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Quasi-experimental designs are gaining popularity in epidemiology and health systems research—in particular for the evaluation of health care practice, programs, and policy—because they allow strong causal inferences without randomized controlled experiments. We describe the concepts underlying five important quasi-experimental designs: Instrumental Variables, Regression Discontinuity, Interrupted Time Series, Fixed Effects, and Difference-in-Differences designs. We illustrate each of the designs with an example from health research. We then describe the assumptions required for each of the designs to ensure valid causal inference and discuss the tests available to examine the assumptions.

As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs-calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.

Tick-borne viruses (TBVs), notably Orthonairovirus haemorrhagiae (Crimean–Congo hemorrhagic fever virus, CCHFV), are emerging global health threats intensified by climate change. Rising temperatures and altered precipitation patterns are expanding the habitats of key tick vectors, increasing their survival and reproductive success. The African continent is characterized by many different climatic zones, and climatic shifts have increased or changed CCHFV transmission patterns, becoming greater risk to humans and livestock. Beyond Africa, CCHFV spread in Europe, the Middle East, and Asia and has been facilitated by factors such as livestock movement, deforestation, and migratory birds. Climate-driven shifts in tick seasonality, behavior, and vector competence may further enhance viral transmission. Addressing these challenges requires integrated responses, including enhanced surveillance, predictive modeling, and climate-adaptive vector control strategies. A One Health approach—linking environmental, animal, and human health domains—is essential. Innovative strategies such as anti-tick vaccines and sustainable vector control methods offer promise in reducing the burden of these diseases. Proactive, collaborative efforts at regional and international levels are crucial in tackling this growing public health challenge.

As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) [greater than or equal to]240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) [greater than or equal to]160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs-calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.

To assess the prevalence and exacerbating factors of violence against women and children in Germany during the coronavirus disease 2019 pandemic. We conducted a representative online survey with partnered women (18-65 years) between 22 April and 8 May 2020, when participants had been under lockdown for a month. We determined the prevalence of several forms of violence within the previous month using both direct elicitation and a list experiment. We conducted a multivariable logistic regression to assess the impact of pandemic-associated risk factors. Of our 3818 survey respondents, 118 (3.09%; 95% confidence interval, CI: 2.54 to 3.64) reported incidents of physical conflict, 293 (7.67%; 95% CI: 6.83 to 8.52) reported emotional abuse, and 97 (6.58%; 95% CI: 5.31 to 7.85) of 1474 respondents with children reported child corporal punishment. We estimated that 3.57% (95% CI: -0.33 to 7.46) had non-consensual intercourse with their partner. Our regression analysis revealed an increased risk of physical conflict with home quarantine (odds ratio, OR: 2.38; 95% CI: 1.56 to 3.61), financial worries (OR: 1.60; 95% CI: 0.98 to 2.61), poor mental health (OR: 3.41; 95% CI: 2.12 to 5.50) and young (< 10 years) children (OR: 2.48; 95% CI: 1.32 to 4.64); we obtained similar results for other forms of violence. Awareness and use of pertinent support services was low. Our findings of an increased risk of domestic violence during the pandemic should prompt policy-makers to improve the safety of women and children. Interventions to alleviate risks factors and extend support services are required.

Metodos Realizamos una encuesta online representativa con mujeres en pareja (18-65 anos) entre el 22 de abril y el 8 de mayo de 2020, cuando las participantes llevaban un mes confinadas. Determinamos la prevalencia de varias formas de violencia en el mes anterior utilizando tanto la elicitacion directa como un experimento de lista. Realizamos una regresion logistica multivariable para evaluar el impacto de los factores de riesgo asociados a la pandemia.

Metodos Realizamos una encuesta online representativa con mujeres en pareja (18-65 anos) entre el 22 de abril y el 8 de mayo de 2020, cuando las participantes llevaban un mes confinadas. Determinamos la prevalencia de varias formas de violencia en el mes anterior utilizando tanto la elicitacion directa como un experimento de lista. Realizamos una regresion logistica multivariable para evaluar el impacto de los factores de riesgo asociados a la pandemia.

Metodos Realizamos una encuesta online representativa con mujeres en pareja (18-65 anos) entre el 22 de abril y el 8 de mayo de 2020, cuando las participantes llevaban un mes confinadas. Determinamos la prevalencia de varias formas de violencia en el mes anterior utilizando tanto la elicitacion directa como un experimento de lista. Realizamos una regresion logistica multivariable para evaluar el impacto de los factores de riesgo asociados a la pandemia.

The newly discovered group of Jingmenviruses has been shown to infect a wide range of hosts and has been associated with febrile illness in humans. During a survey for Jingmenviruses in ticks from Lower Saxony, Germany, Alongshan virus (ALSV) was identified in Ixodes spp. ticks. Additional virus screenings revealed the presence of ALSV in the bodies and saliva of ticks collected at several locations in Lower Saxony. Vector competence studies that included Ixodes ricinus and Dermacentor reticulatus validated the replication of ALSV within those tick species. In vitro feeding experiments with ALSV-injected Ixodes ricinus demonstrated effective viral transmission during blood feeding. To evaluate the potential viral transmission during a natural blood meal, sera from wild game and domestic animals were investigated. One serum sample from a red deer was found to be positive for ALSV RNA, while serological screenings in game and domestic animals revealed the presence of ALSV-specific antibodies at different locations in Lower Saxony. Overall, those results demonstrate the broad distribution of ALSV in ticks in Lower Saxony and hypothesize frequent exposure to animals based on serological investigations. Hence, its potential risk to human and animal health requires further investigation.

Wildlife is one of the most important food resources in rural areas and popular among all social layers of Lao PDR. Numerous vertebrate species are sold at the local markets, but a comprehensive understanding of people’s involvement and their impact on survival of local populations remains insufficient. This study provides the first interdisciplinary assessment using a questionnaire-based survey approach to investigate both markets and households in Khammouane Province in central Lao PDR. Data were recorded during the dry season (October and November 2017), as well as the rainy season (June and July 2018). We documented 66 traded species, mainly intended for consumption purposes, with more than half of them protected under either national law or international convention/red list. Furthermore, an evaluation of wildlife use from urban to the most accessible rural areas, indicated differences in affordability and trapping behavior. Our results suggest that wildlife availabilities can less and less satisfy the unchanged demands.