Frontiers in epidemiology最新文献

Background: Despite advances in treatment, mortality in patients with chronic limb-threatening ischemia (CLTI) is high. The aim of our study was to evaluate 5-year all-cause mortality and factors associated with it in endovascularly treated (EVT) patients with foot ischemic ulcers.

Methods: We reviewed all patients who had undergone EVT for lower extremity peripheral artery disease between January 2016 and December 2018. Adjustments in multivariate analyses were performed for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, postprocedural ipsilateral amputation, ipsilateral reintervention, number of endovascularly treated regions, fibrinogen and creatinine.

Results: Four hundred and fifty-one patients (155 women, 296 men) with a mean age of 70.4 ± 9.60 years were included in the analysis. The 5-year all-cause mortality was 60.5%. In multivariate analysis mortality risk was higher in women (HR 1.42; 95% CI 1.09-1.86; p = 0.010), and after EVT in two or more anatomical regions (HR 1.37; 95% CI 1.05-1.79; p = 0.022). The mortality risk was positively associated with creatinine (HR 1.003; 95% CI 1.002-1.004; p < 0.001), and fibrinogen (HR 1.19; 95% CI 1.11-1.29; p < 0.001). Ipsilateral reintervention (HR 0.67; 95%CI 0.47-0.94; p = 0.021) and ipsilateral amputation after EVT (HR 0.71; 95% CI 0.51-0.98; p = 0.037) were associated with lower all-cause mortality risk.

Conclusions: Female sex, treatment in two or more anatomical regions, creatinine and fibrinogen were associated with higher 5-year mortality risk. Lower 5-year all-cause mortality risk was observed in patients with ipsilateral reintervention and ipsilateral amputation after EVT.

This perspective piece explores the potential to implement wastewater surveillance on military vessels to improve disease monitoring and prevention. We examine five key topics: (1) recent studies of wastewater surveillance on military bases and training centers; (2) best practices for confined populations (e.g., colleges, prisons, hospitals, and low-income and middle-income countries) and their transferability to military settings; (3) current technologies enabling deployed personnel to conduct wastewater surveillance without advanced microbiological training; (4) key questions the military should address to prevent future outbreaks on vessels; and (5) unique ethical considerations surrounding implementation. This work aims to inform military decision-makers considering the adoption of wastewater surveillance programs.

Background: Parotitis is an inflammation of the parotid glands. It can be acute or chronic based on etiological factors such as bacterial and viral infections, autoimmune and metabolic disorders. The prevalence and characteristics of parotitis among the Saudi population are unknown. Therefore, this study aimed to explore the frequency, demographic patterns, and temporal trends of parotitis in Saudi Arabia.

Methodology: This was a multicenter, retrospective cohort study using electronic health record data from five tertiary medical centers (Riyadh, Jeddah, Dammam, Madinah, and Taif) of the Ministry of National Guard Health Affairs (NGHA) between 2015 and 2023. Data from clinically diagnosed patients with parotitis were collected, including demographics, patient type, body mass index (BMI), and region. Statistical analysis was conducted using R (version 4.3.2). Categorical variables were expressed as counts (%) and continuous variables as mean (SD) or median (IQR), as appropriate. Several statistical tests were performed, including annual counts and proportions for temporal trends, and join-point regression to estimate data-driven change points. Statistical significance was estimated at a P-value of less than 0.05.

Results: A total of 1,340 cases of parotitis were recorded between March 2015 and March 2023. The average age at diagnosis was 27.2 years. Males accounted for 54.6% of this cohort, 36.67% of the patients were underweight, and 19.2% were obese. Additionally, 49% of the cases were inpatients, and the majority (66.1%) resided in Riyadh. Within the designated timeframe (2015-2023), no significant changes in parotitis occurrence were observed, especially during the COVID-19 pandemic, with a higher frequency among patients aged 1-20 years.

Conclusion: This exploratory study characterized parotitis cases among Saudi patients. The high frequency of parotitis diagnosis among children and adolescents compared to adults, along with other demographic characteristics, highlights the need to understand the underlying factors that could improve clinical awareness, documentation, and prevention strategies.

Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans. There are many known reservoirs of C. burnetii, including cattle, sheep, and goats with an expanding list of potential reservoirs including birds, reptiles, ticks and additional mammalian species, such as swine. Feral swine are a highly invasive species in the United States with significant populations and a broad geographic distribution. The role of feral swine in the transmission and spread of C. burnetii is poorly understood, although a recent report identified overlap between feral swine seroprevalence and human Q fever incidence in Texas. California accounts for a large proportion of human Q fever cases in the United States and in this study we characterized the seroprevalence of C. burnetii in feral swine populations in the state. Feral swine showed seropositivity rates up to 1.64% indicating some level of exposure and the possibility that they may serve as a reservoir for disease transmission and spread. Overlap with human Q fever incidence was identified in the central region of California. Although this study does not directly link feral swine to human infection, it identified spatial overlap between feral swine seroprevalence and human Q fever incidence in the state of California, possibly due to the presence of ruminants as the principal reservoirs of C. burnetii. The environmental stability and low infectious dose of C. burnetii, coupled with the geographic overlap between feral swine seroprevalence and human Q fever incidence suggests that feral swine may contribute to zoonotic disease transmission and spread.

Recently, it has been shown that the transition rates of the illness-death model (IDM) for chronic conditions are related to the age-specific prevalence by a partial differential equation (PDE). Given mortality, the PDE could be used to estimate incidence rates from cross-sectional data. The aim of this article is to extend the IDM and introduce a novel method to estimate the age-specific incidence rate together with the two mortality rates from aggregated current status (ACS) data. By ACS data we mean counts of people in the four states of the extended IDM at different points in time. ACS data stem from epidemiological studies where only current disease status and vital status data need to be collected without following-up people (as, for example, in cohort studies). To demonstrate feasibility of the method, we use a simulation study from the context of diabetes in Germany. Two estimation methods are introduced, a least squares estimator and a maximum likelihood estimator. We find a good agreement between the estimates and the input parameters used to set up the simulation.

Background: In the United States, cardiovascular disease (CVD) disproportionately affects communities facing adverse social determinants of health (SDOH). Community Health Workers (CHWs) can bridge gaps in trust, navigation, and culturally tailored education.

Methods: We conducted a U.S.-focused narrative review (2015-2025) of PubMed, Scopus, and Google Scholar, prioritizing empirical evaluations of CHW-led CVD interventions, training models, integration strategies, and financing mechanisms. International CHW programs were used only to extract practices transferable to U.S. delivery and payment contexts.

Results: Multidisciplinary team-based care demonstrates that engaging CHWs in US regions improves blood pressure control and medication adherence. Economic evaluations increasingly support CHW models for CVD prevention and control. Effective programs specify CHW task bundles (e.g., self-measured BP onboarding, adherence coaching, care navigation, SDOH linkage) and align training with national core competencies. Integration pathways include clinic-embedded, payer-based, public health, and community-based partnerships. U.S. reimbursement options are emerging through Medicare Community Health Integration/Principal Illness Navigation and state Medicaid mechanisms. Faith-based collaborations can extend reach when coupled with standardized training and simple outcome tracking.

Conclusions: For U.S. health systems and payers, immediate priorities are (1) competency-based CHW training with cardiac modules, (2) sustainable reimbursement tied to cardiovascular quality metrics, and (3) a minimal outcome set to demonstrate value. Global best practices should be adapted to the U.S. scope-of-practice, supervision, and documentation requirements to scale equitable CVD care.

Background: The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) trains skilled field epidemiologists to strengthen surveillance systems and respond to public health threats. This assessment aimed to evaluate GFELTP's achievements, identify gaps in training and service delivery, and provide recommendations for improvement.

Methods: A convergent mixed-methods evaluation was used, combining a self-administered questionnaire, program record reviews (graduation rates, surveillance outputs, publications), and three Focus Group Discussions (FGDs) involving staff, alumni, mentors, and residents. Thematic content analysis and triangulation with quantitative data were conducted to assess achievements and training gaps from 2007 to 2024.

Results: Twenty-four participants (4 staff, 5 alumni, 5 mentors, and 10 residents) were interviewed. GFELTP operates as a regional program, training individuals from seven African countries. From October 2007 to March 2024, it enrolled 17 cohorts, producing 192 graduates and training 35 current residents. Of the graduates, 72% (139/192) were Ghanaians. Most graduates (89%) came from the human health sector, with 8% from the animal health sector and 3% from environmental health. Residents and graduates conducted over 200 outbreak investigations and evaluated more than 300 surveillance systems. They also delivered over 350 scientific presentations locally and internationally. FGDs revealed several challenges: limited mentorship funding, low program visibility, inadequate digital capacity for modern public health practices, and limited funding for resident exchange programs.

Conclusions: GFELTP has made substantial contributions to public health capacity-building in Ghana and West Africa, through training, outbreak response, and scientific engagement. Key strengths include its regional reach, robust alumni network, One Health integration, and strategic collaborations. However, challenges remain in mentorship support, online visibility, and funding for resident development opportunities. Addressing these gaps through sustained mentorship, improved stakeholder engagement, and enhanced resource mobilization will further strengthen the program's impact and long-term sustainability in building a resilient public health workforce.

Background: Urolithiasis significantly affects global health, contributing to substantial morbidity, healthcare costs, and reduced quality of life. Understanding temporal changes in the incidence, prevalence, mortality, and age-standardized disability-adjusted life year rates (ASDR) associated with urolithiasis is crucial for public health planning. However, few studies have systematically compared national and global trends, particularly in countries undergoing rapid healthcare transformation, such as China.

Methods: Using data from the Global Burden of Disease database from 1990 to 2021, we assessed the age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and ASDR associated with urolithiasis in China and globally. Joinpoint regression was used to identify trend changes, and sex-specific subgroup analyses were performed.

Results: From 1990 to 2021, China showed substantial declines in all burden metrics: ASIR (-1.99%), ASPR (-1.99%), ASMR (-3.83%), and ASDR (-3.27%). Global declines were more modest: ASIR (-0.81%), ASPR (-0.81%), ASMR (-1.20%), and ASDR (-1.05%). Males consistently bore a higher burden.

Conclusions: The burden of urolithiasis has declined markedly from 1990 to 2021, with China showing greater improvements than the global average. This divergence suggests that systemic health reforms and expanded coverage may have contributed to the observed trends. Comparative findings imply that promoting equitable access to prevention and early intervention could be beneficial, particularly in resource-limited settings.

Syphilis, caused by the bacterium Treponema pallidum, is among the most prevalent STIs globally and represents a significant public health challenge in Brazil. Vertical transmission can occur at any stage of pregnancy, leading to severe consequences such as miscarriage, stillbirth, preterm birth, and low birth weight. In severe cases, congenital syphilis may result, potentially causing deformities, neurological damage, or even neonatal death. Maternal syphilis (MS) occurrence is often influenced by social inequalities, meager income, and educational levels, which present further public health challenges. We evaluated the incidence of maternal syphilis in the Administrative Regions of the Federal District (FD), Brazil, from 2019 to 2023, highlighting the distribution of notified cases regarding the sociodemographic profile of affected pregnant women. We utilized data from the Info Saúde DF portal (https://info.saude.df.gov.br/sifilissalasit/) and the latest report from the most recent District Household Sample Survey. The cumulative incidence of MS was 25.3 cases per 1,000 live births. Simple linear regression analysis was used to assess the association between MS incidence and sociodemographic characteristics. A moderate negative correlation was observed (r = -0.4038), indicating that higher education levels are associated with a lower incidence of MS. Lower-income populations living in the FD, Brazil, face a heightened risk of maternal syphilis, possibly due to a combination of economic and social factors, suggesting that public health policies aimed at controlling the disease should prioritize this population.