Pub Date : 2025-05-08DOI: 10.1016/j.gloepi.2025.100204
Nicole Rafalko , Milena Gianfrancesco , Neal D. Goldstein
The increasing availability and accessibility of electronic health record (EHR) data has made it a rich secondary source to conduct comparative effectiveness studies. To perform such studies, many researchers are turning to the target trial framework (TTF) to emulate the hypothetical randomized clinical trial. The quality of this emulation depends, in part, on the availability and accessibility of data for each component of the TTF. Yet one overarching challenge with using EHR data is that unstructured fields, such as clinical encounter notes, contain copious details on the patient yet require additional steps to extract if needed in the conduct of the study. Natural language processing (NLP) represents a spectrum of methods to assist with automating this extraction, from simpler rule-based methods to machine learning and artificial intelligence approaches that can handle complex language structures. What follows is a discussion on how NLP methods can augment information and data for researchers looking to estimate a treatment effect using EHR data via the TTF to emulate the hypothetical clinical trial. We conclude with recommendations for researchers interested in using NLP methods to obtain data stored in the free text of the EHR as well as considerations regarding the quality and validity of this data for the TTF.
{"title":"On the use of natural language processing to implement the target trial framework using unstructured data from the electronic health record","authors":"Nicole Rafalko , Milena Gianfrancesco , Neal D. Goldstein","doi":"10.1016/j.gloepi.2025.100204","DOIUrl":"10.1016/j.gloepi.2025.100204","url":null,"abstract":"<div><div>The increasing availability and accessibility of electronic health record (EHR) data has made it a rich secondary source to conduct comparative effectiveness studies. To perform such studies, many researchers are turning to the target trial framework (TTF) to emulate the hypothetical randomized clinical trial. The quality of this emulation depends, in part, on the availability and accessibility of data for each component of the TTF. Yet one overarching challenge with using EHR data is that unstructured fields, such as clinical encounter notes, contain copious details on the patient yet require additional steps to extract if needed in the conduct of the study. Natural language processing (NLP) represents a spectrum of methods to assist with automating this extraction, from simpler rule-based methods to machine learning and artificial intelligence approaches that can handle complex language structures. What follows is a discussion on how NLP methods can augment information and data for researchers looking to estimate a treatment effect using EHR data via the TTF to emulate the hypothetical clinical trial. We conclude with recommendations for researchers interested in using NLP methods to obtain data stored in the free text of the EHR as well as considerations regarding the quality and validity of this data for the TTF.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-07DOI: 10.1016/j.gloepi.2025.100206
Louis Anthony Cox Jr.
How can causal models be used to quantify the fractions of risk associated with environmental and occupational exposures that would be prevented by reducing exposures by different amounts? This paper provides a constructive answer. It introduces three key metrics — Interventional Probability of Causation (IPoC), Causal Assigned Shares (CAS), and Preventable Risk Fraction (PRF) curves — to help overcome the limitations of traditional association-based metrics, such as Population Attributable Fractions (PAFs), which are sometimes misused to answer interventional causal questions. The tools introduced here provide scenario-specific, individual-level predictions of risk reductions grounded in mechanistic causality rather than associations. Using case studies of benzene exposure and acute myeloid leukemia (AML), smoking and lung cancer, and blood lead levels and mortality, we demonstrate how PRF curves quantify the potential risk-reduction benefits caused by exposure reductions at both the individual and population levels, even under uncertainty or heterogeneity. Monte Carlo simulations capture inter-individual variability, and scenario analyses identify practical thresholds where additional exposure reductions yield minimal added benefit. These methods can provide evidence-based assessments of how specific exposure reductions affect risk. By shifting the focus from attribution to prevention of harm, this framework can potentially advance risk assessment, policy development, and legal decision-making. It offers a simple, easily visualized, transparent, and scientifically rigorous approach to identifying causally effective interventions and quantifying risk-reduction benefits.
{"title":"Calculating preventable risk fractions for exposure-reducing interventions","authors":"Louis Anthony Cox Jr.","doi":"10.1016/j.gloepi.2025.100206","DOIUrl":"10.1016/j.gloepi.2025.100206","url":null,"abstract":"<div><div>How can causal models be used to quantify the fractions of risk associated with environmental and occupational exposures that would be prevented by reducing exposures by different amounts? This paper provides a constructive answer. It introduces three key metrics — Interventional Probability of Causation (IPoC), Causal Assigned Shares (CAS), and Preventable Risk Fraction (PRF) curves — to help overcome the limitations of traditional association-based metrics, such as Population Attributable Fractions (PAFs), which are sometimes misused to answer interventional causal questions. The tools introduced here provide scenario-specific, individual-level predictions of risk reductions grounded in mechanistic causality rather than associations. Using case studies of benzene exposure and acute myeloid leukemia (AML), smoking and lung cancer, and blood lead levels and mortality, we demonstrate how PRF curves quantify the potential risk-reduction benefits caused by exposure reductions at both the individual and population levels, even under uncertainty or heterogeneity. Monte Carlo simulations capture inter-individual variability, and scenario analyses identify practical thresholds where additional exposure reductions yield minimal added benefit. These methods can provide evidence-based assessments of how specific exposure reductions affect risk. By shifting the focus from attribution to prevention of harm, this framework can potentially advance risk assessment, policy development, and legal decision-making. It offers a simple, easily visualized, transparent, and scientifically rigorous approach to identifying causally effective interventions and quantifying risk-reduction benefits.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-02DOI: 10.1016/j.gloepi.2025.100203
Julie E. Goodman , Denali Boon , Robyn L. Prueitt
O'Brien et al. [6] reported on the patterns and reliability of self-reported talc use in the Sister Study, a US-based prospective cohort study of women aged 35–74 who had a sister with a history of breast cancer. They found that among certain groups of women, reported use of talc was different at baseline and follow-up. O'Brien et al. [7] evaluated the association between talc and ovarian cancer in this cohort and conducted a quantitative bias analysis (QBA), reporting evidence for differential recall of talc use at baseline and follow-up, which likely increased the magnitude of risk estimates based on recall at follow-up. Additional analyses (e.g., using distributions of recall bias rather than fixed point estimates) may allow for a more complete characterization of the potential impact of recall bias, including a better characterization of the uncertainty around the bias-corrected effect estimates. Future analyses that evaluate recall and other biases more comprehensively, particularly with respect to more fully addressing uncertainty, will contribute to a better understanding of the magnitude of the impact of differential recall on estimated risks.
{"title":"Talc, ovarian cancer, and recall bias in the sister study","authors":"Julie E. Goodman , Denali Boon , Robyn L. Prueitt","doi":"10.1016/j.gloepi.2025.100203","DOIUrl":"10.1016/j.gloepi.2025.100203","url":null,"abstract":"<div><div>O'Brien et al. [<span><span>6</span></span>] reported on the patterns and reliability of self-reported talc use in the Sister Study, a US-based prospective cohort study of women aged 35–74 who had a sister with a history of breast cancer. They found that among certain groups of women, reported use of talc was different at baseline and follow-up. O'Brien et al. [<span><span>7</span></span>] evaluated the association between talc and ovarian cancer in this cohort and conducted a quantitative bias analysis (QBA), reporting evidence for differential recall of talc use at baseline and follow-up, which likely increased the magnitude of risk estimates based on recall at follow-up. Additional analyses (e.g., using distributions of recall bias rather than fixed point estimates) may allow for a more complete characterization of the potential impact of recall bias, including a better characterization of the uncertainty around the bias-corrected effect estimates. Future analyses that evaluate recall and other biases more comprehensively, particularly with respect to more fully addressing uncertainty, will contribute to a better understanding of the magnitude of the impact of differential recall on estimated risks.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to compare access to diagnostics, treatment, rehabilitation, and outcome in women and men with stroke.
Methods
In this observational study we used routinely-collected, aggregate health data from all patients admitted with a stroke in the Capital Region and Region Zealand, Denmark from May 2016 until October 2022.
Results
Among 28,855 stroke patients (55 % men, 45 % women), women were older (53 % women vs. 47 % men with age > 75 years). Overall, women had reduced access to: magnetic resonance imaging (MRI; 40 % vs. 43 %, CI 95 %: 1.06–1.16), computer tomography (CT)-angiography (25 % vs. 28 %, CI95%: 1.07–1.19), carotid ultrasound (48 % vs. 52 %, CI95%: 1.12–1.23), thrombolysis (16 % vs. 18 %, CI95%: 1.13–1.28), and neuropsychological assessment (9 % vs. 16 %, CI95%: 1.70–1.97). Home discharge rates were lower for women (45 % vs. 47 %, CI95%: 1.04–1.15), while in-hospital mortality was higher (8 % vs. 6 %, CI95%: 0.59–0.71). For patients >75 years, women had less access to MRI (34 % vs. 35 %, CI95%: 1–1.16), carotid ultrasound (46 % vs. 51 %, CI95%: 1.13–1.30), thrombolysis (15 % vs. 16 %, CI95%: 1.02–1.24), and neuropsychological assessment (2 % vs. 4 %, CI95%: 1.60–2.42). Women's in-hospital mortality remained higher also in patients >75 years (12 % vs. 8 %, CI95%: 0.62–0.79).
Conclusions
Women had reduced access to testing, treatment, and rehabilitation across all age groups and stroke types. This disparity was most notable in interventions not included in the national quality assessment program.
{"title":"Comparison of access to stroke diagnostics, treatment, rehabilitation, and outcome between men and women","authors":"Josefine Grundtvig , Katrine Sværke , Mathilde Preskou , Louisa Marguerite Christensen , Thorsten Steiner , Hanne Christensen","doi":"10.1016/j.gloepi.2025.100201","DOIUrl":"10.1016/j.gloepi.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to compare access to diagnostics, treatment, rehabilitation, and outcome in women and men with stroke.</div></div><div><h3>Methods</h3><div>In this observational study we used routinely-collected, aggregate health data from all patients admitted with a stroke in the Capital Region and Region Zealand, Denmark from May 2016 until October 2022.</div></div><div><h3>Results</h3><div>Among 28,855 stroke patients (55 % men, 45 % women), women were older (53 % women vs. 47 % men with age > 75 years). Overall, women had reduced access to: magnetic resonance imaging (MRI; 40 % vs. 43 %, CI 95 %: 1.06–1.16), computer tomography (CT)-angiography (25 % vs. 28 %, CI95%: 1.07–1.19), carotid ultrasound (48 % vs. 52 %, CI95%: 1.12–1.23), thrombolysis (16 % vs. 18 %, CI95%: 1.13–1.28), and neuropsychological assessment (9 % vs. 16 %, CI95%: 1.70–1.97). Home discharge rates were lower for women (45 % vs. 47 %, CI95%: 1.04–1.15), while in-hospital mortality was higher (8 % vs. 6 %, CI95%: 0.59–0.71). For patients >75 years, women had less access to MRI (34 % vs. 35 %, CI95%: 1–1.16), carotid ultrasound (46 % vs. 51 %, CI95%: 1.13–1.30), thrombolysis (15 % vs. 16 %, CI95%: 1.02–1.24), and neuropsychological assessment (2 % vs. 4 %, CI95%: 1.60–2.42). Women's in-hospital mortality remained higher also in patients >75 years (12 % vs. 8 %, CI95%: 0.62–0.79).</div></div><div><h3>Conclusions</h3><div>Women had reduced access to testing, treatment, and rehabilitation across all age groups and stroke types. This disparity was most notable in interventions not included in the national quality assessment program.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-28DOI: 10.1016/j.gloepi.2025.100202
Ebrahim Abbasi , Mohammad Djaefar Moemenbellah-Fard
Introduction
Arboviruses, including Chikungunya (CHIKV), Dengue (DENV), and West Nile (WNV) viruses, are significant viral threats that affect numerous people globally each year. This report explores the prevalence of these viruses in Iran through a systematic review and meta-analysis.
Methods
The present survey was performed using a systematic review and meta-analysis method on the seroprevalence of WNV, CHIKV, and DENV using the ELISA test. Accordingly, by searching Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar scientific databases, all relevant published papers were sorted out and reviewed. Power ratification of data was conducted with a random effects model in meta-analysis, meta-regression, I2 index, and Egger test.
Results
This meta-analysis report embodies twelve published papers between 2000 and 2024. The seroprevalence of positive ELISA tests for WNV in Iran was estimated at 12.9 % (CI = 95 %: 7.4–18.4) and for CHIKV at 6.2 % (CI = 95 %: 0.6–11.8). Regarding DENV, only two studies were conducted, with a zero prevalence in one study and a seroprevalence of 5.6 % in another study.
Conclusion
According to these data, WNV, CHIKV, and DENV fevers have been detected in Iran using the ELISA test. Considering the seropositivity of WNV and CHIKV and their detection in several provinces, it can be assumed that these viruses are ubiquitous, while DENV fever remains sporadic in Iran.
{"title":"Prevalence of Chikungunya, Dengue, and West Nile arboviruses in Iran based on enzyme-linked immunosorbent assay (ELISA): A systematic review and meta-analysis","authors":"Ebrahim Abbasi , Mohammad Djaefar Moemenbellah-Fard","doi":"10.1016/j.gloepi.2025.100202","DOIUrl":"10.1016/j.gloepi.2025.100202","url":null,"abstract":"<div><h3>Introduction</h3><div>Arboviruses, including Chikungunya (CHIKV), Dengue (DENV), and West Nile (WNV) viruses, are significant viral threats that affect numerous people globally each year. This report explores the prevalence of these viruses in Iran through a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>The present survey was performed using a systematic review and meta-analysis method on the seroprevalence of WNV, CHIKV, and DENV using the ELISA test. Accordingly, by searching Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar scientific databases, all relevant published papers were sorted out and reviewed. Power ratification of data was conducted with a random effects model in meta-analysis, meta-regression, <em>I</em><sup><em>2</em></sup> index, and Egger test.</div></div><div><h3>Results</h3><div>This meta-analysis report embodies twelve published papers between 2000 and 2024. The seroprevalence of positive ELISA tests for WNV in Iran was estimated at 12.9 % (CI = 95 %: 7.4–18.4) and for CHIKV at 6.2 % (CI = 95 %: 0.6–11.8). Regarding DENV, only two studies were conducted, with a zero prevalence in one study and a seroprevalence of 5.6 % in another study.</div></div><div><h3>Conclusion</h3><div>According to these data, WNV, CHIKV, and DENV fevers have been detected in Iran using the ELISA test. Considering the seropositivity of WNV and CHIKV and their detection in several provinces, it can be assumed that these viruses are ubiquitous, while DENV fever remains sporadic in Iran.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-22DOI: 10.1016/j.gloepi.2025.100200
Evans O. Omorogie , Kolade M. Owolabi , Bola T. Olabode , Tunde T. Yusuf , Edson Pindza
The resurgence of Covid-19, accompanied by various variants of the virus, highlights the fact that Covid-19 is still present within the population. The study proposed a Covid-19 dynamical model for analyzing the effect of vaccination and the continuous use of non-medical interventions for addressing Covid-19 transmission dynamics. The Lyaponov function and Jacobian matrix techniques were used to analyze the stability of the model's equilibria. The model was transformed into a problem of optimal control with time-dependent variables, aimed at managing efforts to prevent the spread of Covid-19. Numerical assessments were deployed to assess the effect of vaccination and the continuous use of non-medical intervention strategies to mitigate the spread of Covid-19. The global sensitivity analysis of the model was used to detect the key parameters influencing the behavior of the model. In addition, numerical results showed a significant decrease in the basic reproduction rate when implementing and , either separately or together. The optimal control results suggested that the control measures should be consistently enforced without any relaxation.
{"title":"Resurgence in focus: Covid-19 dynamics and optimal control frameworks","authors":"Evans O. Omorogie , Kolade M. Owolabi , Bola T. Olabode , Tunde T. Yusuf , Edson Pindza","doi":"10.1016/j.gloepi.2025.100200","DOIUrl":"10.1016/j.gloepi.2025.100200","url":null,"abstract":"<div><div>The resurgence of Covid-19, accompanied by various variants of the virus, highlights the fact that Covid-19 is still present within the population. The study proposed a Covid-19 dynamical model for analyzing the effect of vaccination and the continuous use of non-medical interventions for addressing Covid-19 transmission dynamics. The Lyaponov function and Jacobian matrix techniques were used to analyze the stability of the model's equilibria. The model was transformed into a problem of optimal control with time-dependent variables, aimed at managing efforts to prevent the spread of Covid-19. Numerical assessments were deployed to assess the effect of vaccination and the continuous use of non-medical intervention strategies to mitigate the spread of Covid-19. The global sensitivity analysis of the model was used to detect the key parameters influencing the behavior of the model. In addition, numerical results showed a significant decrease in the basic reproduction rate <span><math><mfenced><msub><mi>ℛ</mi><mn>0</mn></msub></mfenced></math></span> when implementing <span><math><mi>σ</mi></math></span> and <span><math><mi>ξ</mi></math></span>, either separately or together. The optimal control results suggested that the control measures should be consistently enforced without any relaxation.</div><div>2010 Mathematics Subject Classification: 92D30, 93C95, 49 N90, 34H05, 37 N25.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-10DOI: 10.1016/j.gloepi.2025.100199
Minh Cong Tran , Lara Prisco , Phuong Minh Pham , Huy Quoc Phan , Mario Ganau , Nhat Pham , Linh Huyen Truong , Proochista Ariana , Phuong Viet Dao , Dung Tien Nguyen , Chi Van Nguyen , Hoa Thi Truong , Thang Huy Nguyen , Jeyaraj Pandian , Ton Duy Mai , Andrew Farmery
Background
Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.
Method
We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.
Findings
Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206–242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.
Interpretation
The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.
{"title":"Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990–2019 and RES-Q 2017–2023","authors":"Minh Cong Tran , Lara Prisco , Phuong Minh Pham , Huy Quoc Phan , Mario Ganau , Nhat Pham , Linh Huyen Truong , Proochista Ariana , Phuong Viet Dao , Dung Tien Nguyen , Chi Van Nguyen , Hoa Thi Truong , Thang Huy Nguyen , Jeyaraj Pandian , Ton Duy Mai , Andrew Farmery","doi":"10.1016/j.gloepi.2025.100199","DOIUrl":"10.1016/j.gloepi.2025.100199","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.</div></div><div><h3>Method</h3><div>We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.</div></div><div><h3>Findings</h3><div>Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206–242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.</div></div><div><h3>Interpretation</h3><div>The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-22DOI: 10.1016/j.gloepi.2025.100198
Pierluigi Francesco Salvo , Valentina Iannone , Francesca Lombardi , Arturo Ciccullo , Francesco Lamanna , Rosa Anna Passerotto , Gianmaria Baldin , Rebecca Jo Steiner , Andrea Carbone , Valentina Massaroni , Simona Di Giambenedetto , Alberto Borghetti
Background
Risk factors for acquiring SARS-CoV-2 infection in people living with HIV (PLWH) and the true relationship between HIV and SARS CoV-2, are still not fully understood.
Objectives
The aim of this study was to identify the independent risk factors for SARS-CoV-2 acquisition in treatment experienced PLWH, shedding light on potential risk factors associated with SARS CoV-2 infection in PLWH undergoing treatment.
Study design
PLWH were recruited from the Infectious Diseases Outpatient Clinic of Fondazione Policlinico Universitario A.Gemelli IRCCS in Italy and randomly interviewed via a questionnaire during their follow-up visits to determine if they had experienced a SARS-CoV-2 infection between March 2020 and June 2022.
For each participant with reported history of SARS-CoV-2 (cases), two PLWH with no declared COVID-19 infection were selected (controls); PLWH had a similar potential exposure time to SARS-CoV-2. A total 220 PLWH were selected: 72 cases and 148 controls. None developed severe Covid-19 disease and only one participant required hospitalization.
Results
Overall, 220 PLWH were enrolled: 72 cases and 148 controls. Characteristics of cases and controls were similar, except for the ART regimen used and the last HIV-RNA concentration before the enrollment date. By an adjusted multivariable logistic regression, the estimated odds of SARS-CoV-2 infection was higher in more recent years (2022 versus 2020 aOR 20.74, 95 % CI 5.26–81.8) and in PLWH with last HIV-RNA >50 cp/mL before enrollment date (versus <50 aOR 4.56, 95 % CI 1.01–20.46). A reduced odds was correlated with >3 vaccine doses (versus <3 or not vaccinated aOR 0.08, 95 % CI 0.02–0.24).
Conclusion
In this cohort, the odds of SARS-CoV-2 acquisition increased over time, probably due to change in lock-down measures and in SARS-CoV-2 circulating variants.Detectable viral load was associated with increased risk of infection, highlighting the importance of HIV-RNA monitoring during pandemics.
HIV感染者感染SARS-CoV-2的危险因素以及HIV与SARS-CoV-2之间的真正关系尚不完全清楚。目的本研究的目的是确定PLWH治疗中感染SARS-CoV-2的独立危险因素，揭示PLWH治疗中感染SARS-CoV-2的潜在危险因素。研究设计从意大利杰梅利大学基金会（Fondazione Policlinico Universitario a . gemelli IRCCS）传染病门诊诊所招募plwh，并在随访期间通过问卷随机采访，以确定他们是否在2020年3月至2022年6月期间经历过SARS-CoV-2感染。对于每一名报告有SARS-CoV-2病史的参与者（病例），选择两名未报告感染COVID-19的PLWH（对照组）；PLWH对SARS-CoV-2的潜在暴露时间相似。共选取PLWH 220例：72例，对照组148例。没有人患上严重的Covid-19疾病，只有一名参与者需要住院治疗。结果共纳入PLWH 220例，其中病例72例，对照组148例。除了使用抗逆转录病毒治疗方案和入组日期前最后一次HIV-RNA浓度不同，病例和对照组的特征相似。通过调整后的多变量logistic回归，近年来SARS-CoV-2感染的估计几率更高（2022年比2020年aOR 20.74, 95% CI 5.26-81.8），在入组日期前最后一次HIV-RNA为50 cp/mL的PLWH中（50 aOR 4.56, 95% CI 1.01-20.46）。降低的比值与接种3剂疫苗相关（与未接种3剂或未接种相关：or 0.08, 95% CI 0.02-0.24）。在该队列中，SARS-CoV-2感染的几率随着时间的推移而增加，可能是由于封锁措施和SARS-CoV-2循环变体的变化。可检测的病毒载量与感染风险增加有关，这突出了在大流行期间监测艾滋病毒rna的重要性。
{"title":"Estimating risk of acquiring SARS-COV2 infection in treatment-experienced PLWH: A case-control study","authors":"Pierluigi Francesco Salvo , Valentina Iannone , Francesca Lombardi , Arturo Ciccullo , Francesco Lamanna , Rosa Anna Passerotto , Gianmaria Baldin , Rebecca Jo Steiner , Andrea Carbone , Valentina Massaroni , Simona Di Giambenedetto , Alberto Borghetti","doi":"10.1016/j.gloepi.2025.100198","DOIUrl":"10.1016/j.gloepi.2025.100198","url":null,"abstract":"<div><h3>Background</h3><div>Risk factors for acquiring SARS-CoV-2 infection in people living with HIV (PLWH) and the true relationship between HIV and SARS CoV-2, are still not fully understood.</div></div><div><h3>Objectives</h3><div>The aim of this study was to identify the independent risk factors for SARS-CoV-2 acquisition in treatment experienced PLWH, shedding light on potential risk factors associated with SARS CoV-2 infection in PLWH undergoing treatment.</div></div><div><h3>Study design</h3><div>PLWH were recruited from the Infectious Diseases Outpatient Clinic of Fondazione Policlinico Universitario A.Gemelli IRCCS in Italy and randomly interviewed via a questionnaire during their follow-up visits to determine if they had experienced a SARS-CoV-2 infection between March 2020 and June 2022.</div><div>For each participant with reported history of SARS-CoV-2 (cases), two PLWH with no declared COVID-19 infection were selected (controls); PLWH had a similar potential exposure time to SARS-CoV-2. A total 220 PLWH were selected: 72 cases and 148 controls. None developed severe Covid-19 disease and only one participant required hospitalization.</div></div><div><h3>Results</h3><div>Overall, 220 PLWH were enrolled: 72 cases and 148 controls. Characteristics of cases and controls were similar, except for the ART regimen used and the last HIV-RNA concentration before the enrollment date. By an adjusted multivariable logistic regression, the estimated odds of SARS-CoV-2 infection was higher in more recent years (2022 versus 2020 aOR 20.74, 95 % CI 5.26–81.8) and in PLWH with last HIV-RNA >50 cp/mL before enrollment date (versus <50 aOR 4.56, 95 % CI 1.01–20.46). A reduced odds was correlated with >3 vaccine doses (versus <3 or not vaccinated aOR 0.08, 95 % CI 0.02–0.24).</div></div><div><h3>Conclusion</h3><div>In this cohort, the odds of SARS-CoV-2 acquisition increased over time, probably due to change in lock-down measures and in SARS-CoV-2 circulating variants.Detectable viral load was associated with increased risk of infection, highlighting the importance of HIV-RNA monitoring during pandemics.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.gloepi.2025.100197
Carlos Arturo Álvarez-Moreno , Ludovic Reveiz , Claudia Aristizabal , Jesús Quevedo , María Lucia Mesa Rubio , Leonardo Arévalo-Mora , Julián Felipe Porras Villamil , Monica Padilla , Juan Carlos Alzate-Angel , Jamie Rylance , Kurbonov Firdavs , Ilich de la Hoz , Sandra Liliana Valderrama-Beltran , Santiago Arboleda , Otto Sussmann , Javier Andrade , Carolina Murillo Velásquez , Estefania García , Ximena Galindo , Daniela Martínez , Antoine Chaillon
Introduction
In 2022, the world experienced a monkeypox outbreak caused by the Clade IIb strain of the virus. While this outbreak had widespread effects, more information is needed on mpox's specific impact in Colombia, particularly regarding how it is managed, its burden, and its epidemiology. This research seeks to examine the medical context, clinical presentation, and health outcomes of individuals diagnosed with mpox infection, with a particular focus on those with HIV in Colombia.
Methods
This retrospective study was conducted in fourteen Health institutions in Colombia based on computerized clinical records from Jan 2022 to Dec 2023. Clinical and epidemiological characteristics were collected from diagnosis until discharge (or death). Participants in the study were diagnosed through molecular methods (PCR) and their clinical evolution was tracked through hospital and/or outpatient medical records. Registered variables were based on the mpox 2023 Case Report Form (2023 - CRF) proposed by the World Health Organization.
Results
One thousand four hundred thirteen (1413, 97.2 % male) individuals, including 2.6 % identified as healthcare workers, were included in this study. The majority (54 %, 764/1413 individuals) were persons living with HIV (PWH) and almost one-third of them (30.1 %, n = 284) of participants had concomitant sexually transmitted diseases and HIV, with syphilis being the most prevalent (20.4 %), followed by Neisseria gonorrhoeae (16.4 %). Complications were infrequent, with cellulitis being the most common, and no individuals received mpox-specific treatment or vaccination. Although all individuals had skin lesions distributed across various body regions, differences were noted in lesion distribution among women. Those living with HIV showed higher emergency department attendance and reported having known mpox contacts. While complications were rare, with cellulitis being the most common, women living with HIV showed a higher rate of emergency room visits and known mpox contacts. Although not statistically significant, gastrointestinal, musculoskeletal, psychological, respiratory, and STI symptoms, including syphilis and urethritis, were more common in the virologically non-suppressed HIV group. At the same time, proctitis was more prevalent in the suppressed group. No significant differences were found based on CD4 count, using 200 cells/mm3 in PWH.
Conclusion
Over half of the participants were people living with HIV (PWH), with a significant presence of STIs like syphilis. While skin lesions and complications varied, no significant differences were linked to CD4 count or viral load suppression. Mpox symptomatology was not significantly associated with unsuppressed viral loads or low CD4 levels, highlighting the need for further research.
{"title":"Mpox: Characterization and clinical outcomes of patients in Colombian healthcare institutions","authors":"Carlos Arturo Álvarez-Moreno , Ludovic Reveiz , Claudia Aristizabal , Jesús Quevedo , María Lucia Mesa Rubio , Leonardo Arévalo-Mora , Julián Felipe Porras Villamil , Monica Padilla , Juan Carlos Alzate-Angel , Jamie Rylance , Kurbonov Firdavs , Ilich de la Hoz , Sandra Liliana Valderrama-Beltran , Santiago Arboleda , Otto Sussmann , Javier Andrade , Carolina Murillo Velásquez , Estefania García , Ximena Galindo , Daniela Martínez , Antoine Chaillon","doi":"10.1016/j.gloepi.2025.100197","DOIUrl":"10.1016/j.gloepi.2025.100197","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2022, the world experienced a monkeypox outbreak caused by the Clade IIb strain of the virus. While this outbreak had widespread effects, more information is needed on mpox's specific impact in Colombia, particularly regarding how it is managed, its burden, and its epidemiology. This research seeks to examine the medical context, clinical presentation, and health outcomes of individuals diagnosed with mpox infection, with a particular focus on those with HIV in Colombia.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted in fourteen Health institutions in Colombia based on computerized clinical records from Jan 2022 to Dec 2023. Clinical and epidemiological characteristics were collected from diagnosis until discharge (or death). Participants in the study were diagnosed through molecular methods (PCR) and their clinical evolution was tracked through hospital and/or outpatient medical records. Registered variables were based on the mpox 2023 Case Report Form (2023 - CRF) proposed by the World Health Organization.</div></div><div><h3>Results</h3><div>One thousand four hundred thirteen (1413, 97.2 % male) individuals, including 2.6 % identified as healthcare workers, were included in this study. The majority (54 %, 764/1413 individuals) were persons living with HIV (PWH) and almost one-third of them (30.1 %, <em>n</em> = 284) of participants had concomitant sexually transmitted diseases and HIV, with syphilis being the most prevalent (20.4 %), followed by <em>Neisseria gonorrhoeae</em> (16.4 %). Complications were infrequent, with cellulitis being the most common, and no individuals received mpox-specific treatment or vaccination. Although all individuals had skin lesions distributed across various body regions, differences were noted in lesion distribution among women. Those living with HIV showed higher emergency department attendance and reported having known mpox contacts. While complications were rare, with cellulitis being the most common, women living with HIV showed a higher rate of emergency room visits and known mpox contacts. Although not statistically significant, gastrointestinal, musculoskeletal, psychological, respiratory, and STI symptoms, including syphilis and urethritis, were more common in the virologically non-suppressed HIV group. At the same time, proctitis was more prevalent in the suppressed group. No significant differences were found based on CD4 count, using 200 cells/mm<sup>3</sup> in PWH.</div></div><div><h3>Conclusion</h3><div>Over half of the participants were people living with HIV (PWH), with a significant presence of STIs like syphilis. While skin lesions and complications varied, no significant differences were linked to CD4 count or viral load suppression. Mpox symptomatology was not significantly associated with unsuppressed viral loads or low CD4 levels, highlighting the need for further research.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-14DOI: 10.1016/j.gloepi.2025.100196
Hiam Al-Atnah , Anas Al-Qubati , Amir Addin Al-Hashedi , Muath Al-Saidy , Saleh Al-Shawish , Moamer M. Badi , Najeeb Al-Qubati , Yasser Ghaleb , Maha Al-Muntaser
Background
Long-term disability and a reduced quality of life are often associated with congenital anomalies (CAs), which present as structural, functional, or metabolic defects. This study provides a comprehensive view of neonatal congenital anomalies in 14 Yemeni governorates, a significant but often overlooked public health concern. The current study aimed to determine the patterns and associated factors of congenital anomalies in 14 Yemeni governorates between 2021 and 2023.
Methods
An unmatched case-control 1:2 design was conducted using secondary data collected from various health facilities across 14 Yemeni governorates during 2021–2023. Sample size was calculated and data was analyzed using Epi Info version 7.2, with 612 neonates with documented diagnosis of congenital anomalies and 1224 healthy neonates. Binary and multiple logistic regression were used to identify factors associated with congenital anomalies, alongside the chi-square test.
Results
The majority of the congenital anomalies identified were located in Al Hudaydah (34 %), Ibb (17.2 %), and Sana'a (13.1 %). Most were isolated 518 (84.64 %), whereas 94 (15.36 %) were multiple. The predominant system was the nervous system (33.9 %), followed by the skeletal system (14.8 %) and orofacial anomalies (10.6 %). Furthermore, strong associations were found with positive consanguinity (OR = 28.82), low socioeconomic status (OR = 10.70), maternal age ≥ 35 years old (OR = 7.66), stress (OR = 4.95), acute diseases (OR = 3.56), gestational age < 37 weeks (OR = 3.32), maternal age < 20 years old (OR = 2.32), positive family history (OR = 1.74), low birth weight (OR = 1.27), grand-multiparity (OR = 0.71) and male sex (OR = 0.10).
Interpretation
This broad research identified significant patterns, maternal and neonatal associations, and protective variables for congenital anomalies. These results can help inform national interventions and policies for prevention and improving neonatal care.
Funding
This study was self-funded by the authors and did not receive any external funding or any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
{"title":"Patterns and Associated Factors of Congenital Anomalies Among Neonates in 14 Yemeni Governorates 2021–2023: A Case: Control Study","authors":"Hiam Al-Atnah , Anas Al-Qubati , Amir Addin Al-Hashedi , Muath Al-Saidy , Saleh Al-Shawish , Moamer M. Badi , Najeeb Al-Qubati , Yasser Ghaleb , Maha Al-Muntaser","doi":"10.1016/j.gloepi.2025.100196","DOIUrl":"10.1016/j.gloepi.2025.100196","url":null,"abstract":"<div><h3>Background</h3><div>Long-term disability and a reduced quality of life are often associated with congenital anomalies (CAs), which present as structural, functional, or metabolic defects. This study provides a comprehensive view of neonatal congenital anomalies in 14 Yemeni governorates, a significant but often overlooked public health concern. The current study aimed to determine the patterns and associated factors of congenital anomalies in 14 Yemeni governorates between 2021 and 2023.</div></div><div><h3>Methods</h3><div>An unmatched case-control 1:2 design was conducted using secondary data collected from various health facilities across 14 Yemeni governorates during 2021–2023. Sample size was calculated and data was analyzed using Epi Info version 7.2, with 612 neonates with documented diagnosis of congenital anomalies and 1224 healthy neonates. Binary and multiple logistic regression were used to identify factors associated with congenital anomalies, alongside the chi-square test.</div></div><div><h3>Results</h3><div>The majority of the congenital anomalies identified were located in Al Hudaydah (34 %), Ibb (17.2 %), and Sana'a (13.1 %). Most were isolated 518 (84.64 %), whereas 94 (15.36 %) were multiple. The predominant system was the nervous system (33.9 %), followed by the skeletal system (14.8 %) and orofacial anomalies (10.6 %). Furthermore, strong associations were found with positive consanguinity (OR = 28.82), low socioeconomic status (OR = 10.70), maternal age ≥ 35 years old (OR = 7.66), stress (OR = 4.95), acute diseases (OR = 3.56), gestational age < 37 weeks (OR = 3.32), maternal age < 20 years old (OR = 2.32), positive family history (OR = 1.74), low birth weight (OR = 1.27), grand-multiparity (OR = 0.71) and male sex (OR = 0.10).</div></div><div><h3>Interpretation</h3><div>This broad research identified significant patterns, maternal and neonatal associations, and protective variables for congenital anomalies. These results can help inform national interventions and policies for prevention and improving neonatal care.</div></div><div><h3>Funding</h3><div>This study was self-funded by the authors and did not receive any external funding or any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"9 ","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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