Journal Description
Epidemiologia
Epidemiologia
is an international, peer-reviewed, open access journal on epidemiologic research published quarterly online by MDPI. The Italian Society of Environmental Medicine (SIMA) is affiliated with Epidemiologia, and its members receive discounts on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within ESCI (Web of Science), Scopus, PMC, PubMed, FSTA, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 26.4 days after submission; acceptance to publication is undertaken in 5.8 days (median values for papers published in this journal in the first half of 2025).
- Journal Rank: JCR - Q2 (Public, Environmental and Occupational Health) / CiteScore - Q2 (Medicine (miscellaneous))
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
- Epidemiologia is a companion journal of JCM.
Impact Factor:
2.2 (2024);
5-Year Impact Factor:
1.9 (2024)
Latest Articles
Oral Health Assessment in Prisoners: A Cross-Sectional Observational and Epidemiological Study
Epidemiologia 2025, 6(4), 88; https://doi.org/10.3390/epidemiologia6040088 (registering DOI) - 5 Dec 2025
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Objectives: This cross-sectional observational and epidemiological study aimed to collect data on the oral health conditions of the prison population in Rio de Janeiro, Brazil. Methods: The Penitentiary Moniz Sodré, part of the Penitentiary Complex of Bangu, houses 1385 male inmates of different
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Objectives: This cross-sectional observational and epidemiological study aimed to collect data on the oral health conditions of the prison population in Rio de Janeiro, Brazil. Methods: The Penitentiary Moniz Sodré, part of the Penitentiary Complex of Bangu, houses 1385 male inmates of different nationalities. They were divided into groups according to age: Group 1, prisoners aged 18 to 27 years; Group 2, from 28 to 37 years; Group 3, from 38 to 47 years; and Group 4, from 48 and older. A survey was performed, and the Decayed, Missing, Filled Teeth (DMFT) index was applied. A statistical analysis was conducted, considering a p-value of less than 0.05 as significant. Then, multiple linear regression was implemented to verify correlations among the studied parameters, to adjust for confounders, and to examine predictors of DMFT scores. Results: The average age was 26.95 ± 6.72 years, with 57.7% smokers (n = 720) and 7.7% (n = 96) former smokers. Lung diseases were also relatively common (20.9%). The most frequently reported oral issue was bleeding on probing (37.7%, n = 470), with 100% presenting visible dental plaque and 71.3% dental calculus. Oral hygiene habits showed moderate adherence, with 20.1% brushing their teeth at least once daily and 20.3% flossing; however, only 10.3% reported using fluoride mouthwash. The average DMFT score progressively increased across age groups: Group 1 (age: 18–27): 6.89; Group 2 (age: 28–37): 10.87; Group 3 (age: 38–47): 16; and Group 4 (age ≥ 48): 22.5 (p < 0.0001). Decayed (D) teeth scores showed a moderate increase: Group 1: 2.94 ± 2.74; Group 2: 3.38 ± 2.65; Group 3: 3.11 ± 2.56; Group 4: 3.75 ± 3.1 (p = 0.0029). Missing (M) teeth scores demonstrated a significant increase with age, from 2.74 (±2.84) in group 1 to 18.12 (±7.71) in group 4 (p < 0.0001), whereas Filled (F) teeth scores were highest in group 3 (mean 1.92 ± 4.13), followed by a decline in the oldest group (mean 0.62 ± 1.18) (p < 0.0001). These findings indicate a strong age-related increase in the total DMFT score, primarily driven by the number of missing teeth. Conclusions: High levels of caries and its sequelae exist, demonstrating a correlation with age, as well as a low level of previous periodontal treatment or intervention. As the treatments performed did not manage to reduce the incidence of caries and periodontal diseases, a high number of extractions were observed in patients in confinement.
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Open AccessFeature PaperArticle
The Relationship Between Retrospectively Measured Pregnancy Intentions and Women’s Stages of Behavior Change for Contraceptive Use and Effectiveness Level of Contraceptive Method Choice
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Otobo I. Ujah, Jason L. Salemi, Rachel B. Rapkin, William M. Sappenfield, Ellen M. Daley and Russell S. Kirby
Epidemiologia 2025, 6(4), 87; https://doi.org/10.3390/epidemiologia6040087 (registering DOI) - 2 Dec 2025
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Background/Objectives: Unintended pregnancy is linked to an increased risk of subsequent unintended pregnancies, but its impact on contraceptive use and intention remains vastly understudied. This study assessed whether unintended pregnancy independently influences women’s stages of behavior change for contraceptive use and the
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Background/Objectives: Unintended pregnancy is linked to an increased risk of subsequent unintended pregnancies, but its impact on contraceptive use and intention remains vastly understudied. This study assessed whether unintended pregnancy independently influences women’s stages of behavior change for contraceptive use and the effectiveness of their chosen contraceptive methods. Methods: Using pooled data from three cross-sectional surveys of the Performance Monitoring and Accountability 2020 project in Nigeria, we analyzed responses from 8014 non-pregnant women aged 15–49 years nested within 892 communities. Multilevel multinomial logistic regression accounted for compositional and contextual factors. Results: Women with a mistimed pregnancy had higher odds of being in the contemplation stage of behavior change compared to those with an intended pregnancy (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] = 1.13–2.22), with a similar but non-significant trend for unwanted pregnancies (aOR = 1.46, 95% CI = 0.91–2.34). Mistimed and unwanted pregnancies were also linked to higher odds of being in the action stage (aOR = 2.17 and 1.85, respectively). Regarding contraceptive effectiveness, women with a mistimed pregnancy were more likely to use moderately effective methods (aOR = 1.47, 95% CI = 1.02–2.12) and highly effective methods (aOR = 2.45, 95% CI = 1.41–4.26). Unwanted pregnancies showed even stronger associations with highly effective methods (aOR = 4.03, 95% CI = 1.18–13.74). Community-level variability significantly influenced outcomes. Conclusions: Together, these findings underscore the importance of person-centered approaches and public health interventions tailored to stages of contraceptive behavior change, targeting both women and communities at high risk of unintended pregnancy.
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Open AccessArticle
Early Menarche and Hypertension Among Postmenopausal Women: The Mediating Role of Obesity
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Eunice Carolina Ibáñez-García, Mónica Alethia Cureño-Díaz, María Alicia Mejía-Blanquel, Ana Cristina Castañeda-Márquez, Ahidée Leyva-López, Yaneth Citlalli Orbe Orihuela, Miguel Trujillo-Martínez, Ricardo Castrejón-Salgado, Erick Ordoñez-Villordo and José Ángel Hernández-Mariano
Epidemiologia 2025, 6(4), 86; https://doi.org/10.3390/epidemiologia6040086 (registering DOI) - 2 Dec 2025
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Background/Objectives: Cardiovascular diseases are the leading cause of mortality worldwide and are strongly influenced by obesity and hypertension. Age at menarche has been proposed as an early marker of cardiometabolic risk, but evidence in postmenopausal women is inconsistent, particularly in Mexico. We aimed
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Background/Objectives: Cardiovascular diseases are the leading cause of mortality worldwide and are strongly influenced by obesity and hypertension. Age at menarche has been proposed as an early marker of cardiometabolic risk, but evidence in postmenopausal women is inconsistent, particularly in Mexico. We aimed to evaluate the association between early menarche and obesity and hypertension in postmenopausal women, and to examine whether obesity mediates this relationship. Methods: We conducted a cross-sectional study based on a retrospective review of 462 medical records of postmenopausal women who attended a tertiary hospital in Mexico City between January 2023 and August 2024. Early menarche was defined as <12 years. Obesity and hypertension were identified from records. Associations were estimated using Poisson regression with robust variance to obtain prevalence ratios (PRs) and 95% confidence intervals (CIs). We assessed effect modification by age at menopause and conducted a mediation analysis under the counterfactual framework to estimate the proportion of the menarche–hypertension association explained by obesity. Results: Early menarche was associated with a higher prevalence of obesity (PR = 1.36, 95% CI = 1.08–1.70) and hypertension (PR = 1.34, 95% CI = 1.06–1.71). Associations were stronger among women with menopause at ≤45 years. Mediation analysis indicated that obesity explained 61.6% of this relationship, with a significant indirect effect (PR = 1.18, 95% CI = 1.05–1.33). Conclusions: Early menarche was independently associated with obesity and hypertension in postmenopausal women, with obesity acting as a potential intermediary factor. Given the cross-sectional design, causality cannot be established, but the associations observed are biologically and temporally coherent.
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Open AccessArticle
Adult Food Allergy Is an Under-Recognized Health Problem in Northwestern Mexico: A Population-Based Cross-Sectional Survey
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Lizbeth Vizcarra-Olguin, Marcela de Jesús Vergara-Jiménez, Juancarlos Manuel Velásquez-Rodríguez, Oscar Gerardo Figueroa-Salcido, Elisa María Barrón-Cabrera, Perla Y. Gutiérrez-Arzapalo, Fernando Salas-López, Noé Ontiveros and Jesús Gilberto Arámburo-Gálvez
Epidemiologia 2025, 6(4), 85; https://doi.org/10.3390/epidemiologia6040085 (registering DOI) - 2 Dec 2025
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Objectives: To estimate the prevalence, clinical characteristics, and risk factors of IgE-mediated food allergy (FA) in adults from northwestern Mexico. Methods: A population-based, cross-sectional study was conducted in Culiacán, Sinaloa. A validated questionnaire was administered to 834 adults (valid response rate: 87.5%) in
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Objectives: To estimate the prevalence, clinical characteristics, and risk factors of IgE-mediated food allergy (FA) in adults from northwestern Mexico. Methods: A population-based, cross-sectional study was conducted in Culiacán, Sinaloa. A validated questionnaire was administered to 834 adults (valid response rate: 87.5%) in public spaces. Prevalence rates (95% CI) were calculated, and associations were analyzed using odds ratios (OR). Results: The prevalence rates of “current immediate-type FA”, “food-induced anaphylaxis” and adult-onset “current immediate-type FA” were 5.75% (4.27–7.49), 2.5% (1.75–4.10) and 2.99% (1.94–4.39), respectively. The most common allergens were shellfish (2.14% (1.28–3.39)) and milk (1.19% (0.57–2.19)). Epinephrine was prescribed in 9.5% of the cases with anaphylaxis history. General practitioners made the diagnosis of 63.4% of the FA cases. FA was associated with personal and family history of atopy. Conclusions: Adult FA is frequent in the population studied and could be an emerging public health problem, characterized by a high rate of adult-onset cases and suboptimal management of anaphylaxis.
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Open AccessArticle
Population Attributable Fraction of Tobacco Use and Type 2 Diabetes Mellitus: An Analysis of the ENSANUT 2021
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Julio Cesar Campuzano, Jorge Martin Rodríguez, Luz Myriam Reynales, Anaid Hernández and Diana Carolina Urrego
Epidemiologia 2025, 6(4), 84; https://doi.org/10.3390/epidemiologia6040084 (registering DOI) - 2 Dec 2025
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Background: Robust evidence demonstrates that tobacco use acts as a causal and, therefore, modifiable risk factor for the development of type 2 diabetes mellitus (T2DM). However, its specific population-level impact in Mexico has not yet been quantified. Objective: This study aimed to estimate
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Background: Robust evidence demonstrates that tobacco use acts as a causal and, therefore, modifiable risk factor for the development of type 2 diabetes mellitus (T2DM). However, its specific population-level impact in Mexico has not yet been quantified. Objective: This study aimed to estimate the population attributable fraction (PAF) of T2DM associated with tobacco use among Mexican adults, utilizing data from the 2021 National Health and Nutrition Survey (ENSANUT). Methods: A nested case–control analysis was conducted within the complex sampling design of the ENSANUT. Adults aged 20 years or older were included. Cases were defined as individuals with a self-reported medical diagnosed T2DM diagnosis; controls were individuals without T2DM. Exposure status was categorized as current person who smokes, former person who smokes, and never person who smokes. A logistic regression model was employed, adjusting for key covariates including age, sex, socioeconomic status, and comorbidities. The PAF was subsequently calculated using the Miettinen formula. Results: The adjusted PAF for T2DM attributable to smoking was 10.1% (95% CI: 4.07–14.97). This finding suggests that approximately one in eight T2DM cases could be prevented through the elimination of tobacco use. The association was more pronounced among men and individuals with a history of heavy tobacco use. Conclusion: The estimated PAF for T2DM due to tobacco use underscores the significant contribution of policies established within the WHO Framework Convention on Tobacco Control to the prevention of chronic diseases. The implementation and strengthening of such policies, including increased tobacco taxes, comprehensive smoking bans in public places, on-package warnings, and advertising prohibitions, would prove highly beneficial. These findings show a strong population-level association between tobacco use and T2DM, but causality cannot be established. Future longitudinal studies in Mexico are needed to confirm these results.
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(This article belongs to the Special Issue Advances in Environmental Epidemiology, Health and Lifestyle)
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Open AccessArticle
Respiratory Infant Mortality Rate by Month of Birth in Mexico
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Alessandro Milán, Juan C. Cuevas-Tello and Daniel E. Noyola
Epidemiologia 2025, 6(4), 83; https://doi.org/10.3390/epidemiologia6040083 - 2 Dec 2025
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Background: Respiratory syncytial virus (RSV) is a major contributor to severe Acute Respiratory Infections (ARI) in infants worldwide, leading to significant morbidity and mortality. The seasonal nature of RSV and other respiratory infections presents unique risks, especially for infants in low- and middle-income
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Background: Respiratory syncytial virus (RSV) is a major contributor to severe Acute Respiratory Infections (ARI) in infants worldwide, leading to significant morbidity and mortality. The seasonal nature of RSV and other respiratory infections presents unique risks, especially for infants in low- and middle-income countries, such as Mexico, where comprehensive RSV surveillance is limited. This study aims to analyze respiratory infant mortality rates by month of birth across Mexico, with a focus on identifying high-risk periods and regional differences. Methods: National birth and mortality data from the Instituto Nacional de Estadística y Geografía were analyzed for all infants born between April 2014 and March 2020. Respiratory mortality rates (based on ICD-10 J and U codes) were calculated by month of birth and examined across eight geographical regions in Mexico. Mortality trends were analyzed using descriptive statistics to assess seasonal and regional variations. A correlation analysis was conducted between respiratory mortality and confirmed RSV hospitalization data to assess the temporal relationship between increased mortality and epidemic activity of this virus. Results: A total of 12,604,902 live births were recorded in Mexico during the study period, with 8805 infant deaths attributed to respiratory causes, resulting in a respiratory infant mortality rate of 0.7 deaths per 1000 births. Mortality rates exhibited strong seasonal patterns, with infants born between September and November at higher risk of respiratory death, peaking in October. The highest mortality rates were observed in the South region, while the lowest rates were in the Northeast. Conclusions: These findings highlight the importance of implementing preventive strategies in Mexico that are aligned with regional RSV seasonality. Timing preventive interventions with regional and seasonal mortality trends should enhance the cost-effectiveness and impact of RSV immunization programs, ultimately reducing infant mortality nationwide.
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Open AccessSystematic Review
Perinatal Health Disparities Between Roma and Non-Roma Populations: A Systematic Review
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Afroditi Dimogerontaki, Nikoletta Iacovidou, Styliani Paliatsiou, Paraskevi Volaki, Theodoros Xanthos, Ioannis Panagiotopoulos, Zoi Iliodromiti, Theodora Boutsikou and Rozeta Sokou
Epidemiologia 2025, 6(4), 82; https://doi.org/10.3390/epidemiologia6040082 - 30 Nov 2025
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Background: Women from Roma communities face considerable health inequalities, primarily due to limited access to healthcare systems, alongside broader social and structural disadvantages. Among Roma women these disparities are reflected in poorer perinatal outcomes when compared to non-Roma populations. This systematic review aims
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Background: Women from Roma communities face considerable health inequalities, primarily due to limited access to healthcare systems, alongside broader social and structural disadvantages. Among Roma women these disparities are reflected in poorer perinatal outcomes when compared to non-Roma populations. This systematic review aims at: (a) exploring disparities in neonatal health outcomes between Roma and non-Roma populations in relation to maternal factors such as health status, lifestyle, and education; (b) summarizing key perinatal characteristics in these groups; (c) assessing the influence of prenatal care on neonatal outcomes. Comprehending these disparities is crucial for guiding effective interventions and promoting health equity. Methods: A systematic literature review was conducted in major databases, such as PubMed and Scopus, to identify studies published up to 2025. The eligible studies focused on observational research that compared perinatal outcomes, including preterm birth, low birth weight (LBW), stillbirth, and neonatal mortality, between Roma and non-Roma populations. The potential discrepancies between these populations are thoroughly discussed in the review. Results: A comprehensive search yielded a total of 157 studies. After meticulous screening, 48 relevant studies were identified, reporting substantial health disparities between Roma and non-Roma mothers and their newborns. Roma populations exhibited significantly increased rates of preterm birth, LBW, and neonatal mortality vs. non-Roma populations. Socioeconomic status, access to prenatal care, maternal education, and systemic discrimination were identified as the primary contributing factors to these disparities. Conclusions: The findings highlight the significant and enduring disparities in perinatal health between Roma and non-Roma populations. In order to effectively address these disparities, it is necessary to have a comprehensive and multi-level strategy that prioritizes the social determinants of health, ensures equitable access to high-quality maternal care, and mitigates actively systemic discrimination. Future research should prioritize the development and rigorous evaluation of targeted interventions to reduce these inequities and improve perinatal outcomes among Roma populations.
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Open AccessArticle
Epidemiological, Socioeconomic, and Health Service Factors Associated with Tuberculosis Treatment Interruption in Brazil
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Jéssica Simões Mendonça, Fabrício Sette Abrantes Silveira, Renata Maria Colodette, Deíse Moura de Oliveira, Érica Toledo de Mendonça, Rosângela Minardi Mitre Cotta, Antônio Almeida de Barros Junior, João Vitor Andrade and Tiago Ricardo Moreira
Epidemiologia 2025, 6(4), 81; https://doi.org/10.3390/epidemiologia6040081 - 26 Nov 2025
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Background: Brazil must make progress toward eliminating tuberculosis as a public health problem and achieving the goal of reducing treatment interruption to below 5%. Improving adherence requires a thorough understanding of the factors that influence this outcome. Objectives: To identify epidemiological,
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Background: Brazil must make progress toward eliminating tuberculosis as a public health problem and achieving the goal of reducing treatment interruption to below 5%. Improving adherence requires a thorough understanding of the factors that influence this outcome. Objectives: To identify epidemiological, socioeconomic, and health service-related factors associated with tuberculosis treatment interruption in Brazilian municipalities from 2018 to 2022. Methods: This ecological study utilized secondary data from all Brazilian municipalities. Independent variables were organized into three blocks: epidemiological, health service coverage, and socioeconomic. A zero-inflated beta regression model was employed to analyze both the proportion and zero-inflated components. Results: The mean treatment interruption rate was 8.1%. Interruption was associated with the proportion of laboratory-confirmed cases, Family Health Strategy coverage, and the proportion of the population residing in rural areas. Tuberculosis incidence, sputum smear microscopy, molecular rapid tests, contact investigation, directly observed therapy, AIDS detection rate, Gini index, household crowding, and illiteracy were associated with treatment adherence. In the zero-inflated component, directly observed therapy, consultations per inhabitant, illiteracy, and the proportion of the population residing in rural areas increased the probability of a zero-interruption rate, whereas TB incidence, AIDS detection, municipal population, and household crowding decreased that probability. Conclusions: Tuberculosis treatment interruption in Brazil is shaped by socioeconomic, epidemiological, and health service factors, highlighting the need for integrated strategies that combine social protection with strengthened primary care to improve adherence and progress toward elimination goals.
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Open AccessArticle
Spatial Distribution of Breast Cancer in Morocco and the Impact of Travel Distance and Rural Residence on Cancer Stage
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Chaimaa Elattabi, Jeroen Berden, Najoua Lamchabbek, Ilhame Bourais, Karima Bendahhou, Saber Boutayeb, Najia Mane, Siham Mrah, Inge Huybrechts, Elodie Faure and Mohamed Khalis
Epidemiologia 2025, 6(4), 80; https://doi.org/10.3390/epidemiologia6040080 - 25 Nov 2025
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Introduction: Breast cancer is the most common cancer among women worldwide, and its prognosis can be influenced by various factors, including geographic accessibility of healthcare services. This study describes the geographic distribution of breast cancer cases in the Casablanca-Settat region and evaluates the
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Introduction: Breast cancer is the most common cancer among women worldwide, and its prognosis can be influenced by various factors, including geographic accessibility of healthcare services. This study describes the geographic distribution of breast cancer cases in the Casablanca-Settat region and evaluates the association between breast cancer stage at diagnosis, rural residence, and travel distance to healthcare facilities in the Casablanca-Settatregion. Methods: A retrospective hospital-based study was conducted on 2161 women diagnosed with breast cancer and admitted to Ibn Rochd University Hospital between December 2018 and January 2022. Patient residential addresses and healthcare facility locations were geocoded using Geographic Information Systems (GIS), and a straight-line distance was calculated from patients’ residences to the nearest Primary Healthcare Center (PHCC), Provincial Hospital Center (PHC), Regional Hospital Center (RHC), and University Hospital Center (UHC). Statistical analysis assessed associations between stage at diagnosis, rural/urban residence, and travel distance. Results: The overall mean distance to the UHC was 32.5 km (range: 0.19–164 km); 8.3 km (range: 0.02–83 km) to PHCs; and 1.25 km (range: 0.01–12.1 km) to PHCCs. Rural patients had longer distances to all facility types compared to urban patients. However, no significant association was found between cancer stage at diagnosis and rural residence or long travel distance to healthcare facilities (p > 0.05). Conclusions: The stage of breast cancer at diagnosis appears not to be influenced by travel distance to healthcare facilities or by rural residence.
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Open AccessArticle
Chlamydia trachomatis Infection and Its Association with Human Papillomavirus Among Adolescent Girls and Young Women of Eastern Cape, South Africa
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Olufunmilayo O. Akapo and Zizipho Z. A. Mbulawa
Epidemiologia 2025, 6(4), 79; https://doi.org/10.3390/epidemiologia6040079 - 12 Nov 2025
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Background/Objectives: Adolescent girls and young women (AGYW) have a high burden of sexually transmitted infections (STIs). This study examined the prevalence of Chlamydia trachomatis, its association with human papillomavirus (HPV), and other associated factors among AGYW of rural communities. Methods: Secondary data
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Background/Objectives: Adolescent girls and young women (AGYW) have a high burden of sexually transmitted infections (STIs). This study examined the prevalence of Chlamydia trachomatis, its association with human papillomavirus (HPV), and other associated factors among AGYW of rural communities. Methods: Secondary data on C. trachomatis, HPV, and linked questionnaires from 214 sexually active AGYW were used. Self-collected vaginal specimens were previously tested using the Allplex™ STI Essential Assay and Roche Linear Array HPV genotyping assay. Results: The overall prevalence of C. trachomatis was 29.4% (63/214), and it was not influenced by age. The majority of the AGYW were C. trachomatis negative and HPV positive (52.4%, 111/212), followed by being C. trachomatis and HPV co-infected (23.6%, 50/212), C. trachomatis and HPV co-negative (18.4%, 39/212) and least were C. trachomatis positive and HPV negative (5.7%, 12/212). There was an increased prevalence of being HPV infected among C. trachomatis individuals than being C. trachomatis positive among HPV positive individuals (RR: 2.60, 95% CI: 2.00–3.38, p < 0.0001). C. trachomatis positive AGYW had a significantly higher association of HPV types targeted by Cervarix® HPV vaccine (HPV-16 and/or -18) than C. trachomatis negatives (RR: 2.58, 95% CI: 1.37–4.82, p = 0.005), targeted by Gardasil®4 HPV vaccine (HPV-6, -11, -16 and/or -18; RR: 2.21, 95% CI: 1.32–3.65, p = 0.005) and Gardasil®9 HPV vaccine (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58; RR: 1.92, 95% CI: 1.37–2.67, p < 0.001). Conclusions: There was a high burden of C. trachomatis and HPV coinfection. C. trachomatis coinfection influenced HPV genotype prevalence and distribution, including those that are targeted by the current commercial HPV vaccines, suggesting that the high burden of C. trachomatis among AGYW may pose challenges to the ongoing HPV vaccination program. Integrated STI screening and prevention strategies are needed in rural South African settings.
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Open AccessArticle
Molecular Epidemiology of SARS-CoV-2 in Northern Greece from the Index Case up to Early 2025 Using Nanopore Sequencing
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Georgios Meletis, Styliani Pappa, Georgia Gioula, Maria Exindari, Maria Christoforidi and Anna Papa
Epidemiologia 2025, 6(4), 78; https://doi.org/10.3390/epidemiologia6040078 - 12 Nov 2025
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Background/Objectives: Since its emergence in late 2019, SARS-CoV-2 has demonstrated remarkable genetic diversity driven by mutations and recombination events that shaped the course of the COVID-19 pandemic. Continuous genomic monitoring is essential to track viral evolution, assess the spread of variants of concern
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Background/Objectives: Since its emergence in late 2019, SARS-CoV-2 has demonstrated remarkable genetic diversity driven by mutations and recombination events that shaped the course of the COVID-19 pandemic. Continuous genomic monitoring is essential to track viral evolution, assess the spread of variants of concern (VOCs), and inform public health strategies. The present study aimed to characterize the molecular epidemiology of SARS-CoV-2 in northern Greece from the first national case in February 2020 through early 2025. Methods: A total of 66 respiratory samples collected from hospitalized patients across Northern Greece were subjected to whole-genome sequencing using Oxford Nanopore Technologies’ MinION Mk1C platform and the ARTIC protocol. Sequences were analyzed with PANGO, Nextclade, and GISAID nomenclature systems for lineage and clade assignment, and the WHO nomenclature for VOCs. Results: Across 66 genomes, 34 PANGO lineages were identified. Early introductions included B.1 (2/66), B.1.177 (3/66), and B.1.258 (1/66). Alpha (5/66) and Beta (5/66) circulated in February–June 2021. Delta (AY.43) was detected in early 2022 (2/66; Jan–Feb) but was rapidly displaced by Omicron and reached 100% of the sequences by May 2022. Omicron diversified into BA.1/BA.1.1 (3/66), BA.2 (6/66), BA.4/BA.5 (14/66), BF.5 (1/66), EG.5 (1/66; designated a WHO Variant of Interest in 2023), JN.1 (4/66; globally dominant lineage prompting vaccine updates in 2024–2025), KS.1 (2/66; together with KS.1.1 are recognized PANGO lineages that were tracked internationally but remained less prevalent), KP.3 (5/66; together with KP.3.1.1, prominent “FLiRT” descendants circulating in 2024), and recombinants XDK, XDD, and XEC (5/66), reported by their PANGO names in accordance with the WHO’s current framework, which reserves Greek letters only for newly designated VOCs. Conclusions: This five-year genomic analysis provides an insight into the continuous evolution of SARS-CoV-2 in northern Greece. The findings underscore the importance of sustained genomic surveillance, integrated with epidemiological data, to detect emerging variants, monitor recombination, and strengthen preparedness for future coronavirus threats.
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Open AccessArticle
Genetic Diversity and Temporal Shifts of Porcine Reproductive and Respiratory Syndrome Virus Type 2 (PRRSV-2) Strains in Japan (2020–2023): Evidence of Modified Live Vaccine Influence on Cluster Distribution
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Yoriko Yonezawa, Osamu Taira, Atsushi Kato, Ryosuke Takai, Ryohei Nukui, Nobuyuki Tsutsumi, Ryota Matsuyama and Kohei Makita
Epidemiologia 2025, 6(4), 77; https://doi.org/10.3390/epidemiologia6040077 - 6 Nov 2025
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Background: Porcine reproductive and respiratory syndrome virus type 2 (PRRSV-2) remains a significant threat to swine production globally, including Japan. While the genetic diversity of PRRSV-2 has been reported previously, the potential association with modified live vaccines (MLVs) is not well understood. This
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Background: Porcine reproductive and respiratory syndrome virus type 2 (PRRSV-2) remains a significant threat to swine production globally, including Japan. While the genetic diversity of PRRSV-2 has been reported previously, the potential association with modified live vaccines (MLVs) is not well understood. This study aimed to characterize PRRSV-2 strains currently circulating in Japan and assess possible links with MLVs. Methods: A total of 1190-nucleotide open reading frame 5 sequences of PRRSV-2 were collected across Japan between 2020 and 2023, and phylogenetic analyses were performed to classify genetic clusters. Additionally, correlations between cluster distribution and MLV usage were examined, using sequences detected in the Kanto region. Results: Phylogenetic analysis revealed that 48.5% of the sequences belonged to Cluster III, with a median nucleotide identity of 88.2% to the Japanese reference strain EDRD-1. Notably, the sequence identity between the strains detected in this study and EDRD-1 was significantly lower than that of strains identified in 1992–1993 (p < 0.05). In the Kanto region, Cluster I and II variants, which exhibited high sequence homology to MLV strains, were exclusively detected on farms with a history of MLV usage. Furthermore, Cluster IV displayed substantial genetic divergence, suggesting it comprises a heterogeneous group of distinct lineages. Conclusions: These findings demonstrated the temporal changes in the genetic diversity of Cluster III and provided suggestions of a possible influence that MLV usage influences PRRSV-2 cluster distribution, with Clusters I and II likely representing vaccine-origin viruses. The marked heterogeneity of Cluster IV also highlights the limitations of the current cluster-based classification.
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Open AccessArticle
Babesiosis and Malaria in the United States: Epidemiology, Research Funding, Medical Progress, & Recommendations for Improvement
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Ryan P. Jajosky, Wenhui Li, Audrey N. Jajosky, Philip G. Jajosky and Sean R. Stowell
Epidemiologia 2025, 6(4), 76; https://doi.org/10.3390/epidemiologia6040076 - 6 Nov 2025
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Background: Babesiosis and malaria are infectious diseases caused by the intraerythrocytic parasites Babesia and Plasmodium, respectively. While no human red blood cell (RBC) receptors have been shown to be essential for B. microti (Bm) invasion, Duffy (ACKR1) was reported to
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Background: Babesiosis and malaria are infectious diseases caused by the intraerythrocytic parasites Babesia and Plasmodium, respectively. While no human red blood cell (RBC) receptors have been shown to be essential for B. microti (Bm) invasion, Duffy (ACKR1) was reported to be essential for P. knowlesi and P. vivax invasion in 1975 and 1976, respectively. This suggests additional medical progress is needed for babesiosis, warranting a detailed analysis. Methods: Given similarities in the target cell of infection, data about babesiosis and malaria cases in the US were obtained from the Centers for Disease Control and Prevention (CDC). Research funding was quantified using National Institutes of Health (NIH) data, and medical progress was evaluated through a literature review. Results: Over the 5-year span of 2018–22, there were 9799 and 7722 confirmed babesiosis and malaria cases, respectively. Confirmed babesiosis cases exceeded malaria cases in 4 of 5 years. In 2022, babesiosis and malaria data were either not reported or unavailable to the CDC by ten and one US state(s), respectively. Regarding babesiosis, it is likely that the vast majority of cases were due to domestically acquired Bm, in the context of no chemoprophylaxis. Concerning malaria, >90% of US cases were imported from foreign locations, ~95% of cases were linked with not taking chemoprophylaxis, and P. falciparum (Pf) was the most common cause. From 2018–22, babesiosis and malaria were the underlying cause of death for 70 and 32 US residents, respectively. NIH funding estimates suggest ~$4 million in support of babesiosis and ~$169 million for malaria in 2024. There are many malaria-inspired medications, two malaria vaccines, and hundreds of characterized Plasmodium proteins, while these measures of medical progress are far behind for babesiosis. Outside of the US, there are >200 million malaria cases per year, while babesiosis is rare. Conclusions: In the US from 2018–22, there were more babesiosis cases and deaths than malaria. Decades of robust CDC and NIH funding for malaria led to its elimination from the US, improved medical knowledge and interventions, and reduced foreign morbidity and mortality. These data suggest that leveraging similar approaches used for malaria, including increased NIH and CDC funding for babesiosis, would likely lead to progress (e.g., improved treatment). Babesiosis qualifies as both a rare and an orphan disease.
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Open AccessArticle
Educational Level Mediates the Relationship Between Knowledge and Preventive Practices in Multidrug-Resistant Tuberculosis Patients
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Raquel Clemencia Guardia Zuñiga, Blanca Victoria Abad de Vite, Amariles Azañero Suarez, Danicsa Karina Espino Carrasco, Esther García Santos, Idalia Eufemia Lajo Aquise and Irma Cachay Sánchez
Epidemiologia 2025, 6(4), 75; https://doi.org/10.3390/epidemiologia6040075 - 6 Nov 2025
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Background: Multidrug-resistant tuberculosis (MDR-TB) prevention presents significant challenges in Peruvian healthcare settings, with substantial gaps in knowledge implementation and preventive practices. However, little is known about how patients’ sociodemographic factors influence the translation of knowledge into preventive practices. Methods: This cross-sectional study examined
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Background: Multidrug-resistant tuberculosis (MDR-TB) prevention presents significant challenges in Peruvian healthcare settings, with substantial gaps in knowledge implementation and preventive practices. However, little is known about how patients’ sociodemographic factors influence the translation of knowledge into preventive practices. Methods: This cross-sectional study examined the associations between knowledge, preventive practices, and potential mediating roles of occupation, educational level, and sex among MDR-TB patients. We surveyed 280 patients from twelve health centers in the Piura-Castilla Network, Peru, recruited from urban (38.55%), marginal urban (32.06%), and rural (29.39%) areas through nonprobability convenience sampling. Participants represented diverse occupational backgrounds, including housewives (19.85%), workers (20.99%), and unemployed individuals (23.28%). Results: Measurement instruments were validated through confirmatory factor analysis, demonstrating adequate reliability (McDonald’s ω > 0.80) and discriminant validity (HTMT < 0.85). Path analysis using structural equation modeling assessed direct and indirect relationships. Knowledge showed a significant direct association with preventive practices (β = 0.194, p < 0.001). Among the three mediating variables examined, only educational level demonstrated a significant indirect effect (β = 0.073, p < 0.001), while occupation (β = −0.010, p = 0.490) and sex (β = −0.035, p = 0.150) showed no significant indirect associations. The model explained 29.7% of the variance in preventive practices. Conclusions: Educational level appears to facilitate the translation of knowledge into preventive practices among MDR-TB patients, though the cross-sectional design precludes causal or directional inferences. Healthcare institutions should develop tailored educational interventions according to patients’ educational backgrounds, including literacy-sensitive materials, simplified visual aids, and personalized counseling sessions to enhance MDR-TB prevention effectiveness in clinical settings.
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Open AccessArticle
Assessment of Gaps and Inequalities in Cancer Screening at the District Level in Peru
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Akram Hernández-Vásquez, Lucía Villar Bernaola, Maricela Curisinche-Rojas and Raúl Timaná-Ruiz
Epidemiologia 2025, 6(4), 74; https://doi.org/10.3390/epidemiologia6040074 - 4 Nov 2025
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Objectives: This study assessed socioeconomic inequalities in cancer screening at the district level in Peru, focusing on bilateral mammography, fecal occult blood test (FOBT), and prostate-specific antigen (PSA) test. Methods: An ecological study was conducted using 2021–2023 data from the Health
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Objectives: This study assessed socioeconomic inequalities in cancer screening at the district level in Peru, focusing on bilateral mammography, fecal occult blood test (FOBT), and prostate-specific antigen (PSA) test. Methods: An ecological study was conducted using 2021–2023 data from the Health Information System (HIS) of MINSA. Screening rates were calculated per 1000 eligible individuals. Socioeconomic disparities were assessed using concentration indices (CIs) and gap analysis, with the Human Development Index (HDI) as the stratification variable. Results: Screening rates were higher in districts with greater HDI. The mean district-level rates were 15.41 (SD: 72.66) for mammography, 97.27 (SD: 107.34) for FOBT, and 104.87 (SD: 101.92) for PSA per 1000 eligible individuals. Positive concentration indices indicated a pro-rich inequality: CI for mammography (0.1745, p = 0.045), FOBT (0.0633, p < 0.001), and PSA (0.0290, p = 0.028). The largest gaps were observed in Amazonian and Andean regions, where screening coverage remained markedly low. Spatial distribution revealed that certain districts, particularly in Loreto, Ucayali, and Amazonas, had screening gaps exceeding 97%. Conclusions: Significant disparities in cancer screening exist across Peruvian districts, disproportionately affecting lower-HDI districts areas. Targeted interventions, including education, telemedicine, and improved infrastructure, are necessary to enhance equitable access to early detection services and reduce the burden of disease.
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Digital Health Literacy of Adolescents and Its Association with Vaccination Literacy: The First Evidence from Lithuania
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Kristina Motiejunaite, Gerda Kuzmarskiene and Saulius Sukys
Epidemiologia 2025, 6(4), 73; https://doi.org/10.3390/epidemiologia6040073 - 3 Nov 2025
Abstract
Background: Health literacy, including its digital and vaccination-specific components, is essential for informed health decision-making in adolescence—a developmental period when health attitudes and behaviors are shaped and may persist into adulthood. Although the importance of these competencies is increasingly recognized, little is known
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Background: Health literacy, including its digital and vaccination-specific components, is essential for informed health decision-making in adolescence—a developmental period when health attitudes and behaviors are shaped and may persist into adulthood. Although the importance of these competencies is increasingly recognized, little is known about the relationship between digital health literacy (DHL) and vaccination literacy (VL) among adolescents. The aim of this study was to investigate the associations between DHL and VL among Lithuanian adolescents, and to evaluate the psychometric properties of the Digital Health Literacy Questionnaire (HLS19-DIGI) and the Vaccination Literacy Questionnaire (HLS19-VAC) in this population. Methods: A cross-sectional survey was conducted with 9–12 grades students from Lithuanian gymnasiums using HLS19-DIGI and HLS19-VAC instruments. Analyses included confirmatory factor analyses for validity, McDonald’s omega for reliability, ANOVA and chi-square tests for group comparisons, and linear regression to evaluate DHL—VL associations, adjusting for gender, grade, and frequency of digital resource use. Results: A total of 792 students (42.0% male; mean age 16.4 years) completed the survey. The HLS19-DIGI (CFI = 0.945, TLI = 0.923, RMSEA = 0.081) and HLS19-VAC (CFI = 0.986, TLI = 0.959, RMSEA = 0.089) showed satisfactory structural validity, and both scales had good reliability (0.757 and 0.803). Mean DHL and VL scores were 78.28 (SD = 24.24) and 82.64 (SD = 27.22), respectively. Over half of the participants had excellent DHL (55.7%) and VL (63.4%). DHL was a strong predictor of VL (β = 0.429, p < 0.001). The frequency of digital resource use was not significantly related to VL. Conclusions: Higher DHL is associated with higher VL, suggesting that skills in searching for, appraising, and applying online health information can enhance informed vaccination decision-making. Interventions delivered through trusted channels, such as schools and healthcare providers, should aim to strengthen both literacies, address misinformation, and foster critical evaluation competencies to support vaccine uptake in youth.
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Open AccessCase Report
Problem-Solving and Behavioural Activation for Young Mothers with Depression in Harare, Zimbabwe: A Mixed-Methods Case Series
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Concilia Tarisai Bere, Rufaro Hamish Mushonga, Rhulani Beji-Chauke, Patrick Smith, Jermaine Dambi, Dzifa Abra Attah, Takudzwa Mtisi, Dixon Chibanda and Melanie Abas
Epidemiologia 2025, 6(4), 72; https://doi.org/10.3390/epidemiologia6040072 - 3 Nov 2025
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Background. Depression and anxiety among young people in Africa are highly prevalent and a significant public health concern. Evidence-based interventions (EBIs) tailored to this demographic’s unique cultural and contextual needs are limited. Methods. We evaluated an intervention that integrates Behavioural Activation (BA) into
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Background. Depression and anxiety among young people in Africa are highly prevalent and a significant public health concern. Evidence-based interventions (EBIs) tailored to this demographic’s unique cultural and contextual needs are limited. Methods. We evaluated an intervention that integrates Behavioural Activation (BA) into Problem-Solving Therapy (PST), focusing on its acceptability, feasibility, preliminary impact on depression and anxiety, and necessary adaptations. Three participants with clinically elevated depression received the six-week intervention. Measures of depression (PHQ-9) and anxiety (GAD-7) were administered pre-intervention and at six subsequent time points. Results. PHQ-9 scores decreased from a baseline median score of 15 (Q1–Q3: 11–17) to a follow-up median score of 3 (Q1–Q3: 1–8). GAD-7 score decreased from a baseline median score of 12 (Q1–Q3: 5–14) to a median score of 6 (Q1–Q3: 1–8). Participants endorsed BA components, emphasizing social interaction and achievement-oriented activities, which were perceived as empowering and culturally resonant. Qualitative feedback highlighted the need for adaptations, including simplified language and localized examples, to enhance relevance. Conclusions. Findings support the feasibility of task-sharing BA-enhanced PST with lay workers, but point to the necessity of iterative cultural adaptation to address socioeconomic barriers.
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Absence of Brucella canis Detection in Dogs from Central Italy: Implications for Regional Surveillance and Zoonotic Risk
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Maria Luisa Marenzoni, Sabrina Attura, Brigitta Favi, Maria Teresa Antognoni, Maria Beatrice Conti, Andrea Felici, Carmen Maresca, Eleonora Scoccia, Maria Rita Bonci, Alessia Pistolesi, Simona Zanghì, Anna Confaloni, Lakamy Sylla, Daniele Marini, Fabrizio De Massis, Flavio Sacchini and Manuela Tittarelli
Epidemiologia 2025, 6(4), 71; https://doi.org/10.3390/epidemiologia6040071 - 3 Nov 2025
Abstract
Background: Brucella canis is a zoonotic pathogen associated with reproductive disorders in dogs and represents an emerging public health concern. Dogs are the only known source of infection for humans, and transmission is often associated with close contact, particularly in occupational settings.
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Background: Brucella canis is a zoonotic pathogen associated with reproductive disorders in dogs and represents an emerging public health concern. Dogs are the only known source of infection for humans, and transmission is often associated with close contact, particularly in occupational settings. Reports of canine and human infections in Europe are increasing, underscoring the need for integrated surveillance to assess the risk of introduction and spread. Objectives: This study aimed to investigate the possible circulation of B. canis in different subgroups of dogs from Central Italy, representing diverse risk contexts (stray, breeding, blood donor, refugee-associated, and previously outbreak-linked dogs), and to generate sentinel data to inform further risk-based surveillance and zoonotic risk assessment. Methods: A comprehensive serological, molecular, and bacteriological survey was conducted on 128 dogs sampled in the Umbria region, covering animals from different backgrounds and risk contexts. Blood samples were tested using bacterial culture, real-time PCR, serum agglutination test, complement fixation test, and/or indirect immunofluorescence antibody test. Results: All tested dogs were negative for B. canis. The upper 95% confidence limit for prevalence was 3.5%, suggesting that widespread circulation is unlikely, although a low/moderate prevalence in specific groups cannot be excluded. Conclusions: Although no cases of B. canis were detected, the results provide sentinel information and highlight the need for continued risk-based surveillance, particularly in low-prevalence areas to prevent introduction of the infection and to enable early detection in case of occurrence. As dogs are the only known source of human infection, veterinary monitoring plays a pivotal role in mitigating zoonotic risks and supporting One Health strategies for evidence-based control.
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Recreational Nitrous Oxide Use and Associated Neuropsychiatric Presentations in Patients Attending the Emergency Department
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Katy Boyce, Harshini M. Liyanage, Emma Tam and Soumitra Das
Epidemiologia 2025, 6(4), 70; https://doi.org/10.3390/epidemiologia6040070 - 1 Nov 2025
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Background/Objectives: Nitrous oxide (N2O), commonly known as laughing gas, is increasingly being used recreationally. While neurological risks are recognized, psychiatric effects remain underexplored. This study investigates neuropsychiatric presentations among patients referred to the Emergency Mental Health (EMH) team at Sunshine Hospital,
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Background/Objectives: Nitrous oxide (N2O), commonly known as laughing gas, is increasingly being used recreationally. While neurological risks are recognized, psychiatric effects remain underexplored. This study investigates neuropsychiatric presentations among patients referred to the Emergency Mental Health (EMH) team at Sunshine Hospital, Melbourne, Australia, associated with recreational N2O use. Methods: We conducted a retrospective observational review of EMH referrals between August 2020 and July 2024. Inclusion criteria were patients with documented recreational N2O use within the preceding 12 months. Cases were operationally defined as presenting with either predominantly psychiatric features (psychosis or suicidal ideation/self-harm documented by clinician) or predominantly neurological features (ataxia, paresthesia, pyramidal signs, or other focal deficits). Primary outcomes included type and severity of neuropsychiatric presentation, concurrent substance use, and disposition from the Emergency Department. Results: Of 25 identified patients, 23 met inclusion criteria (12 males, 11 females; mean age 29.3 ± 8.3 years). Psychotic symptoms were reported in 11/23 (47.8%, 95% CI 27.3–69.0) and suicidal ideation or self-harm in 8/23 (34.8%, 95% CI 17.2–55.7). Neurological symptoms, including paraesthesia and ataxia, occurred in 5/23 (21.7%, 95% CI 7.5–43.7). Concurrent substance use was documented in 19/23 (82.6%, 95% CI 61.2–95.0), most frequently cannabis, alcohol, and tobacco. Over half of patients (12/23; 52.2%, 95% CI 30.6–73.2) identified as culturally and linguistically diverse (CALD). Conclusions: Among EMH-referred ED patients, recreational N2O use is associated with a spectrum of neuropsychiatric presentations, including psychosis, suicidality, and neurological symptoms. These findings reflect clinical associations rather than causal relationships and highlight the need for early recognition, targeted assessment, and appropriate follow-up in high-risk patients.
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Patient Satisfaction Among Opioid Use Disorder Treatment Sample in an Opioid Treatment Program: A Mixed Method Research Study
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Stanley Nkemjika
Epidemiologia 2025, 6(4), 69; https://doi.org/10.3390/epidemiologia6040069 - 30 Oct 2025
Abstract
Background/Objectives: Patient satisfaction is increasingly recognized as a key indicator of the effectiveness of substance use disorder (SUD) treatment. While some studies suggest disparities in satisfaction across treatment settings, there remains limited research examining these differences, particularly among vulnerable populations. This study aimed
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Background/Objectives: Patient satisfaction is increasingly recognized as a key indicator of the effectiveness of substance use disorder (SUD) treatment. While some studies suggest disparities in satisfaction across treatment settings, there remains limited research examining these differences, particularly among vulnerable populations. This study aimed to assess patient perceptions of satisfaction with opioid use treatment services and explore how demographic and socioeconomic factors influence these experiences. Methods: Conducted between 1 February and 31 March 2025, the study took place at a longstanding Opioid Treatment Program in Philadelphia. A total of 217 participants receiving treatment were recruited through convenience sampling during routine clinic visits. Data collection involved an electronically administered survey using the validated Client Satisfaction Questionnaire-8, with both quantitative and qualitative components. Quantitative data were analyzed using SAS 9.4, while qualitative responses underwent thematic analysis in Excel. Results: Findings revealed an average satisfaction score of 27.16, with employment status emerging as a significant predictor; employed individuals reported lower satisfaction (β = −1.118, p = 0.040), and race showed a marginal association. Qualitative analysis highlighted themes such as supportive staff, financial struggles, and personal growth. Conclusion: The results emphasize the need for equitable, culturally responsive treatment approaches that account for socioeconomic disparities in patient experience and care quality.
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