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        <title>Frontiers in Epidemiology | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/epidemiology</link>
        <description>RSS Feed for Frontiers in Epidemiology | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-11T09:49:01.342+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1765678</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1765678</link>
        <title><![CDATA[Detecting comorbidity patterns in rare disease patients with machine learning]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Benjamin Mark Connor</author><author>Claire Hill</author><author>Lu Bai</author><author>Amy Jayne McKnight</author><author>Anna Jurek-Loughrey</author>
        <description><![CDATA[IntroductionWhilst individually rare, affecting only a small percentage of the population, rare diseases as a whole impact around 6% of the global population (with this number likely an underestimate). Rare diseases are often complex, with specific challenges in diagnosis, management, and treatment due to limited knowledge and research. Rare disease patients have been shown to have more comorbidities compared to those without a rare disease diagnosis. Studying comorbidities in patients with rare diseases is particularly important as these patients may exhibit unique patterns of multiple diseases which are not well understood. Understanding these comorbidity patterns can lead to insights into the etiology and progression of rare diseases, potentially identifying new therapeutic targets and improving clinical management strategies. Additionally, studying comorbidities can help in predicting complications, improving the quality of life of patients, and offering a more comprehensive approach to health care for those affected by rare diseases.MethodsA machine learning based method known as hierarchical clustering was applied to diagnosis data from the UK Biobank to study comorbidity patterns in patients with rare diseases. The results were then compared with patterns detected for the general population.ResultsTwelve clusters were identified for the rare disease group, and 14 for the no rare disease group.DiscussionUnique comorbidity patterns were observed for individuals with and without a rare disease diagnosis, highlighting potential priorities for intervention to improve both disease management and patient care.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1750089</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1750089</link>
        <title><![CDATA[Seasonal variations in hospital admissions and case-fatality of ischemic stroke: a nationwide analysis of >4.2 million cases in Germany]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Omar Hahad</author><author>Simon-Noah Hakim-Meibodi</author><author>Seyed Hamed Rastguye Haghi</author><author>Sasan Faridi</author><author>Andreas Daiber</author><author>Alexandra Schneider</author><author>Kathrin Wolf</author><author>Nikolaos Nikolaou</author><author>Volker H. Schmitt</author><author>Philipp Lurz</author><author>Christine Espinola-Klein</author><author>Yafang Cheng</author><author>Andrea Pozzer</author><author>Jos Lelieveld</author><author>Thomas Münzel</author><author>Daniel Wollschläger</author><author>Lukas Hobohm</author><author>Karsten Keller</author>
        <description><![CDATA[BackgroundIschemic stroke is a leading cause of global morbidity and mortality, with seasonal variations potentially influencing both outcomes. While previous studies have suggested a pronounced association of the cold months with increased stroke morbidity and mortality, the evidence remains limited and inconsistent. This study aimed to assess seasonal variations in ischemic stroke hospital admissions and in-hospital case-fatality and complications in Germany over an 18-year period.MethodsThis nationwide retrospective analysis included all hospitalizations for ischemic stroke in Germany from 2005 to 2022, using data from the Federal Statistical Office. Patients were categorized by season of hospital admission (winter, spring, summer, autumn). Multivariable logistic regression models were used to assess the association between season and in-hospital case-fatality, adjusting for age, sex, and comorbidities.ResultsA total of 4,236,789 ischemic stroke hospitalizations were analyzed. No statistically significant seasonal variation in stroke hospitalization was observed. However, in-hospital case-fatality was significantly higher in winter (7.4%) compared to summer (6.6%, p < 0.001). This seasonal association was independent of patient age, sex, and comorbidities [adjusted odds ratio (OR): 1.140, 95% confidence interval (CI): 1.128–1.152; p < 0.001]. Similar trends were observed in both men (adjusted OR: 1.122, 95% CI: 1.103–1.141; p < 0.001) and women (adjusted OR: 1.112, 95% CI: 1.096–1.128; p < 0.001), without substantial sex-specific differences.ConclusionWhile ischemic stroke hospital admissions remained stable across seasons, in-hospital case-fatality was significantly increased during winter compared to summer. These findings highlight the need for targeted seasonal prevention and management strategies. Further research is needed to explore underlying mechanisms and evaluate potential interventions to mitigate excess winter case-fatality among stroke patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1816934</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1816934</link>
        <title><![CDATA[Malaria antibody responses augment surveillance in low-transmission settings in the Upper River Region, the Gambia]]></title>
        <pubdate>2026-04-21T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Rihana A. Aydin</author><author>Thomas Keller</author><author>Edgard D. Dabira</author><author>Nuredin Mohammed</author><author>Annette Erhart</author><author>Chris Drakeley</author><author>Umberto D’Alessandro</author><author>Gillian Stresman</author>
        <description><![CDATA[IntroductionIn low-transmission malaria settings, routine surveillance often fails to detect asymptomatic infections in partially immune populations. P(Detect), defined as the proportion of infections captured by surveillance systems, serves as a proxy for both population immunity and surveillance completeness. We evaluated whether antibody responses to Plasmodium falciparum antigens could classify low vs. high P(Detect) populations and identify surveillance blind spots.MethodsWe analyzed data from 5,300 seropositive individuals across 32 villages in The Gambia following mass drug administration. Random forest classification models were used to predict low vs. high P(Detect) groups based on antibody responses to 19 P. falciparum antigens. Analyses were stratified by transmission intensity (<5% and <10% PCR prevalence). Model performance was assessed using precision–recall area under the curve (PR AUC) in held-out test data, and permutation-based variable importance identified key predictive antigens.ResultsModels demonstrated strong discrimination between detectability groups, with PR AUCs of 0.92–0.93 in the <5% stratum and 0.89–0.90 in the <10% stratum using a reduced 8-antigen panel. PfSEA, PfMSP1-19, gSG6, and Etramp4.Ag2 were consistently important predictors, though rankings varied by transmission context. Individual antigen models outperformed combined immune score approaches.DiscussionAntibody profiles can identify populations where surveillance underestimates transmission due to immunity. Integrating serological data into surveillance systems may improve detection of hidden reservoirs and support more targeted malaria elimination strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1740227</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1740227</link>
        <title><![CDATA[Global prevalence and predictors of depression and anxiety in patients with liver cirrhosis: a systematic review and meta-analysis]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Omar Abureesh</author><author>Araek Al-Shraideh</author><author>Joelle Sleiman</author><author>Chloe Lahoud</author><author>Brendan Plann-Curley</author><author>Liliane Deeb</author>
        <description><![CDATA[BackgroundLiver cirrhosis is a complex disorder that affects nearly 122 million patients worldwide. This study synthesizes global prevalence estimates of depression and anxiety among patients with cirrhosis, together with associated risk factors and geographic distribution.MethodAn electronic search was conducted on Medline, Embase, Cochrane Central and Web of Science databases. Results were then filtered according to the inclusion criteria over two stagesData from eligible studies were extracted into a standardized spreadsheet, which was then subjected to analysis and evidence synthesis.ResultsOur search yielded 23 articles from countries all over the world describing 979,113 patients.The pooled prevalence was 0.37 [95% C.I. 0.29–0.46, p = 0.01] for depression and of 0.53 [95% C.I. 0.33–0.73, p < 0.010] for anxiety, in cirrhotic patients, however, high heterogeneity was noted. Meta-regression was performed to assess the ability of demographic factors (Ager, Sex), and etiological factors to predict depression in cirrhotic patients. Age, alcoholism, and viral etiologies, were linked to depression incidence. Advancing age was associated with increased depression prevalence among cirrhosis patients (p = 0.02).ConclusionDepression and anxiety substantially impair quality of life in patients with cirrhosis, but their diagnosis remains limited and under-investigated. Standardizing depression and anxiety screening for cirrhosis patients can improve their outcomes and quality of life significantly.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1746012</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1746012</link>
        <title><![CDATA[Behavioral symptoms of dementia and psychotropic use during the COVID-19 pandemic]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jung Min Yoon</author><author>Kwame Kissi-Twum</author><author>Alison M. Trinkoff</author><author>T. Joseph Mattingly</author>
        <description><![CDATA[BackgroundAs nursing home settings and their residents were severely affected by the COVID-19 pandemic, changes in care practices along with increased social isolation during the pandemic may have increased the prevalence of behavioral and psychological symptoms of dementia (BPSD) and psychotropic medication use in nursing homes.MethodsWe conducted a repeated cross-sectional study using 2019 and 2020 Minimum Data Set from nursing homes in New York, Utah, and Colorado. The primary outcome was a composite BPSD measure, defined as two or more symptoms among depression, wandering, rejection of care, hallucinations, delusions, or verbal/physical behavioral symptoms. Secondary outcomes included neuropsychiatric sub-syndromes and psychotropic use.ResultsFrom 2019 to 2020, the prevalence of two or more BPSDs increased from 19.0% (95% CI, 18.8–19.2) to 20.2% (95% CI, 20.0–20.5). Increases in BPSD were largely driven by depressive symptoms, which increased by 63%, from 17.4% (95%CI, 17.1–17.6) in 2019 to 28.3% (95%CI, 28.0–28.5) in 2020. Whereas, the prevalence of psychosis-related symptoms changed minimally, from 5.6% (95%CI, 5.5–5.8) to 5.7% (95%CI, 5.5–5.8), and agitation-related symptoms decreased from 30.0% (95%CI, 29.8–30.3) in 2019 to 29.6% (95%CI, 29.4–30.0) in 2020. Antipsychotic and sedative use decreased while antidepressant and antianxiety use remained steady.DiscussionIn this study of nursing home residents, the prevalence of BPSD was higher during the COVID-19 pandemic, primarily driven by increased depressive symptoms. These findings underscore the need to strengthen depression screening and mental health support for nursing home residents during public health emergencies such as pandemics.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1798451</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1798451</link>
        <title><![CDATA[Hearing loss and incident dementia over 8 years in Black and White older adults: the Atherosclerosis Risk in Communities Neurocognitive Study]]></title>
        <pubdate>2026-04-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jennifer A. Deal</author><author>John J. Shin</author><author>Kening Jiang</author><author>A. Richey Sharrett</author><author>Josef Coresh</author><author>Rebecca F. Gottesman</author><author>David S. Knopman</author><author>Thomas Mosley</author><author>Keenan A. Walker</author><author>Frank R. Lin</author><author>Nicholas S. Reed</author>
        <description><![CDATA[ObjectiveWe investigated potential racial disparities in the effects of audiometric hearing loss and its treatment on dementia and mortality among 3,602 older adults aged 68–89 years, 22% of whom were self-identified Black race.MethodsAdjudicated all-cause dementia was determined using neurocognitive test data, proxy reports, and surveillance of hospital records and death certificates. Audiometric hearing loss, defined as the better-ear averaged pure-tone threshold (0.5–4 kHz), was categorized using clinical cutpoints. Multivariable-adjusted Cox proportional hazards models included hearing loss–race interaction terms.ResultsDementia risk associated with moderate-to-severe hearing loss did not differ by race [Black participants: hazard ratio (HR): 1.66; 95% confidence interval (CI): 1.05, 2.61; White participants: HR: 1.71; 95% CI: 1.16, 2.51; P-interaction = 0.92]. However, moderate-to-severe hearing loss was associated with a 2.3-fold increase in mortality among Black participants only (95% CI: 1.17, 4.60).ConclusionsOur findings emphasize the importance of including minoritized populations in hearing treatment research to build an evidence base for policy development and clinical decision-making. Hearing loss affects the health of both Black and White Americans. Racial disparities in hearing healthcare should be addressed to advance health equity for all older adults.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1717102</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1717102</link>
        <title><![CDATA[Epidemiology of hepatitis A in Saudi Arabia: a retrospective analysis of Ministry of Health surveillance and yearbook data, 2006–2023]]></title>
        <pubdate>2026-03-30T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ibrahim G. Alghamdi</author>
        <description><![CDATA[BackgroundThis study investigates the epidemiology of hepatitis A virus (HAV) infection in Saudi Arabia from 2006 to 2023, focusing on temporal, demographic, and geographic variations in incidence. The aim was to characterize long-term national trends and identify high-risk subgroups to inform prevention strategies.MethodsNational HAV surveillance data were obtained from the Saudi Ministry of Health Statistical Yearbooks. Crude incidence rates (CIRs) were calculated using mid-year population estimates. Temporal trends were assessed via Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Regional differences were analyzed with negative binomial regression using Riyadh as the reference. Group comparisons employed nonparametric tests, with statistical significance set at α=0.05.ResultsBetween 2006 and 2023, 9,820 HAV cases were reported (mean 546/year). National CIR declined from 11.1 per 100,000 in 2006 to 0.48 in 2023, with an AAPC of −19.5% (95% CI −24.2 to −14.4; p < 0.001). Children aged 5–14 years bore the highest burden (53.5% of cases). Significant regional heterogeneity was observed, with persistently higher CIRs in Najran and Qurayyat, while urban centers showed lower, stable rates. Negative binomial regression identified higher adjusted risks in Qurayyat (IRR 2.89) and Najran (IRR 2.52). Saudis initially showed higher incidence than non-Saudis, but rates converged by 2023. Males consistently outnumbered females (ratio ∼1.6).ConclusionHAV incidence in Saudi Arabia has markedly declined over the past two decades, reflecting improved sanitation and public health measures. This decline may, in part, reflect the impact of the national hepatitis A vaccination program introduced in 2008. However, age-, region-, and nationality-specific disparities remain, underscoring the need for geographically tailored interventions and consideration of targeted vaccination strategies to sustain progress and prevent resurgence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1529289</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1529289</link>
        <title><![CDATA[Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review]]></title>
        <pubdate>2026-03-25T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Zaidat Adesola Musa</author><author>Folahanmi Tomiwa Akinsolu</author><author>Abideen Oluwarotimi Salako</author><author>Olunike Rebecca Abodunrin</author><author>Oluwabukola Mary Ola</author><author>Oliver Chukwujekwu Ezechi</author>
        <description><![CDATA[IntroductionStepped-wedge design (SWD) has gained prominence as a versatile research methodology, particularly in public health and implementation science, due to its ability to balance ethical concerns with methodological rigor. This systematic review aims to evaluate the implementation and effectiveness of SWD in sub-Saharan African (SSA) research contexts, focusing on the types of interventions, primary outcomes, and the unique geographic and cultural factors influencing the studies.MethodologyA systematic review protocol was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42024530774. A comprehensive search strategy was employed to identify studies conducted in SSA using SWD from January 2000 to March 2024 across five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and Cochrane Library), along with Google Scholar and citation tracking. Studies were included if they utilized SWD in SSA settings and reported relevant public health, clinical, or social interventions. Data were extracted on study characteristics, SWD implementation details, statistical methods, and sample size calculations. A total of 85 studies were included after screening 873 titles and abstracts and conducting full-text reviews of 93 articles.ResultsThe 85 studies included in the review spanned a wide range of health domains, including HIV/AIDS, maternal and child health, tuberculosis, and malaria, conducted across diverse SSA settings such as hospitals, communities, and schools. The studies involved a total of 1,895,788 participants, with sample sizes ranging from 17 to 780,000. Most studies (84.7%) were facility-based, while 15.3% were community-based. The number of clusters per study varied, with some studies using as few as four clusters, while others utilized up to 54 clusters. The number of steps ranged from two to twelve, depending on the complexity and scale of the intervention. Sample size calculations were often based on expected changes in primary outcomes, with many studies assuming an intra-cluster correlation coefficient to account for clustering effects. The SWD was primarily chosen to address ethical concerns, logistical challenges, and resource limitations. The review highlights significant variability in study designs, interventions, and outcomes, reflecting the adaptability of SWD to different contexts and challenges.ConclusionThe SWD has been effectively utilized in SSA research to evaluate a wide range of interventions across diverse settings, demonstrating its flexibility and suitability for addressing complex public health challenges. However, the review also identifies challenges related to study duration, logistical implementation, randomization processes, and statistical analysis, suggesting the need for careful planning and methodological rigor in future studies using SWD. The findings provide valuable insights for researchers and policymakers seeking to optimize the use of SWD in resource-limited settings, ensuring that interventions are both effective and ethically implemented.<br>Systematic Reviews Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024530774, PROSPERO CRD42024530774.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1765215</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1765215</link>
        <title><![CDATA[Vitamin D and the metabolic-associated steatotic liver disease—type 2 diabetes axis: a scoping-narrative review of global evidence and emerging perspectives for Sub-Saharan Africa]]></title>
        <pubdate>2026-03-11T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Bruno Basil</author>
        <description><![CDATA[BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) and Type 2 Diabetes Mellitus (T2DM) are rapidly emerging as twin epidemics in Sub-Saharan Africa (SSA), driven by urbanization and nutritional transition. While global evidence links Vitamin D deficiency (VDD) to the progression of both disorders, data specific to African populations remains fragmented. This review explores the Vitamin D–MASLD–T2DM axis, contrasting global mechanistic insights with the unique genetic, environmental, and infectious disease landscape of SSA.MethodsA hybrid scoping-narrative review was conducted searching PubMed/MEDLINE, Scopus, and Embase for literature published up to 2025. The search targeted mechanistic studies, clinical trials, and regional epidemiological data. Out of 948 initial citations, 59 high-quality studies were prioritized for synthesis. The review integrates molecular evidence of Vitamin D Receptor (VDR) signaling with clinical outcomes and evaluates their applicability to the African context.ResultsMechanistic evidence indicates that Vitamin D exerts potent anti-inflammatory and insulin-sensitizing effects via VDR activation, specifically by downregulating hepatic de novo lipogenesis (SREBP-1c) and suppressing NF-κB signaling in Kupffer cells. Epidemiological data consistently associate VDD with increased liver fibrosis and insulin resistance. However, randomized controlled trials yield conflicting results, likely due to heterogeneity in dosing and baseline status. Uniquely in SSA, the “Vitamin D Paradox” (low total levels with preserved bone health), the rarity of the PNPLA3 genetic risk variant, and the metabolic toxicity of antiretroviral therapy (e.g., Efavirenz) create a distinct pathophysiological environment where standard definitions of deficiency may be inadequate.ConclusionVitamin D deficiency is a plausible, modifiable driver of the MASLD–T2DM axis in Sub-Saharan Africa, potentially filling the risk void left by the absence of major genetic drivers like PNPLA3. However, Eurocentric thresholds for deficiency may not apply. Future research must prioritize establishing ancestry-specific reference ranges and conducting region-specific trials that account for the “triple burden” of HIV, urbanization, and dietary transition to inform effective public health interventions such as fortification.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1737016</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1737016</link>
        <title><![CDATA[Evidence-based directed acyclic graphs for perinatal pharmacoepidemiologic studies in rheumatology: a structured approach for development and implementation in administrative health data]]></title>
        <pubdate>2026-03-10T00:00:00Z</pubdate>
        <category>Methods</category>
        <author>Vienna Cheng</author><author>Neda Amiri</author><author>Vicki Cheng</author><author>Jacquelyn J. Cragg</author><author>Laurie Proulx</author><author>Mary A. De Vera</author>
        <description><![CDATA[BackgroundEvidence-based Directed Acyclic Graphs (DAGs) are effective tools to comprehensively visualize complex causal and biasing pathways in pharmacoepidemiologic research in rheumatology. This paper outlines the process of developing and implementing a DAG, using a cohort study evaluating the impact of targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) on congenital anomalies as a case example. We include a discussion of how factors would be operationalized into variables in administrative data within the case example.MethodsDAG Development involved: 1) identifying exposure and outcome, 2) identifying factors affecting the exposure, 3) identifying factors affecting the outcome, 4) identifying factors affecting both the exposure and outcome, 5) ascertaining relationships between factors, and lastly, 6) finalizing the DAG in DAGitty v3.1.ResultsThe final DAG for our case example on evaluating the association between tsDMARDs and congenital anomalies consisted of 21 nodes (points in the diagram representing factors such as exposures, outcomes, confounders, or mediators): 1 affecting the exposure, 12 affecting the outcome, 7 on the biasing pathways, and 1 mediator (maternal infection) on the exposure-outcome pathway. One minimally sufficient adjustment set was identified to inform confounder adjustment in a multivariable model, consisting of: concomitant conventional synthetic DMARDs, rheumatic disease activity, and maternal demographics (i.e., age, place of residence, race/ethnicity). Implications for implementing this DAG in a study using administrative health data include comprehensively revealing confounders to be adjusted for.ConclusionsOur systematic approach to developing a DAG is particularly valuable for improving study designs in the growing field of perinatal pharmacoepidemiology in rheumatology, where there is a critical need for robust perinatal data on novel arthritis medications.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1710531</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1710531</link>
        <title><![CDATA[Navigating sociocultural practices and traditions in HIV management: a review of African cultural barriers to achieving sustainable development goal target 3.3]]></title>
        <pubdate>2026-03-05T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Reneilwe G. Mashaba</author><author>Cairo B. Ntimana</author>
        <description><![CDATA[The narrative review aimed to explore how the sociocultural belief systems influence the health-seeking behavior of individuals living with HIV (late ART initiation and treatment discontinuation) and the subsequent impact on SDG Target 3.3. We searched PubMed, using a search strategy using keywords such as “HIV management barriers,” “SDG Target 3.3,” and “sociocultural beliefs”, and it was adapted on Google Scholar, and AJOL between 1st may to 30th June 2025. Findings demonstrate that pluralistic health-seeking behavior, such as sequential use of biomedical care, religious healing, and traditional medicine, persists amongst individuals living with HIV. This is informed by society, religious, and traditional healers. The pluralistic health-seeking behavior is practiced based on what the individual perceives as the causes of HIV, the influence of religion and faith leaders, and traditional claims of HIV cure. Although pluralistic health-seeking behavior may offer emotional support, they associated with delayed initiation, disruptions, and adherence to ART, inadequate retention in care, and lower likelihood of long-term viral suppression, weakening the HIV care continuum. Although emerging research has explored the potential role of traditional medicine in HIV management, there is a lack of evidence to support its use as a standalone treatment. The findings of this review, emphasizes a need for a structured collaborative care models. Formal engagement and dialogue amongst traditional, religious leaders, and PHC practitioners’, development of referral linkages and integration of culturally sensitive HIV education within existing health systems at a policy level should be explored.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1671078</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1671078</link>
        <title><![CDATA[Sleep duration and prevalence of coronary artery disease among adults in Chongqing, China]]></title>
        <pubdate>2026-03-02T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jie He</author>
        <description><![CDATA[ObjectiveThis study aimed to explore the association between sleep duration and prevalence ofcoronary artery diseases (CAD) among adults in Chongqing, China, and discuss implications for clinical practice and public health policy.MethodsBaseline variables were collected from 2,320 adults who participated in community medical examinations in Chongqing, China, between August 2018 and October 2020. Sleep duration was self-reported and categorized into short (<6 h/day), normal (6–8 h/day), and long (>8 h/day). Multivariate logistic regression was used to examine associations between sleep duration and CAD, adjusting for demographic and clinical confounders.ResultsShort sleep (<6 h/day; OR = 1.595, 95% CI = 1.230–2.067) and long sleep (>8 h/day; OR = 2.284, 95% CI = 1.456–3.583) were significantly associated with increased odds of CAD compared to normal sleep duration (6–8 h/day), even after adjusting for confounders. Long sleep duration demonstrated a notably stronger association with CAD risk.ConclusionBoth short and long sleep durations are significant risk factors for coronary artery diseases, with longer sleep duration showing a stronger association. Public health initiatives and clinical practices should integrate sleep duration assessments to identify at-risk populations and implement targeted interventions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1696282</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1696282</link>
        <title><![CDATA[Hierarchical forecasting of COVID-19 cases in Africa using machine learning models]]></title>
        <pubdate>2026-02-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Claris Shoko</author><author>Caston Sigauke</author><author>Katleho Makatjane</author>
        <description><![CDATA[IntroductionThe COVID-19 pandemic posed significant challenges for public health systems, especially in Africa, where data scarcity, inadequate healthcare infrastructure, and regional disparities hindered effective forecasting and response efforts. Conventional forecasting methods have faced challenges in adequately addressing the complexity and detail necessary for effective policy interventions at various administrative levels. This study examines the challenge of producing accurate and coherent forecasts of COVID-19 cases within the hierarchical structure of Africa, which includes the continental, regional, and national levels.MethodsTo establish a comprehensive forecasting model that uses hierarchical time series forecasting through a bottom-up reconciliation approach augmented by machine learning algorithms. We employ extreme gradient boosting (XGBoost) and random forest models, subsequently improving predictive accuracy via a weighted average ensemble method. We produce forecasts at the national level and then aggregate them to ensure consistency across all hierarchical levels. The models are evaluated in comparison to conventional methods such as ARIMA and exponential smoothing.ResultsEmpirical findings indicate that XGBoost is the best among all the single forecast models used in this study, combining forecasts from the XGBoost with the random forest and assigning more weights to the XGBoost surpasses all other models in the area of mean absolute error, root mean square error, and mean absolute scale error. Results further revealed that Southern Africa, despite its low population density, reported the highest number of cases, indicating underlying health vulnerabilities and socioeconomic factors. In summary, the bottom-up HTSF method, when combined with machine learning, serves as an effective tool for forecasting in environments with limited data availability.DiscussionIt is advisable to apply similar models to other infectious diseases and to expand their use to guide health interventions, resource allocation, and early warning systems in future pandemics.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1798141</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1798141</link>
        <title><![CDATA[Retraction: Awareness and infection prevention practices of hepatitis B virus among informal caregivers in public hospitals of Addis Ababa, Ethiopia, 2024]]></title>
        <pubdate>2026-02-02T00:00:00Z</pubdate>
        <category>Retraction</category>
        
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2026.1702848</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2026.1702848</link>
        <title><![CDATA[Factors associated with all-cause mortality in endovascularly treated patients with chronic limb-threatening ischemia]]></title>
        <pubdate>2026-01-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mária Rašiová</author><author>Veronika Pavlíková</author><author>Marek Hudák</author><author>Viktor Kožár</author><author>Lucia Dekanová</author>
        <description><![CDATA[BackgroundDespite advances in treatment, mortality in patients with chronic limb-threatening ischemia (CLTI) is high. The aim of our study was to evaluate 5-year all-cause mortality and factors associated with it in endovascularly treated (EVT) patients with foot ischemic ulcers.MethodsWe reviewed all patients who had undergone EVT for lower extremity peripheral artery disease between January 2016 and December 2018. Adjustments in multivariate analyses were performed for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, postprocedural ipsilateral amputation, ipsilateral reintervention, number of endovascularly treated regions, fibrinogen and creatinine.ResultsFour hundred and fifty-one patients (155 women, 296 men) with a mean age of 70.4 ± 9.60 years were included in the analysis. The 5-year all-cause mortality was 60.5%. In multivariate analysis mortality risk was higher in women (HR 1.42; 95% CI 1.09–1.86; p = 0.010), and after EVT in two or more anatomical regions (HR 1.37; 95% CI 1.05–1.79; p = 0.022). The mortality risk was positively associated with creatinine (HR 1.003; 95% CI 1.002–1.004; p < 0.001), and fibrinogen (HR 1.19; 95% CI 1.11–1.29; p < 0.001). Ipsilateral reintervention (HR 0.67; 95%CI 0.47–0.94; p = 0.021) and ipsilateral amputation after EVT (HR 0.71; 95% CI 0.51–0.98; p = 0.037) were associated with lower all-cause mortality risk.ConclusionsFemale sex, treatment in two or more anatomical regions, creatinine and fibrinogen were associated with higher 5-year mortality risk. Lower 5-year all-cause mortality risk was observed in patients with ipsilateral reintervention and ipsilateral amputation after EVT.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2025.1630930</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2025.1630930</link>
        <title><![CDATA[Wastewater surveillance in the military: how deployed members of the armed forces can monitor outbreaks on military vessels]]></title>
        <pubdate>2026-01-14T00:00:00Z</pubdate>
        <category>Perspective</category>
        <author>Anna Gitter</author><author>Kristina D. Mena</author><author>Michelle Crum</author><author>Erick Butler</author>
        <description><![CDATA[This perspective piece explores the potential to implement wastewater surveillance on military vessels to improve disease monitoring and prevention. We examine five key topics: (1) recent studies of wastewater surveillance on military bases and training centers; (2) best practices for confined populations (e.g., colleges, prisons, hospitals, and low-income and middle-income countries) and their transferability to military settings; (3) current technologies enabling deployed personnel to conduct wastewater surveillance without advanced microbiological training; (4) key questions the military should address to prevent future outbreaks on vessels; and (5) unique ethical considerations surrounding implementation. This work aims to inform military decision-makers considering the adoption of wastewater surveillance programs.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2025.1742715</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2025.1742715</link>
        <title><![CDATA[Burden, demographic patterns, and temporal trends of parotitis in Saudi Arabia, 2015–2023: a multicenter electronic health record study]]></title>
        <pubdate>2026-01-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rimah Abdullah Saleem</author><author>Hatouf Sukkarieh</author><author>Rana K. Alkattan</author><author>Rami Bustami</author><author>Sarah Daher</author><author>Noara Alhusseini</author><author>Rajaa Fakhoury</author>
        <description><![CDATA[BackgroundParotitis is an inflammation of the parotid glands. It can be acute or chronic based on etiological factors such as bacterial and viral infections, autoimmune and metabolic disorders. The prevalence and characteristics of parotitis among the Saudi population are unknown. Therefore, this study aimed to explore the frequency, demographic patterns, and temporal trends of parotitis in Saudi Arabia.MethodologyThis was a multicenter, retrospective cohort study using electronic health record data from five tertiary medical centers (Riyadh, Jeddah, Dammam, Madinah, and Taif) of the Ministry of National Guard Health Affairs (NGHA) between 2015 and 2023. Data from clinically diagnosed patients with parotitis were collected, including demographics, patient type, body mass index (BMI), and region. Statistical analysis was conducted using R (version 4.3.2). Categorical variables were expressed as counts (%) and continuous variables as mean (SD) or median (IQR), as appropriate. Several statistical tests were performed, including annual counts and proportions for temporal trends, and join-point regression to estimate data-driven change points. Statistical significance was estimated at a P-value of less than 0.05.ResultsA total of 1,340 cases of parotitis were recorded between March 2015 and March 2023. The average age at diagnosis was 27.2 years. Males accounted for 54.6% of this cohort, 36.67% of the patients were underweight, and 19.2% were obese. Additionally, 49% of the cases were inpatients, and the majority (66.1%) resided in Riyadh. Within the designated timeframe (2015–2023), no significant changes in parotitis occurrence were observed, especially during the COVID-19 pandemic, with a higher frequency among patients aged 1–20 years.ConclusionThis exploratory study characterized parotitis cases among Saudi patients. The high frequency of parotitis diagnosis among children and adolescents compared to adults, along with other demographic characteristics, highlights the need to understand the underlying factors that could improve clinical awareness, documentation, and prevention strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2025.1692664</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2025.1692664</link>
        <title><![CDATA[Exposure of feral swine to Coxiella burnetii overlaps with human Q fever incidence in California]]></title>
        <pubdate>2026-01-05T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ian A. McMillan</author><author>Samuel J. Golon</author><author>Michael H. Norris</author><author>Gregory A. Franckowiak</author><author>James M. Grinolds</author><author>Richard A. Bowen</author><author>Vienna R. Brown</author><author>Bradley R. Borlee</author>
        <description><![CDATA[Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans. There are many known reservoirs of C. burnetii, including cattle, sheep, and goats with an expanding list of potential reservoirs including birds, reptiles, ticks and additional mammalian species, such as swine. Feral swine are a highly invasive species in the United States with significant populations and a broad geographic distribution. The role of feral swine in the transmission and spread of C. burnetii is poorly understood, although a recent report identified overlap between feral swine seroprevalence and human Q fever incidence in Texas. California accounts for a large proportion of human Q fever cases in the United States and in this study we characterized the seroprevalence of C. burnetii in feral swine populations in the state. Feral swine showed seropositivity rates up to 1.64% indicating some level of exposure and the possibility that they may serve as a reservoir for disease transmission and spread. Overlap with human Q fever incidence was identified in the central region of California. Although this study does not directly link feral swine to human infection, it identified spatial overlap between feral swine seroprevalence and human Q fever incidence in the state of California, possibly due to the presence of ruminants as the principal reservoirs of C. burnetii. The environmental stability and low infectious dose of C. burnetii, coupled with the geographic overlap between feral swine seroprevalence and human Q fever incidence suggests that feral swine may contribute to zoonotic disease transmission and spread.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2025.1691459</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2025.1691459</link>
        <title><![CDATA[Estimation of the transition rates in the illness-death model for chronic diseases from aggregated current status data: a feasibility and simulation study]]></title>
        <pubdate>2025-12-19T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Ralph Brinks</author><author>Maryam Mohammadi Saem</author><author>Sabrina Voß</author>
        <description><![CDATA[Recently, it has been shown that the transition rates of the illness-death model (IDM) for chronic conditions are related to the age-specific prevalence by a partial differential equation (PDE). Given mortality, the PDE could be used to estimate incidence rates from cross-sectional data. The aim of this article is to extend the IDM and introduce a novel method to estimate the age-specific incidence rate together with the two mortality rates from aggregated current status (ACS) data. By ACS data we mean counts of people in the four states of the extended IDM at different points in time. ACS data stem from epidemiological studies where only current disease status and vital status data need to be collected without following-up people (as, for example, in cohort studies). To demonstrate feasibility of the method, we use a simulation study from the context of diabetes in Germany. Two estimation methods are introduced, a least squares estimator and a maximum likelihood estimator. We find a good agreement between the estimates and the input parameters used to set up the simulation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fepid.2025.1597970</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fepid.2025.1597970</link>
        <title><![CDATA[Bridging communities, prevention, and heart health: U.S. strategies for CHW cardiovascular training and integration]]></title>
        <pubdate>2025-12-16T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Akua G. Asare</author><author>Melvin R. Echols</author>
        <description><![CDATA[BackgroundIn the United States, cardiovascular disease (CVD) disproportionately affects communities facing adverse social determinants of health (SDOH). Community Health Workers (CHWs) can bridge gaps in trust, navigation, and culturally tailored education.MethodsWe conducted a U.S.–focused narrative review (2015–2025) of PubMed, Scopus, and Google Scholar, prioritizing empirical evaluations of CHW-led CVD interventions, training models, integration strategies, and financing mechanisms. International CHW programs were used only to extract practices transferable to U.S. delivery and payment contexts.ResultsMultidisciplinary team-based care demonstrates that engaging CHWs in US regions improves blood pressure control and medication adherence. Economic evaluations increasingly support CHW models for CVD prevention and control. Effective programs specify CHW task bundles (e.g., self-measured BP onboarding, adherence coaching, care navigation, SDOH linkage) and align training with national core competencies. Integration pathways include clinic-embedded, payer-based, public health, and community-based partnerships. U.S. reimbursement options are emerging through Medicare Community Health Integration/Principal Illness Navigation and state Medicaid mechanisms. Faith-based collaborations can extend reach when coupled with standardized training and simple outcome tracking.ConclusionsFor U.S. health systems and payers, immediate priorities are (1) competency-based CHW training with cardiac modules, (2) sustainable reimbursement tied to cardiovascular quality metrics, and (3) a minimal outcome set to demonstrate value. Global best practices should be adapted to the U.S. scope-of-practice, supervision, and documentation requirements to scale equitable CVD care.]]></description>
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