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The Revolution Will Be Hard to Evaluate: How Co-Occurring Policy Changes Affect Research on the Health Effects of Social Policies. 革命难以评估:同时发生的政策变化如何影响社会政策对健康影响的研究》(The Revolution Will Hard Evaluate: How Co-Occurcurring Policy Changes Affect Research on the Health Effects of Social Policies)。
IF 5.2 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab009
Ellicott C Matthay, Erin Hagan, Spruha Joshi, May Lynn Tan, David Vlahov, Nancy Adler, M Maria Glymour

Extensive empirical health research leverages variation in the timing and location of policy changes as quasi-experiments. Multiple social policies may be adopted simultaneously in the same locations, creating co-occurrence that must be addressed analytically for valid inferences. The pervasiveness and consequences of co-occurring policies have received limited attention. We analyzed a systematic sample of 13 social policy databases covering diverse domains including poverty, paid family leave, and tobacco use. We quantified policy co-occurrence in each database as the fraction of variation in each policy measure across different jurisdictions and times that could be explained by covariation with other policies. We used simulations to estimate the ratio of the variance of effect estimates under the observed policy co-occurrence to variance if policies were independent. Policy co-occurrence ranged from very high for state-level cannabis policies to low for country-level sexual minority-rights policies. For 65% of policies, greater than 90% of the place-time variation was explained by other policies. Policy co-occurrence increased the variance of effect estimates by a median of 57-fold. Co-occurring policies are common and pose a major methodological challenge to rigorously evaluating health effects of individual social policies. When uncontrolled, co-occurring policies confound one another, and when controlled, resulting positivity violations may substantially inflate the variance of estimated effects. Tools to enhance validity and precision for evaluating co-occurring policies are needed.

广泛的实证健康研究利用政策变化的时间和地点变化作为准实验。在同一地点可能会同时采用多种社会政策,这就产生了共同发生的现象,必须对其进行分析才能得出有效的推论。对同时出现的政策的普遍性和后果的关注还很有限。我们对 13 个社会政策数据库进行了系统抽样分析,这些数据库涵盖了贫困、带薪家事假和烟草使用等不同领域。我们将每个数据库中的政策共存性量化为每个政策措施在不同司法管辖区和不同时间的变异中,可由与其他政策的共变解释的部分。我们通过模拟来估算观察到的政策共存情况下的效应估计方差与政策独立情况下的方差之比。政策共现程度从州级大麻政策的非常高到国家级性少数群体权利政策的较低不等。在 65% 的政策中,超过 90% 的地点-时间变异是由其他政策解释的。政策共存使效应估计值的方差增加了 57 倍。政策共存的现象很常见,这对严格评估单项社会政策的健康影响构成了方法上的重大挑战。当不加以控制时,同时出现的政策会相互混淆;而当加以控制时,由此产生的正向违规可能会大大增加估计效果的方差。我们需要一些工具来提高评估同时出现的政策的有效性和精确性。
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引用次数: 0
Assumptions Not Often Assessed or Satisfied in Published Mediation Analyses in Psychology and Psychiatry. 在心理学和精神病学发表的调解分析中不经常评估或满足的假设。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab007
Elizabeth A Stuart, Ian Schmid, Trang Nguyen, Elizabeth Sarker, Adam Pittman, Kelly Benke, Kara Rudolph, Elena Badillo-Goicoechea, Jeannie-Marie Leoutsakos

Mediation analysis aims to investigate the mechanisms of action behind the effects of interventions or treatments. Given the history and common use of mediation in mental health research, we conducted this review to understand how mediation analysis is implemented in psychology and psychiatry and whether analyses adhere to, address, or justify the key underlying assumptions of their approaches. All articles (n = 206) were from top academic psychiatry or psychology journals in the PsycInfo database and were published in English from 2013 to 2018. Information extracted from each article related to study design, covariates adjusted for in the analysis, temporal ordering of variables, and the specific method used to perform the mediation analysis. In most studies, underlying assumptions were not adhered to. Only approximately 20% of articles had full temporal ordering of exposure, mediator, and outcome. Confounding of the exposure-mediator and/or mediator-outcome relationships was controlled for in fewer than half of the studies. In almost none of the articles were the underlying assumptions of their approaches discussed or causal mediation methods used. These results provide insights to how methodologists should aim to communicate methods, and motivation for more outreach to the research community on best practices for mediation analysis.

中介分析的目的是研究干预或治疗效果背后的作用机制。鉴于调解在心理健康研究中的历史和普遍应用,我们进行了本综述,以了解调解分析是如何在心理学和精神病学中实施的,以及分析是否坚持、解决或证明其方法的关键潜在假设。所有文章(n = 206)均来自PsycInfo数据库中顶级学术精神病学或心理学期刊,发表时间为2013 - 2018年。从每篇文章中提取的信息与研究设计、分析中调整的协变量、变量的时间顺序以及用于进行中介分析的具体方法有关。在大多数研究中,基本假设没有得到遵守。只有大约20%的文章有完整的暴露、中介和结果的时间顺序。在不到一半的研究中,暴露-中介和/或中介-结果关系的混淆得到了控制。几乎没有一篇文章讨论了他们的方法的基本假设或使用了因果中介方法。这些结果为方法学家应该如何致力于交流方法提供了见解,并激励他们更多地向研究界推广调解分析的最佳实践。
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引用次数: 6
Assessment of Physical Activity in Adults Using Wrist Accelerometers. 使用腕部加速度计评估成人的身体活动。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab004
Fangyu Liu, Amal A Wanigatunga, Jennifer A Schrack

The health benefits of physical activity (PA) have been widely recognized, yet traditional measures of PA, including questionnaires and category-based assessments of volume and intensity, provide only broad estimates of daily activities. Accelerometers have advanced epidemiologic research on PA by providing objective and continuous measurement of PA in free-living conditions. Wrist-worn accelerometers have become especially popular because of low participant burden. However, the validity and reliability of wrist-worn devices for adults have yet to be summarized. Moreover, accelerometer data provide rich information on how PA is accumulated throughout the day, but only a small portion of these rich data have been used by researchers. Last, new methodological developments are emerging that aim to overcome some of the limitations of accelerometers. In this review, we provide an overview of accelerometry research, with a special focus on wrist-worn accelerometers. We describe briefly how accelerometers work; summarize the validity and reliability of wrist-worn accelerometers; discuss the benefits of accelerometers, including measuring light-intensity PA; and discuss pattern metrics of daily PA recently introduced in the literature. A summary of large-scale cohort studies and randomized trials that implemented wrist-worn accelerometry is provided. We conclude the review by discussing new developments and directions of research using accelerometers, with a focus on wrist-worn accelerometers.

体育活动(PA)的健康益处已得到广泛认可,但传统的PA测量方法,包括问卷调查和基于类别的量和强度评估,只能提供对日常活动的广泛估计。加速度计通过在自由生活条件下提供客观和连续的PA测量,推动了PA的流行病学研究。由于参与者负担低,腕带加速度计变得特别受欢迎。然而,成人腕戴设备的有效性和可靠性还有待总结。此外,加速度计数据提供了PA全天如何积累的丰富信息,但这些丰富数据中只有一小部分被研究人员使用。最后,新的方法发展正在出现,旨在克服加速度计的一些局限性。在这篇综述中,我们提供了加速度计的研究概况,特别关注腕式加速度计。我们将简要描述加速度计的工作原理;总结了腕式加速度计的有效性和可靠性;讨论加速度计的好处,包括测量光强PA;并讨论了最近在文献中介绍的每日PA的模式指标。本文提供了大规模队列研究和随机试验的总结,这些研究采用了腕带加速度计。最后,我们讨论了加速度计的最新发展和研究方向,重点讨论了腕式加速度计。
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引用次数: 15
Evolution and Reproducibility of Simulation Modeling in Epidemiology and Health Policy Over Half a Century. 半个世纪以来流行病学和卫生政策模拟模型的演变和可重复性。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab006
Mohammad S Jalali, Catherine DiGennaro, Abby Guitar, Karen Lew, Hazhir Rahmandad

Simulation models are increasingly being used to inform epidemiologic studies and health policy, yet there is great variation in their transparency and reproducibility. In this review, we provide an overview of applications of simulation models in health policy and epidemiology, analyze the use of best reporting practices, and assess the reproducibility of the models using predefined, categorical criteria. We identified and analyzed 1,613 applicable articles and found exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Model details were not reported in almost half of the studies. We also provide in-depth analysis of modeling best practices, reporting quality and reproducibility of models for a subset of 100 articles (50 highly cited and 50 randomly selected from the remaining articles). Only 7 of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We identify areas for increased application of simulation modeling and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in epidemiology and health policy.

模拟模型越来越多地被用于流行病学研究和卫生政策,但其透明度和可重复性差异很大。在这篇综述中,我们概述了模拟模型在卫生政策和流行病学中的应用,分析了最佳报告实践的使用,并使用预定义的分类标准评估了模型的可重复性。我们确定并分析了1,613篇适用的文章,发现在过去的半个世纪里,研究数量呈指数增长,其中动态建模方法的增长最快。最大的研究子集集中在疾病政策模型上(70%),其中病理状况、病毒性疾病、肿瘤和心血管疾病占文章的三分之一。几乎一半的研究没有报告模型细节。我们还为100篇文章的子集(50篇被高度引用的文章和50篇随机选择的文章)提供建模最佳实践、报告质量和模型可重复性的深入分析。在26项深度评价标准中,只有7项的样本满意率超过80%。我们确定了增加模拟建模应用的领域,以及在流行病学和卫生政策模拟建模的实施和报告中加强严谨性和文件记录的机会。
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引用次数: 11
Longitudinal Methods for Modeling Exposures in Pharmacoepidemiologic Studies in Pregnancy. 妊娠药物流行病学研究中暴露建模的纵向方法。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab002
Mollie E Wood, Angela Lupattelli, Kristin Palmsten, Gretchen Bandoli, Caroline Hurault-Delarue, Christine Damase-Michel, Christina D Chambers, Hedvig M E Nordeng, Marleen M H J van Gelder

In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as "ever exposed" versus "never exposed" within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and does not to incorporate important aspects such as dosage, timing of exposure, and treatment duration. Alternative exposure modeling methods can better summarize complex, individual-level medication use trajectories or time-varying exposures from information on medication dosage, gestational timing of use, and frequency of use. We provide an overview of commonly used methods for more refined definitions of real-world exposure to medication use during pregnancy, focusing on the major strengths and limitations of the techniques, including the potential for method-specific biases. Unsupervised clustering methods, including k-means clustering, group-based trajectory models, and hierarchical cluster analysis, are of interest because they enable visual examination of medication use trajectories over time in pregnancy and complex individual-level exposures, as well as providing insight into comedication and drug-switching patterns. Analytical techniques for time-varying exposure methods, such as extended Cox models and Robins' generalized methods, are useful tools when medication exposure is not static during pregnancy. We propose that where appropriate, combining unsupervised clustering techniques with causal modeling approaches may be a powerful approach to understanding medication safety in pregnancy, and this framework can also be applied in other areas of epidemiology.

在许多围产期药物流行病学研究中,在每个三个月甚至整个怀孕期间,药物暴露被分为“曾经暴露”和“从未暴露”。这种方法往往与现实世界的暴露模式相距甚远,可能导致暴露错误分类,并且没有纳入剂量、暴露时间和治疗持续时间等重要方面。替代暴露建模方法可以从药物剂量、妊娠期使用时间和使用频率等信息中更好地总结复杂的、个体水平的药物使用轨迹或时变暴露。我们概述了常用的方法,以更精确地定义怀孕期间药物使用的真实世界暴露,重点是这些技术的主要优势和局限性,包括方法特异性偏差的可能性。无监督聚类方法,包括k-means聚类、基于群体的轨迹模型和分层聚类分析,之所以引起人们的兴趣,是因为它们可以直观地检查怀孕期间药物使用轨迹和复杂的个人水平暴露,并提供对药物和药物转换模式的洞察。时变暴露方法的分析技术,如扩展Cox模型和罗宾斯的广义方法,在怀孕期间药物暴露不是静态的情况下是有用的工具。我们建议,在适当的情况下,将无监督聚类技术与因果建模方法相结合可能是了解妊娠用药安全的有力方法,并且该框架也可以应用于流行病学的其他领域。
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引用次数: 15
Epidemiologic Methods: Seeing the Forest and the Trees. 流行病学方法:看到森林和树木。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab010
Kara E Rudolph, Bryan Lau
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引用次数: 0
Burden of Antimicrobial Resistance: Compared to What? 抗菌素耐药性负担:与什么相比?
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab001
Marlieke E A de Kraker, Marc Lipsitch

The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.

对抗菌素耐药性(AMR)的公共卫生负担的日益关注提出了概念上的挑战,例如确定多药耐药生物体造成的危害程度,或如何确定这种负担。在此,我们提出了一个反事实框架,并为协调研究方法和优化研究质量提供了指导。在抗菌素耐药性负担研究中,采用了两种反事实方法:耐药感染的危害相对于相同药敏感染的危害(易感感染反事实);以及相对于这种感染被预防的情况(无感染反事实),耐药感染的总危害。我们建议使用基于干预的因果方法来确定最合适的反事实。我们表明干预方案,感兴趣的物种和感染类型影响反事实的选择。我们建议使用目的设计的队列研究来应用这种反事实框架,据此,队列(耐药患者、药敏感染患者和无感染患者)的选择应基于暴露密度抽样与感染的时间匹配,以避免有偏估计。考虑到竞争项目,优先考虑生存方法的应用。最后,我们主张使用无感染和易感感染反事实来估计抗菌素耐药性的负担。由此得出的数字将提供有关未来旨在控制抗生素耐药性的干预措施上限和下限的政策相关信息。反事实应应用于队列研究,即选择未暴露的队列应基于暴露密度抽样,采用避免时间相关偏差和混淆的方法。
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引用次数: 21
Is the Way Forward to Step Back? Documenting the Frequency With Which Study Goals Are Misaligned With Study Methods and Interpretations in the Epidemiologic Literature. 后退是前进的道路吗?记录研究目标与流行病学文献中的研究方法和解释不一致的频率。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab008
Katrina L Kezios

In any research study, there is an underlying process that should begin with a clear articulation of the study's goal. The study's goal drives this process; it determines many study features, including the estimand of interest, the analytic approaches that can be used to estimate it, and which coefficients, if any, should be interpreted. Misalignment can occur in this process when analytic approaches and/or interpretations do not match the study's goal; misalignment is potentially more likely to arise when study goals are ambiguously framed. In this study, misalignment in the observational epidemiologic literature was documented and how the framing of study goals contributes to misalignment was explored. The following 2 misalignments were examined: use of an inappropriate variable selection approach for the goal (a "goal-methods" misalignment) and interpretation of coefficients of variables for which causal considerations were not made (e.g., Table 2 Fallacy, a "goal-interpretation" misalignment). A random sample of 100 articles published 2014-2018 in the top 5 general epidemiology journals were reviewed. Most reviewed studies were causal, with either explicitly stated (n = 13; 13%) or associational-framed (n = 71; 69%) aims. Full alignment of goal-methods-interpretations was infrequent (n = 9; 9%), although clearly causal studies (n = 5 of 13; 38%) were more often fully aligned than were seemingly causal ones (n = 3 of 71; 4%). Goal-methods misalignments were common (n = 34 of 103; 33%), but most frequently, methods were insufficiently reported to draw conclusions (n = 47; 46%). Goal-interpretations misalignments occurred in 31% (n = 32) of the studies and occurred less often when the methods were aligned (n = 2; 2%) compared with when the methods were misaligned (n = 13; 13%).

在任何研究中,都有一个潜在的过程,应该从研究目标的清晰表述开始。这项研究的目标推动了这一过程;它决定了许多研究特征,包括兴趣的估计,可以用来估计它的分析方法,以及哪些系数(如果有的话)应该被解释。当分析方法和/或解释与研究目标不匹配时,在这一过程中可能发生偏差;当研究目标含糊不清时,更有可能出现偏差。本研究记录了观察性流行病学文献中的偏差,并探讨了研究目标的框架如何导致偏差。检查了以下两种偏差:使用不适当的目标变量选择方法(“目标-方法”偏差)和解释变量系数,其中没有考虑因果关系(例如,表2谬误,“目标-解释”偏差)。随机抽取2014-2018年在五大普通流行病学期刊上发表的100篇文章进行综述。大多数回顾的研究都是因果关系,要么明确说明(n = 13;13%)或关联框架(n = 71;69%)的目标。目标-方法-解释的完全一致很少(n = 9;9%),尽管有明确的因果关系研究(n = 5 / 13;38%)比表面上的因果关系更容易完全一致(n = 3 / 71;4%)。目标-方法偏差很常见(n = 34 / 103;33%),但最常见的是,方法报告不足,无法得出结论(n = 47;46%)。31%的研究(n = 32)发生了目标解释偏差,当方法对齐时发生偏差的频率较低(n = 2;2%),与方法未对齐时相比(n = 13;13%)。
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引用次数: 1
Monte Carlo Simulation Approaches for Quantitative Bias Analysis: A Tutorial. 定量偏差分析的蒙特卡罗模拟方法:教程。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2022-01-14 DOI: 10.1093/epirev/mxab012
Hailey R Banack, Eleanor Hayes-Larson, Elizabeth Rose Mayeda

Quantitative bias analysis can be used to empirically assess how far study estimates are from the truth (i.e., an estimate that is free of bias). These methods can be used to explore the potential impact of confounding bias, selection bias (collider stratification bias), and information bias. Quantitative bias analysis includes methods that can be used to check the robustness of study findings to multiple types of bias and methods that use simulation studies to generate data and understand the hypothetical impact of specific types of bias in a simulated data set. In this article, we review 2 strategies for quantitative bias analysis: 1) traditional probabilistic quantitative bias analysis and 2) quantitative bias analysis with generated data. An important difference between the 2 strategies relates to the type of data (real vs. generated data) used in the analysis. Monte Carlo simulations are used in both approaches, but the simulation process is used for different purposes in each. For both approaches, we outline and describe the steps required to carry out the quantitative bias analysis and also present a bias-analysis tutorial demonstrating how both approaches can be applied in the context of an analysis for selection bias. Our goal is to highlight the utility of quantitative bias analysis for practicing epidemiologists and increase the use of these methods in the epidemiologic literature.

定量偏倚分析可用于经验性地评估研究估计与事实的距离(即,无偏倚的估计)。这些方法可用于探索混杂偏倚、选择偏倚(对撞机分层偏倚)和信息偏倚的潜在影响。定量偏倚分析包括可用于检查研究结果对多种类型偏倚的稳健性的方法,以及使用模拟研究来生成数据并了解特定类型偏倚在模拟数据集中的假设影响的方法。在本文中,我们回顾了定量偏差分析的两种策略:1)传统的概率定量偏差分析和2)生成数据定量偏差分析。这两种策略之间的一个重要区别与分析中使用的数据类型(真实数据与生成数据)有关。两种方法都使用蒙特卡罗模拟,但每种方法的模拟过程用于不同的目的。对于这两种方法,我们概述并描述了进行定量偏倚分析所需的步骤,并提供了一个偏倚分析教程,展示了如何将这两种方法应用于选择偏倚分析的背景下。我们的目标是强调定量偏倚分析对执业流行病学家的效用,并在流行病学文献中增加这些方法的使用。
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引用次数: 6
Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union. 欧盟监狱中针头和注射器项目的可得性、可及性和覆盖范围。
IF 5.5 2区 医学 Q1 Medicine Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa003
Babak Moazen, Kate Dolan, Sahar Saeedi Moghaddam, Masoud Lotfizadeh, Karen Duke, Florian Neuhann, Heino Stöver, Albrecht Jahn

Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.

针头和注射器规划是控制监狱内注射吸毒者感染传播的最有效干预措施之一。我们评估了欧盟国家监狱中nsp的可得性、可及性和覆盖范围。根据系统评价和荟萃分析的首选报告项目(PRISMA)标准,我们系统地检索了4个同行评议出版物数据库(MEDLINE (PubMed), ISI Web of Science, EBSCO和ScienceDirect)和53个包含灰色文献的数据库,以收集2008年1月至2018年8月发表的数据。共发现文献23,969份(论文17,297份,灰色文献6,672份),其中26份纳入本研究。2018年,28个欧盟国家的监禁率在芬兰的每10万人中有51人,立陶宛的每10万人中有235人。只有4个国家的监狱中有国家安全服务提供者:德国(在1所监狱中)、卢森堡(没有发现覆盖数据)、罗马尼亚(在50%以上的监狱中)和西班牙(在所有监狱中)。葡萄牙在6个月的试点阶段后停止了NSP。尽管以监狱为基础的国家卫生服务方案对感染传播具有保护作用,但只有4个欧盟国家向在监狱注射毒品的人分发无菌注射器,而且这些国家内项目的覆盖率非常低。由于大多数囚犯最终将返回社区,欧盟监狱中缺乏国家卫生服务提供者不仅对囚犯的健康构成威胁,而且危害公共卫生。
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引用次数: 11
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Epidemiologic Reviews
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