,9a-hexahydro-6,9-methano-2,4,3-benzodioxathiepin 3-oxide) and other agricultural chemicals can be transported from farms to rivers by several airborne pathways including spray drift and vapor transport. This paper describes a modeling framework for quantifying both of these airborne pathways, consisting of components describing the source, dispersion, and deposition phases of each pathway. Throughout, the framework uses economical descriptions consistent with the need to capture the major physical processes. The dispersion of spray and vapor is described by similarity and mass-conservation principles approximated by Gaussian solutions. Deposition of particles to vegetation is described by a single-layer model incorporating contributions from settling, impaction, and Brownian diffusion. Vapor deposition to water surfaces is described by a simple kinetic formulation dependent on an exchange velocity. All model components are tested against available field and laboratory data. The models, and the measurements used for comparisons, both demonstrate that spray drift and vapor transport are significant pathways. The broader context, described in another paper, is an integrative assessment of all transport pathways (both airborne and waterborne) contributing to endosulfan transport from farms to rivers.

Mastitis, ketosis, and milk fever in 31 organic and 93 conventional Norwegian dairy herds.

The aim of this study was to investigate differences in disease incidence between organic and conventional herds. The study was based on data from the Norwegian Dairy Herd Recording, which includes the Norwegian Cattle Health Recording System. All herds certified for organic farming in 1994 with a herd size of more than five cow-years were included. Conventional herds were matched on size and region, and from these, three herds were randomly selected for each organic herd. This resulted in a study group of 31 organic and 93 conventional herds with data from 1994 through 1997. The study unit was the cow within a lactation. Factors influencing disease incidence were studied by means of a generalized linear model approach. Management system had a highly significant effect on disease incidence. Odds ratios for organic compared with conventional herds were as follows: mastitis, 0.38; ketosis, 0.33; and milk fever, 0.60. Other significant factors that emerged in modeling the three diseases were year and lactation category for mastitis; lactation category, maximum milk yield, and season for ketosis; and lactation category and milk yield for milk fever. There was no marked difference in milk somatic cell count (SCC) between organic and conventional herds. However, cows in organic herds had lower SCC in lactation two and greater counts in lactations six and higher.

Factors prior to dry period associated with high and low levels of cow milk somatic cell counts in next lactation.

Data from a randomized controlled field study of selective dry cow therapy were used in which 686 cows had been allocated to 2 control groups (sampling only or placebo) or 2 therapy groups. Possible factors from previous lactation were assessed in determining their association with the probability of 'failure', designated as a cow milk somatic cell count (CMSCC) of greater than 399,000 per ml in geometric mean of several measurements during subsequent lactation. Success cows were those with a CMSCC of less than 200,000 per ml. For our analyses, this targeted 187 success cows and 186 failure cows. Therapy was given as a total dose of 400,000 IU penicillin and 100 mg neomycin per infected quarter as dry cow preparation once, or as a lactation formula with a total dose of 1.2 million IU penicillin and 1,200 mg dihydrostreptomycin per infected quarter during a 1-week period. Significant factors in the predictive model for success included therapy, low level of CMSCC (geometric mean of the 3 last tests) in previous lactation, low level of CMSCC (weighted by daily milk yield mean) in the herd, young cows, and not having had a case of treatment for chronic clinical mastitis. Additional information on the probability of failure in treated and untreated cows can be predicted by number of quarters infected with Staphylococcus aureus approximately 1.5 months before drying off. The models derived are considered for use as tools in selective treatment and culling decisions.

Determinants of success or failure in the elimination of major mastitis pathogens in selective dry cow therapy.

Discriminant factors for the elimination of major pathogens (mainly Staphylococcus aureus and Streptococcus dysgalactiae) were identified from a randomized, double-blind, field study on dry cow therapy. From an original study of 686 cows, 269 fulfilled the criteria for this analysis: 93 from the control group, 83 from group C (treated with Benestermycin vet. "LEO") and 93 from group D (treated with Leocillin with Dihydrostreptomycin vet. "LEO"). A "success" cow was defined as a cow that had all quarters healthy in two tests after dry period. Isolation of a major pathogen (mainly Staph. aureus or Strep. dysgalactiae) in any quarter in both samples after the dry period was defined as "failure." Better elimination was associated with short-acting preparations (therapy D) rather than with long-acting therapy C (odds ratio = 0.32), as was a smaller mean value of the last three composite milk somatic cell counts (CMSCC) before dry cow therapy. Cows with a major pathogen in the right hind quarter at drying off or at least one case of acute clinical mastitis during the previous lactation were more likely to have a major pathogen in the next lactation (odds ratio = 4.1 and 3.6, respectively). Young cows without major pathogens at drying off should not be recommended for dry cow therapy, and cows with high CMSCC should be considered for culling if their profiles also show previous acute clinical mastitis in combination with generally high CMSCC and low cure rates in the herd.

Possible risk factors associated with penicillin-resistant strains of Staphylococcus aureus from bovine subclinical mastitis in early lactation.

A randomized controlled field study of selective dry cow therapy with 686 cows allocated to two control groups (sampling only or placebo) or two therapy groups was used to screen for possible factors associated with penicillin-resistant strains of Staphylococcus aureus after the dry period. Therapy was given either as a total dose of 400,000 IU of penicillin and 100 mg of neomycin per infected quarter as dry cow preparation or as a total dose of 1.2 million IU of penicillin and 1200 mg of dihydrostreptomycin per infected quarter as a lactation formula. Success cows had all quarters identified as being free of penicillin-resistant strains of Staphylococcus aureus both at calving and at 30 +/- 17 d after calving. Failure cows were those having penicillin-resistant strains of Staph. aureus in any quarter at both or one of these two samples after the dry period. Using logistic regression, four variables were found to be associated with penicillin-resistant strains of Staph. aureus after the dry period. These included the identification of penicillin-resistant strains of Staph. aureus either at 45 +/- 32 d before drying off and at drying off, treatment for acute clinical mastitis at least once during the previous lactation, the weighted SCC of all cows' milk by daily milk yield within the herd, and therapy in the lactation formula compared with the two control groups. Our finding that the use of lactation formula increases the risk of resistance development is contradictory to present arguments underlying Norwegian dry cow therapy strategy.