Epidemiologia, Volume 4, Issue 4 (December 2023) – 11 articles

(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. Full article

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. Full article

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. Full article

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. Full article

Informal caregivers’ own quality of life, health status, and determinants are poorly understood despite their concern for the health of the individuals they assist. To compare the quality of life and the health determinants of older informal caregivers with those of older adults without caregiving responsibilities. An online survey was designed to investigate the quality of life and the health determinants of people aged 65 years and over, with a focus on informal caregivers. In addition to socio-demographic data, the number of informal caregivers was ascertained and the Zarit scale of caregiver burden was applied. Quality of life (SF-12) and health determinants (access to technology and level of physical activity (IPAQ)) were assessed and compared between informal caregivers and non-caregivers. A total of 111 participants were included in the study (70 ± 3.83 years, 71.2% women). The majority of respondents (91.8%) were Belgian. One-third of the respondents identified themselves as informal caregivers and declared themselves as having a severe burden (61.9 ± 15.2/88). Socio-demographic characteristics and access to technology were similar between informal caregivers and non-caregivers (p > 0.05). However, informal caregivers had a lower SF-12 score in the mental score domain (44.3 ± 10.2 vs. 50.7 ± 7.0; p = 0.004) and a lower level of physical activity (434 ± 312 METS/min/week vs. 1126 ± 815 METS/min/week; p = 0.01) than their peers. Informal caregivers reported a lower quality of life and a lower level of physical activity than their peers. Given the recognized importance of physical activity for overall health, this survey highlights the need to promote physical activity among older informal caregivers. Full article

Background: Prevention of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) to ensure the “Right to Occupational Safety” is a special challenge globally, as HCWs have a higher risk of acquiring the infection in hospital settings because of frequent close exposure to patients suffering from tuberculosis (TB). Methods: Aretrospective study was performed with the aim of assessing the prevalence of LTBI related to demographical and occupational risk factors among HCWs employed in a large hospital in Italy. The study involved 1461 HCWs screened for LTBI by Mantoux tuberculin skin test (TST) and then confirmed with Interferon Gamma Release Assay (IGRA) test in case of positivity. Immunosuppressed and BGC-vaccinated workers were tested directly with IGRA. Results: LTBI was diagnosed in 4.1% of the HCWs and the prevalence resulted lower than other studies conducted in low TB incidence countries. The variables significantly linked with higher frequency of the infection were: age ≥40 years (OR = 3.14; 95% CI: 1.13–8.74; p < 0.05), length of service ≥15 years (OR = 4.11; 95% CI: 1.48–11.43; p < 0.05) and not being trained on TB prevention (OR = 3.46; 95% CI: 1.85–6.46; p < 0.05). Not trained HCWs presented a higher risk of LTBI also after adjustment for age and length of service, compared to trained HCWs. Conclusions: screening of HCWs for LTBI should be always considered in routinely occupational surveillance in order to early diagnose the infection and prevent its progression. Safety policies in hospital settings centered on workers’ training on TB prevention is crucial to minimize LTBI occurrence in HCWs. Full article

Infectious disease epidemics are challenging for medical and public health practitioners. They require prompt treatment, but it is challenging to recognize and define epidemics in real time. Knowing the prediction of an infectious disease epidemic can evaluate and prevent the disease’s impact. Mathematical models of epidemics that work in real time are important tools for preventing disease, and data-driven deep learning enables practical algorithms for identifying parameters in mathematical models. In this paper, the SIR model was reduced to a logistic differential equation involving a constant parameter and a time-dependent function. The time-dependent function leads to constant, rational, and birational models. These models use several constant parameters from the available data to predict the time and number of people reported to be infected with the COVID-19 Omicron variant. Two out of these three models, rational and birational, provide accurate predictions for countries that practice strict mitigation measures, but fail to provide accurate predictions for countries that practice partial mitigation measures. Therefore, we introduce a time-series model based on neural networks to predict the time and number of people reported to be infected with the COVID-19 Omicron variant in a given country that practices both partial and strict mitigation measures. A logistics-informed neural network algorithm was also introduced. This algorithm takes as input the daily and cumulative number of people who are reported to be infected with the COVID-19 Omicron variant in the given country. The algorithm helps determine the analytical solution involving several constant parameters for each model from the available data. The accuracy of these models is demonstrated using error metrics on Omicron variant data for Portugal, Italy, and China. Our findings demonstrate that the constant model could not accurately predict the daily or cumulative infections of the COVID-19 Omicron variant in the observed country because of the long series of existing data of the epidemics. However, the rational and birational models accurately predicted cumulative infections in countries adopting strict mitigation measures, but they fell short in predicting the daily infections. Furthermore, both models performed poorly in countries with partial mitigation measures. Notably, the time-series model stood out for its versatility, effectively predicting both daily and cumulative infections in countries irrespective of the stringency of their mitigation measures. Full article

South Africa has the highest number of people living with the human immunodeficiency virus (HIV) in the world, accounting for nearly one in five people living with HIV globally. As of 2021, 8 million people in South Africa were infected with HIV, which is 13% of the country’s total population. Approximately 450,000 people in the country develop tuberculosis (TB) disease every year, and 270,000 of those are HIV positive. This suggests that being HIV positive significantly increases one’s susceptibility to TB, accelerating the spread of the epidemic. To better understand the disease burden at the population level, a Susceptible–Infected–Recovered–Dead (SIRD) TB–HIV co-infection epidemic model is presented. Parameter values are estimated using the method of moments. The disease-free equilibrium and basic reproduction number of the model are also obtained. Finally, numeric simulations are carried out for a 30-year period to give insights into the transmission dynamics of the co-infection. Full article

Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults. Full article

The Japanese National Database (NDB), a useful data source for epidemiological studies, contains information on health checkups, disease diagnoses, and medications, which can be used when investigating common cardiometabolic diseases. However, before the initiation of an integrated analysis, we need to combine several pieces of information prepared separately into an all-in-one dataset (AIOD) and confirm the validation of the dataset for the study. In this study, we aimed to confirm the degree of agreement in data entries between diagnoses and prescribed medications and self-reported pharmacotherapy for common cardiometabolic diseases in newly assembled AIODs. The present study included 10,183,619 people who underwent health checkups from April 2018 to March 2019. Over 95% of patients prescribed antihypertensive and antidiabetic medications were diagnosed with each disease. For dyslipidemia, over 95% of patients prescribed medications were diagnosed with at least one of the following: dyslipidemia, hypercholesterolemia, or hyperlipidemia. Similarly, over 95% of patients prescribed medications for hyperuricemia were diagnosed with either hyperuricemia or gout. Additionally, over 90% of patients with self-reported medications for hypertension, diabetes, and dyslipidemia were diagnosed with each disease, although the proportions differed among age groups. Our study demonstrated high levels of agreement between diagnoses and prescribed medications for common cardiometabolic diseases and self-reported pharmacotherapy in our AIOD. Full article