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多种驱动因素至关重要， 这会导致资源匮乏地区的儿童反复出现腹泻疾病和生长不良。至 加速将基于人群的数据转化为政策就绪、可操作的证据、新颖的流行病学证据 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。在本次 K01 指导研究科学家发展奖中 伊丽莎白·T·罗高斯基 (Elizabeth T. Rogawski) 博士，公共卫生科学助理教授 弗吉尼亚州 (UVA) 提议应用这些创新方法来为两项成果的实施提供信息 南方肠道感染的多中心观察研究和两项单中心随机干预试验 非洲和坦桑尼亚。观察性研究是 MAL-ED，一项针对肠道感染的 8 个地点出生队列研究， 腹泻和儿童发育，以及 GEMS，一项针对中度至重度腹泻的 7 个中心病例对照研究。 具体来说，Rogawski 博士将：1）确定改变影响的特定地点的社会和环境因素 评估 MAL-ED 中腹泻和生长不良的危险因素，并使用以下方法将效应估计值转化为 GEMS 站点： 逆概率加权法； 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 公式根据观察数据降低腹泻风险并改善儿童生长；和 3) 估计饮用水质量干预随机试验中评估的干预措施的影响 （南非）以及在其他 MAL-ED 和 GEMS 地点的多因素儿童健康干预（坦桑尼亚）。 主要风险因素和潜在干预目标包括水、环境卫生和个人卫生相关因素， 肠道病原体、抗菌药物的使用、大量和微量营养素以及疾病。 Rogawski 博士提出了一个 职业发展计划，包括指导、实地考察、课程作业、出版物和演示。她的 提案将由具有互补方法论的优秀指导团队监督， 实质性和临床技能。丰富的研究和指导经验，强大的培训 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 支持这些活动。她的获奖目标是成为肠道感染方面的专家 环境性肠病，培养对新型流行病学因果推断方法的熟练程度 与实施研究相关，并通过学术成功过渡到独立 流行病学职业维持儿科传染病的国际研究计划 立足美国，同时发展 。 ，她计划 新颖的分析方法，以促进有影响力的呈现 流行病学结果。 K01 指导研究科学家发展奖将促进她的过渡 作为弥合流行病学和公共卫生政策之间差距的调查员的独立性 实施到 减少传染病负担并改善全球儿童发展。

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.