Frontiers in epidemiology最新文献

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.

Chronic inflammatory diseases such as autoimmune disorders, cancer, cardiovascular diseases and neurodegenerative disorders are a significant cause of morbidity and mortality in the industrialized world. Socioeconomically disadvantaged communities bear a disproportionately high burden of these inflammatory diseases. This review synthesizes evidence linking various domains of the Social Determinants of Health (SDoH)-economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context-to inflammatory pathways and mechanisms. Across domains, biological mechanisms such as cytokine dysregulation, toll-like receptor (TLR) activation, hypothalamic-pituitary-adrenal (HPA) axis alterations and gut microbiome disruption act together to sustain proinflammatory states that drive adverse health outcomes in marginalized communities. Although causality is obscured by interrelated determinants, identifying inflammation as a shared pathway between various determinants highlights the need for structural interventions to reduce chronic disease burden.

Introduction: Synedmic geographic analysis is new epidemiological tool used to implement crucial effective intervention to combat integrated diseases. This study aims to determine spatial patterns and geographic profiling of three concurrent diseases including TB/CPVID-19, HIV/HCV, and Mortality/Morbidity in Libya during the Libyan armed conflict.

Methods: Geographic thematic mapping and spatiotemporal analysis were used to examine the syndemic geographic profiling of three integrated diseases including COVID-19 and TB, HCV/HIV, and Mortality and Morbidity during the Libyan armed conflict. The total number of notified TB and the cumulative number of COVID-19 cases, HIV and HCV cases, and Mortality and morbidity cases during the conflict period were reported. Such data were obtained at individual and geographic levels from each district involved in the armed conflict then analyzed and classified according to location, timing, and intensity of the Libyan armed conflict.

Results: High co-occurrence of TB and COVID-19 was evident. The southern region (i.e., Sebha), Tripoli, and Benghazi consistently portrayed higher incorporation patterns of the two intertwined infections. Conversely, the western mountain region and the Southeast region exhibited a lower concordance during the pandemic period. The co-occurrence of HIV and HCV infections was clear all over the country. The highest condensation of the concomitant is in the Western region, particularly the western mountains, Zawia followed by Jufra and Ghat. Followed by the Eastern region, particularly Deana and Benghazi. This was less tense in the Southern and Med region municipalities. Mortality and morbidity show a visible syndemic geographic pattern. The highest density of these two concomitant patterns was Benghazi, Derna and, Ajdabia in the Eastern region and Sirt, Musrta, Baniwaled in the Western region and to a lesser extent in Zawia and Shati.This study highlights the need syndemic geographic patterns of integrated diseases to focus on wellbeing beyond standard health parameters. Clear decisions about prioritisation of health care to be provided based the geographic region in need.

Introduction: A high burden of tuberculosis (TB) complicated by occupational risk factors implies a need for the workplace to develop strategies to reduce workplace incidence of TB.

Methods: We conducted a cross-sectional study to establish the knowledge, attitudes, and practices (KAP) related to TB among senior management officials of manufacturing and construction companies associated with exposure to silica dust. The study was conducted in Lusaka and Southern provinces of Zambia between February and October 2022 using a 28-question multiple-choice self-administered electronic questionnaire. Descriptive statistics were used to determine KAP levels. The total score in KAP was calculated based on correct responses out of a maximum of 17, 7, and 14 points, respectively and categorized into "poor" or "good" using the mean/median. Logistic regression was done to explore the association between characteristics and KAP.

Results: Of 118 participants, 48.3% were aged between 31-40 years, 86.4% were male), and 63.6% represented construction companies. The median/mean KAP scores were 8(IQR 6-10), 3.3 (SD 1.66) and 6.00 (IQR 4-8) respectively. Of the participants, only 47.5% (56/118) had good knowledge, 49.2% (58/118) had good attitudes, and 47.5% (56/118) had good practice scores. Individuals aged over 50 years old, female, and officials from construction companies had higher odds of good knowledge (aOR = 7.8, p = 0.027; aOR = 4.70, p = 0.016 and aOR = 3.45, p = 0.008 respectively) and good attitude (aOR = 14.64, p = 0.021; aOR = 6.51, p = 0.006 and aOR = 3.90, p = 0.006 respectively) Participants working in construction companies had higher odds of good practice (aOR = 2.26, p = 0.048).

Discussion: Senior management officials had gaps in knowledge despite having favorable attitudes and practices. Companies must be educated on TB alongside efforts to improve attitudes and practices towards TB in the workplace.

In Germany, a consortium of authority-accredited laboratories (ALM) covered approximately 90% of all severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) tests during the COVID-19 pandemic (March 2020 until January 2023), and they likewise conducted serological mass tests for IgG antibodies until May 2021. We analyzed the ALM-observed week-resolved time courses of test-positive fractions of PCR and IgG tests, by least-squares fitting a simple function of the former to the course of the latter. Specifically, we show that scaling and shifting the cumulative sum of previous PCR-positive fractions effectively reproduces the time course of the IgG-positive fraction. The value of 0.14 found for the fitted scaling parameter means that only 14% of those who were tested PCR-positively actually became infected with SARS-CoV-2. This parameter fit further implies that a quarter of the German population already carried IgG antibodies from natural infections in their blood at the turn of the year from 2020 to 2021. To check this fit using a second, independent analysis, we took from the literature the Germany-specific ratio of 1:10 for the ratio between one positive PCR test and the corresponding number of persons actually infected with SARS-CoV-2, and therewith estimated the time course of the latter within the German population. The courses of all three fractions, i.e., both the observed and the fit-estimated IgG-positives and the fit-estimated infected, matched each other well in the period from early December 2020 to May 2021. The extrapolated courses of both the fit-estimated fractions, i.e., those of the IgG-positives and the infected, align well to perfectly with the IgG-positive fraction (92%) reported by the Robert Koch Institute at the end of 2021.

Background: Colorectal cancer (CRC) is a leading cause of cancer deaths in the United States. While national CRC mortality rates have improved over time, this rate differs between non-Hispanic (nH) Black and nH White populations and by geography.

Methods: The 30 most populous cities in the US were analyzed using national vital statistics data. Numerators were obtained from death certificates of residents of these cities with CRC as the underlying cause of death. US Census data provided population-based denominators. We calculated Black:White rate ratios (RRs) and corresponding confidence intervals for the most recent time period studied (2017-2019) to assess racial inequities. We calculated average annual percent changes to evaluate CRC mortality trends from 2009-2019.

Results: CRC mortality rates statistically significantly decreased nationally and in 25 of the 30 cities. In most cities, nH Black populations experienced a greater decrease in CRC mortality over time than nH White populations. However, in 20 cities, the Black:White CRC mortality rate ratio was greater than 1 (ranging from 1.28 in New York to 2.68 in Washington, D.C.; p < 0.05), indicating persistent racial inequities. Between 2009 and 2019, six cities saw statistically significant decreases in racial inequities, two cities saw increases, and the remaining cities demonstrated persistent disparities.

Conclusions: Despite improvements in CRC mortality, Black:White disparities persist. Structural racism may contribute to these disparities through differential access to care and risk factor exposure. Identifying geographic differences in Black:White CRC mortality may serve as a catalyst for local governments to implement place-based initiatives that reduce screening barriers and contribute to health equity.

Background and objective: American Indian populations face disproportionately high rates of atherosclerotic cardiovascular disease (CVD), yet the potential consequences of mid-life carotid atherosclerosis on brain health and cognition later in life remain poorly understood. This study addresses a critical knowledge gap by evaluating whether subclinical carotid atherosclerosis in midlife is associated with later-life structural brain abnormalities and cognitive performance in a large cohort of American Indian adults from the Strong Heart Study. This is the first investigation to explore these associations in this underserved and understudied population, using longitudinal data with vascular, neuroimaging, and cognitive measures.

Methods: A total of 783 participants (mean age 59.9 years) underwent carotid ultrasonography between 1998 and 1999 to assess intima-media thickness and plaque. Between 2010 and 2013, participants received brain magnetic resonance imaging to assess infarcts, hemorrhages, white matter lesions, and brain atrophy. Cognitive function was also evaluated during this period. Multivariable regression models adjusted for sociodemographic, behavioral, and clinical CVD risk factors were used to assess associations.

Results: Greater intima-media thickness was associated with more severe sulcal widening, and presence and extent of plaque were associated with poorer verbal fluency; both findings remained significant after adjustment for sociodemographic, behavioral, and clinical risk factors. No significant associations were observed between carotid measures and the presence of infarcts, hemorrhages, or white matter lesions.

Conclusion: These findings suggest that subclinical carotid atherosclerosis in midlife may contribute to later-life brain atrophy and cognitive vulnerability, particularly in verbal fluency, among American Indians.