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Background: Life course epidemiology examines associations between repeated measures of risk and health outcomes across different phases of life. Empirical research, however, is often based on discrete-time models that assume that sporadic measurement occasions fully capture underlying long-term continuous processes of risk., Methods: We propose (i) the functional relevant life course model (fRLM), which treats repeated, discrete measures of risk as unobserved continuous processes, and (ii) a testing procedure to assign probabilities that the data correspond to conceptual models of life course epidemiology (critical period, sensitive period and accumulation models). The performance of the fRLM is evaluated with simulations, and the approach is illustrated with empirical applications relating body mass index (BMI) to mRNA-seq signatures of chronic kidney disease, inflammation and breast cancer., Results: Simulations reveal that fRLM identifies the correct life course model with three to five repeated assessments of risk and 400 subjects. The empirical examples reveal that chronic kidney disease reflects a critical period process and inflammation and breast cancer likely reflect sensitive period mechanisms., Conclusions: The proposed fRLM treats repeated measures of risk as continuous processes and, under realistic data scenarios, the method provides accurate probabilities that the data correspond to commonly studied models of life course epidemiology. fRLM is implemented with publicly-available software., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: The covid-19 pandemic has highlighted the role of living systematic reviews. The speed of evidence generated during the covid-19 pandemic accentuated the challenges of managing high volumes of research literature., Methods: In this article, we summarise the characteristics of ongoing living systematic reviews on covid-19, and we follow a life cycle approach to describe key steps in a living systematic review., Results: We identified 97 living systematic reviews on covid-19, published up to 7th November 2022, which focused mostly on the effects of pharmacological interventions (n = 46, 47%) or the prevalence of associated conditions or risk factors (n = 30, 31%). The scopes of several reviews overlapped considerably. Most living systematic reviews included both observational and randomised study designs (n = 45, 46%). Only one-third of the reviews has been updated at least once (n = 34, 35%). We address practical aspects of living systematic reviews including how to judge whether to start a living systematic review, methods for study identification and selection, data extraction and evaluation, and give recommendations at each step, drawing from our own experience. We also discuss when it is time to stop and how to publish updates., Conclusions: Methods to improve the efficiency of searching, study selection, and data extraction using machine learning technologies are being developed, their performance and applicability, particularly for reviews based on observational study designs should improve, and ways of publishing living systematic reviews and their updates will continue to evolve. Finally, knowing when to end a living systematic review is as important as knowing when to start., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The COVID-19 pandemic has led to an unprecedented amount of scientific publications, growing at a pace never seen before. Multiple living systematic reviews have been developed to assist professionals with up-to-date and trustworthy health information, but it is increasingly challenging for systematic reviewers to keep up with the evidence in electronic databases. We aimed to investigate deep learning-based machine learning algorithms to classify COVID-19-related publications to help scale up the epidemiological curation process., Methods: In this retrospective study, five different pre-trained deep learning-based language models were fine-tuned on a dataset of 6365 publications manually classified into two classes, three subclasses, and 22 sub-subclasses relevant for epidemiological triage purposes. In a k-fold cross-validation setting, each standalone model was assessed on a classification task and compared against an ensemble, which takes the standalone model predictions as input and uses different strategies to infer the optimal article class. A ranking task was also considered, in which the model outputs a ranked list of sub-subclasses associated with the article., Results: The ensemble model significantly outperformed the standalone classifiers, achieving a F1-score of 89.2 at the class level of the classification task. The difference between the standalone and ensemble models increases at the sub-subclass level, where the ensemble reaches a micro F1-score of 70% against 67% for the best-performing standalone model. For the ranking task, the ensemble obtained the highest recall@3, with a performance of 89%. Using an unanimity voting rule, the ensemble can provide predictions with higher confidence on a subset of the data, achieving detection of original papers with a F1-score up to 97% on a subset of 80% of the collection instead of 93% on the whole dataset., Conclusion: This study shows the potential of using deep learning language models to perform triage of COVID-19 references efficiently and support epidemiological curation and review. The ensemble consistently and significantly outperforms any standalone model. Fine-tuning the voting strategy thresholds is an interesting alternative to annotate a subset with higher predictive confidence., (© 2023. The Author(s).)

Objectives: This study aimed to examine (1) the association between patient activation (PA), health locus of control (HLOC), sociodemographic and clinical factors, and (2) the effect of HLOC dimensions, sociodemographic and clinical factors on PA., Methods: Three hundred U.S. adults, with at least one chronic condition (CC) were recruited through Amazon Mechanical Turk and completed an online survey which included sociodemographic questions, the Patient Activation Measure ® - 10, and the Multidimensional Locus of Control (MHLC) - Form B. Statistical analyses, including descriptive, correlation, and multiple linear regression, were conducted using IBM SPSS v25., Results: Of the 300 participants, more than half were male (66.3%), White (70.7%), with at least a college degree (76.0%), and employed full-time (79.0%). The average PA score was 68.8 ± 14.5. Multiple linear regression indicated that participants who reported they were Black, retired, with a greater number of CCs, and with higher scores in Chance MHLC had higher PA, while participants with higher scores in Internal MHLC, were unemployed and reported to have been affected by COVID-19-related worry or fear to manage their CC, had lower PA., Discussion: HLOC dimensions should be addressed concurrently with PA for patients with CCs, thus adding to a more patient-centered clinical approach.

Background: Vaccinations are successful, cost-effective tools to prevent the spread of certain infectious diseases. Many colleges conduct vaccination campaigns on their campuses for various vaccine-preventable diseases, including measles, mumps, influenza, HPV, and most recently, for SARS-CoV-2, the virus responsible for COVID-19. Implementing these campaigns requires substantial effort and understanding their effectiveness is an important factor in justifying these programs., Aim: This scoping review aims to identify, review, and summarize existing evaluation methods for vaccination campaigns on college campuses in order to provide evaluation guidance for institutions planning future vaccination campaigns., Methods: Publications that focused on vaccination campaigns on college campuses for students and/or faculty and staff and described their evaluation methods were included in our analysis. A systematic search of the literature identified 2,101 articles. After duplicates were removed, titles and abstracts were screened, and references searched, 43 articles were identified for full-text review. Sixteen articles provided evaluation information and were systematically reviewed., Results: Interventions targeted a variety of vaccine-preventable diseases, with the majority either aiming to increase HPV vaccine uptake or vaccinate against meningococcal serogroups. Most studies reported on campaigns that included both educational activities and provided vaccinations. Evaluation methods varied widely. Some studies measured vaccine-related knowledge and attitudes. Vaccine uptake was most commonly measured as a simple count of doses administered., Conclusions: College campus vaccination campaigns are evaluated in multiple ways, with little consistency in how the effectiveness of campaigns are measured. There is a need to develop clear evaluation methods for college vaccination programs, especially how to calculate vaccination rates associated with these efforts., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Marie Barnard reports financial support was provided by Indiana Immunization Coalition., (© 2022 The Authors.)

Purpose: To examine the relationship between social participation and subjective well-being (SWB) among older adults using pain medications and evaluate the impact of sex on this relationship., Methods: A cross-sectional analysis was conducted using the 2019 National Health and Aging Trends Study data, a nationally-representative sample of Medicare beneficiaries 65 years and older. Individuals were included if they reported taking pain medications for five days or more per week over the last month. Social participation was operationalized using the sum score of four items: visiting family and friends, going out for enjoyment, attending religious services, and participation in other organized activities. SWB was operationalized as a latent variable using four items reflecting positive and negative emotions, and three items reflecting self-evaluation. Structural equation modeling was used to test the relationship between key study constructs, as well as the moderating effect of sex on the relationship between social participation and SWB., Results: A total of 964 (weighted N = 7,660,599) participants were included in the study. Most participants were female (61.3%), White (81.0%), community-dwelling (94.9%) older adults. Confirmatory factor analysis showed appropriate fit for SWB. Social participation had a statistically significant association with SWB (unstandardized regression coefficient = 0.133; 95% CI 0.071, 0.196; p < 0.001) after adjusting for covariates. However, this relationship was not moderated by sex (p = 0.836)., Conclusion: Social participation is positively and significantly associated with SWB among older adults using pain medications. Interventions aimed at improving SWB should consider incorporating a social activities component., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Medication nonadherence is an important public health issue that has individual and system-level implications. Nonadherence can lead to negative health outcomes and illness, which in turn produce increased healthcare costs for both the individual and system. The transtheoretical model of change (TTM) can be a useful basis for interventions, as it can identify patients' current stages of change and guide them from nonadherence to adherence., Objective: The objective of this systematic review was to determine the utilization of the TTM to predict or improve medication adherence in patients with chronic conditions., Methods: A systematic review of current literature was conducted to obtain an overview of the use of TTM-informed interventions for medication adherence in chronic conditions. PubMed, Embase, PsycInfo and CINAHL databases were searched in July 2020. The methodological quality of the studies was evaluated using the Downs and Black checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for data extraction, analysis, and reporting., Results: Ten studies were included in the final data synthesis of this review. Eight of the reviewed studies supported the utility of TTM to predict or improve medication adherence in patients with chronic conditions, while two studies did not find any significant improvement in medication adherence after using a TTM-based intervention. The Downs and Black checklist revealed the overall methodological quality of the included studies to be fair [mean (SD) = 16.3 (4.5) of a possible maximum score of 28]., Conclusion: This systematic review provides an overview of the utility of TTM in predicting and improving medication adherence in patients with chronic conditions. Although TTM-based interventions in patients with low or moderate medication adherence were effective, there were few studies identified, suggesting the need for further research., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic has resulted in significant changes in pharmacy graduate students' (PhGS) lives. While pharmacy graduate programs across the U.S. have reported adjustments due to the pandemic, there is currently no data on the PhGS' wellness, and the impact on and extent to which offered supports and guidance has met PhGS needs., Objective: This study's objectives were 1) to explore PhGS' perspectives on their challenges and the impact of these challenges on their wellness, and 2) to identify PhGS' suggestions for pharmacy graduate programs to improve guidance and support offered during the COVID-19 pandemic., Methods: This study conducted semi-structured interviews based on the Objective, Reflective, Interpretative, Decisional (ORID) methodology. Pharmacy students working on completing a PhD in programs across the United States were invited to participate. All interviews were conducted using the Zoom platform between May and June 2020. Digital audio recordings were auto transcribed using the Trint platform. Thematic analysis was conducted using the six-dimensional model of wellness developed by Hettler as a guide, while open coding of the PhGS' suggestions was conducted inductively., Results: Thirteen PhGS across six universities in the U.S. were interviewed. During the pandemic, all six dimensions of the Wellness model were found to be challenged for PhGS. PhGS' challenges differed based on their laboratory-based vs. non-laboratory-based research settings. International PhGS reported differing challenges from domestic PhGS. PhGS also provided 18 practical suggestions for improving the teaching process and facilitating student's academic growth in the context of the COVID-19 pandemic., Conclusions: Despite the COVID-19 pandemic, graduate programs should continue developing a robust and tailored system to encourage and maintain mentorship programs to facilitate graduate students' successful path through their doctoral studies. Moreover, the suggestions offered by the PhGS participants in this study, when appropriately implemented, can also position graduate program success post-pandemic., (Copyright © 2021 Elsevier Inc. All rights reserved.)

After the emergency use authorization of coronavirus disease 2019 (COVID-19) vaccinations in the United States, existing pharmacy infrastructure was leveraged to disseminate vaccines. However, the national uptake of COVID-19 vaccines remains poor. This survey study of Mississippi pharmacists aimed to identify barriers to providing COVID-19 vaccination among pharmacists in practice settings that provided other vaccines. A thematic analysis was used to analyze open-ended survey responses. This study found that the greatest identified barrier to COVID-19 vaccination for pharmacists was patient willingness. The thematic analysis revealed logistical barriers, vaccine hesitancy, and rural pharmacy distribution concerns. These findings suggest that pharmacists require further training in overcoming vaccine hesitancy, and potentially indicate a need for the distribution of vaccination responsibilities to additional pharmacy staff members.

Background: Patient activation has an impact on the management of patients' health, clinical outcomes, and treatment costs. Mobile electronic devices (MEDs) have shown the potential to engage patients in wellness behavior. Furthermore, the potentially positive role of MEDs is evident in supporting health professionals in their practice., Objective: This study aims to explore the impact of MEDs on patient activation to search for information on chronic conditions and medications and the impact of MEDs on the empowerment of health professionals or future health professionals., Methods: We conducted 6 focus groups-2 with health sciences students, 2 with health professionals, and 2 with hospitalized patients with chronic conditions. A protocol comprising eight questions was used to guide discussions. Audio-recorded data were transcribed verbatim and analyzed thematically; a ranking system was used to analyze the relevance of identified themes and subthemes, using a coding system depicted by the + symbol, to indicate different relevance levels., Results: Our results suggest that MEDs can positively affect patient activation to search for chronic conditions and medication information by facilitating patients' information-seeking behavior. Key drivers leading to patients' activation to seek information related to chronic conditions and medications through MEDs were the accessibility and abundance of available and detailed information, reduced search time, information updates, and convenience in finding information at any time and place. The lack of accurate information in one's native language, access to incorrect information, and limited access to the internet were key obstacles to seeking information related to chronic conditions and medications via MEDs. In addition, findings of this study suggest that MEDs in general and mobile apps, in particular, may have a positive impact on the work routine of health care professionals as they enable them to make quicker decisions by accessing the required information faster, thus improving practice efficiency. Furthermore, the appropriate usage of MEDs by patients for seeking information about their chronic conditions and medications may positively impact the physician-patient relationship. All focus groups recognized the questionable reliability of health information on the internet and its potential negative effects on patients. Therefore, our findings suggest the need for an additional role of health professionals in assisting patients in using MEDs to search for health and medication information, such as providing reliable websites and mobile apps where patients can safely search for health-related information on the web., Conclusions: The use of MEDs may help activate patients to seek chronic conditions and medication-related information, potentially leading to better management of their chronic conditions and medications. Our findings also highlight the positive impact MEDs may have on empowering health professionals in their practice and the need for health professionals to help patients through specific education that addresses MEDs utilization for chronic conditions and medication information seeking., (©Hyllore Imeri, Shane Desselle, Dardan Hetemi, Kreshnik Hoti. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 11.08.2021.)

Background: Medication nonadherence is associated with more than $100 billion in preventable medical costs each year in the United States. Medication synchronization (med sync) programs have emerged as a potential solution to addressing nonadherence., Objectives: To assess the impact of med sync programs on adherence in adults on chronic medications through a meta-analysis., Methods: A comprehensive literature search was conducted for studies of med sync and adherence in adults published in English from database inception to May 2020. Studies were included if they provided a description of the med sync program, reported a quantitative measure of medication adherence using the proportion of days covered metric, and were conducted in the United States. The search terms included "medication synchronization," "med sync," "adherence," and "PDC." Pooled odds ratios (ORs) and 95% CIs using random-effects models were calculated to assess overall impact and subgroup analyses. The risk of bias of individual studies was assessed using the Downs and Black checklist., Results: Nine studies reporting 30 effect sizes were included in the meta-analysis. On the basis of the Downs and Black checklist, the methodological quality of the studies was fair (mean [SD] 17.6 [1.7]). Med sync was associated with greater odds of adherence (pooled OR 2.29 [95% CI 1.99-2.64], I 2  = 93.3%, τ 2  = 1.11). In addition, the type of med sync program influenced the variation in effect sizes (Cochran Q statistic [Q between ] = 45.4, P < 0.001), with appointment-based med sync programs having the largest impact on adherence (3.14 [95% CI 2.72-3.63])., Conclusion: In this meta-analysis of the impact of med sync on adherence, med sync was associated with statistically significant improvement in adherence. Policy makers and payers should consider reimbursement to pharmacies to support med sync programs in efforts to combat medication nonadherence and improve health outcomes., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Chronic conditions (CCs) management during the COVID-19 pandemic and the impact of the pandemic on patient activation (PA) and health locus of control (HLOC) remain unknown. This cross-sectional online survey study examined the role of COVID-19 pandemic-related worry or fear in PA and HLOC among patients with CCs. Individuals with CCs (n = 300) were recruited through MTurk Amazon. The questionnaire included sociodemographic questions, the Patient Activation Measure, and the Multidimensional Health Locus of Control-Form B. Out of the 300 participants, 9.7% were diagnosed with COVID-19, and 7.3% were hospitalized. Patients with cancer, chronic kidney disease, chronic obstructive pulmonary disease, drug abuse/substance abuse, and stroke reported significant difficulties in managing their CCs due to worry or fear because of COVID-19. More than half of the sample (45.7%) reported COVID-19-related worry or fear about managing their CCs, and these patients had lower PA and lower external HLOC compared to patients not affected by COVID-19-related worry or fear. Health professionals should provide more support for patients facing difficulties in managing their CCs during the COVID-19 pandemic., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Outbreaks of infectious diseases generate outbreaks of scientific evidence. In 2016 epidemics of Zika virus emerged, and in 2020, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic of coronavirus disease 2019 (COVID-19). We compared patterns of scientific publications for the two infections to analyse the evolution of the evidence., Methods: We annotated publications on Zika virus and SARS-CoV-2 that we collected using living evidence databases according to study design. We used descriptive statistics to categorise and compare study designs over time., Results: We found 2286 publications about Zika virus in 2016 and 21,990 about SARS-CoV-2 up to 24 May 2020, of which we analysed a random sample of 5294 (24%). For both infections, there were more epidemiological than laboratory science studies. Amongst epidemiological studies for both infections, case reports, case series and cross-sectional studies emerged first, cohort and case-control studies were published later. Trials were the last to emerge. The number of preprints was much higher for SARS-CoV-2 than for Zika virus., Conclusions: Similarities in the overall pattern of publications might be generalizable, whereas differences are compatible with differences in the characteristics of a disease. Understanding how evidence accumulates during disease outbreaks helps us understand which types of public health questions we can answer and when.

Background: There is disagreement about the level of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a living systematic review and meta-analysis to address three questions: (1) Amongst people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) Amongst people with SARS-CoV-2 infection who are asymptomatic when diagnosed, what proportion will develop symptoms later? (3) What proportion of SARS-CoV-2 transmission is accounted for by people who are either asymptomatic throughout infection or presymptomatic?, Methods and Findings: We searched PubMed, Embase, bioRxiv, and medRxiv using a database of SARS-CoV-2 literature that is updated daily, on 25 March 2020, 20 April 2020, and 10 June 2020. Studies of people with SARS-CoV-2 diagnosed by reverse transcriptase PCR (RT-PCR) that documented follow-up and symptom status at the beginning and end of follow-up or modelling studies were included. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with an adapted checklist for case series, and the relevance and credibility of modelling studies were assessed using a published checklist. We included a total of 94 studies. The overall estimate of the proportion of people who become infected with SARS-CoV-2 and remain asymptomatic throughout infection was 20% (95% confidence interval [CI] 17-25) with a prediction interval of 3%-67% in 79 studies that addressed this review question. There was some evidence that biases in the selection of participants influence the estimate. In seven studies of defined populations screened for SARS-CoV-2 and then followed, 31% (95% CI 26%-37%, prediction interval 24%-38%) remained asymptomatic. The proportion of people that is presymptomatic could not be summarised, owing to heterogeneity. The secondary attack rate was lower in contacts of people with asymptomatic infection than those with symptomatic infection (relative risk 0.35, 95% CI 0.10-1.27). Modelling studies fit to data found a higher proportion of all SARS-CoV-2 infections resulting from transmission from presymptomatic individuals than from asymptomatic individuals. Limitations of the review include that most included studies were not designed to estimate the proportion of asymptomatic SARS-CoV-2 infections and were at risk of selection biases; we did not consider the possible impact of false negative RT-PCR results, which would underestimate the proportion of asymptomatic infections; and the database does not include all sources., Conclusions: The findings of this living systematic review suggest that most people who become infected with SARS-CoV-2 will not remain asymptomatic throughout the course of the infection. The contribution of presymptomatic and asymptomatic infections to overall SARS-CoV-2 transmission means that combination prevention measures, with enhanced hand hygiene, masks, testing tracing, and isolation strategies and social distancing, will continue to be needed., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: GS has participated in two scientific meetings for Merck and Biogen. NL is a member of the PLOS Medicine editorial board.

Introduction: There is increasing evidence linking periodontal infections to Alzheimer's disease (AD). Saliva sampling can reveal information about the host and pathogen interactions that can inform about physiological and pathological brain states., Methods: A cross-sectional cohort of age-matched participants (78) was segmented according to their chemosensory (University of Pennsylvania Smell Identification Test; UPSIT) and cognitive scores (Mini-Mental State Exam; MMSE and clinical dementia rating; CDR). Mid-morning saliva was sampled from each participant and processed for microbiome composition and cytokine analysis. Linear discriminant analysis (LDA) was used to unravel specific changes in microbial and immunological signatures and logistic regression analysis (LRA) was employed to identify taxa that varied in abundance among patient groups., Results: Using olfaction we distinguish in the cognitively normal population a segment with high chemosensory scores (CNh, 27) and another segment with chemosensory scores (CNr, 16) as low as mild cognitive impairment (MCI, 21) but higher than the AD group (17). We could identify stage-specific microbial signatures changes but no clearly distinct cytokine profiles. Periodontal pathogen species as Filifactor villosus decline with the increasing severity of AD, whereas opportunistic oral bacteria such as Leptotrichia wadei show a significant enrichment in MCI., Conclusions: The salivary microbiome indicates stage-dependent changes in oral bacteria favoring opportunistic species at the expense of periodontal bacteria, whereas the inflammatory profiles remain mainly unchanged in the sampled population., (© 2020 the Alzheimer's Association.)