Epidemiology and Population Health


Epidemiology and Population Health

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News Article | May 16, 2017
Site: www.eurekalert.org

Responders to the West African Ebola epidemic of 2014-2016 who returned to the UK and Ireland included many who reported possible Ebola virus exposure or Ebola-associated symptoms, according to a new study published in PLOS Medicine. The study, conducted by Catherine F. Houlihan of the London School of Hygiene & Tropical Medicine, UK and colleagues, also reports that the vast majority showed no evidence of Ebola virus infection. Using an online questionnaire, 268 clinical, laboratory, research, and other responders detailed their experiences. Oral fluid collection devices were mailed to participants and returned samples were tested for Ebola virus antibodies with follow-up blood samples collected where necessary. Despite "near-miss" exposure events for 16% (43/268) of the returnees and symptoms in 21% (57/268), 99% (266/268) showed no evidence of Ebola virus infection. Of note, 70% (40/57) of those who experienced symptoms did not get tested for Ebola virus at the time. A limitation of the study is that not all returning responders were included and participants were not a random sample. The authors say: "The descriptions of near-miss events and the finding that many of those who experienced illness were not tested at the time suggest that protocols for the management of possible exposure to Ebola virus and for the management of illness should be reviewed and standardised across organisations that deploy staff to outbreaks." CFH and JRG received funding from the Wellcome Trust: Enhancing Research Activity in Epidemic Situations, grant number ER1503. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. I have read the journal's policy and the authors of this manuscript have the following competing interests: RT has received funding from the Wellcome Trust via the University of Liverpool, and has received non-financial support from NHSBT, as part of the Convalescent Plasma Study. All other authors have declared that no competing interests exist. Houlihan CF, McGowan CR, Dicks S, Baguelin M, Moore DAJ, Mabey D, et al. (2017) Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014-2016: A cross-sectional study. PLoS Med 14(5): e1002300. https:/ Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom Faculty of Medical Sciences, University College London, London, United Kingdom Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom Transfusion Microbiology, National Health Service Blood and Transplant, London, United Kingdom NHSBT/PHE Blood Borne Virus Unit, Serology Development Unit, Public Health England, London, United Kingdom Centre of Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

Brandwein-Gensler M.,Einstein Montefiore Head and Neck Research Group | Brandwein-Gensler M.,University of Alabama at Birmingham | Smith R.V.,Otolaryngology Head and Neck Surgery | Theilken A.,Johannes Gutenberg University Mainz | And 14 more authors.
American Journal of Surgical Pathology | Year: 2010

BACKGROUND: Half of the patients with head and neck squamous cell carcinoma (HNSCC) can be expected to fail therapy, indicating that more aggressive treatment is warranted for this group. We have developed a novel risk model that can become a basis for developing new treatment paradigms. Here we report on the performance of our model in a new multicenter cohort. DESIGN: Eligible patients from 3 institutions (Montefiore Medical Center, University of Manitoba, and New York University Medical Center) were identified and pathology slides from their resection specimens were reviewed by Margaret Brandwein-Gensler; risk category was assigned as previously published. Kaplan-Meier analysis was performed for disease progression and survival. Cox proportional hazards regression was performed, adjusted for potential confounders. A teaching module was also developed; attending pathologists were asked to score coded slides after a lecture and multiheaded microscope teaching session. Agreement was assessed by calculating Cohen unweighted κ coefficients. RESULT: The validation cohort consisted of 305 patients, from the above institutions, with 311 primary HNSCC of the oral cavity, oropharynx, and larynx. The median follow-up period for all patients was 27 months. Risk category predicts time to disease progression (P=0.0005), locoregional recurrence (P=0.013), and overall survival (P=0.0000) by Kaplan-Meier analysis. High-risk status is significantly associated with decreased time to disease progression, adjusted for clinical confounders (P=0.015, hazard ratio 2.32, 95% confidence interval 1.18-4.58) compared with collapsed intermediate and low-risk groups. We also demonstrate substantial interrater agreement (κ=0.64), and very good rater agreement when compared with the standard (κ=0.87). CONCLUSIONS: We demonstrate significant predictive performance of the risk model in a new cohort of patients with primary HNSCC, adjusted for confounders. Our training experience also supports the feasibility of adapting the risk model in clinical practice. © 2010 Lippincott Williams & Wilkins.

O'Brien S.J.,University of Liverpool | O'Brien S.J.,Epidemiology and Population Health | O'Brien S.J.,Farr Institute at HeRC | Donaldson A.L.,University of Liverpool | And 3 more authors.
Journal of Infectious Diseases | Year: 2016

In a prospective, population-based cohort study and a study of primary-healthcare consultations, we had a rare opportunity to estimate age-specific rates of norovirus-associated infectious intestinal disease in the United Kingdom. Rates in children aged <5 years were significantly higher than those for other age groups in the community (142.6 cases per 1000 person-years [95% confidence interval {CI}, 99.8-203.9] vs 37.6 [95% CI, 31.5-44.7]) and those for individuals presenting to primary healthcare (14.4 cases per 1000 person-years [95% CI, 8.5-24.5] vs 1.4 [95% CI,. 9-2.0]). Robust incidence estimates are crucial for vaccination policy makers. This study emphasises the impact of norovirus-associated infectious intestinal disease, especially in children aged <5 years. © 2016 The Author.

PubMed | Epidemiology and Population Health, Yeshiva University, University of Houston, Regional Alliance for Sustainable Development and College of Medicine and Health Sciences, University of Rwanda
Type: Journal Article | Journal: The Journal of infectious diseases | Year: 2015

Plasmodium falciparum infection can result in severe disease that is associated with elevated inflammation and vital organ dysfunction; however, malaria-endemic residents gain protection from lethal outcomes and manifest only mild symptoms during infection. To characterize host responses associated with this more effective antimalarial response, we characterized whole-blood transcriptional profiles in Rwandan adults during a mild malaria episode and compared them with findings from a convalescence sample. We observed transcriptional up-regulation in many pathways, including type I interferon, interferon , complement activation, and nitric oxide during malaria infection, which provide benchmarks of mild disease physiology. Transcripts encoding negative regulators of T-cell activation, such as programmed death ligand 1 (PD-L1), programmed death 1 ligand 2 (PD-L2), and the butyrophilin family member butyrophilin-like 2 (BTNL2) were also increased. To support an important functional role for BTNL2 during malaria infection, we studied chimeric mice reconstituted with BTNL2(-/-) or wild-type hematopoietic cells that were inoculated with Plasmodium berghei ANKA, a murine model of cerebral malaria. We found that BTNL2(-/-) chimeric mice had a significant decrease in survival compared with wild-type counterparts. Collectively these data characterize the immune responses associated with mild malaria and uncover a novel role for BTNL2 in the host response to malaria.

Page A.-L.,Epidemiology and Population Health | de Rekeneire N.,Epidemiology and Population Health | Sayadi S.,Epidemiology and Population Health | Aberrane S.,Center Hospitalier Intercommunal | And 11 more authors.
PLoS ONE | Year: 2013

Background:Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.Methods:Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.Results:Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.Conclusions:These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data. © 2013 Page et al.

Green R.,Yeshiva University | Santoro N.F.,Yeshiva University | McGinn A.P.,Epidemiology and Population Health | Wildman R.P.,Epidemiology and Population Health | And 4 more authors.
Climacteric | Year: 2010

Method To test the hypothesis that psychosocial symptomatology differs by country of origin and acculturation among Hispanic women, we examined 419 women, aged 42-52 years at baseline, enrolled in the New Jersey site of the Study of Women's Health Across the Nation (SWAN). Women were categorized into six groups: Central (CA, n=29) or South American (SA, n=106), Puerto Rican (PR, n=56), Dominican (D, n=42), Cuban (Cu, n=44) and non-Hispanic Caucasian (NHC, n=142). Acculturation, depressive symptoms, hostility/cynicism, mistreatment/ discrimination, sleep quality, social support, and perceived stress were assessed at baseline. Physical functioning, trait anxiety and anger were assessed at the fourth annual follow-up. Comparisons between Hispanic and non-Hispanic Caucasians used χ2, t test or non-parametric alternatives; ANOVA or KruskalWallis testing examined differences among the five Hispanic sub-groups. Multivariable regression models used PR women as the reference group. ResultsHispanic women were overall less educated, less acculturated (p<0.001 for both) and reported more depressive symptoms, cynicism, perceived stress, and less mistreatment/discrimination than NHCs. Along with D women, PR women reported worse sleep than Cu women (p<0.01) and more trait anxiety than SA and Cu women (p<0.01). Yet, PR women were most acculturated (21.4% highly acculturated vs. CA (0.0%), D (4.8%), SA (4.8%) and Cu (2.3%) women; p<0.001). In regression models, PR women reported depressive symptoms more frequently than D, Cu, or SA women, and reported trait anxiety more frequently than Cu or SA women. Greater acculturation was associated with more favorable psychosocial status, but PR ethnicity was negatively related to psychosocial status. ConclusionPsychosocial symptomatology among Hispanic women differs by country of origin and the relatively adverse profile of Puerto Rican women is not explained by acculturation. © 2010 International Menopause Society.

People who leave school without a school certificate are more than twice as likely to have a heart attack as those with a university degree, according to groundbreaking new Australian research from the largest ongoing study of healthy ageing in the Southern Hemisphere, the Sax Institute's 45 and Up Study. Researchers investigated the links between education and cardiovascular disease events (such as a heart attack or stroke) by following 267,153 men and women in the state of New South Wales aged over 45, who are part of the Sax Institute's 45 and Up Study, for over five years. The results were published in the International Journal for Equity in Health and were the subject of discussion today at the Cardiovascular Disease Inequalities Partnership Project meeting in the nation's capital, Canberra. "The lower your education, the more likely you are to have a heart attack or a stroke - that's the disturbing but clear finding from our research," said lead researcher Dr Rosemary Korda, a Fellow at the National Centre for Epidemiology and Population Health at The Australian National University (ANU). "Our study found that in adults aged 45-64 years, heart attack rates among those with no educational qualifications were more than double (around 150% higher) those of people with a university degree. The risk was around two-thirds (70%) higher among those with intermediate levels of education (non-university qualifications). "Mid-age adults who hadn't completed high school were 50% more likely to have a first stroke than those with a university degree; those with intermediate levels of education (non-university qualifications) were 20% more likely." Dr Korda said a similar pattern of inequality existed between household income and cardiovascular disease events. "What these differences in cardiovascular disease rates between more and less disadvantaged groups show us is just how much cardiovascular disease in the population can be prevented. The Cardiovascular Disease Inequalities Partnership Project is continuing research in this area to better understand what is driving these socioeconomic differences." Professor Emily Banks, Scientific Director of the 45 and Up Study and Head of Epidemiology for Policy and Practice at ANU, said these findings demonstrated the value of the 45 and Up Study as an unparalleled Australian research resource making it possible for researchers to investigate big questions in large numbers of people and to get faster answers that are useful for policy makers. "This research demonstrates, now that we have more robust data, how much worse the inequalities in cardiovascular disease are than we previously thought," said Professor Banks. "This research also provides important clues about how much cardiovascular disease can be prevented." CEO of the Heart Foundation New South Wales Kerry Doyle said that heart disease was the single leading cause of death in Australia, with an average of one Australian dying every 27 minutes. "We know that a good education impacts long term health by influencing what type of job you have, where you live and what food choices you make," said Ms Doyle. "This research provides an opportunity to further unpack the specific relationship between educational achievement and cardiovascular disease risk, and what can be done to reduce this risk," she added. The Sax Institute is an independent Australian leader in helping decision makers find and make best use of research to solve real-world health and social problems. The Cardiovascular Disease Inequalities Partnership Project is collaboration between the Australian National University, The Agency for Clinical Innovation, The Consumers Health Forum of Australia and The National Heart Foundation. It is partly funded by the National Health and Medical Research Council and The National Heart Foundation. About the 45 and Up Study: The Sax Institute's 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere, involving a quarter of a million people - one in every 10 men and women aged 45 and over in New South Wales. It is a major national research tool being used by both researchers and policy makers to better understand how Australians are ageing, how they're using health services, how to prevent and manage ill-health and disability and how this can guide decisions on our health system. Over time, we are asking all participants ongoing questions about their health, lifestyle, and the medications they use. This is providing the first large-scale, comprehensive measure of health as people move from mid to later life and allowing governments and health policy makers to better plan health services and programs for our ageing population.

PubMed | Epidemiology and Population Health, Cornell University, Montefiore Medical Center and Yeshiva University
Type: | Journal: Pain medicine (Malden, Mass.) | Year: 2016

Language barriers can prevent pain physicians and patients from forming meaningful rapport and drive health care disparities. Non-adherence with scheduled pain clinic appointments deprives patients with chronic pain of needed specialist care.We evaluated the benefit of comprehensive initiatives to overcome language barriers to improve patient adherence with initial scheduled chronic pain clinic appointments.After implementation of our initiative, we performed a retrospective cross-sectional analysis and fit logistic regression models to investigate the association between demographic factors and adherence.We collected retrospective data from an observational cohort with a scheduled appointment at the adult inner-city underserved outpatient Pain Center at Montefiore Medical Center, Bronx, New York.Between March 2012 and March 2014, 14,459 appointments were scheduled; 3,035 of these appointments represented initial first visits; patients had a mean age of 53 years; 15% were predominantly Spanish-speaking, 65% were female.Our initiative to overcome language barriers in our pain clinic included appointment reminders in the patients preferred language, Spanish-speaking staff, and unified locations with equitable access.Our dependent variable was adherence with a first scheduled pain clinic appointment.We found that after implementation of our initiative, speaking Spanish was now statistically significantly associated with higher rates of adherence with appointments (Odds Ratio 1.32, 95% confidence interval [1.06-1.64]).We infer from our results that coordinated initiatives to overcome language barriers can be beneficial in improving appointment adherence and access to care by enhancing rapport and communication between pain physicians and their patients.The results of this retrospective cross-sectional analysis of patients adherence with scheduled appointments in an inner-city chronic pain clinic suggests that targeted initiatives including a pre-clinic reminder phone call in the patients own language may help to overcome language barriers and improve access to care.

PubMed | University of Otago, World Health Organization, University of Barcelona, Swiss Tropical and Public Health Institute and 6 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP). To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require <2 days of training to perform the assay. Further, given that the aim is to reduce inappropriate antimicrobial use as well as to deliver appropriate treatment for patients with bacterial infections, the group agreed on minimal diagnostic performance requirements of >90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i) time-to-result <10 min (but maximally <2 hrs); ii) storage conditions at 0-40C, 90% non-condensing humidity with a minimal shelf life of 12 months; iii) operational conditions of 5-40C, 90% non-condensing humidity; and iv) minimal sample collection needs (50-100L, capillary blood). This expert approach to define assay requirements for a bacterial vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.

Page A.-L.,Epidemiology and Population Health | De Rekeneire N.,Epidemiology and Population Health | Sayadi S.,Epidemiology and Population Health | Aberrane S.,Center Hospitalier Intercommunal | And 3 more authors.
Pediatrics | Year: 2014

BACKGROUND: Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings. METHODS: From November 2007 to July 2008, we prospectively recruited 311 children aged 6 to 59 months hospitalized with SAM plus a medical complication in Maradi, Niger. Blood, urine, and stool cultures and chest radiography were performed systematically on admission. CRP and PCT were measured by rapid tests and by reference quantitative methods using frozen serum sent to a reference laboratory. RESULTS: Median CRP and PCT levels were higher in children with bacteremia or pneumonia than in those with no proven bacterial infection (P < .002). However, both markers performed poorly in identifying invasive bacterial infection, with areas under the curve of 0.64 and 0.67 before and after excluding children with malaria, respectively. At a threshold of 40 mg/L, CRP was the best predictor of death (81% sensitivity, 58% specificity). Rapid test results were consistent with those from reference methods. CONCLUSIONS: CRP and PCT are not sufficiently accurate for diagnosing invasive bacterial infections in this population of hospitalized children with complicated SAM. However, a rapid CRP test could be useful in these settings to identify children most at risk for dying. Copyright © 2014 by the American Academy of Pediatrics.

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