Translation of epidemiologic findings in enteric disease to public health action

项目概要/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， 这导致在资源匮乏环境中的儿童反复出现腹泻和发育不良。到 加速将基于人群的数据转化为政策准备，可采取行动的证据，新的流行病学 最近开发了一些方法来评估结果的普遍性，并估计 观察数据的潜在干预措施。K 01指导研究科学家发展奖 应用程序，伊丽莎白T.罗加夫斯基是密歇根大学公共卫生科学助理教授， 弗吉尼亚州（弗吉尼亚大学），建议应用这些创新的方法，以通知执行结果，从两个 南方肠道感染的多中心观察性研究和两项单中心随机干预试验 非洲和坦桑尼亚。这些观察性研究是MAL-ED，一项8中心肠道感染出生队列研究， 腹泻和儿童发育，以及GEMS，一项中重度腹泻的7中心病例对照研究。 具体而言，Rogawski博士将：1）确定修改影响的特定地点的社会和环境因素 MAL-ED中腹泻和生长不良的风险因素，并使用 逆概率加权方法; 2）估计现实的公共卫生干预措施的影响，以减少 使用参数g公式从观察数据中消除风险并改善儿童生长;以及3） 评估饮用水质量干预措施随机试验中评估的干预措施的影响 （南非）和多因素儿童健康干预（坦桑尼亚）在其他MAL-ED和GEMS网站。 关键的风险因素和潜在的干预目标包括水、卫生设施和与可卡因有关的因素， 肠道病原体、抗菌药物的使用、大量和微量营养素以及疾病。Rogawski博士建议 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 建议书将由一个优秀的指导小组进行监督， 实质性和临床技能。丰富的研究和指导经验，强大的培训 基础设施和UVA长期的国际合作使这个机构成为理想的环境 支持这些活动。她获奖的目标是成为肠道感染方面的专家， 环境性肠病，熟练掌握新的流行病学因果推理方法， 相关的实施研究，并成功地过渡到独立通过学术 在流行病学的职业生涯保持在儿科传染病的国际研究计划 总部设在美国，同时发展 . ，她计划 新的分析方法，以促进有影响力的 流行病学结果。 K 01指导研究科学家发展奖将促进她的过渡 作为一名弥合流行病学和公共卫生政策之间差距的独立调查员， 实施到 减少传染病负担，促进全球儿童发展。

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.