Journal Description
Epidemiologia
Epidemiologia
is an international, peer-reviewed, open access journal on epidemiologic research published quarterly online by MDPI. The Italian Society of Environmental Medicine (SIMA) is affiliated with Epidemiologia, and its members receive discounts on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within ESCI (Web of Science), Scopus, PMC, PubMed, FSTA, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 28.4 days after submission; acceptance to publication is undertaken in 5.5 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
- Epidemiologia is a companion journal of JCM.
Latest Articles
Post-COVID-19: Time to Change Our Way of Life for a Better Future
Epidemiologia 2024, 5(2), 211-220; https://doi.org/10.3390/epidemiologia5020015 - 22 May 2024
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Background and Objectives: From the year 1 anno Domini until 1855, with the third plague, major pandemics occurred on average every 348 years. Since then, they have occurred on average every 33 years, with coronavirus disease 2019 (COVID-19) now underway. Even though current
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Background and Objectives: From the year 1 anno Domini until 1855, with the third plague, major pandemics occurred on average every 348 years. Since then, they have occurred on average every 33 years, with coronavirus disease 2019 (COVID-19) now underway. Even though current technologies have greatly improved the way of life of human beings, COVID-19, with more than 700,000,000 cases and 6,950,000 deaths worldwide by the end of 2023, reminds us that much remains to be done. This report looks back at 18 months of COVID-19, from March 2020 to August 2021, with the aim of highlighting potential solutions that could help mitigate the impact of future pandemics. Materials and Methods: COVID-19 data, including case and death reports, were extracted daily from the Worldometer platform to build a database for the macroscopic analysis of the spread of the virus around the world. Demographic data were integrated into the COVID-19 database for a better understanding of the spatial spread of the SARS-CoV-2 virus in cities/municipalities. Without loss of generality, only data from the top 30 (out of 200 and above) countries ranked by total number of COVID-19 cases were analyzed. Statistics (regression, t-test (p < 0.05), correlation, mean ± std, etc.) were carried out with Excel software (Microsoft® Excel® 2013 (15.0.5579.1001)). Spectral analysis, using Matlab software (license number: 227725), was also used to try to better understand the temporal spread of COVID-19. Results: This study showed that COVID-19 mainly affects G20 countries and that cities/municipalities with high population density are a powerful activator of the spread of the virus. In addition, spectral analysis highlighted that the very first months of the spread of COVID-19 were the most notable, with a strong expansion of the SARS-CoV-2 virus. On the other hand, the following six months showed a certain level of stability, mainly due to multiple preventive measures such as confinement, the closure of non-essential services, the wearing of masks, distancing of 2 m, etc. Conclusion: Given that densely populated cities and municipal areas have largely favored the spread of the SARS-CoV-2 virus, it is believed that such a demographic context is becoming a societal problem that developed countries must address in a manner that is adequate and urgent. COVID-19 has made us understand that it is time to act both preventatively and curatively. With phenomenological evidence suggesting that the next pandemic could occur in less than 50 years, it may be time to launch new societal projects aimed at relieving congestion in densely populated regions.
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Open AccessSystematic Review
The Association between Antenatal Tea Drinking and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis
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Ahmed Arafa, Haytham A. Sheerah, Omar Khaled Alzaydan and Yasser Sabr
Epidemiologia 2024, 5(2), 200-210; https://doi.org/10.3390/epidemiologia5020014 - 30 Apr 2024
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Several adverse maternal outcomes have been linked to the excessive consumption of caffeine during pregnancy. Tea is an important source of caffeine. Hypertensive disorders of pregnancy (HDP) are common pregnancy complications with unfavorable maternal and fetal complications. This study aimed to investigate the
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Several adverse maternal outcomes have been linked to the excessive consumption of caffeine during pregnancy. Tea is an important source of caffeine. Hypertensive disorders of pregnancy (HDP) are common pregnancy complications with unfavorable maternal and fetal complications. This study aimed to investigate the relationship between antenatal tea drinking and HDP using a meta-analysis of available evidence. We systematically retrieved eligible studies before computing the pooled odds ratio (OR) and 95% confidence interval (CI) of HDP for women who reported the highest versus the lowest frequencies of antenatal tea drinking. We used the I2 statistic to measure heterogeneity across studies and the test for funnel plot asymmetry to evaluate publication bias. The results showed that the highest frequencies of antenatal tea drinking were associated with increased odds of HDP (pooled OR = 1.16, 95% CI: 1.01, 1.33). We identified no signs of heterogeneity across studies (I2 = 0.0% and p-heterogeneity = 0.498) or publication bias (z = 0.791 and p-publication bias = 0.429). When the outcome was limited to (pre-)eclampsia, the association became statistically non-significant (pooled OR = 1.28, 95% CI: 0.86, 1.89, I2 = 0.0%, and p-heterogeneity = 0.751). In conclusion, our results indicated that the highest frequency of antenatal tea drinking was positively associated with HDP. Pregnant women should be advised against excessive tea consumption. Still, future prospective cohort studies, considering the effects of different tea types and caffeine content, are needed to confirm our conclusions.
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Open AccessArticle
Analyzing the COVID-19 Transmission Dynamics in Acre, Brazil: An Ecological Study
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Joseane Elza Tonussi Mendes, Blanca Elena Guerrero Daboin, Tassiane Cristina Morais, Italla Maria Pinheiro Bezerra, Matheus Paiva Emidio Cavalcanti, Andres Ricardo Perez Riera, Matias Noll and Luiz Carlos de Abreu
Epidemiologia 2024, 5(2), 187-199; https://doi.org/10.3390/epidemiologia5020013 - 25 Apr 2024
Abstract
The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to
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The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to healthcare access. The crisis was further influenced by multiple lineages that emerged as significant virus variants associated with increased transmissibility. Within this context, our ecological study focused on analyzing the epidemiological evolution of COVID-19 in the state of Acre. We constructed time-series trends in incidence, lethality, and mortality from March 2020 to December 2022 using the Prais–Winsten regression model. Our findings revealed that in 2020, there was an increasing trend in incidence, while mortality and lethality continued to decrease (p < 0.05). In the following year, both incidence and mortality decreased, while lethality increased at a rate of 1.02% per day. By the end of 2022, trends remained stationary across all rates. These results underscore the importance of ongoing surveillance and adaptive public health measures to bolster the resilience of healthcare systems in remote and vulnerable regions. Indeed, continuous monitoring of the most predominant SARS-CoV-2 lineages and their dynamics is imperative. Such proactive actions are essential for addressing emerging challenges and ensuring effective responses to adverse situations.
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(This article belongs to the Special Issue Global Health Epidemiology and Disease Control)
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Open AccessArticle
Cellular Immunity of SARS-CoV-2 in the Borriana COVID-19 Cohort: A Nested Case–Control Study
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Salvador Domènech-Montoliu, Joan Puig-Barberà, María Rosario Pac-Sa, Alejandro Orrico-Sanchéz, Lorna Gómez-Lanas, Diego Sala-Trull, Carmen Domènech-Leon, Alba Del Rio-González, Manuel Sánchez-Urbano, Paloma Satorres-Martinez, Laura Aparisi-Esteve, Gema Badenes-Marques, Roser Blasco-Gari, Juan Casanova-Suarez, María Gil-Fortuño, Noelia Hernández-Pérez, David Jovani-Sales, Laura López-Diago, Cristina Notari-Rodríguez, Oscar Pérez-Olaso, María Angeles Romeu-Garcia, Raquel Ruíz-Puig and Alberto Arnedo-Penaadd
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Epidemiologia 2024, 5(2), 167-186; https://doi.org/10.3390/epidemiologia5020012 - 10 Apr 2024
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Our goal was to determine the cellular immune response (CIR) in a sample of the Borriana COVID-19 cohort (Spain) to identify associated factors and their relationship with infection, reinfection and sequelae. We conducted a nested case–control study using a randomly selected sample of
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Our goal was to determine the cellular immune response (CIR) in a sample of the Borriana COVID-19 cohort (Spain) to identify associated factors and their relationship with infection, reinfection and sequelae. We conducted a nested case–control study using a randomly selected sample of 225 individuals aged 18 and older, including 36 individuals naïve to the SARS-CoV-2 infection and 189 infected patients. We employed flow-cytometry–based immunoassays for intracellular cytokine staining, using Wuhan and BA.2 antigens, and chemiluminescence microparticle immunoassay to detect SARS-CoV-2 antibodies. Logistic regression models were applied. A total of 215 (95.6%) participants exhibited T-cell response (TCR) to at least one antigen. Positive responses of CD4+ and CD8+ T cells were 89.8% and 85.3%, respectively. No difference in CIR was found between naïve and infected patients. Patients who experienced sequelae exhibited a higher CIR than those without. A positive correlation was observed between TCR and anti-spike IgG levels. Factors positively associated with the TCR included blood group A, number of SARS-CoV-2 vaccine doses received, and anti-N IgM; factors inversely related were the time elapsed since the last vaccine dose or infection, and blood group B. These findings contribute valuable insights into the nuanced immune landscape shaped by SARS-CoV-2 infection and vaccination.
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Open AccessOpinion
The COVID-19 Pandemic Affected Hepatitis C Virus Circulation and Genotypic Frequencies—Implications for Hepatitis C Prevention, Treatment and Research
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Julio Daimar Oliveira Correa and José Artur Bogo Chies
Epidemiologia 2024, 5(2), 160-166; https://doi.org/10.3390/epidemiologia5020011 - 4 Apr 2024
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Hepatitis C is regarded as a global health issue caused by hepatitis C virus (HCV) infection. HCV is targeted for elimination by 2030 as a global public health goal. However, the COVID-19 pandemic has changed human circulation and prevented access to diagnostics and
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Hepatitis C is regarded as a global health issue caused by hepatitis C virus (HCV) infection. HCV is targeted for elimination by 2030 as a global public health goal. However, the COVID-19 pandemic has changed human circulation and prevented access to diagnostics and treatment to many other diseases, including hepatitis C. COVID-19 impacted HCV global elimination efforts with implications not fully comprehended yet. The high genetic variability in HCV makes the development of vaccines and pan-genotypic drug therapies a difficult task. Changes in the dynamics of HCV impose new challenges for public health and opportunities for future research. Meta-analysis, the follow up of new cases and sampling of HCV patients compared with previously available data are options for investigating the possible changes. The determination of HCV genotypes and subtypes is important for understanding viral dynamics and treatment; therefore, the changes in genotype and subtype prevalences can directly affect such processes. Recent results in the literature already suggest changes in HCV dynamics during the COVID-19 pandemic, both considering viral circulation and differential genotypic frequencies in distinct geographic areas. In this context, we propose a further examination of these trends using different approaches to provide support for the hypothesis that the COVID-19 pandemic affected HCV circulation, since these findings would have important implications for hepatitis C prevention, treatment and research.
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(This article belongs to the Special Issue Prevalence of HBV, HCV, HIV, Sexually Transmitted Infections, and Their Complications)
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Open AccessArticle
Self-Medication Practices among Adult Population in Bangladesh: A Cross-Sectional Study
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Nitai Roy, Md. Nazrul Islam, Md. Shahjalal, Aysha Siddiky, Sultan Mahmud Imran, Md. Aktarujjaman, Md. Mobarak Hossain, Bryan T. Rogers, Kamal Krishna Biswas and Ekhtear Hossain
Epidemiologia 2024, 5(2), 146-159; https://doi.org/10.3390/epidemiologia5020010 - 1 Apr 2024
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Background: The practice of self-medication (SM) is common worldwide and is an important component of medical self-care. However, improper practice can be dangerous. This study aimed to estimate the prevalence of SM and the factors associated with it among Bangladeshi adults. Methods: A
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Background: The practice of self-medication (SM) is common worldwide and is an important component of medical self-care. However, improper practice can be dangerous. This study aimed to estimate the prevalence of SM and the factors associated with it among Bangladeshi adults. Methods: A cross-sectional survey was conducted between April and June 2021 among Bangladeshi adults (aged > 19 years) using convenient sampling. A total of 1320 subjects were collected through face-to-face interviews using a standardized questionnaire. Multivariable logistic regression analysis was used to identify factors associated with the practice of SM. Results: Overall, 41% of adults in our survey reported SMP. The most common illnesses that prompted SM were common cold/flu (66.4%), gastric problems (65%), and headache (64.4%). The most frequent reasons for SM were to get better-perceived quality of care (30.6%), perceiving SM without side effects (23.3%), and saving time with effectiveness (14.56%). Potential risk factors included 10 years (AOR = 1.91; 95% CI: 1.04–3.50) and >12 years of schooling (AOR = 5.03; 95% CI: 2.27–11.15), being a businessman (AOR = 4.64; 95% CI: 1.74–12.37), having ≤6 family members (AOR = 2.13; 95% CI: 1.40–3.24), being a member of a social group (AOR = 1.53; 95% CI: 1.10–2.12), a health status check after every six months (AOR = 1.52; 95% CI: 1.08–2.13), and current ill-health (AOR = 1.41; 95% CI: 1.06–1.87). Protective factors identified included ≤30 years of age (AOR = 0.40; 95% CI: 0.17–0.93), and practice of modern (AOR = 0.39; 95% CI: 0.22–0.69) and herbal (AOR = 0.45; 95% CI: 0.21–0.97) treatment modality. Conclusion: More than one-third of the study participants reported practicing SM. Increasing the community’s awareness of the adverse outcomes of SM and not just the average experience might sway individuals away from SM, and implementing strict jurisdiction could be a way to minimize inappropriate SM.
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Open AccessCommunication
The Requirements of Managing Phase I Clinical Trials Risks: The British and Italian Case Studies
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Davide Di Tonno, Laura Martena, Manuela Taurisano, Caterina Perlin, Anna Chiara Loiacono, Stefano Lagravinese, Santo Marsigliante, Michele Maffia, Susanna Esposito, Gianluca Villa, Giovanni Gori, Leonardo Bray, Alessandro Distante, Alessandro Miani, Prisco Piscitelli and Alberto Argentiero
Epidemiologia 2024, 5(1), 137-145; https://doi.org/10.3390/epidemiologia5010009 - 13 Mar 2024
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Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety
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Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the “Clinical Trial Quality Team”, which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.
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Open AccessArticle
Knowledge, Attitudes, and Practices of Hand Hygiene, Mask Use, and Social Distancing among Public Hospital and Polyclinic Nurses in Barbados during the Coronavirus 2019 Pandemic
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Uma Gaur, Wendy Sealy, Ambadasu Bharatha, Natasha P. Sobers, Kandamaran Krishnamurthy, Michael H. Campbell, Cara Cumberbatch, Maia Drakes, Marielle Gibbs, Charisse Alexander, Heather Harewood, O. Peter Adams, Subir Gupta, Ali Davod Parsa, Russell Kabir and Md Anwarul Azim Majumder
Epidemiologia 2024, 5(1), 122-136; https://doi.org/10.3390/epidemiologia5010008 - 6 Mar 2024
Abstract
Background: Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among
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Background: Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among nursing staff. Several preventive measures were adopted to contain the spread of the COVID-19 virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic. Method: An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) in Barbados from March 2021 to December 2021 was conducted. A nonsystematic convenience sampling method was employed to recruit nurses who were readily available and willing to participate. A questionnaire captured the sociodemographic information and knowledge and practices related to hand hygiene, the use of face masks, and social distancing. Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60–80%), or good (>80–100%). Results: Of the 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). The findings revealed that 45.8% had poor knowledge of hand hygiene, and that the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% confidence interval 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask wearing, 53.6% of nurses had average knowledge, and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% confidence interval 1.5, 7.4) of having good knowledge compared to nursing assistants. A total of 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by the WHO. Conclusions: The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.
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Open AccessReview
Cannabis Use and Its Impact on Mental Health in Youth in Australia and the United States: A Scoping Review
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Aayush Baral, Fahad Hanna, Ritesh Chimoriya and Kritika Rana
Epidemiologia 2024, 5(1), 106-121; https://doi.org/10.3390/epidemiologia5010007 - 29 Feb 2024
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Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental
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Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis.
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(This article belongs to the Special Issue Epidemiology of Violence, Substance Use, and Mental Health Problems)
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Open AccessArticle
The Molecular Epidemiology of Epizootic Hemorrhagic Disease Viruses Identified in Israel between 2015 and 2023
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Natalia Golender and Bernd Hoffmann
Epidemiologia 2024, 5(1), 90-105; https://doi.org/10.3390/epidemiologia5010006 - 20 Feb 2024
Cited by 1
Abstract
Epizootic hemorrhagic disease (EHD) is an infectious, non-contagious viral disease seriously affecting cattle and some wild ruminants and has a worldwide distribution. All viruses can be subdivided into “Eastern” and “Western” topotypes according to geographic distribution via the phylogenetic analysis of internal genes.
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Epizootic hemorrhagic disease (EHD) is an infectious, non-contagious viral disease seriously affecting cattle and some wild ruminants and has a worldwide distribution. All viruses can be subdivided into “Eastern” and “Western” topotypes according to geographic distribution via the phylogenetic analysis of internal genes. In Israel, during the last decade, three outbreaks were registered: caused by EHDV-6 in 2015, by EHDV-1 in 2016, and by EHDV-7 in 2020. Additionally, RNA of EHDV-8 was found in imported calves from Portugal in 2023. During the same period in other countries of the region, non-Israeli-like EHDV-6 and EHDV-8 were identified. Full genome sequencing, BLAST, and phylogenetic analyses of the locally and globally known EHDV genomes allowed us to presume the probable route and origin of these viruses detected in Israel. Thus, EHDV-6 has probably been circulating in the region for a long period when EHDV-1 and -8 appeared here for the last years, while their route of introduction into the new areas was probably natural; all of them belonged to the “Western” topotype. In contrast, EHDV-7 probably had the “Eastern”, anthropogenic origin. Data from the study can facilitate the evaluation of the appearance or reappearance of EHDVs in the Mediterranean area and enhance the planning of prevention measures.
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(This article belongs to the Section Molecular Epidemiology)
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Open AccessArticle
Genomic Surveillance of SARS-CoV-2: Data Analysis and Assessment of Tunisian Strategy from January 2021 to February 2022
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Arwa Neffati, Mouna Safer, Wissal Kalai, Aicha Hechaichi, Sonia Dhaouadi, Hajer Letaief, Chaima Aichouch, Leila Bouabid, Sondes Darouiche, Nawel El Mili, Henda Triki, Ilhem Boutiba, Maha Mastouri, Lamia Fki Berrajah and Nissaf Bouafif Ben Alaya
Epidemiologia 2024, 5(1), 80-89; https://doi.org/10.3390/epidemiologia5010005 - 6 Feb 2024
Abstract
Due to the emergence of the SARS-CoV-2 B.1.1.7 (Alpha) variant in the UK in 2020 and its risk of increased transmission, the Ministry of Health in Tunisia implemented a sequencing surveillance strategy for SARS-CoV-2. The aim of this study was to analyze SARS-CoV-2
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Due to the emergence of the SARS-CoV-2 B.1.1.7 (Alpha) variant in the UK in 2020 and its risk of increased transmission, the Ministry of Health in Tunisia implemented a sequencing surveillance strategy for SARS-CoV-2. The aim of this study was to analyze SARS-CoV-2 genomic surveillance data in Tunisia (January 2021–February 2022) and to assess the implementation of the sequencing strategy for SARS-CoV-2 in accordance with national recommendations and the guidance for SARS-CoV-2 genomic surveillance for public health goals. A descriptive study of all sequenced RT-PCR samples sequenced (January 2021–February2022). An internal audit was also done to assess the compliance against standards covering national recommendations and the Guidance for SARS-CoV-2 genomic surveillance for public health goals. A total of 12 simple or composite requirements related to the following areas were included in the audit standards: sampling (one requirements); data collection/analysis (six requirements); partnership (one requirement); and ethical considerations (one requirement). A total of 4819 samples were sent to laboratories and 4278 samples were sequenced. A total of 3648 samples were classified. Positive variants of concern (VOC) samples were 80.92%, differentiated as follows: Alpha, 40.24%; Beta, 0.24%; Gamma, 0.03%; Delta, 45.26%; and Omicron, 14.19%. Three principal phases of VOCs per ISO-week were shown: Alpha 3/2021–25/2021; Delta 26/2021–2/2022; and Omicron 3/2022–6/2022. Levels of compliance were identified; from a total of 12 requirements, 7 were considered as “not met”, 4 as “partially met”, and 1 as “fully met” but including not totally achieved objectives. In conclusion, the internal audit of the national SARS-CoV-2 sequencing strategy revealed an overall “not met” level of compliance. The results offered a trigger to collaborate with all stakeholders to develop a surveillance strategy for early detection and response to outbreaks caused by VOCs.
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(This article belongs to the Special Issue Field Epidemiology Research in the Mediterranean Region)
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Open AccessSystematic Review
Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023)
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Matteo Riccò, Antonio Baldassarre, Silvia Corrado, Marco Bottazzoli and Federico Marchesi
Epidemiologia 2024, 5(1), 41-79; https://doi.org/10.3390/epidemiologia5010004 - 31 Jan 2024
Cited by 1
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Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of
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Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies.
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Open AccessPerspective
Myopia, Sodium Chloride, and Vitreous Fluid Imbalance: A Nutritional Epidemiology Perspective
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Ronald B. Brown
Epidemiologia 2024, 5(1), 29-40; https://doi.org/10.3390/epidemiologia5010003 - 29 Jan 2024
Abstract
Theories of myopia etiology based on near work and lack of outdoor exposure have had inconsistent support and have not prevented the rising prevalence of global myopia. New scientific theories in the cause and prevention of myopia are needed. Myopia prevalence is low
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Theories of myopia etiology based on near work and lack of outdoor exposure have had inconsistent support and have not prevented the rising prevalence of global myopia. New scientific theories in the cause and prevention of myopia are needed. Myopia prevalence is low in native people consuming traditional diets lacking in sodium chloride, and nutritional epidemiological evidence supports the association of rising myopia prevalence with dietary sodium intake. East Asian populations have among the highest rates of myopia associated with high dietary sodium. Similar associations of sodium and rising myopia prevalence were observed in the United States in the late 20th century. The present perspective synthesizes nutritional epidemiology evidence with pathophysiological concepts and proposes that axial myopia occurs from increased fluid retention in the vitreous of the eye, induced by dietary sodium chloride intake. Salt disturbs ionic permeability of retinal membranes, increases the osmotic gradient flow of fluid into the vitreous, and stretches ocular tissue during axial elongation. Based on the present nutritional epidemiology evidence, experimental research should investigate the effect of sodium chloride as the cause of myopia, and clinical research should test a very low-salt diet in myopia correction and prevention.
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(This article belongs to the Special Issue Global Health Epidemiology and Disease Control)
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Open AccessArticle
Childhood Mediterranean Diet Adherence Is Associated with Lower Prevalence of Childhood Obesity, Specific Sociodemographic, and Lifestyle Factors: A Cross-Sectional Study in Pre-School Children
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Eleni Pavlidou, Sousana K. Papadopoulou, Olga Alexatou, Gavriela Voulgaridou, Maria Mentzelou, Fani Biskanaki, Evmorfia Psara, Gerasimos Tsourouflis, Nikos Lefantzis, Sophia Dimoliani, Thomas Apostolou, Anastasia Sampani, Ioanna P. Chatziprodromidou, Exakousti-Petroula Angelakou and Constantinos Giaginis
Epidemiologia 2024, 5(1), 11-28; https://doi.org/10.3390/epidemiologia5010002 - 23 Dec 2023
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Background: The Mediterranean diet (MD) has been related with a decreased probability of overweight/obesity as well as central obesity at all stages of the human life, decreasing the risk of diverse disease states and improving quality of life. Over the last few years,
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Background: The Mediterranean diet (MD) has been related with a decreased probability of overweight/obesity as well as central obesity at all stages of the human life, decreasing the risk of diverse disease states and improving quality of life. Over the last few years, the prevalence of childhood overweight/obesity and especially abdominal obesity has highly increased worldwide, being associated with a higher likelihood of overweight/obesity as well as central obesity at the next stages of the life during adulthood. The purpose of the present study was to explore the relationship of MD compliance with sociodemographic, anthropometry and lifestyle features in pre-school children aged 2–5 years old. Methods: This is a cross-sectional study, which includes 5188 pre-school children from diverse regions of Greece. Relevant questionnaires were applied to evaluate the sociodemographic features of the enrolled children. Anthropometric parameters were measured by relevant techniques. Qualified questionnaires were utilized for assessing several lifestyle factors such as physical activity, quality of life, breastfeeding practices, MD adherence, as well as the prevalence of childhood asthma and diabetes mellitus type I. Results: Of the enrolled children, 41.7% showed low MD compliance and 36.4% of them indicated moderated compliance, while only 21.9% of them showed a high MD adherence. Overweight/obesity was noted in 24.2% of the assigned children, while abdominal obesity was noticed in 18.2% of them. Higher MD compliance was related with an elevated prevalence of sex (boys, p = 0.0005), Greek nationality (p = 0.0088), rural type of residence (p = 0.0099), childhood overweight/obesity (p < 0.0001) and abdominal obesity (p < 0.0001), lower childbirth weight (p < 0.0001), increased physical activity (p = 0.0041), improved quality of life (p = 0.0008), exclusive breastfeeding (p < 0.0001), childhood asthma (p = 0.0001) and diabetes mellitus type 1 (p = 0.0002). Conclusions: A higher MD adherence is associated with specific sociodemographic, better anthropometric, and beneficial lifestyle factors in pre-school children. However, MD compliance remains low or moderate in the vast majority of children aged 2–5 years old. Thus, future public strategies and policies should be performed to inform parents of the potential beneficial effects of MD against obesity and related chronic diseases at the next stage of their children’s lives.
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Open AccessArticle
Incidence of Non-Melanoma Skin Cancers in Salento (Southern Italy): A 15-Year Retrospective Analysis from the Cancer Registry of Lecce
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Emiliano Sordi, Prisco Piscitelli, Carla Albanese, Anna Melcarne, Anna Tardio, Fabrizio Quarta, Enrico Greco, Alessandro Miani, Andrea Falco, Elisabetta De Matteis, Maurizio Congedo and Adele Civino
Epidemiologia 2024, 5(1), 1-10; https://doi.org/10.3390/epidemiologia5010001 - 21 Dec 2023
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Background and Objectives: Non-melanoma skin cancers (NMSCs) include basal cell carcinoma (BCC) and squamous-cell carcinoma (SCC), as well as a wide range of rare skin tumors. NMSCs is the most frequently diagnosed type of tumor among Caucasians. We aimed at estimating the incidence
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Background and Objectives: Non-melanoma skin cancers (NMSCs) include basal cell carcinoma (BCC) and squamous-cell carcinoma (SCC), as well as a wide range of rare skin tumors. NMSCs is the most frequently diagnosed type of tumor among Caucasians. We aimed at estimating the incidence and mortality of NMSCs in the Salento area (Lecce province, Southern Italy), whose population is assumed to experience heavy and frequent sun exposure due to climatic/environmental factors, both for working and leisure activities. Materials and Methods: We computed the incidence of NMSCs in the Province of Lecce by examining the comprehensive real-world data collected by the local cancer registry, which covers all the 830,000 inhabitants, over a period of fifteen years (from 2003 to 2017), with a focus on the latest 5 years (2013–2017) for the analysis of the different histologic morphologies of these tumors. The incidence of NMSCs has been described in terms of absolute frequencies, crude rates and age-adjusted direct standardized rates (DSR). Joinpoint analysis was used to examine temporal trends in the incidence of NMSCs and estimate annual percent changes (APCs). Results: During the period of 2003–2017, the incidence of NMSCs reached a direct standardized rate (DSR) of 162.62 per 100,000 in men (mortality 1.57 per 100,000) and 89.36 per 100,000 in women (mortality 0.52 per 100,000), respectively. The incidence significantly increased among both men and women across the entire period. Basal cell carcinoma (BCC), with its different morphologies, represented about 67.6% of the NMSCs in men (n = 2139 out of a total of 3161 tumors observed between 2013 and 2017) and about 75.8% of the NMSCs in women (n = 1718 out of a total of 2264 tumors from 2013 to 2017), thus accounting for the vast majority of NMSCs. The results are consistent with the literature data carried out both at national and international level. Conclusions: Proper monitoring of this phenomenon through timely reporting and recording of all new NMSC cases is necessary to develop new preventive strategies.
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Open AccessArticle
Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971–1992
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Anita Joshi, L. Joseph Su and Mohammed S. Orloff
Epidemiologia 2023, 4(4), 525-537; https://doi.org/10.3390/epidemiologia4040044 - 5 Dec 2023
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(1) Background: History of TB is a known risk factor for long-term respiratory impairment affecting lung functions in both restrictive and obstructive lung disease. (2) Methods: We analyzed data from the NHANES I Epidemiologic Follow-up Study (NHEFS), a longitudinal study conducted on a
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(1) Background: History of TB is a known risk factor for long-term respiratory impairment affecting lung functions in both restrictive and obstructive lung disease. (2) Methods: We analyzed data from the NHANES I Epidemiologic Follow-up Study (NHEFS), a longitudinal study conducted on a noninstitutionalized adult US population aged 25–74 years. Approximately 93 percent of the original NHANES I cohort was successfully traced by the end of the survey period and was available for analysis. The final adjusted model included age groups, gender, family income, lifetime smoking, body mass index (BMI), and frequency of alcohol consumption as potential confounders. (3) Results: The estimated hazards ratio of developing emphysema during follow-up for individuals with a past diagnosis of TB was 54% lower (95% CI = 0.35, 0.61) that that in individuals with no past TB, after controlling for potential confounders and using proportional hazards regression appropriate to the complex sample design. The association, however, was not statistically significant (HR = 0.86, p-value = 0.38) when only a self-reported history of TB was considered as the exposure in an unadjusted model. (4) Conclusions: Tuberculosis (self-reported or LTBI) was strongly (but inversely) associated with emphysema incidence. The association was not statistically significant with only a self-reported history of TB as exposure.
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Open AccessEditorial
How Healthcare Systems Negatively Impact Environmental Health? The Need for Institutional Commitment to Reduce the Ecological Footprint of Medical Services
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Prisco Piscitelli, Stela Karaj, Alessandro Miani, Tassos C. Kyriakides, Enrico Greco, Elena Colicino, Antonio Bray, Fernando Simón, Vasilis Vasiliou and Andrea A. Baccarelli
Epidemiologia 2023, 4(4), 521-524; https://doi.org/10.3390/epidemiologia4040043 - 22 Nov 2023
Abstract
The global healthcare industry plays a crucial role in preserving human health and well-being [...]
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Rural-Urban Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults: Evidence from Bangladesh Demographic and Health Survey 2017–2018
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Rajat Das Gupta, Hanna A. Frank, Maxwell Akonde, Ananna Mazumder, Nazeeba Siddika, Ehsanul Hoque Apu and Promit Ananyo Chakraborty
Epidemiologia 2023, 4(4), 505-520; https://doi.org/10.3390/epidemiologia4040042 - 22 Nov 2023
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The aim of this study was to identify the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults (≥18 years) by analyzing the cross-sectional Bangladesh Demographic and Health Survey 2017–2018 data. Multilevel multivariable logistic regression was applied to identify
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The aim of this study was to identify the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults (≥18 years) by analyzing the cross-sectional Bangladesh Demographic and Health Survey 2017–2018 data. Multilevel multivariable logistic regression was applied to identify the factors associated with underweight and overweight/obesity in urban and rural areas. The prevalence of underweight was 12.24% and 19.34% in urban and rural areas, respectively. The prevalence of overweight/obesity was 50.23% and 35.96%, respectively, in urban and rural areas. In the final multivariable analysis in both urban and rural areas, 30–49 years of age, female sex, being educated up to college or higher level, living in the wealthiest household, and being currently married or being separated/divorced/widowed had higher odds of being overweight/obese compared to other categories. Residence in the Mymensingh and Sylhet region was associated with decreased odds of overweight/obesity in urban and rural areas. On the other hand, being educated up to college or higher level, living in the wealthiest household, and being married were associated with reduced odds of being underweight in both areas. These high-risk groups should be brought under targeted health promotion programs to curb malnutrition.
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Open AccessArticle
Comprehensive Knowledge about HIV/AIDS among Women of Reproductive Age in India
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Aritro Bhattacharyya, Ritankar Chakraborty, Tapasya Raj, Bijaya Kumar Padhi, Jagdish Khubchandani, Prakasini Satapathy, Sarvesh Rustagi and Vijay Kumar Chattu
Epidemiologia 2023, 4(4), 492-504; https://doi.org/10.3390/epidemiologia4040041 - 16 Nov 2023
Abstract
HIV/AIDS has been a major threat to global public health, with India ranking third when it comes to the global burden of people living with HIV, especially women. It is imperative to assess the level of knowledge women have about transmission and prevention
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HIV/AIDS has been a major threat to global public health, with India ranking third when it comes to the global burden of people living with HIV, especially women. It is imperative to assess the level of knowledge women have about transmission and prevention of this infection. This study sought to delineate the determinants of the comprehensive knowledge of HIV/AIDS among women in the reproductive age groups in India. Data from the fifth round of the National Family Health Survey conducted in India were analyzed. The sample included 95,541 women aged 15–49 years. Multilevel logistic regression was fitted with individual characteristics, household characteristics, and community characteristics to identify determinants of comprehensive knowledge on HIV/AIDS. Nearly a fourth (24.8%) of the women aged 15–49 in India who had ever heard of HIV had comprehensive knowledge of HIV/AIDS. Multilevel logistic regression showed that the likelihood of comprehensive knowledge of HIV/AIDS was higher among women aged 40–44 (AOR = 1.57) and 30–34 (AOR = 1.56). The likelihood of having comprehensive knowledge increased with the increase in the level of education. Women with secondary and higher levels of education were 1.9 times and 3.38 times more likely to have comprehensive knowledge, respectively, than those with no education. Household wealth, access to mass media, and having ever tested for HIV were also significant determinants of comprehensive knowledge of HIV/AIDS among women. The odds of having comprehensive knowledge about HIV/AIDS were higher for women with higher community wealth (AOR = 1.31), higher community education (AOR = 1.09), and higher community employment (AOR = 1.12). Factors at both the individual and community levels were shown to be indicators of comprehensive knowledge of HIV/AIDS. Policymakers and public health practitioners in India should come up with plans to close the information gaps about HIV/AIDS that exist among women and their demographic subgroups.
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(This article belongs to the Special Issue Global Health Epidemiology and Disease Control)
Open AccessArticle
Prevalence and Trends of Basic Activities of Daily Living Limitations in Middle-Aged and Older Adults in the United States
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Halli Heimbuch, Yeong Rhee, Marty Douglas, Kirsten Juhl, Kelly Knoll, Sherri Stastny and Ryan McGrath
Epidemiologia 2023, 4(4), 483-491; https://doi.org/10.3390/epidemiologia4040040 - 9 Nov 2023
Abstract
Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations
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Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. Methods: The analytic sample included 30,418 Americans aged ≥50 years from the 2006–2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Results: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8–17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). Conclusions: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.
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