Frontiers in epidemiology最新文献

Background: Health-related quality of life (HRQoL) is crucial for understanding how health conditions impact overall well-being. The EuroQol-5 Dimension (EQ-5D) is a widely used tool for measuring HRQoL across diseases. In Ethiopia, this tool has been employed to assess HRQoL across various healthcare settings. This study aims to summarize EQ-5D-derived health outcomes in Ethiopian populations and identify key determinants influencing these outcomes.

Methods: A systematic search of PubMed, Embase, and Scopus was conducted through May 2024, with no publication date restrictions, focusing on HRQoL and EQ-5D instruments in Ethiopian populations. Grey literature searches were also performed using Google's Advanced Search. Cross-sectional studies across various diseases were included. Data were extracted by two independent reviewers, and pooled mean EQ-5D utility and EQ-5D visual analog scale (EQ-VAS) scores were calculated using a random-effects model in STATA software version 17. Study quality was evaluated using the Agency for Healthcare Research and Quality (AHRQ) checklist, and heterogeneity was assessed using the I² statistic.

Results: Fourteen cross-sectional studies involving 5,639 patients from 2019 to 2024 in Ethiopia were analyzed. Health utility values varied across diseases, with pain/discomfort and anxiety/depression being the most commonly affected dimensions. The pooled EQ-5D utility for HIV patients was 0.88, and the EQ-VAS score was 76.59. For diabetes mellitus (DM) patients, the pooled utility was 0.78, and the EQ-VAS score was 69.36. For COVID-19 patients, the pooled utility was 0.86, and the EQ-VAS score was 74.56. Cancer patients had a pooled EQ-VAS score of 67.87.

Conclusion: The EQ-5D is a reliable tool for measuring HRQoL in Ethiopian patients across various diseases. The study's pooled EQ-5D scores provide valuable insights for future economic evaluations in the Ethiopian healthcare system.

Systematic review registration: https://doi.org/10.1136/bmjopen-2024-085354, PROSPERO (CRD42024505028).

Background: A sharp increase in reported brucellosis incidence was observed in northwestern Tajikistan (from 1.0/100,000 people in January-May 2022 to 32.7/100,000 in January-May 2023). Most (82%) cases were from the same remote mountainous village (population = 10,712). The aim of this study was to identify risk factors for brucellosis infection and mitigate disease risk.

Methods: Using a case-control design, we conducted face-to-face interviews and collected blood samples during May-June 2023. Fifty-seven cases and 114 controls were recruited. Cases were the first person in a household diagnosed with brucellosis during February-June 2023 with positive serum agglutination test and antibody titers ≥1/160 from blood samples. Two controls were selected for each case (neighbors from different households matched by age and sex). Controls testing positive were excluded and replaced. We conducted conditional multivariable logistic regression to calculate adjusted odds ratio (AOR) and 95% confidence intervals (CI).

Results: Among the 87 brucellosis patients reported, 57 (66%) agreed to participate and didn't have secondary cases in the household. Of the 57 cases, 68% were 15-44 years old, and 44% were male. Cases peaked in May 2023. Common symptoms were joint pain (95%), fever (84%), weakness (72%), and night sweats (65%). Of selected controls, 13% tested positive and were excluded. All cases and 94% of controls owned livestock (mostly cattle, sheep, or goats); no animals had not been vaccinated in the past 5 years. Brucellosis was associated with consumption of both homemade kaymak (clotted cream) and home-raised meat compared with neither (AOR: 59 [95%CI: 4.3-798], p < 0.01), home-raised meat but not kaymak compared with neither (AOR: 54 [4.0-731], p < 0.01), and involvement in animal slaughter compared with no involvement (AOR: 36 [2.8-461], p < 0.01).

Conclusion: Contact with unvaccinated livestock or consumption of their products was a key contributor to this outbreak in a remote village of Tajikistan. With 13% of controls testing positive, true incidence was likely greater than reported. Following our investigation, a brucellosis awareness education campaign and animal vaccination campaigns were carried out in the region and only one case was reported in September 2023.

Dementia is a leading cause of death and disability with over 60% of cases residing in low- and middle-income countries (LMICs). Therefore, new strategies to mitigate risk are urgently needed. However, despite the high burden of disease associated with dementia in LMICs, research into dementia risk profiling and risk prediction modelling is limited. Further, dementia risk prediction models developed in high income countries generally do not transport well to LMICs suggesting that context-specific models are instead needed. New prediction models have been developed, in China and Mexico only, with varying predictive accuracy. However, none has been externally validated or incorporated variables that may be important for predicting dementia risk in LMIC settings such as socio-economic status, literacy, healthcare access, nutrition, stress, pollutants, and occupational hazards. Since there is not yet any curative treatment for dementia, developing a context-specific dementia prediction model is urgently needed for planning early interventions for vulnerable groups, particularly for resource constrained LMIC settings.

Traditional methods for measuring chemical exposure have challenges in terms of obtaining sufficient data; therefore, improved methods for better assessing occupational exposure are needed. One possible approach to mitigate these challenges is to use self-monitoring methods such as sensors, diaries, or biomarkers. In the present study, a self-monitored method for measuring soot exposure, which included real-time air monitoring, a work diary, and the collection of urine samples, was evaluated. To validate the method, exposure measurements during the workday and diary entries were compared with velocities calculated from GPS tracking and the expected polycyclic aromatic hydrocarbon (PAH) metabolite patterns in urine. The method was applied with chimney sweeps, an occupational group at a high risk of many severe health outcomes and for whom effective control measures for reducing exposure are needed. In the study, 20 chimney sweeps followed a self-monitoring protocol for 8 consecutive workdays. Personal exposure to soot was measured as black carbon (BC) using micro-aethalometers. A diary was used to record the work tasks performed, and urine samples were collected and analysed for PAH metabolites. From the expected 160 full day measurements, 146 (91%) BC measurements and 149 (93%) diaries were collected. From the expected 320 urine samples, 304 (95%) were collected. The tasks noted in the diaries overlapped with information obtained from the GPS tracking of the chimney sweeps, which covered 96% of the measurement time. The PAH metabolites in urine increased during the work week. Factors believed to have positively influenced the sample collection and task documentation were the highly motivated participants and the continuous presence of trained occupational hygiene professionals during the planning of the study and throughout the measurement stage, during which they were available to inform, instruct, and address questions. In conclusion, the self-monitored protocol used in this study with chimney sweeps is a valuable and valid method that can be used to collect larger numbers of samples. This is especially valuable for occupations in which the employees are working independently and the exposure is difficult to monitor with traditional occupational hygiene methods.

The natural foci of Crimean-Congo haemorrhagic fever (CCHF) in Kazakhstan are geographically located in the southern regions of the country (Kyzylorda, Turkestan and Zhambyl regions), where the infection of ticks with the CCHF virus predominantly reside, tick species composition and the number of vectors are monitored annually. The objective of our research was to investigate the genetic variants of the CCHF virus in the southern endemic regions, as well as to monitor the spread of the CCHF virus in the western regions of the country (Aktobe, Atyrau and Mangystau regions). In total, 974 (216 pools) ticks from the western regions and 3527 (583 pools) ticks from the southern regions collected during 2021-2022 were investigated. The presence of CCHF virus was detected by real-time reverse transcription PCR (qRT- PCR) in 1 pool out of 799 pools (0.12%) with Hyalomma scupense ticks captured in the CCHF-endemic Kyzylorda region. In the western regions, CCHF virus was not detected in ticks. The sequencing of incomplete fragments of the S, M and L segments of the CCHF virus in the detected virus was identified as genotype Asia - I. Phylogenetic analysis showed that the isolate obtained in this study is grouped with the isolate from a patient with CCHF, which we reported in 2015 (KX129738 Genbank). Our findings highlight the importance of including sequencing in the annual monitoring system for better understanding the evolution of the CCHF virus in the study areas of our country.

Introduction: Global inequality in clinical research capacity and service delivery can be indicated simply by the proportion of clinical trials that a country or region has registered in clinical trial registry databases. The proportion of clinical trials registered in Africa is very low at 0.02%, even though the region accounts for approximately 15% of the world's population. Despite the economic challenges in most African countries, they have shown potential for growth and change in recent years.

Methods: We conducted desk reviews on the interventional clinical trials done in Kenya, Ethiopia, and Nigeria between 2015 to May 2023. The search was done in clinical trials repositories, and journal repositories. The search focused on intervention clinical trials. Data was extracted by screening through the publications and clinical trial platforms. The data extracted from the publications included the type of clinical trial, clinical trial phase, diseases, etc. The data extracted from the reports included: challenges in conducting clinical trials, capacity-building efforts, and the impact of the clinical trial.

Results: The number of clinical trial studies identified in Kenya was 113 (28 were on infant clinical trials). The study identified 97 clinical trials in Nigeria, of which 11 studies were on infant clinical trials. In Ethiopia, there were 28 clinical trials and only five were on infant clinical trials. The landscape review also expanded to capacity and gaps in clinical trials in the three countries. The largest proportion of clinical trials carried out in Kenya was on injury, occupational disease, and poisoning, 30.5% (n = 18) and the smallest proportion was on kidney disease, neonatal disease, obstetrics, and gynecology. Most Infant clinical trials were carried out in the area of infections and infestations 33.3% (n = 7). Most of the challenges faced by clinical trials in the three countries include a lack of infrastructure, a lack of human resources, and a lack of financial resources.

Implications: There is a need to map clinical trials done by African researchers based in Africa to exclude the trials done by non-African researchers based in Africa. Opportunities for clinical trials should be supported and challenges addressed.

Survival analysis (also referred to as time-to-event analysis) is the study of the time elapsed from a starting date to some event of interest. In practice, these analyses can be challenging and, if methodological errors are to be avoided, require the application of appropriate techniques. By using simulations and real-life data based on the French national registry of patients with primary immunodeficiencies (CEREDIH), we sought to highlight the basic elements that need to be handled correctly when performing the initial steps in a survival analysis. We focused on non-parametric methods to deal with right censoring, left truncation, competing risks, and recurrent events. Our simulations show that ignoring these aspects induces a bias in the results; we then explain how to analyze the data correctly in these situations using non-parametric methods. Rare disease registries are extremely valuable in medical research. We discuss the application of appropriate methods for the analysis of time-to-event from the CEREDIH registry. The objective of this tutorial article is to provide clinicians and healthcare professionals with better knowledge of the issues facing them when analyzing time-to-event data.