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Mosquitoes of the genus transmit arboviruses of great importance to human health as dengue, chikungunya, Zika and yellow fever. The tiger mosquito can play an important role as arboviral vector, especially when is absent or present at low levels. Remarkably, the rapid worldwide spreading of the tiger mosquito is expanding the risk of arboviral transmission also to temperate areas, and the autochthonous cases of chikungunya, dengue and Zika in Europe emphasize the need for improved monitoring and control. Proteomic and transcriptomic studies on blood feeding arthropod salivary proteins paved the way toward the exploitation of genus-specific mosquito salivary proteins for the development of novel tools to evaluate human exposure to mosquito bites. We previously found that the culicine-specific 34k2 salivary protein from (al34k2) evokes specific IgG responses in experimentally exposed mice, and provided preliminary evidence of its immunogenicity to humans. In this study we measured IgG responses to al34k2 and to salivary gland protein extracts (SGE) in individuals naturally exposed to the tiger mosquito. Sera were collected in two areas of Northeast Italy (Padova and Belluno) during two different time periods: at the end of the low- and shortly after the high-density mosquito seasons. Anti-SGE and anti-al34k2 IgG levels increased after the summer period of exposure to mosquito bites and were higher in Padova as compared to Belluno. An age-dependent decrease of anti-saliva IgG responses was found especially in Padova, an area with at least 25 years history of colonization. Moreover, a weak correlation between anti-saliva IgG levels and individual perception of mosquito bites by study participants was found. Finally, determination of anti-al34k2 IgG1 and IgG4 levels indicated a large predominance of IgG1 antibodies. Overall, this study provides a convincing indication that antibody responses to al34k2 may be regarded as a reliable candidate marker to detect temporal and/or spatial variation of human exposure to ; a serological tool of this kind may prove useful both for epidemiological studies and to estimate the effectiveness of anti-vectorial measures.

Purpose Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC). Methods A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science). Results We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts. Conclusions The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts.

Ecological studies lack the ability to control for the effects of confounding factors. The findings of a linear relationship between average exposure and disease frequency in ecological studies do not imply that such a linear relationship will be present at the individual levels. This is known as the ‘ecological fallacy’. Despite these limitations, ecological studies may be the best approach to studying exposures that are easier to measure at the group rather than the individual level because most ecological studies make use of routinely collected data. They are also useful for monitoring the effectiveness of population interventions such as vaccination programs, health education campaigns and mass screening programs. Thus, ecological studies are useful epidemiologic tools for public health surveillance if we know their limitations and interpret their results carefully. Ecological studies often help to generate hypotheses, although they rarely provide a strong test of a causal hypothesis.

Numerous multimorbidity indexes exist, focused primarily or solely on somatic conditions. We developed mental multimorbidity indexes as epidemiological tools. Participants in the French NutriNet-Santé cohort (73.5% women; mean age = 59.5 ± 13.7 years; index development N = 20,000; index comparison N = 7,259) completed self-report questionnaires (2020-2022) regarding depressive symptoms, anxiety, eating disorders, insomnia, alcohol use disorders, cognitive difficulties, and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Using established cutoffs, participants were split into 2 groups for each condition. Tweedie regression analyses were performed with the 6 mental health conditions as exposures and the WHODAS 2.0 score as the outcome. Performance (C-index) and calibration of the indexes were compared with a simple count. A general and a sex-specific mental multimorbidity indexes were developed; both were significantly associated with the disability score. The new indexes had slightly better predictive performance than simple counts of mental disorders. We developed mental multimorbidity indexes as epidemiological research tools. Future prospective studies could investigate their predictive potential regarding outcomes such as medication use, healthcare utilization, and quality of life.

During the years since certification of smallpox eradication, the power of infectious disease surveillance has been greatly increased by new biotechnical and electronic technologies. These technologies have transformed the way that surveillance can be used to contribute to public health, and to infectious disease eradication and elimination. In addition to permitting precise geographical placement of infections by incorporating the most up to date geographical positioning systems, infectious disease surveillance can now also provide more comprehensive understanding of the spread and risks of infections because of genomic sequencing that leads to more meaningful epidemiological analysis. These new technologies have made infectious disease surveillance an even more powerful and timely tool than it was during the period of smallpox eradication. Future surveillance will continue to refine these technologies, and adapt newer ones such as rapid point of care diagnostics and hand held communication devices that will lead to more timely and accurate reporting from health facilities. These technologies will also lead to the possibility of direct participation in surveillance by individuals who will be able to report their own disease syndromes, those of their neighbors, or those of domestic and wild animals at the animal/human interface.

Background The standard measurement of oral conditions that are mainly of cosmetic concern can be carried out by a trained clinical professional, or they can be assessed and reported by the individuals who may have the condition or be aware of others who have it. Enamel opacities of anterior teeth are examples of such a condition. At a public health level the interest is only about opacities that are of aesthetic concern, so the need for an index that records opacities that the public perceive to be a problem is clear. Measurement methods carried out by highly trained professionals, using unnatural conditions are not indicated at this level. This study reports on the testing of a novel epidemiological tool that aims to report on the prevalence and impact of self-perceived enamel opacities in a population of young adolescents. Methods A dental health survey was carried out using a random sample of 12-year-old school pupils during 2008/09 by Primary Care Organisations (PCOs) in England. This included the use of a novel self-perception tool which aimed to measure individual’s self-perception of the presence and impact of enamel opacities to produce population measures. This tool comprised questions asking about the presence of white marks on their teeth and whether these marks bothered the volunteers and a sheet of grouped photographs of anterior teeth showing opacities ranging from TF 0, TF 1–2 to TF 2–3. Volunteers were asked which of the groups of photographs looked more like their own teeth. Examining teams from a convenience sample of 3 PCOs from this survey agreed to undertake additional measurements to assess the value of the self-perception tool. Volunteer pupils were asked the questions on a second occasion, some time after the first and clinical examiners recorded their assessments of the most closely matching set of photographs of the volunteers on two occasions. Results The tool was feasible to use, with 74% of pupils making a response to the first question about the presence of white marks on front teeth, 94% to the second (do these marks bother you?) and 79% to the third about which set of images most closely matched the volunteer’s own, with regard to white marks. Responses to these sequential questions showed coherence with pupils who perceived themselves as having white marks on their teeth being more likely to select images that showed teeth with opacities to match with their appearance. Pupils who reported themselves concerned about their white marks were the most likely to select images with the most severe opacities. Repeatability was good among pupils (Kappa = 0.65) and very good among examiners (Kappa = 0.87). Agreement levels between pupil’s and examiner’s choice of images was poor as examiners were less likely than pupils to select images that showed more severe levels of mottling. Conclusions With regard to feasibility, coherence and repeatability the standardised epidemiological tool under scrutiny, with operator training, appears to be a suitable method for measuring the prevalence and impact of self-perceived enamel opacities in a population of young adolescents.

The microbiological safety of food has always been essential to ensuring the public's well‐being; however, over the past decade, many issues have emerged or continue to be of concern. Four of these topics are addressed in this chapter. The application of whole‐genome sequencing to enhance the identification and investigation of outbreaks of foodborne illness through its use as a standard tool for “fingerprinting‐ pathogens has revolutionized surveillance of foodborne‐illness outbreaks and source tracking. Implementation of the U.S. Food and Drug Administration's recently adopted rules of the Food Safety Modernization Act is another factor that should contribute to the enhanced safety of foods, and a brief discussion of the intricacies of this law is provided, highlighting features that are likely to have the greatest impact. Although the food industry generally has a remarkable record of producing safe foods, it is increasingly challenged by consumers' demand for “natural‐ foods that are free of synthetic antimicrobials. In addition, an ever‐increasing percentage of foods consumed in the United States and in many developed countries are imported, of which a major portion originate from developing countries whose sanitary practices in production and processing are often inferior to those employed in developed countries. The food safety landscape is not likely to remain static; however, improvements will need to be balanced against competing nutritional, cost, and sustainability priorities.

To compare the methodological and reporting quality of systematic reviews by authors from China and those from the United States (USA). From systematic reviews of randomized trials published in 2014 in English, we randomly selected 100 from China and 100 from the USA. The methodological quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool, and reporting quality assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) tool. Compared with systematic reviews from the USA, those from China were more likely to be a meta-analysis, published in low-impact journals, and a non-Cochrane review. The mean summary Assessing the Methodological Quality of Systematic Reviews score was 6.7 (95% confidence interval: 6.5, 7.0) for reviews from China and 6.6 (6.1, 7.1) for reviews from the USA, and the mean summary Preferred Reporting Items for Systematic Reviews and Meta-analyses score was 21.2 (20.7, 21.6) for reviews from China and 20.6 (19.9, 21.3) for reviews from the USA. The differences in summary quality scores between China and the USA were statistically nonsignificant after adjusting for multiple review factors. The overall methodological and reporting quality of systematic reviews by authors from China are similar to those from the USA, although the quality of systematic reviews from both countries could be further improved.

Increasingly, risk of bias tools are used to evaluate epidemiologic studies as part of evidence synthesis (evidence integration), often involving meta-analyses. Some of these tools consider hypothetical randomized controlled trials (RCTs) as gold standards. We review the strengths and limitations of risk of bias assessments, in particular, for reviews of observational studies of environmental exposures, and we also comment more generally on methods of evidence synthesis. Although RCTs may provide a useful starting point to think about bias, they do not provide a gold standard for environmental studies. Observational studies should not be considered inherently biased vs. a hypothetical RCT. Rather than a checklist approach when evaluating individual studies using risk of bias tools, we call for identifying and quantifying possible biases, their direction, and their impacts on parameter estimates. As is recognized in many guidelines, evidence synthesis requires a broader approach than simply evaluating risk of bias in individual studies followed by synthesis of studies judged unbiased, or with studies given more weight if judged less biased. It should include the use of classical considerations for judging causality in human studies, as well as triangulation and integration of animal and mechanistic data. Bias assessments are important in evidence synthesis, but we argue they can and should be improved to address the concerns we raise here. Simplistic, mechanical approaches to risk of bias assessments, which may particularly occur when these tools are used by nonexperts, can result in erroneous conclusions and sometimes may be used to dismiss important evidence. Evidence synthesis requires a broad approach that goes beyond assessing bias in individual human studies and then including a narrow range of human studies judged to be unbiased in evidence synthesis. https://doi.org/10.1289/EHP6980.

Summary A fracture risk assessment tool (FRAX™) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK. Introduction The aim of this study was to apply an assessment tool for the prediction of fracture in men and women with the use of clinical risk factors (CRFs) for fracture with and without the use of femoral neck bone mineral density (BMD). The clinical risk factors, identified from previous meta-analyses, comprised body mass index (BMI, as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking, and alcohol intake 3 or more units daily. Methods Four models were constructed to compute fracture probabilities based on the epidemiology of fracture in the UK. The models comprised the ten-year probability of hip fracture, with and without femoral neck BMD, and the ten-year probability of a major osteoporotic fracture, with and without BMD. For each model fracture and death hazards were computed as continuous functions. Results Each clinical risk factor contributed to fracture probability. In the absence of BMD, hip fracture probability in women with a fixed BMI (25 kg/m 2 ) ranged from 0.2% at the age of 50 years for women without CRF’s to 22% at the age of 80 years with a parental history of hip fracture (approximately 100-fold range). In men, the probabilities were lower, as was the range (0.1 to 11% in the examples above). For a major osteoporotic fracture the probabilities ranged from 3.5% to 31% in women, and from 2.8% to 15% in men in the example above. The presence of one or more risk factors increased probabilities in an incremental manner. The differences in probabilities between men and women were comparable at any given T-score and age, except in the elderly where probabilities were higher in women than in men due to the higher mortality of the latter. Conclusion The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.