Frontiers in epidemiology最新文献

Background: Urinary tract infections (UTIs) remain one of the most common diseases worldwide that occur both in the community and in healthcare settings. Thus, this study aimed to compare the burden of nosocomial and community-acquired bacterial UTIs among patients attending Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia.

Method: A hospital-based cross-sectional study was conducted using a convenient sampling technique from January 2024 to April 2024. Descriptive statistics were employed, and bivariate and multivariable logistic regression analyses were used to identify associated factors at p < 0.05 with a 95% confidence interval (CI) considered statistically significant.

Results: The rate of hospital-acquired UTIs was 42% (95% CI: 35-50), while the rate of community-acquired UTIs was 28% (95% CI: 22-36). The predominant bacterial isolates were Escherichia coli (37%), Staphylococcus aureus (7.8%), and Klebsiella pneumoniae (7.8%). The overall multidrug resistance rate was 91 (77.8%). Lack of formal education [adjusted odds ratio (AOR), 0.02; 95% CI: 0.001-0.6], surgery during admission (AOR, 0.02; 95% CI: 0.002-0.3), delay in voiding urine (AOR, 0.01; 95% CI: 0.005-0.1), previous UTIs (AOR, 0.04; 95% CI: 0.004-0.4), and previous admission (AOR, 0.07; 95% CI: 0.01-0.5) were the main factors significantly associated with bacterial UTIs.

Conclusions: A significantly higher prevalence of hospital-acquired bacterial UTIs was observed compared to community-acquired bacterial UTIs. The commonest isolates were E.coli, S. aureus, and K. pneumoniae. The drug resistance rate was very high. Modifiable individual-level factors were the major significant factors of UTIs. Thus, health workers and other stakeholders should tackle UTIs by increasing community awareness, promoting personal hygiene, and improving healthcare service quality.

Background: Cholera is a highly contagious bacterial disease that causes severe watery diarrhea. It spreads mainly through contaminated food or water containing Vibrio cholerae O139 and remains a major global public health threat. We investigated an outbreak to identify its cause, source, and risk factors and to develop control measures.

Method: A suspected case was classified as the occurrence of acute watery diarrhea in a Dollo Ado District resident aged 2 or older between February 2, 2023 and March 15, 2023. A confirmed case was a suspected case with Vibrio cholerae detected in the patient's stool sample. An investigation of the outbreak was conducted; cases were described and the environment, where contamination may take place assessed and an unmatched case-control study conducted in Suftu Kebele, which served as the epi center of the outbreak. Logistic regression was used to identify risk factors for cholera infection.

Results: A total of 92 cases were identified, including 66 males and 26 females, with four deaths (4.3% fatality rate). Males had a higher attack rate (2.4 per 1,000 people) than females (1.6 per 1,000 people). Suftu village was the hardest-hit area (attack rate: 41 per 1,000 people). The outbreak began after a person suspected of having cholera returned from mandera, kenya, on February 2, 2023. Five days later, cases emerged in suftu village. Many residents practiced open defecation and used the dawa river for bathing, washing clothes, and drinking. Using untreated river water significantly increased the risk of infection (AOR = 20, 95% CI: 5.2-73).

Conclusion: The outbreak likely started at a funeral of a suspected cholera case, spreading through contaminated river water. It was contained within a week by restricting river water use and preventing further contamination.

Objective: To evaluate the associations between brominated flame retardants (BFRs), including polybrominated diphenyl ethers (PBDEs), exposure and circulating immune markers in a subset of women from the California Teachers Study cohort.

Methods: In this cross-sectional study, serum from 813 female participants in the California Teachers Study collected in 2013-2016 were evaluated for 11 BFR congeners and 16 immune markers. Three BFR congeners [BDE153 [2,2',4,4',5,5'-Hexabromodiphenyl ether], BDE47 [2,2',4,4'-Tetrabromodiphenyl ether], PBB153 [2,2',4,4',5,5'-Hexabromobiphenyl]] had median levels that were above the level of detection and were further evaluated for associations with circulating immune markers. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by a logistic regression model where BFR congeners (in quartiles) were associated with immune markers (dichotomized as above and below the respective median), adjusted for age and total lipids. Sensitivity analyses were also conducted evaluating BFR congeners as a continuous exposure (per pg/ml).

Results: All participants had at least one of the 11 measured BFR congeners detected in their serum. Increasing levels of BDE47 were associated with elevated levels of BAFF (B-cell activating factor; OR_{Quartile 4} = 1.67, 95% CI = 1.11-2.51), soluble CD27 (sCD27, cluster of differentiation 27; OR_{Quartile 4} = 1.69, 95% CI = 1.12-2.55) and IL6 (interleukin 6; OR_{Quartile 4} = 1.74, 95% CI = 1.13-2.66). Increasing levels of PBB153 were associated with elevated levels of CXCL13 (chemokine ligand 13; OR_{Quartile 4} = 1.55, 95% CI = 1.02-2.35) but inversely associated with sCD27 (OR_{Quartile 4} = 0.57, 95% CI = 0.38-0.87). Results from continuous models of BFR were largely consistent. No associations were observed between BDE153 and any of the immune markers assessed.

Conclusions: Two BFR congeners were statistically associated with altered levels of circulating immune markers involved in B cell activation pathways; replication and further evaluation of these novel associations are warranted. If confirmed, our results add to the current literature regarding possible immune mechanisms by which BFR exposures contribute to immune-related health endpoints and conditions where B cell activation is prominent, including autoimmune conditions.

As the global financial, economic, social, environmental, political, technological and health crises deepen and become more complex, funders are increasingly eliciting for programs/research that demonstrate impact. A lot of evaluations often lack the methodological robustness to inform further action by failing to demonstrate the context mechanism and outcome pathways. The landscape is changing. The value of programs/interventions and research is increasingly coming under scrutiny. Impact evaluation is the process of determining to what extent observed changes in the outcome are attributable to the intervention. Figures alone cannot explain why things are that way, and stories alone cannot demonstrate who or how many people benefited and to what extent. Additional methodological tools, such as participatory methods, theories of change, and human centred designs citizen science and the engagement of all key stakeholders, including those previously known as beneficiaries is fundamental. This facilitates a better understanding of the problems while unraveling potential solutions, bearing in mind that any health system intervention can have positive, negative, intended, unintended, direct and indirect consequences. Transdisciplinary, multi and inter-disciplinary approaches and mixed methods therefore become indispensable. To that end we propose an impact evaluation framework with seven central tenets namely; Theory of change (TOC) or program theory, Stakeholder engagement including beneficiaries, Use of mixed method indicators, Baseline of outcome of interest, Midline assessment of outcome of interest, Endline assessment of outcome of interest and Validation/Co-creation.

This paper summarizes several presentations in the Thresholds in Epidemiology and Risk Assessment session at the Monticello III conference. These presentations described evidence regarding thresholds for particles, including asbestos and silica, and cancer (e.g., mesothelioma) and noncancer (e.g., silicosis) endpoints. In the case of exposure to various types of particles and malignancy, it is clear that even though a linear non-threshold model has often been assumed, experimental and theoretical support for thresholds exist (e.g., through particle clearance, repair mechanisms, and various other aspects of the carcinogenic process). For mesothelioma and exposure to elongate mineral particles (EMPs), there remains controversy concerning the epidemiological demonstration of thresholds. However, using data from the Québec mining cohort studies, it was shown that a "practical" threshold exists for chrysotile exposure and mesothelioma. It was also noted that, in such evaluations, measurement error in diagnosis and exposure assessment needs to be incorporated into risk analyses. Researchers were also encouraged to use biobanks that collect specimens and data on mesothelioma to more precisely define cases of mesothelioma and possible variants for cases of all ages, and trends that may help define background rates and distinguish those mesotheliomas related to EMP exposures from those that are not, as well as other factors that support or define thresholds. New statistical approaches have been developed for identifying and quantifying exposure thresholds, an example of which is described for respirable crystalline silica (RCS) exposure and silicosis risk. Finally, the application of Artificial Intelligence (AI) to considering the multiple factors influencing risk and thresholds may prove useful.

Antiretroviral therapy (ART) has tremendously improved the quality of life of people living with HIV (PLWH). Through rigorous scientific research and development, newer, more effective, and less toxic antiretrovirals (ARVs) have been developed and are available to PLWH in high-income countries (HICs). Although Africa accounts for more than two-thirds of the global burden of HIV/AIDS, this large population does not readily have access to these newer and more effective ARVs. In some instances, new ARVs become available to PLWH in Africa over a decade after they have been approved for use by the Food and Drug Authorities (FDAs) in HICs. Since 2010, 35 new drug entities have been approved; of those, only 3 are in common use in Ghana and most of Sub-Saharan Africa. To achieve the 2030 goal of ending HIV/AIDS as a global health epidemic, it is critical to ensure equity in access to newer and effective ARVs across all regions, including Africa, where the majority of PLWH reside. We highlight here the urgent need to make newer ARVs available in Africa to ensure the realization of the Global End AIDS by 2030 goal.

Background: The probability of presenting with infectious mononucleosis (IM) upon primary Epstein-Barr virus infection increases dramatically at the start of puberty. Aiming to understand why that is, we assessed whether the number of infection-related health events during two specific time periods-ages 10-12 years (pre-teen window) and the three most recent years (recent window)-could predict the likelihood of individuals aged 13-19 years developing IM.

Methods: We used sibship-stratified Cox regression to mitigate socio-demographic confounding and bias. Consequently, we only followed members of IM-affected sibships aged 13-19 years between 1999 and 2021 for IM, based on information from complete nationwide Danish administrative and health registers. Estimates were further adjusted for sex, age, birth order (1, 2, 3+) and sibship constellation [number of siblings and their signed (older/younger) age difference to the index person]. Infection-related health events defining the exposures considered were either a category of antimicrobial prescription, or a hospital contact with an infectious disease diagnosis. We measured evidence/probability of the associations using asymptotic Bayes factors, rather than using p-value based testing.

Results: The adjusted hazard ratio (HR) for IM with 95% confidence limits for an additional antimicrobial prescription in the pre-teen exposure window was [1.01; 0.98-1.04], and the corresponding adjusted HR for an additional antimicrobial prescription in the recent exposure window was [1.02; 0.99-1.06].

Conclusions: IM was not preceded by unusual numbers of infections. Small effect sizes, together with small variation in exposure, did not render the assessed exposures useful for predicting IM for public health or the clinic.

Introduction: Substance use disorders impact a significant portion of the US population. Exposure to neighborhood environment early in life may contribute to disparities in policing, health outcomes and access to treatment for substance use disorders. Although many studies have examined the relationship between neighborhood context and substance use, few studies have accounted for the spatial distribution of substance use and social environment. The current study examined the association between birth address and substance addiction service utilization of individuals born in communities around the New Bedford Harbor Superfund site in southeast Massachusetts that face potential racial, socioeconomic, and environmental stressors.

Methods: The analysis utilized birth record data between January 1992 and December 1998 (N = 12,151) from the Registry of Vital Records and Statistics with follow-up for substance addiction service utilization through June 2022 by the Bureau of Substances Addiction Services within the Massachusetts Department of Public Health (MADPH). We used generalized additive models (GAM) with a smooth for location to estimate local odds ratios (ORs) and 95% confidence intervals (CI) of substance addiction service utilization while adjusting for sociodemographic risk factors to identify important contributors to geographic disparities.

Results: We found that birth addresses were significantly associated with substance addiction service utilization as a young adult (p = 0.037), with the highest statistically significant risk located closest to the harbor (OR = 1.42, 95% CI: 1.00, 2.02). Family education and prenatal care payer were significant predictors (p < 0.001) of substance addiction services use and strong spatial confounders.

Discussion: The current study showed that significant associations between birth addresses and substance addiction service utilization later in life are primarily driven by socioeconomic predictors including family education and prenatal care payer.

There is much focus in the field of HIV prevention research on understanding the impact of social determinants of health (e.g., housing, employment, incarceration) on HIV transmission and developing interventions to address underlying structural drivers of HIV risk. However, such interventions are resource-intensive and logistically challenging, and their evaluation is often limited by small sample sizes and short duration of follow-up. Because they allow for both detailed and large-scale simulations of counterfactual experiments, agent-based models (ABMs) can demonstrate the potential impact of combinations of interventions that may otherwise be infeasible to evaluate in empirical settings and help plan for efficient use of public health resources. There is a need for computational models that are sufficiently realistic to allow for evaluation of interventions that address socio-structural drivers of HIV transmission, though most HIV models to date have focused on more proximal influences on transmission dynamics. Modeling the complex social causes of infectious diseases is particularly challenging due to the complexity of the relationships and limitations in the measurement and quantification of causal relationships linking social determinants of health to HIV risk. Uncertainty exists in the magnitude and direction of associations among the variables used to parameterize the models, the representation of sexual transmission networks, and the model structure (i.e. the causal pathways representing the system of HIV transmission) itself. This paper will review the state of the literature on incorporating social determinants of health into epidemiological models of HIV transmission. Using examples from our ongoing work, we will discuss Uncertainty Quantification and Robust Decision Making methods to address some of the above-mentioned challenges and suggest directions for future methodological work in this area.

The Global Technical Strategy for Malaria 2016-2030 targets eliminating malaria from at least 35 countries and reducing case incidence by 90% globally. The importation of parasites due to human mobilization poses a significant obstacle to achieve malaria elimination as it can undermine the effectiveness of local interventions. Gaining a comprehensive understanding of parasite importation is essential to support control efforts and advance progress toward elimination. Parasite genetic data is widely used to investigate the spatial and temporal dynamics of imported infections. In this context, this systematic review aimed to aggregate evidence on the application of parasite genetic data for mapping imported malaria and the analytical methods used to analyze it. We discuss the advantages and limitations of the genetic approaches employed and propose a suitable type of genetic data along with an analytical framework to discriminate imported malaria infections from local infections. The findings offer potential actionable insights for national control programs, enabling them select the most effective methods for detecting imported cases. This also may aid in the evaluation and refinement of elimination programs by identifying high-risk areas and enabling the targeted allocation of resources to these regions.