Current Epidemiology Reports最新文献

Purpose of review: This review summarises epidemiological research using electronic health records (EHR) for antimicrobial stewardship.

Recent findings: EHRs enable surveillance of antibiotic utilisation and infection consultations. Prescribing for respiratory tract infections has declined in the UK following reduced consultation rates. Reductions in prescribing for skin and urinary tract infections have been less marked. Drug selection has improved and use of broad-spectrum antimicrobics reduced. Diagnoses of pneumonia, sepsis and bacterial endocarditis have increased in primary care. Analytical studies have quantified risks of serious bacterial infections following reduced antibiotic prescribing. EHRs are increasingly used in interventional studies including point-of-care trials and cluster randomised trials of quality improvement. Analytical and interventional studies indicate patient groups for whom antibiotic utilisation may be more safely reduced.

Summary: EHRs offer opportunities for surveillance and interventions that engage practitioners in the effects of improved prescribing practices, with the potential for better outcomes with targeted study designs.

Purpose of review: We reviewed the exposure assessments of ambient air pollution used in studies of fertility, fecundability, and pregnancy loss.

Recent findings: Comprehensive literature searches were performed in the PUBMED, Web of Science, and Scopus databases. Of 168 total studies, 45 met the eligibility criteria and were included in the review. We find that 69% of fertility and pregnancy loss studies have used one-dimensional proximity models or surface monitor data, while only 35% have used the improved models, such as land-use regression models (4%), dispersion/chemical transport models (11%), or fusion models (20%). No published studies have used personal air monitors.

Summary: While air pollution exposure models have vastly improved over the past decade from simple, one-dimensional distance or air monitor data, to models that incorporate physiochemical properties leading to better predictive accuracy, precision, and increased spatiotemporal variability and resolution, the fertility literature has yet to fully incorporate these new methods. We provide descriptions of each of these air pollution exposure models and assess the strengths and limitations of each model, while summarizing the findings of the literature on ambient air pollution and fertility that apply each method.

Purpose of review: Environmental exposures during early stages of life may be particularly relevant for cancer etiology because of the rapid hormonal and tissue changes that occur during puberty and, in women, through first birth. We review evidence from the past five years on environmental exposures during childhood/adolescence through first birth and the risk of breast and other cancers during adulthood.

Recent findings: The studies of breast cancer (n=14) reported associations for childhood/adolescent environmental tobacco smoke (ETS), smoking initiation, pesticides, hair dye use, and living on a road with high traffic. Smoking before first childbirth was also associated with increased breast cancer risk. We identified 12 studies on other cancers, with only 1-2 studies per cancer type, with most focused on ETS or active smoking.

Summary: Despite studies suggesting an important role of exposure to environmental factors during early life and cancer risk in adulthood, few studies have been conducted. Future studies could utilize stored biologic samples from relevant periods or complete residential histories for geographically-based exposures.