Epidemiology Commons^™

Optimal Anthropometric Discharge Criteria From Treatment Of Wasting: Meta-Analysis Of Individual Patient Data From 34 Studies, Lilia Bliznashka, Sandhya Chaudhary, Susan Rattigan, Sheila Isanaka, Ruth Adah, Tahmeed Ahmed, Nur Alam, Rodrigue Alitanou, Paluku Bahwere, Helen Nabwera

Paediatrics and Child Health, East Africa

Background: Community-based treatment of acute malnutrition saves lives, but recovered children remain at risk of relapse post-discharge. Strategies to reduce this risk may include modification of anthropometric discharge criteria.

Objectives: This study aims to compare the diagnostic accuracy of anthropometric indices to reduce post-discharge relapse risk.

Methods: We searched PubMed from inception to June 2022. We included studies that enrolled children aged 0–59 mo successfully treated for severe or moderate acute malnutrition (SAM or MAM), assessed anthropometry at discharge, and had ≥1 follow-up assessment ≤6 mo post-discharge. Pooled sensitivity and specificity for anthropometric indices at discharge over multiple cutoffs were …

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

Residential Segregation And Breast Cancer In Louisville: Impact Of Race And Contextual Factors On Advanced-Stage Diagnosis, Delayed Treatment, And Disease-Specific Mortality., Toheeb Ajani Mustapha

Electronic Theses and Dissertations

Female breast cancer (BC) remains the most commonly diagnosed non-skin cancer and the second leading cause of cancer death among U.S. women. Despite advances in detection and treatment, substantial inequities in BC outcomes persist, driven in part by structural forces such as residential segregation. This dissertation examined the relationship between residential segregation, BC outcomes, and key contextual factors in Louisville, Kentucky. Using data from the Kentucky Cancer Registry, American Community Survey, CDC’s Population-Level Analyses and Community Estimates, and the National Neighborhood Data Archive, the study tested two hypotheses: (1) higher Black/low-income segregation is associated with elevated risks of adverse BC …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Assessing Neurocognitive Functioning Among Adults Ageing With And Without Hiv At The Kenyan Coast: Measurement Issues And Correlates, Patrick Nzivo Mwangala, Carophine Nasambu, Ryan Wagner, Mihaela Duta, Gaia Scerif, Charles Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Cognitive impairment is one of the most prevalent complications of HIV infection, with significant medical and functional impacts. However, valid, and reliable assessment tools are lacking for the newly emergent ageing population of people living with HIV (PLWH) in many parts of sub-Saharan Africa (SSA), including Kenya. Without these tools, critical intervention opportunities, e.g., psychoeducation, treatment and additional support, are missed. To bridge this gap in Kenya, we adapted the Oxford Cognitive Screen Plus (OCSPlus), a tablet-based cognitive assessment tool designed for low-literacy settings, with adults ageing with HIV ≥ 50 years and their uninfected peers. This study examines …

Awareness And Usability Of Community And Facility-Based Health Sector Client Feedback Mechanism In Tanzania Public Health System. A Mixed Methods Study, James Kengia, Pius Kagoma, Ally Kinyaga, Helga Mutasingwa, Simon Debere, Robert Smith, Marcos Mzeru, Rashid Mbunda, Claud Kumalija, Paschal Ruggajo

Internal Medicine, East Africa

Background Client feedback systems are increasingly becoming important in person-centered health care. The systems provide opportunities to the public to interact with the health care providers and policymakers, present their concerns related to the performance of the health care system in order to improve the quality, equity, and responsiveness in the provision of services, hence increase social accountability. This study aimed to assess the situation of client feedback systems in Tanzania, focusing on the awareness and usability of existing facility- and community-based feedback platforms from the client’s perspective.

Methods The study employed a concurrent mixed-method design using both quantitative and …

Understanding Hepatitis C Risk And Harm Reduction Needs Among People Who Smoke Drugs: A Client-Centered Qualitative Inquiry, Maxwell Gustin

Anthropology

The spread of Hepatitis C virus (HCV) via non-injectable equipment is plausible, making people who smoke drugs (PWSD) at-risk for possible infection and transmission. While much research has been conducted into injection drug use (IDU), likely due to the rising opioid epidemic, limited studies focus on the risks PWSD face. Currently, state-funded syringe service programs (SSPs) provide harm reduction education and materials to combat these risks. Safer smoking initiatives have been created and are widely used by PWSD, and have access to SSPs. To gain better insight into the HCV and non-HCV-related risks and burdens PWSD face, a qualitative study …

Reassessing Dementia Risk: Expanding The 2024 Lancet Commission Report For A More Accurate Global Understanding, Cyprian Mostert

Brain and Mind Institute

Background: The 2024 Lancet Commission Report analyzes 14 risk factors thataccount for 45 percent of global dementia cases. However, it overlooks four criticalrisk factors: poverty, wealth shocks, income inequality, and viral infections. This isparticularly concerning given that 57 percent of the identified risk factors in theLancet report are more prevalent in men, even though dementia predominantly affectswomen worldwide.

Method: In this policy paper, we used the recent global review studies and argue that itis essential to recalibrate and expand the 2024 Lancet Commission’s list of risk factorsto include poverty, wealth shocks, income inequality, and viral infections. Our analysissuggests that these …

Title Page Only: Nuts, Seeds, And Specific Cardiometabolic Diseases: The Adventist Health Study 2, Montry Se-Lin Suprono

Loma Linda University Electronic Theses, Dissertations & Projects

No abstract provided.

Clinical Phenotypes Of Motor Neurone Disease In A Kenyan Hospital-Based Population, Effie Nailah Kamadi, Jasmit Shah, Juzar Hooker, Thomas Jenkins, Dilraj Sokhi

Internal Medicine, East Africa

Background: Motor neurone disease (MND) presentation is globally heterogenous and data on the clinical phenotype in Sub-Saharan Africa (SSA) is scarce. We sought to address this by describing the profile of MND patients in a Kenyan hospital-based population.

Methods: The medical charts of all adult MND patients assessed in the facility between January 2010 and December 2023 were retrospectively reviewed. The biographical data and clinical features of these patients were captured from their electronic and manual health records and statistical analysis performed.

Results: In total, 160 patients had their data analyzed. The male to female ratio was 1.76:1. The median …

Prevalence And Molecular Types Of Clostridioides (Clostridium) Difficile On Australian Retail Vegetables And Household Surfaces, Deirdre A. Collins, Su Chen Lim, Jessica Chisholm, Molly Lattin, Linda Selvey, Simon Reid, Thomas V. Riley

Research outputs 2022 to 2026

Objectives: Community-onset Clostridioides (Clostridium) difficile infection (CDI) has risen to >80 % of all CDI cases in Australia. High prevalence of C. difficile contamination has been reported in many community sources including retail root vegetables. Household surfaces may become contaminated with C. difficile when storing and handling contaminated vegetables. This study aimed to determine the prevalence and molecular types of C. difficile present on retail root vegetables and household surfaces. Methods: From April 2023 to March 2024, retail potatoes (n = 255) and onions (n = 305) were sampled at 3-monthly intervals. Environmental samples were collected from homes of householders …

Imbalances In Circulating Monocyte And High-Density Lipoprotein Cholesterol Exacerbates The Residual Risk Of Incident Myocardial Infarction Beyond Ldl-C: A Real-Life, Prospective Cohort Study, Dan Wu, Yulong Lan, Xiong Ding, Lois Balmer, Xingang Li, Wei Wang, Shouling Wu, Youren Chen

Research outputs 2022 to 2026

Background: A sustained oversupply of monocytes and markedly decreased levels of high-density lipoprotein cholesterol (HDL-C) are notable in high-risk groups with residual cardiovascular risk, despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering. This study aimed to explore whether an imbalance in circulating monocyte and HDL-C levels accounts for the residual risk of incident myocardial infarction (MI) within optimal LDL-C levels. Methods: A total of 48,522 participants free of cardiovascular diseases from a real-life, prospective cohort (Kailuan study) were included. The monocyte count, HDL-C level and monocyte-to-HDL-C ratio (MHR), calculated as time-averaged cumulative and baseline values, were used as the exposures. Time-to-event …

A Randomized Controlled Trial Combining House Screening And Insecticide-Treated Nets Reduces Malaria Transmission In Northwestern Ethiopia, Aklilu K. Belay, Abebe Asale, Catherine L. Sole, Abdullahi A. Yusuf, Baldwyn Torto, Zewdu Abro, Menale Kassie, Clifford M. Mutero, David P. Tchouassi

All Peer-Reviewed Publications

House screening (HS) of doors, eaves, and windows using wire-mesh has demonstrated potential in the integrated vector management of malaria. However, limited epidemiological data are available to guide its implementation across different ecological settings. In a 16-month randomized controlled trial (follow-up period) conducted across three agroecological areas (dry mountain, plateau highland, and semi-arid) in Jabi Tehnan district, northwestern Ethiopia, treatment houses were equipped with HS combined with insecticide-treated nets (ITNs), while control houses received ITNs only. The intervention led to a significant 2.3-fold reduction in indoor malaria vector density, the primary entomologic outcome, largely influenced by An. gambiae s.l. mosquitoes. …

Public Health Trade-Offs During A Pandemic: Mobility Decline And Hypertension Risk In India, Arpita Khanna, Tomoki Fujii

Research Collection School Of Economics

The Covid pandemic dramatically altered patterns of daily life, particularly through widespread declines in mobility due to lockdowns and social distancing measures. While the economic and epidemiological effects of these restrictions have been widely studied, their broader health implications remain underexplored. This paper investigates the relationship between mobility decline during the Covid pandemic and hypertension outcomes in India. Leveraging district-level variation in mobility from Google Community Mobility Reports and health data from the 2019–2021 Indian Demographic and Health Survey (DHS), we find that a 1 percentage point reduction in mobility over the 30 days prior to interview is associated with …

Prevalence And Trends Of Coexisting Forms Of Malnutrition And Its Associated Factors Among Children Aged 6–59 Months In South And Southeast Asia, 1996–2022: A Cross-Sectional Time Series Study, Wenjie Guo, Maggie Zgambo, Sanmei Chen, Yoko Shimpuku

Research outputs 2022 to 2026

Background: South and Southeast Asia face severe malnutrition in children under five, with coexisting forms of malnutrition (CFM) exacerbating mortality risks and posing greater challenges than isolated forms of malnutrition. We aimed to assess the prevalence, trends, and factors of CFM among children aged 6–59 months in South and Southeast Asian countries and the entire region. Methods: We used anthropometric and hemoglobin data from 515,170 children aged 6–59 months in seven low- and middle-income South and Southeast Asian countries, based on Demographic and Health Surveys conducted between 1996 and 2022. Weighted multivariable logistic regression was performed to identify the sociodemographic …

Exploring And Validating Associations Between Six Systemic Inflammatory Indices And Ischemic Stroke In A Middle-Aged And Old Chinese Population, Yulu Zheng, Zheng Guo, Jingzheng Wang, Zhiyuan Wu, Xiaolin Chen, Yahong Zhu, Guangle Shan, Haifeng Hou, Xingang Li

Research outputs 2022 to 2026

Background: Inflammation and maladaptive immune mechanisms have been substantiated as integral components in the critical pathological processes of the injury cascade in ischemic stroke (IS). This study aimed to explore the associations between six systemic inflammatory indices and IS in a Chinese population. Methods: This was a case-control study based on the retrospective review of electronic medical records from two hospitals in Shandong Province, China. Systemic inflammatory indices, including the systemic inflammation response index (SIRI), systemic immune inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR), were calculated. Logistic regression …

Trends And Determinants Of Early Neonatal Mortality In Ethiopia: Evidence From The Ethiopian Demographic And Health Survey Data, Tsion Mulat Tebeje, Beminate Lemma Seifu, Yordanos Sisay Asgedom, Kusse Urmale Mare, Zufan Alamrie Asmare, Hiwot Altaye Asebe, Abdu Hailu Shibeshi, Afework Alemu Lombebo, Kebede Gemeda Sabo, Bezawit Melak Fente, Bizunesh Fantahun Kase

Research outputs 2022 to 2026

Background: Early neonatal mortality (ENM) accounts for three-fourths of all neonatal deaths and one-third of overall child mortality. While previous studies have primarily focused on neonatal and under-five mortality, ENM has received comparatively less attention. This study aims to address this gap by analyzing trends and identifying factors associated with ENM in Ethiopia. Methods: Data from the Ethiopian Demographic and Health Survey (EDHS) conducted between 2005 and 2016 were analyzed, comprising a total weighted sample of 22,310 participants. To account for the hierarchical structure of the EDHS data, a mixed-effects binary logistic regression model was applied to identify associated factors. …

Source-Specific Nitrate Intake And Incident Dementia In The Danish Diet, Cancer And Health Study, Catherine P. Bondonno, Pratik Pokharel, Dorit Wielandt Erichsen, Liezhou Zhong, Jörg Schullehner, Cecilie Kyrø, Kirsten Frederiksen, Peter Fjeldstad Hendriksen, Frederik Dalgaard, Lauren C. Blekkenhorst, Stephanie R. Rainey-Smith, Samantha L. Gardener, Torben Sigsgaard, Ole Raaschou-Nielsen, Anne Tjønneland, Jonathan M. Hodgson, Christina C. Dahm, Anja Olsen, Nicola P. Bondonno

Research outputs 2022 to 2026

Introduction: Dietary nitrate, through conversion to nitric oxide, which supports vascular and nervous system function, may lower dementia risk but may also form neurodegenerative N-nitrosamines, depending on the nitrate source. Methods: We investigated associations between source-specific nitrate and nitrite intake and incident and early-onset dementia (< 65 years) in 54,804 dementia-free participants from the Danish Diet, Cancer and Health Cohort Study over ∼27 years. Nitrate and nitrite intakes were derived from food frequency questionnaires and nitrate and nitrite databases. Results: Higher plant-sourced nitrate intake was non-linearly associated with lower rates of incident dementia (fifth vs first quintile hazard ratio 95% confidence interval: 0.90 [0.83, 0.98]), while increased risk was seen for higher intakes of animal-sourced, additive-permitted meat-sourced, and tap water-sourced nitrate. Similar associations were seen for source-specific nitrite intake and were more pronounced for early-onset dementia. No clear effect modification was observed. Discussion: These findings highlight the importance of nitrate source in dementia risk and warrant further investigation. Highlights: Plant nitrate is associated with a lower risk of incident and early-onset dementia. Animal and tap water nitrate are associated with an increased risk of dementia. Encouraging consumption of plant-based nitrate sources may lower risk of dementia.

Feasibility Of Home-Based Urine Collection In Children Under 5 Years In The Origins Birth Cohort Study: Mixed Method Protocol And Sample Completion Results, Courtney D.A. Kidd, Najma A. Moumin, Andrea Macrae, Tim J. Green, Desiree T. Silva, Susan L. Prescott, Nina D’Vaz

Research outputs 2022 to 2026

Background: Urine is an attractive biospecimen for nutritional status and population health surveys. It is an excellent non-invasive alternative to blood for appropriate biomarkers in young children and is suitable for home-based collection, enabling representative collections across a population. However, the bulk of literature in this population is restricted to collection in primary care settings. Feasibility of home-based collection at scale has not been tested. Here, we describe a mixed method approach to collect urine samples in a large cohort study with children under 5 years. Methods: The ORIGINS Project is an ongoing birth cohort investigating early life influences on …

Gender Differences In Healthy Eating Index As Informed By The Awareness Of Diagnosis Of Metabolic Dysfunction-Associated Steatotic Liver Disease, Wei Ting Lin, Madeline Novack, Suthat Liangpunsakul, Chiung Kuei Huang, Hui Yi Lin, Po Hung Chen, Tung Sung Tseng, Peng Sheng Ting

School of Public Health Faculty Publications

Background/Objectives: Dietary quality is a driver of metabolic dysfunction-associated steatotic liver disease (MASLD). Men and women often have different levels of adherence to medical advice, but the effect of gender on adherence to dietary advice as a function of awareness of MASLD is understudied. We aim to investigate the differences in diet quality between men and women who are aware of their diagnosis of MASLD compared to their undiagnosed counterparts. Methods: We utilized the National Health and Nutrition Examination Survey 2017–2020 to identify a nationally representative sample of subjects with MASLD, 127 of whom reported a diagnosis of MASLD (diagnosed …