Journal of Epidemiology and Global Health最新文献

Background: As the impact of the SARS-CoV-2 pandemic extends into 2023 and beyond, the treatment and outcomes of infected patients continues to evolve. Unlike earlier in the pandemic there are now further infectious disease pressures placed on hospitals, which influence patient care and triage decisions.

Methods: The manuscript uses individual patient records linked with associated hospital management information of system pressure characteristics to attribute COVID-19 hospitalisation fatality risks (HFR) to patients and hospitals, using generalised additive mixed effects models.

Results: Between 01 September 2022 and 09 October 2023, the COVID-19 hospitalisation fatality risk in England was estimated as 12.71% (95% confidence interval (CI) 12.53%, 12.88%). Staff absences had  an adjusted odds ratio of 1.038 (95% CI 1.017, 1.060) associated with the HFR when accounting for patient and hospital characteristics.

Interpretation: This observational research presents evidence that a range of local hospital effects can have a meaningful impact on the risk of death from COVID-19 once hospitalised and should be accounted for when reporting estimates. We show that both the patient case mix and hospital pressures impact estimates of patient outcomes.

Background: On September 20, 2022, Uganda declared an Sudan Virus Disease (SVD) outbreak in Mubende District. Another eight districts were infected September-November 2022. We examined how Ugandan community beliefs and practices spread Sudan Ebola Virus (SUDV) in 2022.

Methods: A qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. Nine focus group discussions and six key informant interviews were held. We investigated whether community beliefs and practices contributed to spreading Sudan Ebola Virus (SUDV). Interviews were recorded, translated, transcribed, and thematically analyzed.

Results: The community deaths, later found to be due to Sudan Virus Disease(SVD), were often attributed to witchcraft or poisoning. Key informants reported that SVD patients often sought traditional healers or spiritual leaders before or after formal healthcare failed. They also found that traditional healers treated SVD patients without precautions. Religious leaders praying for SVD patients and their symptomatic contacts, SVD patients hiding in friends' homes, and exhuming SVD patients from safe and dignified burials to allow traditional burials were other themes.

Conclusion: Diversity in community beliefs and culture likely contributed to spreading the 2022 Ugandan SVD outbreak. Public health systems, traditional healers, and religious leaders can help Uganda control ebolavirus outbreaks by identifying socially acceptable and scientifically supported infection control methods.

An effective disease surveillance system can detect outbreaks of emerging zoonotic diseases early and allow the system to respond immediately and control the epidemic. Gujarat is a western Indian state with a population of more than 65 million humans and 26 million livestock, and it has the respective surveillance systems under the Department of Health & Family Welfare for humans and the Department of Animal Husbandry for animals. A veterinarian is placed on establishing cross-sectoral collaborations between these systems, but the joint collaborative activities and their effect on the early warning response are least understood. This provides an opportunity to conduct a secondary policy content analysis study using the One Health Surveillance Matrix (OHSM). The aim of this study was to evaluate the level of collaboration among human-animal disease surveillance systems for zoonotic disease in Gujarat, India. This study findings highlight a few gaps in the human health surveillance system, such as data sharing, sampling, outreach to decision-makers, and external communication, while the animal health surveillance system exhibits deficiencies in the data dissemination to decision-makers, management and storage of data analysis, interpretation of data, and external communication as per the OHSM evaluation. Despite major differences, there is a possibility of developing the One Health Surveillance system in Gujarat, India which is profoundly documented in this study.

Background: Fine particulate matter (PM2.5) has been identified as a significant environmental and public health challenge, particularly due to its association with respiratory diseases like asthma. With the global rise in urbanization and industrialization, PM2.5-related asthma research has grown substantially over the past two decades. This study aims to provide a comprehensive bibliometric analysis to map global research trends, highlight key contributors, and identify emerging hotspots in the relationship between PM2.5 and asthma.

Methods: We performed a bibliometric analysis using the Web of Science Core Collection database, covering research from January 2004 to September 2024. The selected studies were analyzed using CiteSpace and VOSviewer to assess publication trends, global collaborations, and research hotspots through visualized networks and co-occurrence analyses.

Results: A total of 2035 publications were identified, demonstrating a steady increase in research output over the past two decades. The United States and China emerged as dominant contributors, frequently collaborating with countries like Canada, Australia, and South Korea. Key research areas focused on air quality, particulate matter exposure, and asthma exacerbation, with an increasing emphasis on indoor air pollution and long-term exposure risks. Institutional collaborations were led by prominent universities such as the University of California System and Harvard University. Additionally, research on vulnerable populations, particularly children, and the impact of early-life exposure to PM2.5 has gained attention in recent years.

Conclusions: The global research landscape on PM2.5 and asthma has expanded significantly, with growing attention to interdisciplinary approaches that combine environmental science and public health. Future studies should focus on the global burden of air pollution, particularly in low- and middle-income countries, and address the long-term health impacts of PM2.5 exposure, especially in vulnerable populations.

Background: The Middle East, especially Kuwait, is experiencing rapidly rising temperatures due to climate change. Cardiovascular diseases (CVD) are the leading cause of mortality in the country, and extreme heat is expected to exacerbate hospitalizations for cardiovascular diseases. There is limited data quantifying the historical and future impacts of heat on hospitalizations for cardiovascular diseases in Kuwait.

Methods: We collected daily hospital admission data of cardiovascular diseases in Kuwait from 2010 to 2019. We modeled the relationship between temperature and cardiovascular disease hospitalizations using distributed lag non-linear models (DLNMs), adjusting for relative humidity and seasonality. Future temperature projections for Kuwait under moderate and extreme climate change scenarios were obtained from the Coupled Model Inter-comparison Project Phase 6 (CMIP6), and the impact on cardiovascular disease hospitalizations was extrapolated for every decade until 2099.

Results: During the baseline period (2010-2019), a total of 263,182 CVD cases were recorded. Of which, 20,569 (95% eCI: 3,128, 35,757) were attributed to heat. We found that the relative risk of hospitalization for CVD increased from 1.292 (95% CI: 1.051, 1.589) at 41 °C to 1.326 (95% CI: 1.006, 1.747) at 43 °C, compared to the minimum morbidity temperature. Projections showed that, under moderate climate scenarios, CVD hospitalizations would increase by 1.96% by 2090-2099, while under extreme scenarios, the increase could reach 4.44%.

Conclusions: Extreme heat significantly contributes to CVD hospitalizations in Kuwait. This burden is projected to increase under climate change. Findings highlight the urgent need for healthcare system preparedness to mitigate the future health impacts of rising temperatures in Kuwait.

Objective: The anti-COVID vaccination campaign has led to a significant increase in the demand for allergology consultations in patients considered at risk of reaction to anti-COVID-19 vaccines. This study aims to describe the experience of the vaccination campaign held in Piedmont (Italy) which developed a new service of Allergy Call Center (ACC) thus providing for the screening and management of allergy high-risk patients during pandemic.

Study design: A retrospective analysis was performed on all patients considered at high risk for the development of allergic reactions who were referred by the Immunology and Allergy Unit of Azienda Ospedaliera Ordine Mauriziano in Turin, Italy, between December 2020 and December 2022 and also on ACC consultations.

Methods: During the COVID-19 pandemic, Piedmont Region instituted the ACC, active from May 10th, 2021 to December 31st 2022, to allow vaccinating doctors to require a telephonic consultation for patients who were considered at high risk for the development of allergic reactions. If further diagnostic evaluations were required, the ACC scheduled a visit with a Consultant of the Unit to better assess the clinical situation of the patient. Furthermore, patients referred by General Practitioners, Occupational Doctors and other consultants were also evaluated by the Unit when required.

Results: During the operational period the ACC received a total of 15,865 calls and referred only 336 patients to the unit (27.4% of the total referrals), while General Practitioners referred 499 patients (40.8%), Occupational Doctors referred 61 patients (4.9%), and other consultants referred 326 patients (26.6%).

Conclusions: Evaluation and management of a large volume of requests seemed to be facilitated by a proactive framework for screening patients at high risk for allergic reactions as the ones referred by our ACC. This approach led to a prominent decrease in allergological visits to our tertiary care Centre, reducing the waiting times and providing additional support for both patients and healthcare providers, thus allowing the vaccinations to be more easily handled.

Objectives: To assess the carriage of methicillin-resistant Staphylococcus aureus-encoding genes (MRSA) among French Hajj pilgrim cohorts.

Methods: A prospective cohort study was conducted on pilgrims from Marseille during the 2014 to 2018 Hajj. Respiratory samples were collected before and after the pilgrimage. S. aureus and then MRSA-encoding genes were identified using real-time PCR.

Results: A total of 606 pilgrims were included with a sex ratio of 1:1.3 with a median age of 61 years (interquartile = 56-66 years, range = 21-88 years). A total of 511/606 (84.3%) pilgrims presented at least one respiratory symptom during their pilgrimage. Cough was the most frequent symptom occurring in 76.2% of pilgrims, followed by sore throat (57.6%), rhinitis (54.6%), and voice failure (36.3%). 87 (14.4%) were positive with S. aureus before travelling. On return, 130/606 (21.4%) participants were positive. The acquisition rate of S. aureus was 13.0% (79/606). The prevalence of MRSA pre- and post-travel and acquisition rate was 4.1% (25/606), 10.6% (62/606), and 8.2% (50/606), respectively. All MRSA were positive with mecA gene. No case was positive with mecC.

Conclusion: Our study highlights the importance of surveillance and infection control measures during mass gatherings such as the Hajj to mitigate the spread of infectious pathogens, including antimicrobial-resistant bacteria like MRSA. Further research is warranted to elucidate the specific factors contributing to S. aureus and MRSA transmission during the pilgrimage and to inform targeted interventions aimed at reducing the burden of MRSA infection among pilgrims.

Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.

Survivors of COVID-19 are susceptible to diminished health-related quality of life (HRQoL) and adverse psychological health, which may be exacerbated by their experiences of fear and the impact of the pandemic itself. This study aims to identify distinct fear and impact patterns related to the COVID-19 pandemic among survivors through latent profile analysis (LPA) and examine the associations of fear and impact patterns with post-traumatic stress symptoms (PTSS) and HRQoL. A total of 5,890 Vietnamese COVID-19 survivors completed the COVID-19 Impact Battery- Disability Scale (CIB-D), the Fear of COVID-19 Scale (FCoV-19 S), the Impact of Event Scale-Revised for PTSS, and the 36-Item Short Form Survey (SF-36) for HRQoL. Four distinct groups of fear and impact were identified: "Fearful and highly impacted" (26.8%), "moderately impacted yet not fearful" (22.9%), "less impacted and less fearful" (18.6%), and "mildly impacted and neutral" (31.7%). Survivors who were "less impacted and less fearful" exhibited significantly higher HRQoL scores (regression coefficient, B: 10.9; 95% confidence interval (CI): 10.0 - 11.7), both in terms of physical (B: 12.0; 95%CI: 11.1 - 12.9) and mental health (B: 19.4; 95%CI: 9.6 - 11.1), and lower PTSS levels (B: -24.5; 95%CI: -25.8 - -23.3) compared to those who were "highly impacted and fearful". It is imperative to acknowledge the intricate association between fear, impact, and mental health to comprehensively address the diverse needs of this distinct population post-COVID-19. These findings provide insights for designing interventions and support mechanisms for COVID-19 survivors.

Although there is ample proof of the advantages of infection prevention and Control (IPC) in acute-care hospitals, there is still some questions about the efficacy of IPC interventions for multidrug-resistant organisms (MDROs), and there is a need for the development of evidence-based practices. No healthcare facility has found a single effective technique to reduce MDRO. However, a multicomponent intervention that included improved barrier protection, chlorhexidine bathing, microbiological monitoring, and staff involvement significantly decreased the likelihood of infection in the patient surroundings with multidrug-resistant organisms. A practical strategy suited to reducing the burden of MDROs and their transmission potential in the critical care unit must be established in light of the global development of AMR. In this review, we summarize key findings of a multicomponent approaches to reduce MDROs in critical care units.