Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-30 (of 617 Records) |
Query Trace: Bias M [original query] |
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Estimating community-wide indirect effects of influenza vaccination: triangulation using mathematical models and bias analysis
Arinaminpathy N , Reed C , Biggerstaff M , Nguyen AT , Athni TS , Arnold BF , Hubbard A , Reingold A , Benjamin-Chung J . Am J Epidemiol 2024 Understanding whether influenza vaccine promotion strategies produce community-wide indirect effects is important for establishing vaccine coverage targets and optimizing vaccine delivery. Empirical epidemiologic studies and mathematical models have been used to estimate indirect effects of vaccines but rarely for the same estimand in the same dataset. Using these approaches together could be a powerful tool for triangulation in infectious disease epidemiology because each approach is subject to distinct sources of bias. We triangulated evidence about indirect effects from a school-located influenza vaccination program using two approaches: a difference-in-difference (DID) analysis, and an age-structured, deterministic, compartmental model. The estimated indirect effect was substantially lower in the mathematical model than in the DID analysis (2.1% (95% Bayesian credible intervals 0.4 - 4.4%) vs. 22.3% (95% CI 7.6% - 37.1%)). To explore reasons for differing estimates, we used sensitivity analyses and probabilistic bias analyses. When we constrained model parameters such that projections matched the DID analysis, results only aligned with the DID analysis with substantially lower pre-existing immunity among school-age children and older adults. Conversely, DID estimates corrected for potential bias only aligned with mathematical model estimates under differential outcome misclassification. We discuss how triangulation using empirical and mathematical modelling approaches could strengthen future studies. |
Protection against influenza hospitalizations from enhanced influenza vaccines among older adults: A systematic review and network meta-analysis
Ferdinands JM , Blanton LH , Alyanak E , Chung JR , Trujillo L , Taliano J , Morgan RL , Fry AM , Grohskopf LA . J Am Geriatr Soc 2024 BACKGROUND: Influenza vaccines are available to help protect persons aged ≥65 years, who experience thousands of influenza hospitalizations annually. Because some influenza vaccines may work better than others, we sought to assess benefit of high-dose (HD), adjuvanted (ADJ), and recombinant (RIV) influenza vaccines ("enhanced influenza vaccines") compared with standard-dose unadjuvanted influenza vaccines (SD) and with one another for prevention of influenza-associated hospitalizations among persons aged ≥65 years. METHODS: We searched MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library to identify randomized or observational studies published between January 1990 and October 2023 and reporting relative vaccine effectiveness (rVE) of HD, ADJ, or RIV for prevention of influenza-associated hospitalizations among adults aged ≥65 years. We extracted study data, assessed risk of bias, and conducted random-effects network meta-analysis and meta-regression. RESULTS: We identified 32 studies with 90 rVE estimates from five randomized and 27 observational studies (71,459,918 vaccinated participants). rVE estimates varied across studies and influenza seasons. Pooled rVE from randomized studies was 20% (95% CI -54 to 59) and 25% (95% CI -19 to 53) for ADJ and HD compared with SD, respectively; rVE was 6% (95% CI -109 to 58) for HD compared with ADJ; these differences were not statistically significant. In observational studies, ADJ, HD, and RIV conferred modestly increased protection compared with SD (rVE ranging from 10% to 19%), with no significant differences between HD, ADJ, and RIV. With enhanced vaccines combined, rVE versus SD was 18% (95% CI 3 to 32) from randomized and 11% (95% CI 8 to 14) from observational evidence. Meta-regression of observational studies suggested that those requiring laboratory confirmation of influenza reported greater benefit of enhanced vaccines. CONCLUSIONS: HD, ADJ, and RIV provided stronger protection than SD against influenza hospitalizations among older adults. No differences in benefit were observed in comparisons of enhanced influenza vaccines with one another. |
Antivirals for post-exposure prophylaxis of influenza: a systematic review and network meta-analysis
Zhao Y , Gao Y , Guyatt G , Uyeki TM , Liu P , Liu M , Shen Y , Chen X , Luo S , Li X , Huang R , Hao Q . Lancet 2024 404 (10454) 764-772 BACKGROUND: Antiviral post-exposure prophylaxis with neuraminidase inhibitors can reduce the incidence of influenza and the risk of symptomatic influenza, but the efficacy of the other classes of antiviral remains unclear. To support an update of WHO influenza guidelines, this systematic review and network meta-analysis evaluated antiviral drugs for post-exposure prophylaxis of influenza. METHODS: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Global Health, Epistemonikos, and ClinicalTrials.gov for randomised controlled trials published up to Sept 20, 2023 that evaluated the efficacy and safety of antivirals compared with another antiviral or placebo or standard care for prevention of influenza. Pairs of reviewers independently screened studies, extracted data, and assessed the risk of bias. We performed network meta-analyses with frequentist random effects model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The outcomes of interest were symptomatic or asymptomatic infection, admission to hospital, all-cause mortality, adverse events related to antivirals, and serious adverse events. This study is registered with PROSPERO, CRD42023466450. FINDINGS: Of 11 845 records identified by our search, 33 trials of six antivirals (zanamivir, oseltamivir, laninamivir, baloxavir, amantadine, and rimantadine) that enrolled 19 096 individuals (mean age 6·75-81·15 years) were included in this systematic review and network meta-analysis. Most of the studies were rated as having a low risk of bias. Zanamivir, oseltamivir, laninamivir, and baloxavir probably achieve important reductions in symptomatic influenza in individuals at high risk of severe disease (zanamivir: risk ratio 0·35, 95% CI 0·25-0·50; oseltamivir: 0·40, 0·26-0·62; laninamivir: 0·43, 0·30-0·63; baloxavir: 0·43, 0·23-0·79; moderate certainty) when given promptly (eg, within 48 h) after exposure to seasonal influenza. These antivirals probably do not achieve important reductions in symptomatic influenza in individuals at low risk of severe disease when given promptly after exposure to seasonal influenza (moderate certainty). Zanamivir, oseltamivir, laninamivir, and baloxavir might achieve important reductions in symptomatic zoonotic influenza in individuals exposed to novel influenza A viruses associated with severe disease in infected humans when given promptly after exposure (low certainty). Oseltamivir, laninamivir, baloxavir, and amantadine probably decrease the risk of all influenza (symptomatic and asymptomatic infection; moderate certainty). Zanamivir, oseltamivir, laninamivir, and baloxavir probably have little or no effect on prevention of asymptomatic influenza virus infection or all-cause mortality (high or moderate certainty). Oseltamivir probably has little or no effect on admission to hospital (moderate certainty). All six antivirals do not significantly increase the incidence of drug-related adverse events or serious adverse events, although the certainty of evidence varies. INTERPRETATION: Post-exposure prophylaxis with zanamivir, oseltamivir, laninamivir, or baloxavir probably decreases the risk of symptomatic seasonal influenza in individuals at high risk for severe disease after exposure to seasonal influenza viruses. Post-exposure prophylaxis with zanamivir, oseltamivir, laninamivir, or baloxavir might reduce the risk of symptomatic zoonotic influenza after exposure to novel influenza A viruses associated with severe disease in infected humans. FUNDING: World Health Organization. |
School mask policies and SARS-CoV-2 seroprevalence among school-age children-United States, September to December 2021
Nycz E , Deng Y , Van Dyke ME , Bratcher A , Shi J , Iachan R , Berney K , Jones JM , Clarke KEN . Microbiol Spectr 2024 e0069124 During September to December 2021, school mask policies to mitigate SARS-CoV-2 transmission varied throughout the US. We compared infection-induced seroprevalence estimates and estimated seroconversion among children residing in areas with and without school mask requirements. We estimated infection-induced seroprevalence among children in three age groups (5-17, 5-11, and 12-17 years) in areas with and without school district mask requirements for two time points: September 1-30, 2021 and December 15, 2021 to January 14, 2022. Robust Poisson regression models estimated population seroconversion over the semester among initially seronegative children. Permutation tests assessed for significant differences in the estimated population seroconversion due to incident infections by school district mask policy. Residing in an area with no school mask requirement was associated with higher infection-induced seroprevalence among children aged 5-17 years (adjusted prevalence ratio [aPR] = 1.18, 95% confidence interval [CI]: 1.10, 1.26), and those aged 5-11 years (aPR) = 1.21, 95% CI: 1.10, 1.32) and those aged 12-17 years (aPR = 1.16, 95% CI: 1.07, 1.26), compared with areas requiring masks in school. Estimated population seroconversion during the semester was also significantly higher among children in districts without mask policies than those with school mask requirements among all age groups (5-17 years: 23.7% vs 18.1%, P < 0.001; 5-11 years: 6.4% vs 4.5%, P = 0.002;12-17 years: 27.2% vs 21.0%, P < 0.001). During the U.S. Fall 2021 semester, areas with school mask requirements had lower infection-induced seroprevalence and an estimated lower proportion of seroconversion due to incident infection among school-aged children compared with areas without school mask requirements; causality cannot necessarily be inferred from these associations. IMPORTANCE: During the U.S. Fall 2021 school semester, the estimated proportion of previously uninfected school-aged children who experienced a first infection with SARS-CoV-2 was lower in areas where public school district policies required masks for all staff and students compared with areas where the school districts had no mask requirements. Because children are more likely than adults to experience asymptomatic or mild SARS-CoV-2 infections, the presence of infection-induced antibodies is a more accurate measure of infection history than clinical testing. The proportion of children with these antibodies (i.e., seroprevalence) can improve our understanding of SARS-CoV-2 by detecting more infections and eliminating potential bias due to local testing and reporting practices. Enhanced robustness of surveillance for respiratory infections in children, including records of mitigation policies in communities and schools, as well as seroprevalence data, would establish a better evidence base for policy decisions and response measures during future respiratory outbreaks. |
Antivirals for treatment of severe influenza: a systematic review and network meta-analysis of randomised controlled trials
Gao Y , Guyatt G , Uyeki TM , Liu M , Chen Y , Zhao Y , Shen Y , Xu J , Zheng Q , Li Z , Zhao W , Luo S , Chen X , Tian J , Hao Q . Lancet 2024 404 (10454) 753-763 BACKGROUND: The optimal antiviral drug for treatment of severe influenza remains unclear. To support updated WHO influenza clinical guidelines, this systematic review and network meta-analysis evaluated antivirals for treatment of patients with severe influenza. METHODS: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Global Health, Epistemonikos, and ClinicalTrials.gov for randomised controlled trials published up to Sept 20, 2023, that enrolled hospitalised patients with suspected or laboratory-confirmed influenza and compared direct-acting influenza antivirals against placebo, standard care, or another antiviral. Pairs of coauthors independently extracted data on study characteristics, patient characteristics, antiviral characteristics, and outcomes, with discrepancies resolved by discussion or by a third coauthor. Key outcomes of interest were time to alleviation of symptoms, duration of hospitalisation, admission to intensive care unit, progression to invasive mechanical ventilation, duration of mechanical ventilation, mortality, hospital discharge destination, emergence of antiviral resistance, adverse events, adverse events related to treatments, and serious adverse events. We conducted frequentist network meta-analyses to summarise the evidence and evaluated the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. This study is registered with PROSPERO, CRD42023456650. FINDINGS: Of 11 878 records identified by our search, eight trials with 1424 participants (mean age 36-60 years for trials that reported mean or median age; 43-78% male patients) were included in this systematic review, of which six were included in the network meta-analysis. The effects of oseltamivir, peramivir, or zanamivir on mortality compared with placebo or standard care without placebo for seasonal and zoonotic influenza were of very low certainty. Compared with placebo or standard care, we found low certainty evidence that duration of hospitalisation for seasonal influenza was reduced with oseltamivir (mean difference -1·63 days, 95% CI -2·81 to -0·45) and peramivir (-1·73 days, -3·33 to -0·13). Compared with standard care, there was little or no difference in time to alleviation of symptoms with oseltamivir (0·34 days, -0·86 to 1·54; low certainty evidence) or peramivir (-0·05 days, -0·69 to 0·59; low certainty evidence). There were no differences in adverse events or serious adverse events with oseltamivir, peramivir, and zanamivir (very low certainty evidence). Uncertainty remains about the effects of antivirals on other outcomes for patients with severe influenza. Due to the small number of eligible trials, we could not test for publication bias. INTERPRETATION: In hospitalised patients with severe influenza, oseltamivir and peramivir might reduce duration of hospitalisation compared with standard care or placebo, although the certainty of evidence is low. The effects of all antivirals on mortality and other important patient outcomes are very uncertain due to scarce data from randomised controlled trials. FUNDING: World Health Organization. |
Inverse probability weighting to estimate impacts of hypothetical occupational limits on radon exposure to reduce lung cancer
Keil AP , Li Y , Lan Q , Bertke S , Daniels RD , Edwards JK , Kelly-Reif K . Am J Epidemiol 2024 Radon is a known cause of lung cancer. Protective standards for radon exposure are derived largely from studies of working populations that are prone to healthy worker survivor bias. This bias can lead to under-protection of workers and is a key barrier to understanding health effects of many exposures. We apply inverse probability weighting to study a set of hypothetical exposure limits among 4,137 male, White and American Indian radon-exposed uranium miners in the Colorado Plateau followed from 1950 to 2005. We estimate cumulative risk of lung cancer through age 90 under hypothetical occupational limits. We estimate that earlier implementation of the current US Mining Safety and Health Administration annual standard of 4 working level months (implemented here as a monthly exposure limit) could have reduced lung cancer mortality from 16/100 workers to 6/100 workers (95% confidence intervals: 3/100, 8/100), in contrast with previous estimates of 10/100 workers. Our estimate is similar to that among contemporaneous occupational cohorts. Inverse probability weighting is a simple and computationally efficient way address healthy worker survivor bias in order to contrast health effects of exposure limits and estimate the number of excess health outcomes under exposure limits at work. |
At-home specimen self-collection as an additional testing strategy for chlamydia and gonorrhoea: a systematic literature review and meta-analysis
Smith AC , Thorpe PG , Learner ER , Galloway ET , Kersh EN . BMJ Glob Health 2024 9 (8) INTRODUCTION: Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies. METHODS: We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs). RESULTS: 19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)). CONCLUSION: Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method. |
Quantile regression for longitudinal data with values below the limit of detection and time-dependent covariates-application to modeling carbon nanotube and nanofiber exposures
Chen IC , Bertke SJ , Dahm MM . Ann Work Expo Health 2024 BACKGROUND: In studies of occupational health, longitudinal environmental exposure, and biomonitoring data are often subject to right skewing and left censoring, in which measurements fall below the limit of detection (LOD). To address right-skewed data, it is common practice to log-transform the data and model the geometric mean, assuming a log-normal distribution. However, if the transformed data do not follow a known distribution, modeling the mean of exposure may result in bias and reduce efficiency. In addition, when examining longitudinal data, it is possible that certain covariates may vary over time. OBJECTIVE: To develop predictive quantile regression models to resolve the issues of left censoring and time-dependent covariates and to quantitatively evaluate if previous and current covariates can predict current and/or future exposure levels. METHODS: To address these gaps, we suggested incorporating different substitution approaches into quantile regression and utilizing a method for selecting a working type of time dependency for covariates. RESULTS: In a simulation study, we demonstrated that, under different types of time-dependent covariates, the approach of multiple random value imputation outperformed the other approaches. We also applied our methods to a carbon nanotube and nanofiber exposure study. The dependent variables are the left-censored mass of elemental carbon at both the respirable and inhalable aerosol size fractions. In this study, we identified some potential time-dependent covariates with respect to worker-level determinants and job tasks. CONCLUSION: Time dependency for covariates is rarely accounted for when analyzing longitudinal environmental exposure and biomonitoring data with values less than the LOD through predictive modeling. Mistreating the time-dependency as time-independency will lead to an efficiency loss of regression parameter estimation. Therefore, we addressed time-varying covariates in longitudinal exposure and biomonitoring data with left-censored measurements and illustrated an entire conditional distribution through different quantiles. |
Impact of internal standard selection on measurement results for long chain fatty acids in blood
Goodwin JM , Kuiper HC , Brister B , Vesper HW . J Mass Spectrom Adv Clin Lab 2024 33 22-30 Introduction: Internal standards correct for measurement variation due to sample loss. Isotope labeled analytes are ideal internal standards for the measurement of fatty acids in human plasma but are not always readily available. For this reason, quantification of multiple analytes at once is most often done using only a single or few internal standards. The magnitude of the impact this has on method accuracy and precision is not well studied for gas chromatography-mass spectrometry systems. Objective: This study aims to estimate bias and changes in uncertainty associated with using alternative fatty acid isotopologue internal standards for the estimation of similar or dissimilar long chain fatty acids. Method: Using a previously reported method for the quantification of 27 fatty acids in human plasma using 18 internal standards we obtained estimates of bias and uncertainty at up to three levels of fatty acid concentration. Results: With some notable exceptions, method accuracy remained relatively stable when using an alternative internal standard (Median Relative Absolute Percent Bias: 1.76%, Median Spike-Recovery Absolute Percent Bias: 8.82%), with larger changes in method precision (Median Increase in Variance: 141%). Additionally, the degree of difference between analyte and internal standard structure was related to the magnitude of bias and uncertainty of the measurement. Conclusion: The data presented here show that the choice of internal standard used to estimate fatty acid concentration can affect the accuracy and reliability of measurement results and, therefore, needs to be assessed carefully when developing analytical methods for the measurement of fatty acid profiles. Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, and the US Department of Health and Human Services. © 2024 |
The effectiveness of Hope Groups, a mental health, parenting support, and violence prevention program for families affected by the war in Ukraine: Findings from a pre-post study
Hillis S , Tucker S , Baldonado N , Taradaika E , Bryn L , Kharchenko S , Machabelii T , Taylor R , Green P , Goldman P , Awah I , Baldonado J , Gomez P , Flaxman S , Ratmann O , Lachman JM , Villaveces A , Sherr L , Cluver L . Journal of Migration and Health 2024 10(no pagination) Background: Nearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called 'Hope Groups' on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design. Method(s): Participants (n = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0-17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points - baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired t-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex. Finding(s): Compared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1,-57.9; -1.2 days/week), respectively. Outcomes stratified by displacement status remained significant across all groups, as did those according to facilitator type (lay versus professional). Interpretation(s): This study demonstrates preliminary evidence, using a brief survey and pre-post design as is appropriate for acute and early protracted emergency settings, of the feasibility and effectiveness of Hope Groups for war-affected Ukrainian caregivers, on improved mental health, positive parenting, and reduced violence against children. Copyright © 2024 |
A historical survey of key epidemiological studies of ionizing radiation exposure
Little MP , Bazyka D , Gonzalez AB , Brenner AV , Chumak VV , Cullings H , Daniels RD , French B , Grant E , Hamada N , Hauptmann M , Kendall GM , Laurier D , Lee C , Lee WJ , Linet MS , Mabuchi K , Morton LM , Muirhead CR , Preston DL , Rajaraman P , Richardson DB , Sakata R , Samet JM , Simon SL , Sugiyama H , Wakeford R , Zablotska LB . Radiat Res 2024 In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis. |
Estimating the prevalence of injection drug use among acute hepatitis C cases from a national surveillance system: Application of random forest-based multiple imputation
Yin S , Ly KN , Barker LK , Bixler D , Thompson ND , Gupta N . J Public Health Manag Pract 2024 30 (5) 733-743 BACKGROUND: Injection drug use (IDU) is a major contributor to the syndemic of viral hepatitis, human immunodeficiency virus, and drug overdose. However, information on IDU is frequently missing in national viral hepatitis surveillance data, which limits our understanding of the full extent of IDU-associated infections. Multiple imputation by chained equations (MICE) has become a popular approach to address missing data, but its application for IDU imputation is less studied. METHODS: Using the 2019-2021 National Notifiable Diseases Surveillance System acute hepatitis C case data and publicly available county-level measures, we evaluated listwise deletion (LD) and 3 models imputing missing IDU data through MICE: parametric logistic regression, semi-parametric predictive mean matching (PMM), and nonparametric random forest (RF) (both standard RF [sRF] and fast implementation of RF [fRF]). RESULTS: The estimated IDU prevalence among acute hepatitis C cases increased from 63.5% by LD to 65.1% by logistic regression, 66.9% by PMM, 76.0% by sRF, and 85.1% by fRF. Evaluation studies showed that RF-based MICE imputation, especially fRF, has the highest accuracy (as measured by smallest raw bias, percent bias, and root mean square error) and highest efficiency (as measured by smallest 95% confidence interval width) compared to LD and other models. Sensitivity analyses indicated that fRF remained robust when data were missing not at random. CONCLUSION: Our analysis suggested that RF-based MICE imputation, especially fRF, could be a valuable approach for addressing missing IDU data in the context of population-based surveillance systems like National Notifiable Diseases Surveillance System. The inclusion of imputed IDU data may enhance the effectiveness of future surveillance and prevention efforts for the IDU-driven syndemic. |
Evaluation of mortality among Marines, Navy personnel, and civilian workers exposed to contaminated drinking water at USMC base Camp Lejeune: a cohort study
Bove FJ , Greek A , Gatiba R , Boehm RC , Mohnsen MM . Environ Health 2024 23 (1) 61 BACKGROUND: Drinking water at U.S. Marine Corps Base (MCB) Camp Lejeune, North Carolina was contaminated with trichloroethylene and other industrial solvents from 1953 to 1985. METHODS: A cohort mortality study was conducted of Marines/Navy personnel who, between 1975 and 1985, began service and were stationed at Camp Lejeune (N = 159,128) or MCB Camp Pendleton, California (N = 168,406), and civilian workers employed at Camp Lejeune (N = 7,332) or Camp Pendleton (N = 6,677) between October 1972 and December 1985. Camp Pendleton's drinking water was not contaminated with industrial solvents. Mortality follow-up was between 1979 and 2018. Proportional hazards regression was used to calculate adjusted hazard ratios (aHRs) comparing mortality rates between Camp Lejeune and Camp Pendleton cohorts. The ratio of upper and lower 95% confidence interval (CI) limits, or CIR, was used to evaluate the precision of aHRs. The study focused on underlying causes of death with aHRs ≥ 1.20 and CIRs ≤ 3. RESULTS: Deaths among Camp Lejeune and Camp Pendleton Marines/Navy personnel totaled 19,250 and 21,134, respectively. Deaths among Camp Lejeune and Camp Pendleton civilian workers totaled 3,055 and 3,280, respectively. Compared to Camp Pendleton Marines/Navy personnel, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for cancers of the kidney (aHR = 1.21, 95% CI: 0.95, 1.54), esophagus (aHR = 1.24, 95% CI: 1.00, 1.54) and female breast (aHR = 1.20, 95% CI: 0.73, 1.98). Causes of death with aHRs ≥ 1.20 and CIR > 3, included Parkinson disease, myelodysplastic syndrome and cancers of the testes, cervix and ovary. Compared to Camp Pendleton civilian workers, Camp Lejeune had aHRs ≥ 1.20 with CIRs ≤ 3 for chronic kidney disease (aHR = 1.88, 95% CI: 1.13, 3.11) and Parkinson disease (aHR = 1.21, 95% CI: 0.72, 2.04). Female breast cancer had an aHR of 1.19 (95% CI: 0.76, 1.88), and aHRs ≥ 1.20 with CIRs > 3 were observed for kidney and pharyngeal cancers, melanoma, Hodgkin lymphoma, and chronic myeloid leukemia. Quantitative bias analyses indicated that confounding due to smoking and alcohol consumption would not appreciably impact the findings. CONCLUSION: Marines/Navy personnel and civilian workers likely exposed to contaminated drinking water at Camp Lejeune had increased hazard ratios for several causes of death compared to Camp Pendleton. |
Evaluation of flow controllers used with evacuated canisters to assess VOC exposures in occupational and non-occupational environments
Rossner A , Wick DP , LeBouf RF , Lutes C , Carroll M . J Occup Environ Hyg 2024 1-11 Ideally, measuring exposures to volatile organic compounds should allow for modifying sampling duration without loss in sensitivity. Traditional sorbent-based sampling can vary sampling duration, but sensitivity may be affected when capturing shorter tasks. Diaphragm and capillary flow controllers allow for a range of flow rates and sampling durations for air sampling with evacuated canisters. The goal of this study was to evaluate the extent to which commercialized capillary flow controllers satisfy the bias (±10%) and accuracy (±25%) criteria for air sampling methods as established by the National Institute for Occupational Safety and Health (NIOSH) using the framework of ASTM D6246 Standard Practice for Evaluating the Performance of Diffusive Samplers to compare their performance with diaphragm flow controllers in a long-term field study. Phase 1 consisted of a series of laboratory tests to evaluate capillary flow controller flow rates with respect to variations in temperature (-15-24 °C). The results demonstrated a slight increase in flow rate with lower temperatures. In Phase 2, the capillary flow controller was evaluated utilizing a matrix of parameters, including time-weighted average concentration, peak concentration (50-100× base concentration), air velocity across the sampler inlet (0.41-0.5 m/s), relative humidity (20-80%), and temperature (10-32 °C). Comparison of challenge concentrations with reference concentrations revealed the aggregate bias and overall accuracy for four tested compounds to be within the range of criteria for both NIOSH and ASTM standards. Additionally, capillary flow controllers displayed lower variability in flow rate and measured concentration (RSD: 2.4% and 4.3%, respectively) when compared with diaphragm flow controllers (RSD: 6.9% and 7.2%, respectively) for 24-hr laboratory tests. Phase 3 involved further testing of flow rate variability for both diaphragm and capillary flow controllers in a field study. The capillary flow controller displayed a lower level of variability (RSD: 5.2%) than the diaphragm flow controller (RSD: 8.0%) with respect to flow rate, while allowing for longer durations of sampling. |
A pilot study of the outcomes of human trafficking survivors assessment with girls who have experienced commercial sexual exploitation
Helpingstine C , Kenny MC , Rubiales R . Eval Program Plann 2024 106 102462 PURPOSE: This study utilized the Outcome of Human Trafficking Survivors (OHTS) to monitor the progress of female victims of CSE over a year while they were enrolled in a comprehensive treatment program. METHODS: Sixty-seven girls (M age 17.70 years) who were identified as confirmed victims of CSE (46 %) or at risk for CSE (54 %) and presented for treatment were administered the OHTS upon intake into the program and again at 90 day intervals resulting in four data points. Ratings were provided by staff members who interact with the member in each area assessed. A repeated-measures ANOVA was conducted comparing mean outcome differences across all four timepoints. RESULTS: Results indicate that significant changes were found in the area of Housing and Education, with gains in Education over time. For this sample, Parenting and Immigration were domains of less relevance and data was not consistently obtained in these areas. Other categories assessed by the OHTS did not demonstrate significant changes over time. CONCLUSION: The OHTS can be used to track progress of clients enrolled in treatment programming, but the goals of the program should align with the categories that are assessed in the OHTS. Repeated administration may be difficult due to high dropout rates in treatment and there may be rater bias. |
Mitigating matrix effects in LC-ESI-MS-MS analysis of a urinary biomarker of xylenes exposure
Bowman BA , AEjzak E , Reese CM , Blount BC , Bhandari D . J Anal Toxicol 2023 47 (2) 129-135 Liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS) with stable isotope-labeled internal standards (SIL-ISs) is the gold standard for quantitative analysis of drugs and metabolites in complex biological samples. Significant isotopic effects associated with deuterium labeling often cause the deuterated IS to elute at a different retention time from the target analyte, diminishing its capability to compensate for matrix effects. In this study, we systematically compared the analytical performance of deuterated (2H) SIL-IS to non-deuterated (13C and 15N) SIL-ISs for quantifying urinary 2-methylhippuric acid (2MHA) and 4-methylhippuric acid (4MHA), biomarkers of xylenes exposure, with an LC-ESI-MS-MS assay. Analytical method comparison between ISs demonstrated a quantitative bias for urinary 2MHA results, with concentrations generated with 2MHA-[2H7] on average 59.2% lower than concentrations generated with 2MHA-[13C6]. Spike accuracy, measured by quantifying the analyte-spiked urine matrix and comparing the result to the known spike concentration, determined that 2MHA-[2H7] generated negatively biased urinary results of -38.4%, whereas no significant bias was observed for 2MHA-[13C6]. Post-column infusion demonstrated that ion suppression experienced by 2MHA and 2MHA-[13C6] was not equally experienced by 2MHA-[2H7], explaining the negatively biased 2MHA results. The quantitation of urinary 4MHA results between ISs exhibited no significant quantitative bias. These results underscore the importance of the careful selection of ISs for targeted quantitative analysis in complex biological samples. |
Improving HIV pre-exposure prophylaxis uptake with artificial intelligence and automation: A systematic review
Kamitani E , Mizuno Y , Khalil GM , Viguerie A , DeLuca JB , Mishra N . Aids 2024 OBJECTIVES: To identify studies promoting the use of artificial intelligence (AI) or automation with HIV pre-exposure prophylaxis (PrEP) care and explore ways for AI to be used in PrEP interventions. DESIGN: Systematic review. METHODS: We searched in the US Centers for Disease Control and Prevention Research Synthesis database through November 2023 PROSPERO (CRD42023458870). We included studies published in English that reported using AI or automation in PrEP interventions. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using either the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials or an adapted Newcastle-Ottawa Quality Assessment Scale for non-randomized studies. RESULTS: Our search identified 12 intervention studies (i.e., interventions that used AI/automation to improve PrEP care). Currently available intervention studies showed AI/automation interventions were acceptable and feasible in PrEP care while improving PrEP-related outcomes (i.e., knowledge, uptake, adherence, discussion with care providers). These interventions have used AI/automation to reduce workload (e.g., directly observed therapy) and helped non-HIV specialists prescribe PrEP with AI-generated clinical decision-support. Automated tools can also be developed with limited budget and staff experience. CONCLUSIONS: AI and automation have high potential to improve PrEP care. Despite limitations of included studies (e.g., the small sample sizes and lack of rigorous study design), our review suggests that by using aspects of AI and automation appropriately and wisely, these technologies may accelerate PrEP use and reduce HIV infection. |
Semi-automated nonresponse detection for open-text survey data
Cibelli Hibben K , Smith Z , Rogers B , Ryan V , Scanlon P , Hoppe T . Soc Sci Comput Rev 2024 Open-ended survey questions can enable researchers to gain insights beyond more commonly used closed-ended question formats by allowing respondents an opportunity to provide information with few constraints and in their own words. Open-ended web probes are also increasingly used to inform the design and evaluation of survey questions. However, open-ended questions are more susceptible to insufficient or irrelevant responses that can be burdensome and time-consuming to identify and remove manually, often resulting in underuse of open-ended questions and, when used, potential inclusion of poor-quality data. To address these challenges, we developed and publicly released the Semi-Automated Nonresponse Detection for Survey text (SANDS), an item nonresponse detection approach based on a Bidirectional Transformer for Language Understanding model, fine-tuned using Simple Contrastive Sentence Embedding and targeted human coding, to categorize open-ended text data as valid or likely nonresponse. This approach is powerful in that it uses natural language processing as opposed to existing nonresponse detection approaches that have relied exclusively on rules or regular expressions or used bag-of-words approaches that tend to perform less well on short pieces of text, typos, or uncommon words, often prevalent in open-text survey data. This paper presents the development of SANDS and a quantitative evaluation of its performance and potential bias using open-text responses from a series of web probes as case studies. Overall, the SANDS model performed well in identifying a dataset of likely valid results to be used for quantitative or qualitative analysis, particularly on health-related data. Developed for generalizable use and accessible to others, the SANDS model can greatly improve the efficiency of identifying inadequate and irrelevant open-text responses, offering expanded opportunities for the use of open-text data to inform question design and improve survey data quality. © The Author(s) 2024. |
Hearing protection field attenuation estimation systems and associated training for reducing workers' exposure to noise
Morata TC , Gong W , Tikka C , Samelli AG , Verbeek JH . Cochrane Database Syst Rev 2024 5 (5) Cd015066 BACKGROUND: Global Burden of Disease studies identify hearing loss as the third leading cause of years lived with a disability. Their estimates point to large societal and individual costs from unaddressed hearing difficulties. Workplace noise is an important modifiable risk factor; if addressed, it could significantly reduce the global burden of disease. In practice, providing hearing protection devices (HPDs) is the most common intervention to reduce noise exposure at work. However, lack of fit of HPDs, especially earplugs, can greatly limit their effectiveness. This may be the case for 40% of users. Testing the fit and providing instructions to improve noise attenuation might be effective. In the past two decades, hearing protection fit-test systems have been developed and evaluated in the field. They are called field attenuation estimation systems. They measure the noise attenuation obtained by individual workers using HPDs. If there is a lack of fit, instruction for better fit is provided, and may lead to better noise attenuation obtained by HPDs. OBJECTIVES: To assess: (1) the effects of field attenuation estimation systems and associated training on the noise attenuation obtained by HPDs compared to no instruction or to less instruction in workers exposed to noise; and (2) whether these interventions promote adherence to HPD use. SEARCH METHODS: We used CENTRAL, MEDLINE, five other databases, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify studies. We imposed no language or date restrictions. The latest search date was February 2024. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), and interrupted time-series studies (ITSs) exploring HPD fit testing in workers exposed to noise levels of more than 80 A-weighted decibels (or dBA) who use hearing protection devices. The unit 'dBA' reports on the use of a frequency-weighting filter to adjust sound measurement results to better reflect how human ears process sound. The outcome noise attenuation had to be measured either as a personal attenuation rating (PAR), PAR pass rate, or both. PAR pass rate is the percentage of workers who passed a pre-established level of sufficient attenuation from their HPDs, identified on the basis of their individual noise exposure. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, risk of bias, and extracted data. We categorised interventions as fit testing of HPDs with instructions at different levels (no instructions, simple instructions, and extensive instructions). MAIN RESULTS: We included three RCTs (756 participants). We did not find any studies that examined whether fit testing and training contributed to hearing protector use, nor any studies that examined whether age, gender, or HPD experience influenced attenuation. We would have included any adverse effects if mentioned by the trial authors, but none reported them. None of the included studies blinded participants; two studies blinded those who delivered the intervention. Effects of fit testing of HPDs with instructions (simple or extensive) versus fit testing of HPDs without instructions Testing the fit of foam and premoulded earplugs accompanied by simple instructions probably does not improve their noise attenuation in the short term after the test (1-month follow-up: mean difference (MD) 1.62 decibels (dB), 95% confidence interval (CI) -0.93 to 4.17; 1 study, 209 participants; 4-month follow-up: MD 0.40 dB, 95% CI -2.28 to 3.08; 1 study, 197 participants; both moderate-certainty evidence). The intervention probably does not improve noise attenuation in the long term (MD 0.15 dB, 95% CI -3.44 to 3.74; 1 study, 103 participants; moderate-certainty evidence). Fit testing of premoulded earplugs with extensive instructions on the fit of the earplugs may improve their noise attenuation at the immediate retest when compared to fit testing without instructions (MD 8.34 dB, 95% CI 7.32 to 9.36; 1 study, 100 participants; low-certainty evidence). Effects of fit testing of HPDs with extensive instructions versus fit testing of HPDs with simple instructions Fit testing of foam earplugs with extensive instructions probably improves their attenuation (MD 8.62 dB, 95% CI 6.31 to 10.93; 1 study, 321 participants; moderate-certainty evidence) and also the pass rate of sufficient attenuation (risk ratio (RR) 1.75, 95% CI 1.44 to 2.11; 1 study, 321 participants; moderate-certainty evidence) when compared to fit testing with simple instructions immediately after the test. This is significant because every 3 dB decrease in noise exposure level halves the sound energy entering the ear. No RCTs reported on the long-term effectiveness of the HPD fit testing with extensive instructions. AUTHORS' CONCLUSIONS: HPD fit testing accompanied by simple instructions probably does not improve noise attenuation from foam and premoulded earplugs. Testing the fit of foam and premoulded earplugs with extensive instructions probably improves attenuation and PAR pass rate immediately after the test. The effects of fit testing associated with training to improve attenuation may vary with types of HPDs and training methods. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. |
Modeling county-level rare disease prevalence using Bayesian hierarchical sampling weighted zero-inflated regression
Xie H , Rolka DB , Barker LE . J Data Sci 2023 21 (1) 145-157 Estimates of county-level disease prevalence have a variety of applications. Such estimation is often done via model-based small-area estimation using survey data. However, for conditions with low prevalence (i.e., rare diseases or newly diagnosed diseases), counties with a high fraction of zero counts in surveys are common. They are often more common than the model used would lead one to expect; such zeros are called 'excess zeros'. The excess zeros can be structural (there are no cases to find) or sampling (there are cases, but none were selected for sampling). These issues are often addressed by combining multiple years of data. However, this approach can obscure trends in annual estimates and prevent estimates from being timely. Using single-year survey data, we proposed a Bayesian weighted Binomial Zero-inflated (BBZ) model to estimate county-level rare diseases prevalence. The BBZ model accounts for excess zero counts, the sampling weights and uses a power prior. We evaluated BBZ with American Community Survey results and simulated data. We showed that BBZ yielded less bias and smaller variance than estimates based on the binomial distribution, a common approach to this problem. Since BBZ uses only a single year of survey data, BBZ produces more timely county-level incidence estimates. These timely estimates help pinpoint the special areas of county-level needs and help medical researchers and public health practitioners promptly evaluate rare diseases trends and associations with other health conditions. © 2023 The Author(s). |
Population-based denominators matter: Bias in U.S. Virgin islands COVID-19 vaccination coverage under changing population counts
Labgold K , Cranford HM , Ekpo LL , Mac VV , Roth J Jr , Stout M , Ellis EM . Ann Epidemiol 2024 PURPOSE: The U.S. Virgin Islands (USVI) receives an updated population count once every 10 years and used 2010 decennial census population counts to estimate COVID-19 vaccination coverage during the COVID-19 emergency response. We investigated whether using outdated (2010) or modeled (2020 international database [IDB]) population counts biased vaccination coverage estimates used to inform public health priorities during the 2020-2022 COVID-19 response. METHODS: We estimated percentage of USVI residents with a completed primary COVID-19 vaccination series during December 16, 2020-September 20, 2022. Vaccination coverage was calculated as number of persons who completed the vaccination series divided by 2010 and 2020 decennial census population counts and 2020 IDB intercensal estimate. RESULTS: COVID-19 vaccination coverage using the 2020 population count was 12 percentage points higher than coverage using 2010 denominator (2010 denominator: 51%; 2020 denominator: 63%). Vaccination coverage estimated using 2020 IDB was approximately equal with the 2010 decennial census estimate (52%). CONCLUSIONS: Using 2010 and modeled population counts underestimated 2020 USVI COVID-19 vaccination coverage given the 18% population decline during 2010-2020, potentially limiting USVI's ability to assess vaccination progress. Identifying mechanisms for more reliable population enumeration or improved estimate modeling are essential for accurately guiding USVI public health decision-making. |
Continuous quality evaluation of the Asanté rapid test for recent infection for robust kit lot quality verification
Zheng A , Detorio M , Dobbs T , Shanmugam V , Tan X , Vuong J , Domaoal RA , Lee K , Williams L , Jackson K , Parekh B , Yufenyuy EL . PLOS Glob Public Health 2024 4 (5) e0003195 The Sedia Biosciences Asanté rapid test for recent infection (RTRI) can identify HIV infections and characterize HIV-1 as recent or long-term infection via the positive verification (V) line and long-term line (LT) line, respectively. Tracking with Recency Assays to Control the Epidemic (TRACE) program uses RTRI assays. Successful implementation of TRACE requires high-quality test performance. The goal of this study is to evaluate the additional quality practices established for new kit lots prior to field use. Asanté lot quality control data from the manufacturer is reviewed by the Centers for Disease Control and Prevention International Laboratory Branch (CDC-ILB) in the Division of Global HIV and TB using. If a lot passes manufacturer quality control and CDC-ILB review, test kits are sent to CDC-ILB for further evaluation. Evaluation by CDC includes inter-rater reliability and linear regressions comparing the V and LT lines against reference data as well as V and LT line data between testers. A Bland-Altman analysis was conducted to assess bias and systematic error. Overall, CDC-ILB passed 29 (91%) out of 32 Sedia Biosciences Asanté kit lots that initially passed manufacturing quality control from July 2017 to May 2020. Regression analyses demonstrate that test kits are performing as expected with consistent R2≥0.92 for both V and LT lines. On average, inter-rater reliability kappa was 0.9, indicating a strong level of agreement. Bland-Altman analyses demonstrate high agreement with little to no systematic error and bias. Ongoing evaluation of new RTRI kit lots is important to ensure high quality test performance. Rejecting 9% of kit lots highlight the importance of continuing to work with manufacturers to ensure consistent kit production and quality assurance (QA) activities. Investing in effective QA measures, conducting both pre- and post-market performance data reviews, could help improve RTRI accuracy and outcomes in similar testing programs. |
Real world data are not always big data: The case for primary data collection on medication use in pregnancy in the context of birth defects research
Ailes EC , Werler MM , Howley MM , Jenkins MM , Reefhuis J . Am J Epidemiol 2024 Many examples of the use of real-world data in the area of pharmacoepidemiology include "big data" such as insurance claims, medical records, or hospital discharge databases. However, "big" is not always better, particularly when studying outcomes with narrow windows of etiologic relevance. Birth defects are one such outcome, where specificity of exposure timing is critical. Studies with primary data collection can be designed to query details on the timing of medication use, as well as type, dose, frequency, duration, and indication, that can better characterize the "real world". Because birth defects are rare, etiologic studies are typically case-control in design, like the National Birth Defects Prevention Study, Birth Defects Study to Evaluate Pregnancy exposureS, and Slone Birth Defects Study. Recall bias can be a concern, but the ability to collect detailed information on both prescription and over-the-counter medication use and on other exposures such as diet, family history, and sociodemographic factors is a distinct advantage over claims and medical record data sources. Case-control studies with primary data collection are essential to advancing the pharmacoepidemiology of birth defects. |
Systematic review of empiric studies on lockdowns, workplace closures, and other non-pharmaceutical interventions in non-healthcare workplaces during the initial year of the COVID-19 pandemic: benefits and selected unintended consequences
Ahmed F , Shafer L , Malla P , Hopkins R , Moreland S , Zviedrite N , Uzicanin A . BMC Public Health 2024 24 (1) 884 BACKGROUND: We conducted a systematic review aimed to evaluate the effects of non-pharmaceutical interventions within non-healthcare workplaces and community-level workplace closures and lockdowns on COVID-19 morbidity and mortality, selected mental disorders, and employment outcomes in workers or the general population. METHODS: The inclusion criteria included randomized controlled trials and non-randomized studies of interventions. The exclusion criteria included modeling studies. Electronic searches were conducted using MEDLINE, Embase, and other databases from January 1, 2020, through May 11, 2021. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Meta-analysis and sign tests were performed. RESULTS: A total of 60 observational studies met the inclusion criteria. There were 40 studies on COVID-19 outcomes, 15 on anxiety and depression symptoms, and five on unemployment and labor force participation. There was a paucity of studies on physical distancing, physical barriers, and symptom and temperature screening within workplaces. The sign test indicated that lockdown reduced COVID-19 incidence or case growth rate (23 studies, p < 0.001), reproduction number (11 studies, p < 0.001), and COVID-19 mortality or death growth rate (seven studies, p < 0.05) in the general population. Lockdown did not have any effect on anxiety symptoms (pooled standardized mean difference = -0.02, 95% CI: -0.06, 0.02). Lockdown had a small effect on increasing depression symptoms (pooled standardized mean difference = 0.16, 95% CI: 0.10, 0.21), but publication bias could account for the observed effect. Lockdown increased unemployment (pooled mean difference = 4.48 percentage points, 95% CI: 1.79, 7.17) and decreased labor force participation (pooled mean difference = -2.46 percentage points, 95% CI: -3.16, -1.77). The risk of bias for most of the studies on COVID-19 or employment outcomes was moderate or serious. The risk of bias for the studies on anxiety or depression symptoms was serious or critical. CONCLUSIONS: Empiric studies indicated that lockdown reduced the impact of COVID-19, but that it had notable unwanted effects. There is a pronounced paucity of studies on the effect of interventions within still-open workplaces. It is important for countries that implement lockdown in future pandemics to consider strategies to mitigate these unintended consequences. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration # CRD42020182660. |
The National Wastewater Surveillance System (NWSS): From inception to widespread coverage, 2020-2022, United States
Adams C , Bias M , Welsh RM , Webb J , Reese H , Delgado S , Person J , West R , Shin S , Kirby A . Sci Total Environ 2024 171566 Wastewater surveillance is a valuable tool that can be used to track infectious diseases in a community. In September 2020, the Centers for Disease Control and Prevention (CDC) established the National Wastewater Surveillance System (NWSS) to coordinate and build the nation's capacity to detect and quantify concentrations of SARS-CoV-2 RNA in U.S. wastewater. This is the first surveillance summary of NWSS, covering September 1, 2020 to December 31, 2022. Through partnerships with state, tribal, local, and territorial health departments, NWSS became a national surveillance platform that can be readily expanded and adapted to meet changing public health needs. Beginning with 209 sampling sites in September 2020, NWSS rapidly expanded to >1500 sites by December 2022, covering ≈47 % of the U.S. population. As of December 2022, >152,000 unique wastewater samples have been collected by NWSS partners, primarily from wastewater treatment plants (WWTPs). WWTPs participating in NWSS tend to be larger than the average U.S. WWTP and serve more populated communities. In December 2022, ≈8 % of the nearly 16,000 U.S. WWTPs were participating in NWSS. NWSS partners used a variety of methods for sampling and testing wastewater samples; however, progress is being made to standardize these methods. In July 2021, NWSS partners started submitting SARS-CoV-2 genome sequencing data to NWSS. In October 2022, NWSS expanded to monkeypox virus testing, with plans to include additional infectious disease targets in the future. Through the rapid implementation and expansion of NWSS, important lessons have been learned. Wastewater surveillance programs should consider both surge and long-term capacities when developing an implementation plan, and early standardization of sampling and testing methods is important to facilitate data comparisons across sites. NWSS has proven to be a flexible and sustainable surveillance system that will continue to be a useful complement to case-based surveillance for guiding public health action. |
Viral shedding of SARS-CoV-2 in body fluids associated with sexual activity: a systematic review and meta-analysis
Calvet GA , Kara E , Gonsalves L , Seuc AH , de Oliveira RVC , Thwin SS , Gomez Ponce de León R , Gámez MC , Peña GM , Pendás BVR , Alzugaray MG , Carballo GO , Cala DC , Guimarães PMQ , Bonet M , Taylor M , Thorson A , Kim C , Ali M , Broutet N . BMJ Open 2024 14 (2) e073084 OBJECTIVE: To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion). ELIGIBILITY: All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs. INFORMATION SOURCES: The WHO COVID-19 database from inception to 20 April 2022. RISK OF BIAS ASSESSMENT: The National Institutes of Health tools. SYNTHESIS OF RESULTS: The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models. INCLUDED STUDIES: A total of 182 studies with 10 023 participants. RESULTS: The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces. LIMITATIONS: Scarcity of longitudinal studies with follow-up until negative results. INTERPRETATION: SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed. PROSPERO REGISTRATION NUMBER: CRD42020204741. |
Investigating the current harmonization status of tumor markers using global external quality assessment programs: A feasibility study
van Rossum HH . Clin Chem 2024 BACKGROUND: The harmonization status of most tumor markers (TMs) is unknown. We report a feasibility study performed to determine whether external quality assessment (EQA) programs can be used to obtain insights into the current harmonization status of the tumor markers α-fetoprotein (AFP), prostate specific antigen (PSA), carcinoembryonic antigen (CEA), cancer antigen (CA)125, CA15-3 and CA19-9. METHODS: EQA sample results provided by 6 EQA providers (INSTAND [Germany], Korean Association of External Quality Assessment Service [KEQAS, South Korea], National Center for Clinical Laboratories [NCCL, China], United Kingdom National External Quality Assessment Service [UK NEQAS, United Kingdom], Stichting Kwaliteitsbewaking Medische Laboratoriumdiagnostiek [SKML, the Netherlands], and the Royal College of Pathologists of Australasia Quality Assurance Programs [RCPAQAP, Australia]) between 2020 and 2021 were used. The consensus means, calculated from the measurement procedures present in all EQA programs (Abbott Alinity, Beckman Coulter DxI, Roche Cobas, and Siemens Atellica), was used as reference values. Per measurement procedure, the relative difference between consensus mean for each EQA sample and the mean of all patient-pool-based EQA samples were calculated and compared to minimum, desirable, and optimal allowable bias criteria based on biological variation. RESULTS: Between 19040 (CA15-3) and 25398 (PSA) individual results and 56 (PSA) to 76 (AFP) unique EQA samples were included in the final analysis. The mean differences with the consensus mean of patient-pool-based EQA samples for all measurement procedures were within the optimum bias criterion for AFP, the desirable bias for PSA, and the minimum bias criterion for CEA. However, CEA results <8 µg/L exceeded the minimum bias criterion. For CA125, CA15-3, and CA19-9, the harmonization status was outside the minimum bias criterion, with systematic differences identified. CONCLUSIONS: This study provides relevant information about the current harmonization status of 6 tumor markers. A pilot harmonization investigation for CEA, CA125, CA15-3, and CA19-9 would be desirable. |
Region-wide assessment of National Immunization Technical Advisory Groups (NITAGs) using the NITAG Maturity Assessment Tool (NMAT) - Experience from the Eastern Mediterranean Region of the World Health Organization, 2023
Sume GE . Vaccine 2024 National Immunization Technical Advisory Groups (NITAGs) are independent bodies that help improve national immunization programmes in decision making on immunization policy. The new NITAG Maturity Assessment Tool (NMAT) provided an opportunity to conduct a region-wide assessment to improve NITAG capacity and foster institutional growth. We share experience of the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) in using NMAT and the use of findings to develop improvement plans. NITAG chairs and secretariats from 22 EMR countries attended a virtual NMAT training in 2023. They self-assessed their NITAGs using the tool and developed improvement plans. An algorithm used the data to determine maturity levels for seven indicators. We consolidated results for the region by income groups. Of 22 countries (or NITAGs), 20 (91%) submitted NITAG assessment findings and 19 an improvement plan. The proportion of criteria met per indicator varied from 36% for independence and non-bias to 74% for establishment and composition. Maturity level varied by indicator. Of 20 NITAGs, less than half had an intermediate or higher-level maturity for the indicators of independence and non-bias 1 (5%), operations 3 (15%), making recommendations 4 (20%), stakeholder recognition 6 (30%), and resources and secretariat support 7 (35%). Meanwhile 11 (55%) NITAGs had an intermediate or higher maturity level for the indicators of establishment and composition and for integration into policy making process. Participants described NMAT as a concise, useful, user-friendly tool. NMAT is a practical tool that can be used by NITAGs to provide insights and strategic direction for individual countries and regionally. Prevention and management of conflict of interest is the domain that requires the most improvement in EMR. Planned activities should be implemented, monitored and a follow up assessment conducted in 2025. |
Mortality risk after COVID-19 vaccination: A self-controlled case series study
Xu S . Vaccine 2024 BACKGROUND: Although previous studies found no-increased mortality risk after COVID-19 vaccination, residual confounding bias might have impacted the findings. Using a modified self-controlled case series (SCCS) design, we assessed the risk of non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes after primary series COVID-19 vaccination. METHODS: We analyzed all deaths between December 14, 2020, and August 11, 2021, among individuals from eight Vaccine Safety Datalink sites. Demographic characteristics of deaths in recipients of COVID-19 vaccines and unvaccinated individuals were reported. We conducted SCCS analyses by vaccine type and death outcomes and reported relative incidences (RI). The observation period for death spanned from the dates of emergency use authorization to the end of the study period (August 11, 2021) without censoring the observation period upon death. We pre-specified a primary risk interval of 28-day and a secondary risk interval of 14-day after each vaccination dose. Adjusting for seasonality in mortality analyses is crucial because death rates vary over time. Deaths among unvaccinated individuals were included in SCCS analyses to account for seasonality by incorporating calendar month in the models. RESULTS: For Pfizer-BioNTech (BNT162b2), RIs of non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes were below 1 and 95 % confidence intervals (CIs) excluded 1 across both doses and both risk intervals. For Moderna (mRNA-1273), RI point estimates of all outcomes were below 1, although the 95 % CIs of two RI estimates included 1: cardiac-related (RI = 0.78, 95 % CI, 0.58-1.04) and non-COVID-19 cardiac-related mortality (RI = 0.80, 95 % CI, 0.60-1.08) 14 days after the second dose in individuals without pre-existing cancer and heart disease. For Janssen (Ad26.COV2.S), RIs of four cardiac-related death outcomes ranged from 0.94 to 0.98 for the 14-day risk interval, and 0.68 to 0.72 for the 28-day risk interval and 95 % CIs included 1. CONCLUSION: Using a modified SCCS design and adjusting for temporal trends, no-increased risk was found for non-COVID-19 mortality, all-cause mortality, and four cardiac-related death outcomes among recipients of the three COVID-19 vaccines used in the US. |
Can sodium and potassium measured in timed voids be used as reference instruments for validating self-report instruments? Results from a urine calibration study
Freedman LS . Am J Clin Nutr 2024 BACKGROUND: Sodium and potassium measured in 24-hour urine collections are often used as reference measurements to validate self-reported dietary intake instruments. OBJECTIVE: To evaluate whether collection and analysis of a limited number of urine voids at specified times during the day ("timed voids") can provide alternative reference measurements, and to identify their optimal number and timing. METHODS: We used data from a urine calibration study among 441 adults aged 18-39 years. Participants collected each urine void in a separate container for 24 hours and recorded collection time. For the same day, they reported dietary intake using a 24-hour recall. Urinary sodium and potassium were analyzed in a 24-hour composite sample and in four timed voids (morning, afternoon, evening and overnight). Using linear regression models, equations predicting log-transformed 24-hour urinary sodium or potassium level were developed using each of the four single timed voids, six pairs and four triples. The equations also included age, sex, race, body mass index and log creatinine. Optimal combinations minimizing the mean squared prediction error were selected, and the observed and predicted 24-hour levels were then used as reference measures to estimate the group bias and attenuation factors of the 24-hour dietary recall. These estimates were compared. RESULTS: Optimal combinations found were: single voids - Evening; paired voids - Afternoon+Overnight (sodium) and Morning+Evening (potassium); triple voids - Morning+Evening+Overnight (sodium) and Morning+Afternoon+Evening (potassium). Predicted 24-hour urinary levels estimated 24-hour recall group biases and attenuation factors without apparent bias, but with less precision than observed 24-hour urinary levels. To recover lost precision, it was estimated that sample sizes need to be larger by about 2.6-2.7 times for a single void, 1.7-2.1 times for paired voids and 1.5-1.6 times for triple voids. CONCLUSIONS: Our results lay the basis for further development of new reference biomarkers based on timed voids. CLINICAL TRIAL REGISTRY: Home ClinicalTrials.govas NCT01631240. |
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