From Epidemiologic Knowledge to Improved Health: A Vision for Translational Epidemiology

Multidimensional perspectives of geo-epidemiology: from interdisciplinary learning and research to cost-benefit oriented decision-making

Research typically promotes two types of outcomes (inventions and discoveries), which induce a virtuous cycle: something suspected or desired (not previously demonstrated) may become known or feasible once a new tool or procedure is invented and, later, the use of this invention may discover new knowledge. Research also promotes the opposite sequence-from new knowledge to new inventions. This bidirectional process is observed in geo-referenced epidemiology-a field that relates to but may also differ from spatial epidemiology. Geo-epidemiology encompasses several theories and technologies that promote inter/transdisciplinary knowledge integration, education, and research in population health. Based on visual examples derived from geo-referenced studies on epidemics and epizootics, this report demonstrates that this field may extract more (geographically related) information than simple spatial analyses, which then supports more effective and/or less costly interventions. Actual (not simulated) bio-geo-temporal interactions (never captured before the emergence of technologies that analyze geo-referenced data, such as geographical information systems) can now address research questions that relate to several fields, such as Network Theory. Thus, a new opportunity arises before us, which exceeds research: it also demands knowledge integration across disciplines as well as novel educational programs which, to be biomedically and socially justified, should demonstrate cost-effectiveness. Grounded on many bio-temporal-georeferenced examples, this report reviews the literature that supports this hypothesis: novel educational programs that focus on geo-referenced epidemic data may help generate cost-effective policies that prevent or control disease dissemination.

Frequency of exposure to Toxoplasma gondii in COVID-19 patients: a systematic review and meta-analysis

BACKGROUND

Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19.

METHODS

A literature search was conducted in six databases or search tools (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the "JBI-MAStARI".

RESULTS

A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.3% were men and 49.4% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were explicitly examined for T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34-63%; 2,947 participants; 13 studies; I2 = 98%, p < 0.01). In addition, the frequency of exposure to T. gondii, evaluated by IgM presence in patients with COVID-19, was 2% (95% CI: 0-6%; 1,302 participants; 6 studies; I2 = 94%, p < 0.01).

CONCLUSION

It was shown that almost half of COVID-19 patients had previous exposure to T. gondii through the presence of IgG, and a small percentage, 2%, showed active infection through IgM detection. Although the results indicate a possible correlation between exposure to T. gondii and the presence of COVID-19, it is essential to note that this study is based on observational research, which precludes establishing a causal relationship. Consequently, further research is required to deepen understanding of the interaction between the two conditions.

TERMS USED

The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

The challenges of epidemiologic translation: communicating with physicians, policymakers, and the public

Translational epidemiology refers to the practical application of population-health research findings to efforts addressing health disparities and other public health issues. A principal focus of epidemiologic translation is on the communication of results to constituencies who can best make use of this information to effect positive health-related change. Indeed, it is contended that findings from epidemiologic research are of greatest use only if adequately communicated to health professionals, legislators and policymakers, and the public. This paper details the challenges faced by efforts to communicate findings to the these constituencies, especially three types of miscommunication that can derail efforts at translation. These include perceived misinformation, perceived disinformation, and perceived censorship. Epidemiologists are ethically obliged to avoid these types of miscommunication, and, accordingly, are advised to place greater emphasis on messaging and media outreach to physicians, government officials, medical educators, and the general public.

Areas of strength and opportunities for growth in translational science education and training: Results of a scoping review from the NCATS Education Branch

Translational science education and training (E&T) aims to prepare the translational workforce to accelerate progress along the translational pipeline toward solutions that improve human health. In 2020-2021, the National Center for Advancing Translational Sciences (NCATS) Education Branch conducted a scoping review of the E&T literature with this focus. The review used the methodological framework proposed by Arksey and O'Malley. PubMed, Education Resources Information Center (ERIC), and Embase were searched, and forward citations conducted. Screening of titles, abstracts, and full text identified 44 included articles. Data extraction facilitated analysis of E&T content, audiences, modalities, evaluations, and recommendations. The NCATS Translational Science Principles were used to identity described or recommended E&T content. Twenty-nine articles described a translational science E&T opportunity or its evaluation, and another 15 articles offered recommendations for translational science E&T. The most prevalent NCATS Translational Science Principles were boundary-crossing partnerships (77%) and cross-disciplinary team science (75%). Among publications describing E&T opportunities, the most reported modalities were experiential learning (64%) and courses (61%) and the most reported participants were graduate students (68%) and postdoctoral fellows (54%). About half of these articles (n = 15) reported an evaluation, covering a range of proximal to distal outcomes. Recommendations emphasized the value of translational science E&T across training and career stages and the use of varied modalities to reach diverse audiences. This review highlights strengths and opportunities for growth in translational science E&T. Enhancements to content, expansion of participants and modalities, and rigorous evaluations will contribute to building a highly qualified, diverse translational science workforce.

NYC RxStat: Stakeholder perspectives on a national model public health and public safety partnership to reduce overdose deaths

NYC RxStat, the United States' first public health and public safety partnership aiming to reduce overdose deaths, began in 2012 and established a national model for cross-sector partnerships. The partnership aimed to integrate data-driven policing with actionable public health interventions and surveillance to develop and implement cross-sector overdose responses. With federal support, jurisdictions nationally have implemented public health and public safety partnerships modeled on RxStat. To inform partnership replication efforts, we conducted a stakeholder evaluation of RxStat. We conducted in-depth, semi-structured interviews with 25 current and former RxStat stakeholders. Interviews probed stakeholder perceptions of RxStat's successes, challenges, and opportunities for growth. Interview data were iteratively coded and thematically analyzed. Stakeholders reported certainty about the need for cross-sector collaboration and described cross-disciplinary tensions, challenges to collaboration and implementation, and opportunities for partnership optimization and growth. Findings informed 12 strategies to improve RxStat and partnerships in its model, organized into three opportunity areas: (1) ensure stakeholder and agency accountability; (2) build secure and mutually beneficial data systems; and (3) structure partnerships to facilitate equitable collaboration. Cross-sector partnerships offer a promising strategy to integrate the public health and safety sectors, but disciplinary tensions in approach may hamper implementation. Findings can inform efforts to implement and scale cross-sector partnerships.

The Need for Translational Epidemiology in Beta Thalassemia Syndromes: A Thalassemia International Federation Perspective

Epidemiology is the practical tool to provide information on which policy makers should base planning of services. Epidemiological data for thalassemia is based on inaccurate and often conflicting measurements. This study attempts to demonstrate with examples the sources of inaccuracy and confusion. The Thalassemia International Foundation (TIF) suggests that congenital disorders, for which increasing complications and premature death are avoidable through appropriate treatment and follow-up, should be given priority based on accurate data and patient registries. Moreover, only accurate information about this issue, especially for developing countries, will move national health resources in the right direction.

The contribution of research to racial health equity? Blame and responsibility in navigating the status quo of anti-black systemic racism

Thirty-seven years ago, the Secretary's Task Force on Black and Minority Health called attention to a "national paradox" of persistent Black-White health disparities despite overall health improvements for the nation (HHS, 1985). Subsequent updates to the "Heckler Report" came to the same conclusion; Black Americans continued to exhibit poorer health in comparison to White Americans (Satcher et al., 2005). Current population health statistics demonstrate Black-White health disparities comparable to 1985 (AHRQ, 2018; Shiels et al., 2021; Wall et al., 2018). Although psychological, behavioral, social, and economic factors all contribute to Black-White differences in health, there is a noticeable increase in discussions about the importance of systemic racism in producing racial health disparities. This article addresses three questions relevant to research on racism and the health of Black Americans: (1) Why has academic public health research on racism failed to reduce racial health disparities? (2) What can academic public health scientists do differently to reduce the impact of systemic racism on inequities among Black and White Americans? (3) What can Black Americans do in the face of present-day anti-Black systemic racism? We argue that to convert the vision of health equity into a visible reality, health equity research scientists must move beyond discussion, observation, and description. We also argue that to demonstrate progress in reducing racial health disparities, health equity scientists will need to work much more directly on eradicating racism as a fundamental cause of health differences between Black and White Americans. As scientists, the challenge we face is how to accomplish this mission without leaving the realm of science. Racism is a social determinant of Black health and social determinants are political problems. Political problems require political solutions.

Toward a translational epidemiology of religion: challenges and applications

This paper explores the concept of translational epidemiology in the context of epidemiologic studies of religious determinants of morbidity and mortality. Despite a research literature of, by now, thousands of published studies, many in top-tier medical and public health journals, some resistance remains to full acceptance of this work. A principal reason may be the failure of investigators to make the case for real-world applications of epidemiologic findings on religious risk or protection for subsequent personal or population health, in keeping with the definition of translational epidemiology. To remedy this, a case is made for a translational epidemiology of religion. Three types of translation are proposed. The first two recall the standard definition of translational medicine as "from bench to bedside," in this instance two types of bedside encounters, pastoral and clinical. The third application is to public health practice, involving multiple public health professions and specialties. As with other substantive topics within psychosocial epidemiology, research on population-health outcomes of religious exposures provides information that can be applied to development of health promotion and disease prevention programs and formulation of health policy. But this can happen only if investigators give more attention to enumerating potential uses of their findings.

Challenges of translating epidemiologic research: An application to rheumatic and musculoskeletal disorders

Translation of research into public health policy is featured in common definitions of epidemiology, as an end result of scientific discovery on disease occurrence and causes. This dual nature of epidemiology, which brings together discovery and its use, seems to imply two main dimensions by which to judge epidemiologic research: technical or field-specific quality and societal value. This paper uses our research on the epidemiology of rheumatic and musculoskeletal disorders as a starting point to discuss the interface between these dimensions, exploring a number of conceptual, practical and ethical challenges that epidemiologists increasingly need to address when aiming for research translation. Those include not only the appraisal of the technical quality of research, which is familiar to researchers, but also the judgement on the usefulness and actual use of knowledge, as well as the assessment of the legitimacy of research based on translation potential. Several challenges lie ahead, but interdisciplinary conceptual and technical developments have the potential to guide future epidemiologic research of consequence. Approaches that recognize complexity and formalize the involvement of stakeholders in the research process within transparent frameworks open promising avenues for an effective translation of epidemiologic research projected into the future.

Epidemiologists Count: The Role of Diversity and Inclusion in the Field of Epidemiology

We present interpretations of the idea that "epidemiologists count" in response to the current status of membership and diversity and inclusion efforts within the Society for Epidemiological Research (SER). We review whom epidemiologists count to describe the (mis)representation of SER membership and how categorizations of people reflect social constructions of identity and biases that exist in broader society. We argue that what epidemiologists count-how diversity and inclusion are operationalized-has real-world implications on institutional norms and how inclusive/non-inclusive environments are. Finally, we examine which epidemiologists count within the field and argue that inclusion can only be achieved when we address how resources and opportunities are distributed among epidemiologists. To improve diversity and inclusion within SER and beyond, we recommend that SER strengthen its commitment to diversity, inclusion, and equity by: 1) integrating this priority on all agendas; 2) enhancing efforts to improve self-awareness among members and accountability within the organization; 3) supporting the growth of a diversifying workforce in epidemiology; and 4) increasing the visibility of health disparities research and researchers in epidemiology.

Translation of Exposure and Epidemiology for Risk Assessment: A Shifting Paradigm

Risk assessment is a well-established process used for various types of public health decision-making, such as setting chemical site clean-up levels, developing limits on exposures to chemicals in soil, water, air and food, and determining occupational exposure limits[...].