Translation of epidemiologic findings in enteric disease to public health action

项目摘要/摘要 流行病学研究对于了解肠道感染和营养不良的不同驱动因素至关重要， 这会导致资源匮乏环境中的儿童反复出现腹泻疾病和发育不良。至 加快将以人口为基础的数据转化为政策就绪、可操作的证据、新的流行病学 最近已经开发出方法来评估结果的概括性和估计 来自观测数据的潜在干预。在这个K01指导研究科学家发展奖 申请，德克萨斯大学公共卫生科学助理教授伊丽莎白·T·罗加夫斯基博士 弗吉尼亚州(UVA)，建议应用这些创新方法来通知实施来自两个 南方肠道感染的多点观察研究和两个单点随机干预试验 非洲和坦桑尼亚。观察性研究是MAL-ED，一项关于肠道感染的8个地点的出生队列研究， 腹泻、儿童发育和GEMS，这是一项关于中到重度腹泻的7点病例对照研究。 具体地说，罗加夫斯基博士将：1)确定改变影响的特定地点的社会和环境因素 腹泻和生长不良的危险因素，并将影响估计转化为GEM地点使用 逆概率加权方法；2)评估现实公共卫生干预措施的影响，以减少 使用参数g公式从观测数据中获得腹泻风险和改善儿童生长发育；以及3) 评估在饮用水质量干预随机试验中评估的干预措施的影响 (南非)和在其他MAL-ED和GEMS站点进行的多因素儿童健康干预(坦桑尼亚)。 关键风险因素和潜在干预目标包括水、卫生设施和卫生相关因素， 肠道病原体、抗菌药物的使用、大量和微量营养素以及疾病。罗加夫斯基博士提出了一种 职业发展计划，包括指导、实地考察、课程、出版物和演示文稿。她 提案将由一个优秀的指导团队进行监督，并在方法上相互补充， 实质性的和临床的技能。丰富的研究和指导经验，稳健的培训 UVA的基础设施和长期的国际合作使该机构成为理想的环境 以支持这些活动。她的获奖目标是成为肠道感染和 环境肠病，熟练掌握新的流行病学因果推断方法，这些方法 与实施研究相关，并通过学术成功过渡到独立 流行病学生涯维持儿科传染病的国际研究计划 总部设在美国，同时开发 。 ，她计划 新的分析方法，便于展示有影响力的 流行病学结果。 K01指导研究科学家发展奖将促进她的过渡 作为一名在流行病学和公共卫生政策之间架起桥梁的调查员，走向独立 实施到 减少传染病负担，改善全球儿童发展。

PROJECT SUMMARY/ABSTRACT Epidemiologic studies are critical for understanding the diverse drivers of enteric infections and malnutrition, which lead to recurrent diarrheal illnesses and poor growth among children in low-resource settings. To accelerate the translation of population-based data into policy-ready, actionable evidence, novel epidemiologic methods have recently been developed to assess the generalizability of results and estimate the impact of potential interventions from observational data. In this K01 Mentored Research Scientist Development Award application, Dr. Elizabeth T. Rogawski, an Assistant Professor in Public Health Sciences at the University of Virginia (UVA), proposes to apply these innovative methods to inform the implementation of results from two multisite observational studies of enteric infections and two single-site randomized intervention trials in South Africa and Tanzania. The observational studies are MAL-ED, an 8-site birth cohort study of enteric infections, diarrhea, and child development, and GEMS, a 7-site case-control study of moderate-to-severe diarrhea. Specifically, Dr. Rogawski will: 1) identify site-specific social and environmental factors that modify the impact of risk factors for diarrhea and poor growth in MAL-ED and translate effect estimates to GEMS sites using inverse-probability weighting methods; 2) estimate the impact of realistic public health interventions to reduce diarrheal risk and improve child growth from the observational data using the parametric g-formula; and 3) estimate the impact of interventions assessed in the randomized trials of a drinking water quality intervention (South Africa) and a multifactorial child health intervention (Tanzania) at the other MAL-ED and GEMS sites. Key risk factors and potential targets of intervention include water, sanitation, and hygiene-associated factors, enteric pathogens, antimicrobial use, macro- and micronutrients, and illnesses. Dr. Rogawski proposes a career development plan that includes mentorship, fieldwork, coursework, publications, and presentations. Her proposal will be supervised by an outstanding mentoring team with complementary methodological, substantive, and clinical skills. The wealth of research and mentorship experience, robust training infrastructure, and longstanding international collaborations at UVA make this institution the ideal environment to support these activities. Her goals for the award are to become an expert in enteric infections and environmental enteropathy, develop proficiency in novel epidemiologic causal inference methods that are relevant to implementation research, and successfully transition to independence Through an academic career in epidemiology maintain an international research program in pediatric infectious diseases based in the US, while developing . , she plans to novel analytic methods to facilitate the presentation of impactful epidemiologic results. The K01 Mentored Research Scientist Development Award will facilitate her transition to independence as an investigator who bridges the gap between epidemiology and public health policy implementation to reduce infectious disease burden and improve global child development.