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  • Post-Exposure Effects of Vaccines on Infectious Diseases
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-04
    Gallagher T, Lipsitch M.

    Many available vaccines have demonstrated post-exposure effectiveness, but no published systematic reviews have synthesized these findings. We searched the PubMed database for clinical trials and observational human studies concerning the post-exposure vaccination effects, targeting infections with Food and Drug Administration licensed vaccine plus dengue, hepatitis E, malaria, and tick borne encephalitis, which have licensed vaccines outside of the U.S. Studies concerning animal models, serologic testing, and pipeline vaccines were excluded. Eligible studies were evaluated by definition of exposure, and their attempt at distinguishing pre- and post-exposure effects was rated on a scale of 1-4. We screened 4518 articles and ultimately identified 14 clinical trials and 31 observational studies for this review, amounting to 45 eligible articles spanning 7 of the 28 vaccine-preventable diseases. For secondary attack rate, this body of evidence found the following medians for post-exposure vaccination effectiveness: hepatitis A: 85% (IQR: 28; 5 sources), hepatitis B: 85% (IQR: 22; 5 sources), measles: 83% (IQR: 21; 8 sources), varicella: 67% (IQR: 48; 9 sources), smallpox: 45% (IQR: 39; 4 sources), and mumps: 38% (IQR: 7; 2 sources). For case fatality proportions resulting from rabies and smallpox, the vaccine efficacies had medians of 100% (IQR: 0; 6 sources) and 63% (IQR: 50; 8 sources) postexposure. Although mainly used for preventive measures, many available vaccines can modify or preclude disease if administered after exposure. This post-exposure effectiveness could be important to consider during vaccine trials and while developing new vaccines.

    更新日期:2019-11-30
  • The Many Faces of Emerging and Re-emerging Infectious Disease
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-04
    Lessler J, Orenstein W.

    The emergence of disease threats can take many forms, from the adaptation of a traditionally zoonotic pathogen for efficient spread in humans, to the development of antibiotic resistance in well-known pathogens, to the creation of new niches for established disease through social and societal changes. In this commentary, the authors explore these various facets of disease emergence through the lens of the papers included in this issue of Epidemiologic Reviews. The authors explore multiple aspects of emergence, and the ways in which emergent pathogens can be controlled with the limited tools available. In doing so they put the papers in this issue in the context of the broader research agenda around understanding and combatting emergent pathogens.

    更新日期:2019-11-30
  • Forecasting the 2014 West African Ebola Outbreak
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-29
    Carias C, O’Hagan J, Gambhir M, et al.

    In 2014/15 an Ebola outbreak of unprecedented dimensions afflicted the West African countries of Liberia, Guinea, and Sierra Leone. We performed a systematic review of manuscripts that forecasted the outbreak while it was occurring, and derive implications on the ways results could be interpreted by policy-makers. We reviewed 26 manuscripts, published between 2014 and April 2015, that presented forecasts of the West African Ebola outbreak. Forecasted case counts varied widely. An important determinant of forecast accuracy for case counts was how far into the future predictions were made. Generally, those that made forecasts less than 2 months into the future tended to be more accurate than those that made forecasts more than 10 weeks into the future. The exceptions were parsimonious statistical models in which the decay of the rate of spread of the pathogen among susceptible individuals was dealt with explicitly. Regarding future outbreaks, the most important lessons for policy makers when using similar modeling results are: i) uncertainty of forecasts will be higher in the beginning of the outbreak, ii) when data are limited, forecasts produced by models designed to inform specific decisions should be used in complimentary fashion for robust decision making – for this outbreak, two statistical models produced the most reliable case counts forecasts, but did not allow to understand the impact of interventions, while several compartmental models could estimate the impact of interventions but required data that was not available; iii) timely collection of essential data is necessary for optimal model use.

    更新日期:2019-11-30
  • Hepatitis C Virus Infection In Indigenous Populations: A Systematic Review Of The United States And Canada
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-29
    Bruce V, Eldredge J, Leyva Y, et al.

    American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently under-represented in epidemiological studies and surveys that are often used to inform public health efforts. To address this issue, we performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in both AI/AN (1.49% to 67.60%) and Indigenous populations (2.28% to 90.24%). As injection drug use contributes to higher risk of infection, studies that either included or specifically targeted people who inject drugs reported the highest prevalence in both countries. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence found in this review was up to three-fold higher in Aboriginal people compared to general population estimates. This review highlights the disparity of available data on HCV prevalence and emphasizes the need for consistent and enhanced HCV surveillance and reporting among Indigenous people. Moreover, findings support previous reports in that this disease impacts Indigenous peoples to a greater degree than the general population. It is recommended that that tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover healthcare expenses to help stop this epidemic.

    更新日期:2019-11-30
  • A review of asymptomatic and sub-clinical Middle East Respiratory Syndrome Coronavirus Infections
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-29
    Grant R, Malik M, Elkholy A, et al.

    The epidemiology of Middle East Respiratory syndrome coronavirus (MERS-CoV) since 2012 has been largely characterised by recurrent zoonotic spill-over from dromedary camels followed by limited human-to-human transmission, predominantly in health care settings. The full extent of infection of MERS-CoV is not clear, nor is the extent and/or role of asymptomatic infections in transmission. We conducted a review of molecular and serological investigations through PubMed and EMBASE from September 2012 to 15 November 2018 attempting to measure sub-clinical or asymptomatic MERS-CoV infection within and outside of health care settings. We performed retrospective analysis of laboratory-confirmed MERS-CoV infections reported to the World Health Organization to 27 November 2018 to summarize what is known about asymptomatic infections identified through national surveillance systems. We identified 23 studies reporting evidence of MERS-CoV infection outside health care settings, mainly of camel workers, showing ranges of seroprevalence of 0-67% depending on the study location. We identified 20 studies in health care settings, of health care worker (HCW) and family contacts, of which 11 documented molecular evidence of MERS-CoV infection among asymptomatic contacts. Since 2012, 298 laboratory confirmed cases were reported as asymptomatic to the World Health Organization, 164 of whom were HCW. Viral shedding studies of asymptomatic MERS infections have demonstrated the potential to transmit MERS-CoV to others. Our results highlight the possibility for onward transmission of MERS-CoV from asymptomatic individuals. Screening of HCW contacts of confirmed MERS-CoV patients is currently recommended, but systematic screening of non-HCW contacts outside of health care facilities should be encouraged.

    更新日期:2019-11-30
  • Epidemiology of HIV, Sexually Transmitted Infections, Viral Hepatitis, and Tuberculosis Among Incarcerated Transgender People: A Case of Limited Data
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-03-15
    Poteat T, Malik M, Beyrer C.

    Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.

    更新日期:2019-11-18
  • Dynamic Models of Infectious Disease Transmission in Prisons and the General Population
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-03-16
    Ndeffo-Mbah M, Vigliotti V, Skrip L, et al.

    Incarcerated populations experience elevated burdens of infectious diseases, which are exacerbated by limited access to prevention measures. Dynamic models are used to assess the spread and control of diseases within correctional facilities and repercussions on the general population. Our systematic review of dynamic models of infectious diseases within correctional settings identified 34 studies published between 1996 and 2017. Of these, 23 focused on disease dynamics and intervention in prison without accounting for subsequent spread to the community. The main diseases modeled in these studies were human immunodeficiency virus (HIV; n = 14, 41%), tuberculosis (TB; n = 10, 29%), and hepatitis C virus (HCV; n = 7, 21%). Models were fitted to epidemiologic data in 14 studies; uncertainty and sensitivity analyses were conducted in 8, and validation of model projection against empirical data was done in 1 study. According to the models, prison-based screening and treatment may be highly effective strategies for reducing the burden of HIV, TB, HCV, and other sexually transmissible infections among prisoners and the general community. Decreasing incarceration rates were projected to reduce HIV and HCV infections among people who inject drugs and TB infections among all prisoners. Limitations of the modeling studies and opportunities for using dynamic models to develop quantitative evidence for informing prison infection control measures are discussed.

    更新日期:2019-11-18
  • Substance Use During Imprisonment in Low- and Middle-Income Countries
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-03-23
    Mundt A, Baranyi G, Gabrysch C, et al.

    Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0–78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system.

    更新日期:2019-11-18
  • Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-20
    Moazen B, Saeedi Moghaddam S, Silbernagl M, et al.

    Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.

    更新日期:2019-11-18
  • Health Outcomes for Clients of Needle and Syringe Programs in Prisons
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-12
    Lazarus J, Safreed-Harmon K, Hetherington K, et al.

    High levels of drug dependence have been observed in the prison population globally, and the sharing of injecting drug equipment in prisons has contributed to higher prevalence of bloodborne diseases in prisoners than in the general population. Few prison needle and syringe programs (PNSPs) exist. We conducted a systematic review to assess evidence regarding health outcomes of PNSPs. We searched peer-reviewed databases for data relating to needle and syringe programs in prisons. The search methodology was conducted in accordance with accepted guidelines. Five studies met review inclusion criteria, and all presented evidence associating PNSPs with one or more health benefits, but the strength of the evidence was low. The outcomes for which the studies collectively demonstrated the strongest evidence were prevention of human immunodeficiency virus and viral hepatitis. Few negative consequences from PNSPs were observed, consistent with previous evidence assessments. More research is needed on PNSP effectiveness, and innovative study designs are needed to overcome methodological limitations of previous research. Until stronger evidence becomes available, policymakers are urged to recognize that not implementing PNSPs has the potential to cause considerable harm, in light of what is currently known about the risks and benefits of needle and syringe programs and PNSPs and about the high prevalence of human immunodeficiency virus and viral hepatitis in prisons.

    更新日期:2019-11-18
  • Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-10
    Tavoschi L, Vroling H, Madeddu G, et al.

    Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.

    更新日期:2019-11-18
  • Prevalence of Posttraumatic Stress Disorder in Prisoners
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-03-27
    Baranyi G, Cassidy M, Fazel S, et al.

    People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n < 100), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.

    更新日期:2019-11-18
  • Parental Incarceration and Child Health in the United States
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-07
    Wildeman C, Goldman A, Turney K.

    Mass incarceration has profoundly restructured the life courses of not only marginalized adult men for whom this event is now so prevalent but also their families. We examined research published from 2000 to 2017 on the consequences of parental incarceration for child health in the United States. In addition to focusing on specific health outcomes, we also considered broader indicators of child well-being because there has been little research on the association between parental incarceration and objectively measured child health outcomes. Our findings support 4 conclusions. First, paternal incarceration is negatively associated—possibly causally so—with a range of child health and well-being indicators. Second, although some research has suggested a negative association between maternal incarceration and child health, the evidence on this front is mixed. Third, although the evidence for average effects of paternal incarceration on child health and well-being is strong, research has also suggested that some key factors moderate the association between paternal incarceration and child health and well-being. Finally, because of the unequal concentration of parental incarceration and the negative consequences this event has for children, mass incarceration has increased both intracountry inequality in child health in the United States and intercountry inequality in child health between the United States and other developed democracies. In light of these important findings, investment in data infrastructure—with emphasis on data sets that include reliable measures of parental incarceration and child health and data sets that facilitate causal inferences—is needed to understand the child health effects of parental incarceration.

    更新日期:2019-11-18
  • The Health of America’s Aging Prison Population
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-03-23
    Skarupski K, Gross A, Schrack J, et al.

    Older incarcerated individuals comprise the fastest growing demographic in the US prison system. Unhealthy lifestyles among incarcerated individuals and inadequate health care lead to earlier onset and more rapid progression of many chronic conditions that are prevalent among community-living older adults. There are limited peer-reviewed epidemiologic data in this area; however, there is growing interest in identifying strategies for housing aging incarcerated individuals, delivering appropriate health care in prisons, and coordinating after-release health care. In this systematic review, we summarize the epidemiologic evidence of the health challenges facing the aging US prison population. Our comprehensive literature search focused on health outcomes, including diseases, comorbid conditions, mental health, cognition, and mobility. From 12,486 articles identified from the literature search, we reviewed 21 studies published between 2007 and 2017. All the studies were observational and cross-sectional, and most (n = 17) were based on regional samples. Sample sizes varied widely, ranging from 25 to 14,499 incarcerated people (median, 258). In general, compared with their younger counterparts, older incarcerated individuals reported high rates of diabetes mellitus, cardiovascular conditions, and liver disease. Mental health problems were common, especially anxiety, fear of desire for death or suicide, and depression. Activities of daily living were challenging for up to one-fifth of the population. We found no empirical data on cognition among older incarcerated individuals. The findings of this review reveal few empirical data in this area and highlight the need for new data to drive policy and practice patterns that address critical health issues related to the aging prison population.

    更新日期:2019-11-18
  • Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-20
    Kinner S, Young J.

    The world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level—that prisoner health is public health. The reviews also highlight some critical evidence gaps, notably the lack of evidence from low- and middle-income countries, and the limited number of longitudinal studies in which health behaviors, health outcomes, or health service experiences after release from prison are documented. Despite growing evidence of the poor health of detained adolescents, none of the included reviews considered this population. Further research on the health of young people who cycle through juvenile detention should be a priority. Despite a rapidly growing literature on the health of people who experience incarceration, some critical health issues remain poorly understood, and there has been insufficient attention devoted to co-occurring health conditions and the consequent need for coordinated care. Key populations in custodial settings remain understudied, limiting capacity to develop targeted, evidence-based responses to their health needs. The quality of many studies is suboptimal, and although rigorous, independent research in correctional settings can be challenging, it is not impossible and is critical to laying the groundwork for evidence-based reform.

    更新日期:2019-11-18
  • HIV and Viral Hepatitis Among Imprisoned Key Populations
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-04-21
    Wirtz A, Yeh P, Flath N, et al.

    Prisons and other closed facilities create opportunities for transmission of human immunodeficiency virus (HIV) and viral hepatitis during detention and after release. We conducted a systematic review and meta-analysis of peer-reviewed publications (2005–2015) to describe the prevalence of HIV, hepatitis C virus, and hepatitis B virus among key populations in prisons worldwide and to compare estimates of infection with those of other prison populations. Most data were reported for people who inject drugs (PWID; n = 72) and for men who have sex with men (MSM; n = 21); few data were reported on sex workers (SW; n = 6), or transgender women (n = 2). Publications were identified from 29 countries, predominantly middle- and high-income countries. Globally, PWID had 6 times the prevalence of HIV (pooled prevalence ratio (PPR) = 6.0, 95% CI: 3.8, 9.4), 8 times the prevalence of hepatitis C virus (PPR = 8.1, 95% CI: 6.4, 10.4), and 2 times the prevalence of hepatitis B virus (PPR = 2.0, 95% CI: 1.5, 2.7) compared with noninjecting prisoner populations. Among these articles, only those from Iran, Scotland, Spain, and Italy included the availability of methadone therapy; 2 articles included information on access to needle exchange programs by PWID detainees. HIV prevalence was more than 2 times higher among SW (PPR = 2.6, 95% CI: 2.2, 3.1) and 5 times higher among MSM (PPR = 5.3, 95% CI: 3.5, 7.9) compared with other prisoners. None of these articles reported HIV prevention coverage among SW or transgender women; 1 described HIV and sexually transmitted infection screening for MSM in prison. Prevention programs specific to key populations are important, particularly for populations that are criminalized and/or may cycle in and out of prison.

    更新日期:2019-11-18
  • Smoking in Correctional Settings Worldwide: Prevalence, Bans, and Interventions
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-05-08
    Spaulding A, Eldridge G, Chico C, et al.

    Smoking tobacco contributes to 11.5% of deaths worldwide and, in some countries, more hospitalizations than alcohol and drugs combined. Globally in 2015, 25% of men and 5% of women smoked. In the United States, a higher proportion of people in prison smoke than do community-dwelling individuals. To determine smoking prevalence in prisons worldwide, we systematically reviewed the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; we also examined whether prisons banned smoking or treated smokers. We searched databases for articles published between 2012 and 2016 and located 85 relevant articles with data representing 73.5% of all incarcerated persons from 50 countries. In 35 of 36 nations (97%) with published prevalence data, smoking for the incarcerated exceeded community rates 1.04- to 62.6-fold. Taking a conservative estimate of a 2-fold increase, we estimated that, globally, 14.5 million male and 26,000 female smokers pass through prisons annually. Prison authorities’ responses include permitting, prohibiting, or treating tobacco use. Bans may temporarily improve health and reduce in-prison health care costs but have negligible effect after prison release. Evidence-based interventions for smoking cessation effective outside prisons are effective inside; effects persist after release. Because smoking prevalence is heightened in prisons, offering evidence-based interventions to nearly 15 million smokers passing through yearly would improve global health.

    更新日期:2019-11-18
  • Substance Use and Recidivism Outcomes for Prison-Based Drug and Alcohol Interventions
    Epidemiol. Rev. (IF 6.455) Pub Date : 2018-05-03
    de Andrade D, Ritchie J, Rowlands M, et al.

    We conducted a systematic review to examine the substance use and recidivism outcomes of prison-based substance use interventions. We searched public health, criminology, and psychology databases, and conducted forward and backward snowballing methods to identify additional studies. Studies were included if they were published between January 1, 2000 and June 30, 2017; were published in English; and reported substance use and/or recidivism outcomes of prison-based substance use interventions. Studies were reviewed for methodological rigor using the Effective Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies. Our search returned 49 studies: 6 were methodologically strong, 20 were moderate, and 23 were weak. Results suggest therapeutic communities are effective in reducing recidivism and, to a lesser extent substance use after release. There is also evidence to suggest that opioid maintenance treatment is effective in reducing the risk of drug use after release from prison for opioid users. Furthermore, care after release from prison appears to enhance treatment effects for both types of interventions. Results provide evidence that policymakers can use to make informed decisions on best-practice approaches when addressing prisoner substance dependence and improving long-term outcomes. This comprehensive review highlights the difficulties of conducting quality research in the prison setting and suggests innovative study design for future research.

    更新日期:2019-11-18
  • Advances in Data Driven Responses to Preventing Spread of Antibiotic Resistance across Healthcare Settings
    Epidemiol. Rev. (IF 6.455) Pub Date : 2019-11-04
    Fridkin S.

    Among the most urgent and serious antibiotic resistant threats to public health, seven are bacteria predominately acquired during health care delivery. There is an emerging field of healthcare epidemiology focused on preventing healthcare-associated infections with antibiotic resistant bacteria incorporating data from patient transfers or patient movements both within and between facilities; this analytic field is being used to help public health professionals identify best opportunities for prevention. Different analytic approaches drawing on uses of big data is being explored to help target the use of limited public health resources, leverage expertise, and enact effective policy to maximize an impact on a population-level health. This paper will summarize recent advances in data driven responses to preventing spread of antibiotic resistance across healthcare settings: leveraging big data for machine learning, integration or advances in tracking patient movement, and highlighting the value of coordinating response across institutions within a region.

    更新日期:2019-11-01
  • Mother-to-child transmission of human immunodeficiency virus type 1.
    Epidemiol. Rev. (IF 6.455) Pub Date : 1996-01-01
    G C John,J Kreiss

    A great deal of progress has been made in our understanding of mother-to-child transmission of HIV-1. Standardization of case definitions and transmission rate calculation methodologies, and a broader array of diagnostic options for detection of infant HIV-1 infection, will enhance our ability to evaluate and compare cohorts worldwide. In the next decade, several intervention studies should be completed. Carefully designed intervention studies have the potential both to determine which interventions are effective as well as to add to our understanding of vertical transmission of HIV-1. Regional differences in vertical transmission rates reflect a variety of viral, host, and obstetric factors. Intervention strategies will probably need to be regionally designed, taking into consideration these factors. Further research on timing and correlates of vertical transmission is necessary to determine the extent to which specific clinical trials can be extrapolated to public health policy. Research related to maternal-child transmission of human immunodeficiency virus (HIV) has been advanced by standardization of case definitions and transmission rate calculation methodologies as well as enhanced diagnostic options for detecting infant HIV-1 infection. Standardization guidelines have yielded vertical transmission rate estimates of 25-30% in developing countries and 14-25% in developed countries. Mathematical modeling suggests that 95% of infant infections occur later than the last 2 months before delivery. Serial polymerase chain reaction evaluation has identified a 7.7% risk of in utero transmission, a 17.6% risk of combined in utero and intrapartum transmission, and a 4.9% incidence of late postnatal transmission. The risk of transmission through breast feeding has been estimated at 14%, with increases with longer durations. Advanced maternal clinical HIV status, primary infection, decreased maternal cell-mediated immunity, placentitis, ascending genital infection during the peripartum period, and syncytium-inducing HIV-1 strains have been associated with higher rates of maternal-child transmission. Prematurity, lack of cellular immunity, and vitamin A deficiency may be infant risk factors. The finding in an AIDS Clinical Trial Group that zidovudine (AZT) treatment was associated with a 67.5% reduction in risk has prompted widespread use of this regimen in developed countries; however, AZT is expensive and logistically difficult to administer in most developing country contexts. Randomized clinical trials currently underway are assessing the benefits of cesarean section delivery, postpartum HIV-specific immunoglobulin administration to infants, avoidance of breast feeding or early weaning, and antenatal maternal vitamin A administration. Selected intervention strategies should be regionally designed to take into account variations in viral, host, and obstetric factors.

    更新日期:2019-11-01
  • CEPI: Driving Progress Towards Epidemic Preparedness And Response.
    Epidemiol. Rev. (IF 6.455) Pub Date : null
    Dimitrios Gouglas,Mario Christodoulou,Stanley A Plotkin,Richard Hatchett

    The Coalition of Epidemic Preparedness Innovations (CEPI) was formed in the aftermath of the 2014-15 Ebola outbreak in west Africa to support the development of vaccines that could improve the world's preparedness against outbreaks of epidemic infectious diseases. Since its launch in 2017, CEPI has mobilised over US$ 750 million to support its mission to develop vaccines against agents such as Lassa Virus, Middle East Respiratory Syndrome coronavirus, and Nipah Virus, as well as several rapid response vaccine platforms to accelerate response times to unexpected epidemic threats. CEPI has also played a leading role in fostering institutional partnerships between public-sector and private-sector organisations to optimise allocation of resources for vaccine development against its priority pathogens. CEPI's priorities include diversification of its current vaccine research and development investment portfolio to include additional pathogens, such as Rift Valley Fever and Chikungunya; establishment of technical and regulatory pathways for vaccine development across CEPI's portfolio; development of sustainable manufacturing solutions for vaccine candidates nearing completion of safety and immunogenicity testing in humans; and creation of investigational stockpiles of its vaccine candidates for use in emergency situations. This commentary provides an overview of the global health challenges CEPI was established to address, its achievements to date, and indicates priorities for funding and coordination in the coming years.

    更新日期:2019-11-01
  • Is socioeconomic status associated with biological aging as measured by telomere length?
    Epidemiol. Rev. (IF 6.455) Pub Date : 2012-12-22
    Tony Robertson,G David Batty,Geoff Der,Candida Fenton,Paul G Shiels,Michaela Benzeval

    It has been hypothesized that one way in which lower socioeconomic status (SES) affects health is by increasing the rate of biological aging. A widely used marker of biological aging is telomere length. Telomeres are structures at the ends of chromosomes that erode with increasing cell proliferation and genetic damage. We aimed to identify, through systematic review and meta-analysis, whether lower SES (greater deprivation) is associated with shorter telomeres. Thirty-one articles, including 29 study populations, were identified. We conducted 3 meta-analyses to compare the telomere lengths of persons of high and low SES with regard to contemporaneous SES (12 study populations from 10 individual articles), education (15 study populations from 14 articles), and childhood SES (2 study populations from 2 articles). For education, there was a significant difference in telomere length between persons of high and low SES in a random-effects model (standardized mean difference (SMD) = 0.060, 95% confidence interval (CI): 0.002, 0.118; P = 0.042), although a range of sensitivity analyses weakened this association. There was no evidence for an association between telomere length and contemporaneous SES (SMD = 0.104, 95% CI: -0.027, 0.236; P = 0.119) or childhood SES (SMD = -0.037, 95% CI: -0.143, 0.069; P = 0.491). These results suggest weak evidence for an association between SES (as measured by education) and biological aging (as measured by telomere length), although there was a lack of consistent findings across the SES measures investigated here.

    更新日期:2019-11-01
  • Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2011-05-19
    C von Wagner,A Good,K L Whitaker,J Wardle

    Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

    更新日期:2019-11-01
  • Epidemiologic approaches to global health.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2010-06-29
    Thomas C Quinn,Jonathan M Samet

    In this introduction to volume 32 of Epidemiologic Reviews, the authors highlight the diversity and complexity of global health concerns, and they frame the 12 articles included in this issue within the diverse topics of research in this emerging and ever-expanding field. The authors emphasize the need for ongoing research related to the methods used in global health and for comprehensive surveillance, and they offer suggestions for future directions in global health research.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2016-02-26
    Paul J D Roszko,Jonathan Ameli,Patrick M Carter,Rebecca M Cunningham,Megan L Ranney

    Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.

    更新日期:2019-11-01
  • The Lancet-Saturday 13 May 1972. 1972.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2005-06-17
    Alfred Sommer,Wiley H Mosley

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  • Role of litigation in preventing product-related injuries.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Jon S Vernick,Julie Samia Mair,Stephen P Teret,Jason W Sapsin

    更新日期:2019-11-01
  • Role of environmental interventions in injury control and prevention.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Corinne Peek-Asa,Craig Zwerling

    更新日期:2019-11-01
  • Application of behavior-change theories and methods to injury prevention.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Andrea Carlson Gielen,David Sleet

    更新日期:2019-11-01
  • Evaluation of interventions designed to prevent and control injuries.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Lynda Doll,Tom Bartenfeld,Sue Binder

    更新日期:2019-11-01
  • Matched cohort methods for injury research.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Peter Cummings,Barbara McKnight,Sander Greenland

    更新日期:2019-11-01
  • Injury surveillance.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    John M Horan,Sue Mallonee

    更新日期:2019-11-01
  • Introduction: the scientific basis for injury control.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Frederick P Rivara

    更新日期:2019-11-01
  • Measuring the public health impact of injuries.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-08-20
    Maria Segui-Gomez,Ellen J MacKenzie

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Blood transfusions and non-Hodgkin's lymphoma.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Eric J Chow,Elizabeth A Holly

    更新日期:2019-11-01
  • Pharmacologic agents associated with a preventive effect on Alzheimer's disease: a review of the epidemiologic evidence.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    B A in 't Veld,L J Launer,M M B Breteler,A Hofman,B H Ch Stricker

    更新日期:2019-11-01
  • Prevention of lower extremity stress fractures in athletes and soldiers: a systematic review.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Bruce H Jones,Stephen B Thacker,Julie Gilchrist,C Dexter Kimsey,Daniel M Sosin

    更新日期:2019-11-01
  • Prevalence of symptoms and symptom-based conditions among Gulf War veterans: current status of research findings.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Drue H Barrett,Gregory C Gray,Bradley N Doebbeling,Daniel J Clauw,William C Reeves

    更新日期:2019-11-01
  • Do indoor molds in nonindustrial environments threaten workers' health? A review of the epidemiologic evidence.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Henrik A Kolstad,Charlotte Brauer,Martin Iversen,Torben Sigsgaard,Sigurd Mikkelsen

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Genetic and perinatal risk factors for asthma onset and severity: a review and theoretical analysis.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Michael B Bracken,Kathleen Belanger,William O Cookson,Elizabeth Triche,David C Christiani,Brian P Leaderer

    更新日期:2019-11-01
  • Vaginal douching: evidence for risks or benefits to women's health.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Jenny L Martino,Sten H Vermund

    更新日期:2019-11-01
  • Environmental epidemiology of pediatric asthma and allergy.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Christine Cole Johnson,Dennis R Ownby,Edward M Zoratti,Sharon Hensley Alford,L Keoki Williams,Christine L M Joseph

    更新日期:2019-11-01
  • Evolution of surveillance of measles, mumps, and rubella in England and Wales: providing the platform for evidence-based vaccination policy.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    A J Vyse,N J Gay,J M White,M E Ramsay,D W G Brown,B J Cohen,L M Hesketh,P Morgan-Capner,E Miller

    更新日期:2019-11-01
  • Heritable and nonheritable risk factors for autism spectrum disorders.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Craig J Newschaffer,Daniele Fallin,Nora L Lee

    更新日期:2019-11-01
  • Bacterial vaginosis in pregnancy: current findings and future directions.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    Deborah B Nelson,George Macones

    更新日期:2019-11-01
  • Epidemiologic measures of the course and outcome of pregnancy.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2003-05-24
    David A Savitz,Irva Hertz-Picciotto,Charles Poole,Andrew F Olshan

    更新日期:2019-11-01
  • Gender gap in longevity and disability in older persons.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    A B Newman,J S Brach

    更新日期:2019-11-01
  • Height, leg length, and cancer risk: a systematic review.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    D Gunnell,M Okasha,G D Smith,S E Oliver,J Sandhu,J M Holly

    更新日期:2019-11-01
  • Association between hepatitis C virus infection and diabetes mellitus.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    S H Mehta,S A Strathdee,D L Thomas

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Diet and obstructive lung diseases.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    I Romieu,C Trenga

    The results presented in this review suggest that the impact of nutrition on obstructive lung disease is most evident for antioxidant vitamins, particularly vitamin C and, to a lesser extent, vitamin E. By decreasing oxidant insults to the lung, antioxidants could modulate the development of chronic lung diseases and lung function decrement. Antioxidant vitamins could also play an important role in gene-environment interactions in complex lung diseases such as childhood asthma. Data also suggest that omega-3 fatty acids may have a potentially protective effect against airway hyperreactivity and lung function decrements; however, relevant data are still sparse. Although epidemiologic data suggest that consumption of fresh fruit may reduce risk of noncarcinogenic airway limitation, there are no clear data on which nutrients might be most relevant. While some studies evaluate daily intake of vitamin C, other studies use fruit consumption as a surrogate for antioxidant intake. Given the dietary intercorrelations among antioxidant vitamins, particularly vitamin C, beta-carotene, and flavonoids, as well as other micronutrients, it may be difficult to isolate a specific effect. Some population subgroups with higher levels of oxidative stress, such as cigarette smokers, may be more likely to benefit from dietary supplementation, since some studies have suggested that antioxidant intake may have a greater impact in this group. Studies of lung function decrement and COPD in adults suggest that daily intake of vitamin C at levels slightly exceeding the current Recommended Dietary Allowance (60 mg/day among nonsmokers and 100 mg/day among smokers) may have a protective effect (20). In the Schwartz and Weiss (85) and Britton et al. (87) studies, an increase of 40 mg/day in vitamin C intake led to an approximate 20-ml increase in FEV1. Daily mean vitamin C intakes in these studies were 66 mg and 99.2 mg, respectively, and the highest intake level (178 mg/day) was approximately three times the Recommended Dietary Allowance. Although the amplitude of the effect was modest, if these effects accumulate over 20-30 years, they could have a meaningful impact on the rate at which pulmonary function declines, particularly in symptomatic subjects (85). Longitudinal data support the hypothesis that fresh fruit consumption has a beneficial impact on the lung (95). Among children, consumption of fresh fruit, particularly fruit high in vitamin C, has been related to a lower prevalence of asthma symptoms and higher lung function (64). This effect was observed event at low levels of fruit consumption (one or two servings per week vs. less than one serving per week), which suggests that a small increase in dietary intake could have a beneficial effect. Consumption of fish has also been related to lower airway hyperreactivity among children (75) and higher lung function in adults (100); however, longitudinal data do not provide evidence that increased omega-3 fatty acid intake protects against lung disease (101). Experimental studies of persons with asthma suggest that magnesium infusion may have a place in the acute treatment of asthma, but it does not seem to have long-term benefits. The studies of sodium, selenium, and fish oils do not show convincing evidence of clinical benefits. Studies of vitamin C supplementation suggest a short-term protective effect on airway responsiveness and pulmonary function. It remains to be proven whether consistent use of vitamin C would have a protective effect on the evolution of chronic asthma. Results from supplementation studies conducted among subjects exposed to high levels of oxidants (57-60) suggest that daily intake of antioxidant vitamins exceeding the Recommended Dietary Allowance may have a beneficial effect on lung airways and that intake higher than the Recommended Dietary Allowance should be recommended for populations chronically exposed to photooxidant air pollutants (such as ozone), cigarette smoking, or vigorous exercise. It is difficult to determine the amounts of antioxidant vitamins that people should consume. In particular, although vitamin C was shown to have maximum bioavailability when given in a single dose of 200 mg (102), experiments on which this finding was based were conducted under normal conditions. Guidelines from the US National Cancer Institute (103) recommend consumption of five servings of fruit and vegetables daily, corresponding to a vitamin C intake exceeding 200 mg. Dietary surveys carried out in the US population indicate that less than 12 percent of US children and adults meet this recommended level of intake (104). Diet appears to be an important cofactor in the development of obstructive lung disease, although data are still sparse. There is a need for further research in experimental and epidemiologic settings to better understand the physiologic effects of antioxidant vitamins, omega-3 fatty acids, and other nutrients on lung tissues. The impact of diet on the incidence and evolution of asthma and COPD should be investigated using a cohort design that accounts for known risk factors. This will allow researchers to evaluate the exposure-disease relation over an adequate time frame and obtain insight into the causality of the relation. Some of these studies should enroll infants and young children to determine the impact of early diet on respiratory health. Research should also focus on the equally challenging policy issues--namely, finding effective methods of convincing people to increase their daily consumption of fresh fruits and vegetables, to stop smoking cigarettes, and to minimize their environmental and occupational exposure to pollutants and other agents that cause respiratory disease.

    更新日期:2019-11-01
  • Epidemiologic evidence linking antioxidant vitamins to pulmonary function and airway obstruction.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    H J Schünemann,J L Freudenheim,B J Grant

    更新日期:2019-11-01
  • Toxic oil syndrome: the perspective after 20 years.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    M Posada de la Paz,R M Philen,A I Borda

    Toxic oil syndrome burst upon the scene in Spain in May of 1981, draining the resources of a newly evolving political and social medicine system. The vehicle of the causative toxic agent was identified as an illicit oil that had been diverted from industrial use and refined in order to remove the aniline denaturant, and that was sold in unlabeled 5-liter containers by itinerant salesmen. Over 20,000 people were ultimately affected, and over 1,200 deaths from all causes have been recorded in the affected cohort. The epidemiologic investigation of toxic oil syndrome involved all facets of investigative and analytical work; from visits to factories and interviewing workers, to sophisticated chemical and statistical analytical techniques. This investigation serves as a further illustration that data and information of all types, and from a wide range of fields, need to be systematically collected and evaluated in order to best resolve an epidemiologic mystery. Astute clinical observation of the patients, however, led to the hypothesis that toxic oil syndrome was a result of a toxic exposure. In this and other epidemics of unknown etiology, clinical observation and the intense scrutiny of patients' histories, signs, and symptoms by treating clinicians have often led to hypotheses that could be tested epidemiologically. When there are medical unknowns, the role of the astute clinician continues to be crucial. The toxic oil syndrome epidemic is an example of how even a developed country can be affected by a massive epidemic of environmental origin if failures occur in the systems that control and regulate the food supply or other consumer products. However, such failures could occur anywhere that large commercial networks operate on the regulatory edge, and if these business lack an in depth knowledge of the consequences of alterations in manufacturing conditions. Such was the case with eosinophilia-myalgia syndrome as well, when apparently minor alterations in manufacturing conditions of L-tryptophan led to an increase in impurities in the product that were later associated with the illness. These risks are even greater in countries with few or inconsistent control systems, making the food and drug supply potential portals of entry for serious health hazards, as is further exemplified by the tragic episode of pediatric renal failure in Haiti associated with a legitimate consumer product, paracetamol elixir, that had been manufactured using a fraudulently supplied toxic ingredient, diethylene glycol (81). The potential toxicants in the adulterated rapeseed oil were present in extremely small amounts. If fatty acid anilides or related compounds are indeed the etiologic agents in toxic oil syndrome, then these compounds must be extremely toxic at the parts per million concentrations at which they were found. Further, the roles of causative agents in the development of disorders such as scleroderma, eosinophilic fasciitis, eosinophilic perimyositis, and other similar diseases are unknown, but scientists can speculate that some sort of low level environmental agent may play a role if such extremely small quantities of contaminants are indeed capable of causing disease. Although the exact identity of the etiologic agent in toxic oil syndrome remains unknown, work on toxic oil syndrome continues. Follow-up clinical studies and long-term mortality studies are under way. Investigation of the mechanisms involved in toxic oil syndrome continues. The identification of suspect chemical compounds, their characterization, and effects will hopefully one day contribute to the prevention of other similar diseases.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Spontaneous adverse event signaling methods: classification and use with health care treatment products.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-08-24
    J A Clark,S L Klincewicz,P E Stang

    AE signal detection and its techniques are part of the continuum of public health surveillance, borrowing from both its theory and application (171). Like public health surveillance networks, whose major goals are to identify early signs of new outbreaks, pinpoint new organisms, and monitor designated illnesses, AE signaling and surveillance systems attempt to provide early warnings of previously unsuspected product-AE pairs, hypothesize potential drug-event relations, identify populations "at risk," and facilitate case ascertainment and definition. In both examples, definitive research is often subsequently undertaken to quantify the strength of relations that may be proposed. As with any public health surveillance effort, AE surveillance provides an infrastructure for the ongoing collection of health data and its direct integration into the health regulatory policy (172), including its keystone role in risk assessment and management. However, unlike many surveillance systems, postmarketing AE systems collect case information that is often relatively incomplete and imperfect, estimate exposure based on surrogate values (e.g., sales data), and are used by both governmental and the private sector for preventive planning. These factors make AE signaling and surveillance more ambiguous, regulatory oriented, and complex than its disease counterparts (173). Despite such issues, AE signaling methods continue to evolve in extent, complexity, and acceptance (4, 131, 174). Undoubtedly, this is largely due to the widespread practical experience that has been gained with spontaneous reporting systems over the past 4 decades and the cumulative usefulness that has been demonstrated.

    更新日期:2019-11-01
  • Beyond intention to treat.
    Epidemiol. Rev. (IF 6.455) Pub Date : 2002-07-18
    Els Goetghebeur,Tom Loeys

    更新日期:2019-11-01
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