Study objective-To determine the ways in which institutions devoted to international development influence epidemiological studies. Design-This article takes a descriptive epidemiological study of El Salvador, Epidemiological Profile, conducted in 1994 by the US Agency for International Development, as a case study. The methods include discourse analysis in order to uncover the ideological basis of the report and its characteristics as a discourse of development. Setting-El Salvador. Results-The Epidemiological Profile theoretical basis, the epidemiological transition theory, embodies the ethnocentrism of a "colonizer's model of the world." This report follows the logic of a discourse of development by depoliticising development, creating abnormalities, and relying on the development consulting industry. The epidemiological transition theory serves as an ideology that legitimises and dissimulates the international order. Conclusions-Even descriptive epidemiological assessments or epidemiological profiles are imbued with theoretical assumptions shaped by the institutional setting under which epidemiological investigations are conducted. (J Epidemiol Community Health 2001;55:164-171) The field of epidemiology is currently witnessing an upsurge of theoretical debates about the nature of epidemiology and the part that it should play in society. Within this controversy, which has been labelled as the "epidemiology wars," 1 one area of discussion is the role of politics, ideology, and activism in epidemiological research. Is epidemiology (and science in general) immune to the influence of politics and ideology? Can epidemiologists (and scientists in general) be rigorous researchers when they engage in advocacy and social activism?I would like to contribute to this unsettled debate by exploring one of the ways in which the institutional setting under which epidemiological (and other scientific) studies are conducted constitutes a mechanism that conditions the way epidemiology is conceived and its studies accomplished. This article has the purpose of examining the way in which institutions devoted to international development create a discourse that influences the conduct of epidemiological studies with ideological assumptions. MethodsThe object of analysis of this article is a descriptive epidemiological study of the country of El Salvador, the Epidemiological Profile, 2 conducted in 1994 under the sponsorship of the United States Agency for International Development (US AID). This article uses the Epidemiological Profile as a case study, as defined by Yin,3 to explore the ways development institutions influence the practice of epidemiology.This article uses discourse analysis in an attempt to elucidate how the production and circulation of a "discourse of development" influences the Epidemiological Profile. A discourse is not only the communication of specific thoughts by words. Discourses usually have implicit rules about who is allowed to speak, from what point of view, what is allowed and not allowed to ...

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IntroductionHypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity.Materials and methodsParents of children who had undergone hypospadias repair were recruited for this study (n = 104). A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen’s kappa (κ) coefficient was used to assess interobserver agreement and Chi Square “Goodness of Fit” Test was used to determine probability of satisfaction.FindingsConcordance on the level of satisfaction with surgical outcomes for Type cases I was slight (κ = 0.20; CI 95% 0–0.60), for Type II cases was moderate (κ = 0.54; CI 95% 0.13–0.94), and for Type III cases was substantial (κ = 0.62; CI 95% 0–0.56). However, the probability of satisfaction did not change according to severity (Chi Square “Goodness of Fit” Test; parents, p = 0.84; pediatric urologists, p = 0.92). These results cannot be explained by parental health literacy according to SAHLSA-50 test scores.ConclusionThe level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.

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