Annals of Epidemiology最新文献_第4页

Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV 整合酶链转移抑制剂对HIV感染者心血管疾病的影响

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-25 DOI: 10.1016/j.annepidem.2025.11.006

Buwei He , Bankole Olatosi , Jiajia Zhang , Sharon Weissman , Xiaoming Li , Xueying Yang

Purpose

Integrase Strand Transfer Inhibitors (INSTIs) are effective and well-tolerated in HIV treatment, but their cardiovascular impact remains uncertain. This study evaluated the association between INSTI-based antiretroviral therapy (ART) and cardiovascular disease (CVD) risk in people with HIV (PWH).

Methods

We conducted a retrospective cohort study using electronic health records and survey data from the All of Us research program. Adults with HIV on continuous ART for ≥ 1 year, free of CVD at baseline and within one year of ART initiation, were included. INSTI exposure was categorized by regimen status. Cox proportional hazards models assessed the association between INSTI use and CVD. A subgroup analysis examined INSTI-naïve individuals who later switched to INSTI-based ART.

Results

Among 2175 PWH, 437 (20.09 %) experienced CVD events; 1715 (78.85 %) used INSTIs. INSTI-only (aHR = 0.65, 95 % CI: 0.50–0.83) and partial-INSTI use (aHR = 0.34, 95 % CI: 0.27–0.42) were linked to lower CVD risk. In the INSTI-naïve cohort (N = 1300), switching to INSTIs reduced CVD risk (aHR = 0.32, 95 % CI: 0.25–0.40). Older age (≥ 70) increased CVD risk.

Conclusions

INSTI-based ART may lower CVD risk among PWH. Further research is needed to validate these findings.

Summary

INSTI-based ART was associated with reduced cardiovascular disease risk among people with HIV, suggesting potential cardioprotective effects that warrant further investigation.

目的整合酶链转移抑制剂（insis）在HIV治疗中是有效且耐受性良好的，但其对心血管的影响仍不确定。本研究评估了基于inist的抗逆转录病毒治疗（ART）与HIV感染者（PWH）心血管疾病（CVD）风险之间的关系。方法采用电子健康记录和“我们所有人”研究项目的调查数据进行回顾性队列研究。纳入持续接受抗逆转录病毒治疗≥ 1年、基线时无心血管疾病和开始接受抗逆转录病毒治疗一年内的艾滋病毒感染者。INSTI暴露按方案状态分类。Cox比例风险模型评估了INSTI使用与心血管疾病之间的关系。一项亚组分析检查了INSTI-naïve后来转而使用基于insi的ART的个体。结果2175例PWH中，437例（20.09 %）发生CVD事件；1715例（78.85 %）使用insi。仅使用insti （aHR = 0.65, 95 % CI: 0.50-0.83）和部分使用insti （aHR = 0.34, 95 % CI: 0.27-0.42）与降低心血管疾病风险相关。在INSTI-naïve队列中（N = 1300），切换到intis降低了心血管疾病的风险（aHR = 0.32, 95% % CI: 0.25-0.40）。年龄越大（≥70岁）心血管疾病风险增加。结论以sinsti为基础的ART可降低PWH患者心血管疾病风险。需要进一步的研究来验证这些发现。基于sti的ART与艾滋病毒感染者心血管疾病风险降低相关，提示潜在的心脏保护作用值得进一步研究。

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引用次数: 0

Unravelling impact of comorbidities on mortality risks in CKD patients during the COVID-19 pandemic: An explainable AI-driven study COVID-19大流行期间CKD患者合并症对死亡风险的影响：一项可解释的人工智能驱动研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-25 DOI: 10.1016/j.annepidem.2025.11.005

Zeinab Abdollahi , Lin Huo , Donald Fraser , Shang-Ming Zhou

Objectives

The chronic kidney disease (CKD) patients were at high risk for severe clinical complications during the COVID-19 pandemic. Our objectives were to evaluate comorbidity prevalence; predict mortality risks for CKD patients during the pandemic; assess how various health factors interact to influence mortality; and provide insights for targeted prevention strategies.

Method

We analysed data from 186,396 CKD patients in Mexico during the entire pandemic (Jan 2020- May 2023). Explainable artificial intelligence (XAI) methods with extreme gradient boosting (XGBoost) models and Shapley Additive Explanations (SHAP) were developed to predict mortality for CKD patients with model interpretations. Different metrics were used to comprehensively evaluate model’s generalisation performances.

Results

The most prevalent comorbidities were hypertension (64.39 %), diabetes (49.79 %), and obesity (16.46 %). Male patients and older individuals showed higher risk for adverse outcomes. The overall mortality rate was 19.33 %, with significantly higher mortality in COVID-19 positive patients (33.9 %) compared to COVID-19 negative patients (10.1 %). Comorbidities with the most significant impact on the mortality included diabetes, hypertension, and obesity, which were more frequent in the COVID-19 positive group and associated with higher rates of intubation, and ICU admission. Pneumonia was identified as a major predictor of negative outcomes in CKD patients with COVID-19. CVD was more common in the COVID-19 negative group. Our machine learning models achieved performances of AUC= 0.76 and F₁-score= 0.75 for predicting mortality during the pandemic.

Conclusion

Targeted management of comorbid conditions, especially respiratory infections, is crucial in CKD patients during pandemics.

目的新冠肺炎大流行期间，慢性肾脏疾病（CKD）患者是发生严重临床并发症的高危人群。我们的目的是评估合并症的患病率；预测大流行期间CKD患者的死亡风险；评估各种健康因素如何相互作用影响死亡率；并为有针对性的预防战略提供见解。方法：我们分析了墨西哥186,396例CKD患者在整个大流行期间（2020年1月至2023年5月）的数据。采用极端梯度增强（XGBoost）模型和Shapley加性解释（SHAP）的可解释人工智能（XAI）方法来预测具有模型解释的CKD患者的死亡率。采用不同的指标综合评价模型的泛化性能。结果合并症以高血压（64.39 %）、糖尿病（49.79 %）和肥胖（16.46 %）居多。男性患者和老年人出现不良后果的风险更高。总死亡率为19.33 %，其中COVID-19阳性患者的死亡率（33.9 %）明显高于COVID-19阴性患者的死亡率（10.1 %）。对死亡率影响最大的合并症包括糖尿病、高血压和肥胖，这些合并症在COVID-19阳性组中更为常见，并与插管率和ICU入院率较高相关。肺炎被认为是CKD合并COVID-19患者预后不良的主要预测因素。CVD在COVID-19阴性组中更为常见。我们的机器学习模型在预测大流行期间的死亡率方面实现了AUC= 0.76和F1-score= 0.75的性能。结论大流行期间对CKD患者的合并症，特别是呼吸道感染进行有针对性的管理至关重要。

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引用次数: 0

Guiding artificial intelligence in public health and medicine with epidemiology: A lifecycle framework for mitigating AI misalignment 用流行病学指导公共卫生和医学领域的人工智能：减轻人工智能偏差的生命周期框架

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-20 DOI: 10.1016/j.annepidem.2025.11.004

Ahmed Hassoon MD, MPH , Christine Lin MPH , Hyun Yi (Jacqualine) Woo MD, MPH , Ruxandra Irimia MD, PHD, MPH , Jill A. Marsteller PhD, MPP , Anthony Li MD, PMH , Antonio Banderia MD, MPH , Hubert Leo BS , Xiaoyi Peng ScM , David Rastall MD , Mark Dredze PhD

Artificial Intelligence (AI) holds immense promise for public health, yet its potential is undermined by alignment failures where systems act contrary to human values, often exacerbating health disparities. This paper challenges the narrow view that algorithmic bias is solely a data problem, arguing instead that misalignment arises at every stage of the AI development lifecycle. We introduce a comprehensive seven-stage framework, spanning problem definition, team assembly, study design, data acquisition, model training, validation, and post-deployment implementation, viewed through an epidemiological lens. This approach systematically integrates core principles such as population representativeness, rigorous study design, bias characterization, and causal reasoning to identify and mitigate alignment risks. For each stage, we define specific alignment failures, from flawed problem formulation to post-market performance degradation, and propose actionable, evidence-based solutions. By embedding epidemiological rigor throughout the entire AI lifecycle, this framework provides a structured, proactive pathway for researchers, developers, and policymakers to create trustworthy, safe, and fair AI systems. This systemic approach is critical to harnessing AI's transformative benefits for population health while preventing the perpetuation of inequity and harm.

人工智能（AI）为公共卫生带来了巨大的希望，但其潜力因系统违背人类价值观的一致性失败而受到破坏，往往加剧了健康差距。这篇论文挑战了算法偏差仅仅是数据问题的狭隘观点，相反，它认为在人工智能开发生命周期的每个阶段都会出现偏差。我们通过流行病学视角介绍了一个全面的七阶段框架，涵盖问题定义、团队组建、研究设计、数据获取、模型训练、验证和部署后实施。该方法系统地集成了核心原则，如人口代表性、严格的研究设计、偏见表征和因果推理，以识别和减轻对齐风险。对于每个阶段，我们定义具体的校准失败，从有缺陷的问题制定到上市后性能下降，并提出可操作的、基于证据的解决方案。通过在整个人工智能生命周期中嵌入流行病学严密性，该框架为研究人员、开发人员和政策制定者提供了一个结构化的、主动的途径，以创建值得信赖、安全和公平的人工智能系统。这种系统方法对于利用人工智能对人口健康的变革性益处，同时防止不平等和伤害的持续存在至关重要。

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引用次数: 0

Vaginal microbiome structure in pregnancy and host factors predict preterm birth: Results from the ECHO Cohort 妊娠期阴道微生物群结构和宿主因素预测早产：来自ECHO队列的结果。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-19 DOI: 10.1016/j.annepidem.2025.11.003

Kimberly S. McKee PhD, MPH , Christine M. Bassis PhD , Jonathan Golob MD , Beatrice Palazzolo MSc , Sarah S. Comstock PhD , Christian Rosas-Salazar MD, MPH , Joseph B. Stanford MD , Sen Ananda PhD , Thomas O’Connor PhD , James E. Gern MD , Nigel Paneth MD, MPH , Anne L. Dunlop MD, MPH , for the ECHO Cohort Consortium

Purpose

The vaginal microbiome is dynamic, typically shifting during pregnancy toward enrichment of Lactobacillus. However, proliferation of Lactobacillus may be absent among women with preterm births (PTBs). We sought to identify robust vaginal microbiota signatures along with host factors that predicted PTB across diverse U.S. cohorts.

Methods

We meta-analyzed 16S rRNA gene amplicon sequence data from the Environmental influences on Child Health Outcomes Cohort. We classified community state types (CSTs) and employed penalized logistic regression models to assess the association between vaginal CST and PTB. We generated supervised random forest models and validated them using a train-and-test approach to identify the most predictive vaginal taxa and host factors.

Results

Of 683 births, 12 % were preterm. Overall, 26 % had a non- L. iners Lactobacillus-dominant CST (I, II, V), 43 % had a L. iners-dominant CST (III), and 30 % had a diverse, non-Lactobacillus-dominant (IV-B, IV-C) CST. Vaginal CST was strongly associated with PTB (adjusted odds ratio [aOR], 3.86, 95 % confidence interval [CI], 1.57–11.3 for diverse, non-Lactobacillus-dominant communities and aOR, 3.03, 95 % CI, 1.25–8.78 for L. iners-dominant compared to L. crispatus-dominant communities). The model with the highest area under the curve (AUC=.77) included Gardnerella vaginalis, age, Prevotella timonensis, and L. crispatus.

Conclusions

Along with host factors, vaginal microbiota could be used for predictive risk scoring for PTB across different U.S. cohorts.

目的：阴道微生物群是动态的，通常在怀孕期间向乳酸杆菌的富集转移。然而，乳酸菌的增殖可能不存在于早产妇女中。我们试图识别强大的阴道微生物群特征，以及在美国不同人群中预测PTB的宿主因素。方法：我们荟萃分析了来自环境对儿童健康结局影响队列的16S rRNA基因扩增子序列数据。我们对社区状态类型（CST）进行分类，并采用惩罚逻辑回归模型来评估阴道CST与PTB之间的关系。我们生成了有监督的随机森林模型，并使用训练和测试方法验证了它们，以确定最具预测性的阴道分类群和宿主因素。结果：683例新生儿中，早产率为12%。总体而言，26%为非乳杆菌显性CST (I， II， V)， 43%为乳杆菌显性CST (III)， 30%为多种非乳杆菌显性（IV-B, IV-C） CST。阴道CST与PTB密切相关（各种非乳酸菌优势群落的调整优势比[aOR]为3.86,95%可信区间[CI]为1.57-11.3，而乳酸菌优势群落的调整优势比[aOR]为3.03,95% CI为1.25-8.78）。曲线下面积最高（AUC=.77）的模型包括阴道加德纳菌、年龄、铁皮普雷沃菌和crispatus。结论：与宿主因素一起，阴道微生物群可用于美国不同队列中PTB的预测风险评分。

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引用次数: 0

Piloting the novel Evidence Synthesis Equity Companion (ESEC) tool 试点新的证据综合公平配套工具。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-13 DOI: 10.1016/j.annepidem.2025.11.002

Maria Benkhalti, Talia Salzman, Prinon Rahman, Ayan Hashi, Laura Boland, Mallory Drysdale

Introduction

The need for greater evidence on equity-denied population groups continues to be recognized across public health, epidemiology, and community medicine. Despite a number of existing frameworks and tools on the inclusion of equity considerations in evidence syntheses, there was a gap in tools providing step-wise guidance and facilitating the documentation of the process.

Methods

We adapted the Equity Checklist for Health Technology Assessment (ECHTA) to the more specific steps of an evidence synthesis. We complemented the guidance provided from seminal resources with articles from a comprehensive literature search and input from expert methodologists. We piloted the tool with a rapid review on substance-related mortality across racialized and ethic groups. We reported on the methodological changes following the use of the tool and the limitations we have observed.

Results

The Evidence Synthesis Equity Companion (ESEC) tool provides guidance and structure to considering equity and the methods to use at each step of an evidence synthesis. It allows review authors to transparently document their process and explicitly highlight its limitations. During the pilot, using the ESEC tool resulted in enhanced approaches to answer the equity-focused review question. Certain limitations remain with the tools, notably a more thorough guidance development for incorporating equity in the knowledge translation process.

Conclusion

The ESEC tool provides structured guidance, supporting the incorporation of equity considerations throughout the evidence synthesis process. The pilot demonstrated its benefits both for the methods used and the evidence uncovered. Additionally, the process was valuable to the review team. Using the tool in different types of evidence syntheses will allow for greater insight into its value-added.

在公共卫生、流行病学和社区医学领域，需要更多关于被剥夺公平的人群的证据。尽管有一些关于将公平考虑因素纳入证据综合的现有框架和工具，但在提供分步指导和促进记录这一进程的工具方面存在差距。方法：我们将卫生技术评估公平检查表（ECHTA）调整为证据综合的更具体步骤。我们用综合文献检索的文章和专家方法学家的输入补充了开创性资源提供的指导。我们对该工具进行了试点，对不同种族和族裔群体的药物相关死亡率进行了快速审查。我们报告了使用该工具后方法的变化以及我们观察到的局限性。结果：证据合成公平伴侣（ESEC）工具为在证据合成的每个步骤中考虑公平和使用的方法提供了指导和结构。它允许评审作者透明地记录他们的过程，并明确地强调其局限性。在试点期间，使用ESEC工具改进了回答以股权为重点的审查问题的方法。这些工具仍然存在一定的局限性，特别是在知识转化过程中纳入公平的更彻底的指导发展。结论：ESEC工具提供了结构化的指导，支持在整个证据合成过程中纳入公平考虑。该试点项目展示了其所使用的方法和发现的证据的好处。此外，该过程对评审团队是有价值的。在不同类型的证据合成中使用该工具将有助于更深入地了解其价值。

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引用次数: 0

Capturing the implications of residential segregation for the dynamics of infectious disease transmission 捕捉居住隔离对传染病传播动力学的影响。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-12 DOI: 10.1016/j.annepidem.2025.11.001

Jon Zelner , Danielle Stone , Marisa C. Eisenberg , Andrew F. Brouwer , Krzysztof Sakrejda

Purpose

Residential segregation is linked to racial and socioeconomic inequity in outcomes for numerous infections including SARS-CoV-2, influenza, STIs, and tuberculosis. Despite the importance of segregation as a driver of infection inequity, there are few mathematical models to inform our understanding of these dynamics.

Methods

We developed a transmission model including mechanistic relationships between residential segregation and infection inequity. We conceptualize segregation as a fundamental social cause of infection inequity that jointly impacts contact patterns and vulnerability to infection.

Results

We show that the basic reproduction number,

R_{0}

, and equilibrium prevalence are sensitive to interactions between these factors. Our results show that separation alone is insufficient to explain segregation-associated differences in infection risks. Increasing separation only results in concentration of risk in segregated populations when accompanied by increasing vulnerability.

Conclusions

This work shows why it is important to consider causal linkages between high-level social determinants - like segregation - and more-proximal transmission mechanisms when crafting and evaluating public health policies. While the framework in this analysis is stylized, it lays the groundwork for data-driven explorations of the mechanistic impact of residential segregation on infection inequities.

目的：居住隔离与包括SARS-CoV-2、流感、性传播感染和结核病在内的许多感染的结果中的种族和社会经济不平等有关。尽管隔离作为感染不平等的驱动因素很重要，但很少有数学模型可以告诉我们对这些动态的理解。方法：我们建立了一个传播模型，包括居住隔离和感染不平等之间的机制关系。我们将隔离概念化为感染不平等的根本社会原因，它共同影响接触模式和感染脆弱性。结果：基本繁殖数、R0和平衡流行率对这些因素的相互作用较为敏感。我们的研究结果表明，分离本身不足以解释分离相关的感染风险差异。隔离的增加只会导致风险集中在隔离的人群中，同时也会增加脆弱性。结论：这项工作表明，在制定和评估公共卫生政策时，考虑高水平社会决定因素（如隔离）与更近距离传播机制之间的因果关系是很重要的。虽然本分析的框架是程式化的，但它为数据驱动的探索居住隔离对感染不平等的机制影响奠定了基础。

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引用次数: 0

Planning for the sustainability of a youth suicide prevention program in Native American contexts: A modeling study 美国原住民背景下青少年自杀预防计划的可持续性规划：一项模型研究。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-10 DOI: 10.1016/j.annepidem.2025.10.020

Lauren Yan , Zhixi Chen , Novalene Goklish , Kristin Mitchell , Charity Watchman , Meredith Stifter , Victoria O’Keefe , Allison Barlow , Mary Cwik , Takeru Igusa , Emily E. Haroz

Purpose

We aimed to identify actionable, effective sustainment strategies for a community-based suicide prevention program implemented in Tribal contexts through a participatory process of system dynamics modeling.

Methods

Through a series of workshops with teams implementing a suicide prevention program, we prioritized strategies for sustaining implementation and related health outcomes. We used system dynamics modeling and microsimulations to assess the impact of key strategies (increased funding, enhanced program management, and leadership development) on program sustainment outcomes and suicidal behavior among youth.

Results

Enhanced program management impacted sustainment by increasing simulated levels of community trust by 31 % and community and external collaborators by 10 %. Increased funding increased simulated resource availability by 46 % and staffing levels by 13 % over the simulated time frame. Among the three simulated sustainment strategies, enhanced program management most improved clinical outcomes, decreasing non-suicidal self-injury by 1.4 % and suicide attempts by 1.3 %.

Conclusions

We collaboratively developed a simulation model that assessed the relative impact of stakeholders’ prioritized sustainment strategies. A multifaceted intervention for enhanced program management had the greatest impact on program sustainment outcomes. This approach can benefit Tribal communities who are considering methods to support vital community-based programs.

Keywords

System dynamics; Microsimulation; Community-based participatory research; Native American; Suicide prevention; Surveillance; Sustainability

List of abbreviations and acronyms

AI/AN, American Indian and Alaska Native; WMAT, White Mountain Apache Tribe; JHCIH, Johns Hopkins Center for Indigenous Health; C-CASA, Columbia Classification Algorithm for Suicide Assessment; GLS, Garrett Lee Smith Memorial Act; CDC, Centers for Disease Control and Prevention; NHS, National Health Service; SBIRT, Screening, Brief Intervention, Referral to Treatment; PHPCS, Public Health Program Capacity for Sustainability; PSAT, Program Sustainability Assessment Tool; SD, system dynamics; IHS, Indian Health Service

目的：我们旨在通过系统动力学建模的参与性过程，为在部落背景下实施的社区自杀预防计划确定可操作的、有效的维持策略。方法：通过与实施自杀预防计划的团队进行一系列研讨会，我们确定了维持实施和相关健康结果的优先策略。我们使用系统动力学建模和微观模拟来评估关键策略（增加资金、加强项目管理和领导力发展）对项目维持结果和青少年自杀行为的影响。结果：增强的项目管理通过将模拟社区信任水平提高31.9%和伙伴关系提高10.3%来影响可持续发展。在模拟时间框架内，增加的资金使模拟资源可用性提高了51.2%，人员配备水平提高了12.8%。在三种模拟维持策略中，强化项目管理最有效地减轻了临床结果，自杀意念减少0.7%，自我伤害减少1.4%，自杀企图减少1.1%。结论：我们合作开发了一个模拟模型来评估利益相关者优先维持策略的相对影响。加强项目管理的多方面干预对项目维持结果的影响最大。这种方法可以使部落社区受益，考虑如何支持重要的社区项目。关键词（网格）：系统动力学；微观分析;基于社区的参与性研究；印第安人;预防自杀;监测;可持续性缩略语和首字母缩略词列表：AI/AN，美洲印第安人和阿拉斯加原住民；D&I，传播和实施；公共卫生方案可持续性能力；PSAT，项目可持续性评估工具；HIS，印第安人健康服务。

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引用次数: 0

COMBINE EBIs: A novel COllaborative Method for Building INterventions from Existing Evidence-Based Interventions 结合ebi：一种基于现有证据的干预措施构建干预措施的新型协作方法。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-06 DOI: 10.1016/j.annepidem.2025.10.018

Justin Knox , Kara Portier , Christopher Magana , Maggie Denning , Christopher M. Ferraris , Emily Dove-Medows , Cho-Hee Shrader , Ohemaa Poku , Phil Kreniske , Robert Remien , Efrat Aharonovich , Jennifer C. Elliott , Denis Nash , Kathryn Lancaster , Till Baernighausen , Kayo Fujimoto , Adam Carrico , John A. Schneider , Alida Bouris , D. Scott Batey , Stefan D. Baral

Purpose

Combining evidence-based interventions (EBIs) is a discrete process from adapting EBIs, and specific guidance for how to combine EBIs could be helpful amidst the proliferation of frameworks that combine and stage EBIs and calls for services to be combined or bundled. To address this gap, we developed and applied the COllaborative Method for Building INterventions from Existing Evidence-Based Interventions (COMBINE-EBIs) approach, a five-step process for combining EBIs.

Methods

The five steps of COMBINE-EBIs are: (1) Identify and Select EBIs, (2) Develop a Shared Conceptual Model, (3) Evaluate the Conceptual Model, (4) Create a Single Combined Protocol, and (5) Refine through Further Input.

Results

We developed and applied the 5-step COMBINE-EBIs process to build a fully refined, pre-tested, combined multi-component intervention that leverages intrinsic social network support and mHealth technology to support people with HIV who drink heavily improve HIV care outcomes and reduce alcohol use.

Conclusions

COMBINE-EBIs is a rigorous, systematic and efficient approach for building multi-component, multi-modal interventions to address multiple, co-occurring health behaviors simultaneously. COMBINE-EBIs is a resource efficient approach that could facilitate the creation of additional multi-component interventions to address complex, co-occurring health conditions synergistically. Future research should evaluate the feasibility and utility of COMBINE-EBIs, including where adaptations are needed to maximize utility.

目的：结合循证干预措施（ebi）是适应ebi的一个离散过程，对于如何结合ebi的具体指导可能有助于结合和分级ebi的框架的扩散，以及对服务进行组合或捆绑的呼吁。为了解决这一差距，我们开发并应用了基于现有证据的干预措施构建干预措施的协作方法（combined -EBIs）方法，这是一个结合ebi的五步过程。方法：组合ebi的五个步骤是：(1)识别和选择ebi，(2)开发共享概念模型，(3)评估概念模型，(4)创建单个组合协议，(5)通过进一步输入进行改进。结果：我们开发并应用了5步联合ebi流程，以建立一个完全完善的、预先测试的、组合的多成分干预，利用内在的社会网络支持和移动健康技术来支持大量饮酒的艾滋病毒感染者，改善艾滋病毒护理结果并减少酒精使用。结论：联合ebi是一种严谨、系统和有效的方法，可构建多组分、多模式的干预措施，同时解决多种共同发生的健康行为。联合ebi是一种资源效率高的方法，可以促进创建额外的多成分干预措施，以协同解决复杂的、同时发生的健康状况。未来的研究应评估联合ebi的可行性和效用，包括需要在哪些方面进行调整以使效用最大化。

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引用次数: 0

Impact of school-based infection prevention strategies on household COVID-19 and respiratory disease outcomes: A cross-sectional study 基于学校的感染预防策略对家庭COVID-19和呼吸道疾病结局的影响：一项横断面研究

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-04 DOI: 10.1016/j.annepidem.2025.10.019

Sanjana Pampati , Elizabeth A. Stuart , Justin Lessler , Kirsten E. Wiens , Lance A. Waller , Benjamin Lopman , Jodie L. Guest , M. Kate Grabowski , Jeb Jones

Purpose

Schools used a wide range of infection prevention strategies during 2022 when there were surges of the Omicron variant of SARS-CoV-2, respiratory syncytial virus, and influenza. We examined data from the Spring semester of the 2021/2022 school year in the United States to describe use of school-based infection prevention strategies, factors associated with implementation, and associations with COVID-19 and respiratory disease related outcomes.

Methods

We analyzed data from January-June 2022 from the COVID-19 Trends and Impact Survey, a daily, cross-sectional survey on Facebook to examine associations between 11 school-based infection prevention strategies and 5 household COVID-19 and respiratory disease related outcomes (e.g., positive COVID-19 test, COVID-19 like illness). Analyses were restricted to parents with a child < 18 years old who was attending school in-person (n = 228,624). Multivariable, quasibinomial regression models were fit, adjusting for child-, household-, county-level covariates and state.

Results

Universal mask requirements were associated with decreased odds and having no school-based extracurriculars with increased odds of all examined outcomes. Additional prevention strategies were associated with reduced odds of specific outcomes: modified cafeteria use, regular testing of teachers and staff, ventilation improvements, and restricted entry.

Conclusions

Findings affirm the protective effect of universal mask requirements in school settings. No school based extracurriculars being associated with increased odds of examined outcomes may be a result of reverse causation bias. State and local health departments and education agencies can provide technical assistance to schools to ensure appropriate adoption of strategies based on each school’s unique circumstances.

目的：在2022年SARS-CoV-2、呼吸道合胞病毒和流感的欧米克隆变体激增期间，学校采用了广泛的感染预防策略。我们检查了美国2021/2022学年春季学期的数据，以描述基于学校的感染预防策略的使用情况、与实施相关的因素以及与COVID-19和呼吸系统疾病相关结果的关联。方法：我们分析了2022年1月至6月来自COVID-19趋势和影响调查的数据，该调查是Facebook上的一项每日横断面调查，旨在研究11种基于学校的感染预防策略与5种家庭COVID-19和呼吸道疾病相关结果（例如COVID-19检测阳性，COVID-19样疾病）之间的关系。分析仅限于有孩子的父母。结果：普遍的口罩要求与降低的几率有关，没有学校课外活动与所有检查结果的几率增加有关。额外的预防策略与特定结果的几率降低有关：改变自助餐厅的使用，对教师和工作人员进行定期测试，改善通风，限制进入。结论：研究结果肯定了在学校环境中普遍要求口罩的保护作用。没有基于学校的课外活动与测试结果增加的几率相关可能是反向因果偏差的结果。州和地方卫生部门及教育机构可向学校提供技术援助，以确保根据每所学校的独特情况适当采用战略。

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引用次数: 0

Trends and cyclical patterns of dengue disease in Mexico: A 40-year time series analysis 墨西哥登革热的趋势和周期性模式：40年时间序列分析。

IF 3 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Annals of Epidemiology

Pub Date : 2025-11-02 DOI: 10.1016/j.annepidem.2025.10.022

Jaime Briseno-Ramirez , Judith Carolina De Arcos-Jiménez , Ana María López-Yáñez , Roberto Miguel Damián-Negrete , Patricia Noemi Vargas-Becerra , Laura Karina Salas-Salazar , Berenice Martínez-Melendres , Ismael Caballero-Quirarte , Pedro Martínez-Ayala

Purpose

To quantify long-term trends and multi-year cycles in dengue in Mexico (1985–2025) and examine recent serotype–severity patterns.

Methods

We integrated open national surveillance data from the Morbidity Yearbook (1985–2024) and Open Data (2020–2025) using the official estimated-cases definition. Monthly series underwent STL decomposition, Butterworth filtering, periodogram, and autocorrelation analyses. Stationarity was assessed in prespecified windows (1985–2000; 2000–2015; 2015–2025) and by geography (coastal/high-burden vs inland). Serotype distribution and hospitalizations (2020–2025) were summarized among laboratory-confirmed cases and compared across years with χ² tests.

Results

Over 40 years we identified 1715,456 estimated cases; annual burden increased (Mann–Kendall z = 3.25; Sen’s slope ≈ +1275 cases/year). A recurrent multi-year oscillation overlaid the seasonal cycle, with a spectral peak near 5.8 years and an ACF secondary maximum at ∼4.3 years; the signal persisted in coastal/high-burden states and across historical windows. Since 2023, DENV-3 predominated (86 % in 2024; 94.9 % by May-2025) and coincided with higher hospitalization proportions.

Conclusions

Dengue in Mexico shows a significant long-term rise and a reproducible ∼5-year cycle. Cycle-aware baselines, paired with serotype surveillance, could sharpen early-warning thresholds and targeting of vector control.

目的：量化墨西哥登革热（1985-2025）的长期趋势和多年周期，并检查最近的血清型严重程度模式。方法：我们使用官方估计病例定义整合了来自发病率年鉴（1985-2024）和开放数据（2020-2025）的开放国家监测数据。每月序列进行STL分解、巴特沃斯滤波、周期图和自相关分析。在预先指定的窗口（1985-2000年；2000-2015年；2015-2025年）和地理（沿海/高负担vs内陆）评估平稳性。总结实验室确诊病例的血清型分布和住院情况（2020-2025年），并用χ 2检验比较各年之间的差异。结果：40多年来，我们确定了1,715,456例估计病例；年负担增加（Mann-Kendall z=3.25; Sen’s斜率≈+1275例/年）。多年振荡复盖在季节周期上，光谱峰值在5.8 A左右，ACF二次最大值在4.3 A左右；该信号在沿海/高负担州持续存在，并跨越历史窗口。自2023年以来，DENV-3占主导地位（2024年为86%，到2025年5月为94.9%），同时住院率较高。结论：登革热在墨西哥呈现显著的长期上升趋势和可重复的5年周期。周期意识基线与血清型监测相结合，可提高早期预警阈值和媒介控制的目标。

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引用次数: 0