2025
Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study
Timalsena D, Nakarmi C, Mali S, Dhakal A, Bharati A, Bishwokarma A, Adhikari A, Poudel B, Kulung B, Baral P, Bhattarai S, Dixit L, Pokharel Y, Rhodes E, Xu D, Spiegelman D, Shrestha A. Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study. BMJ Open 2025, 15: e090923. PMID: 40935428, DOI: 10.1136/bmjopen-2024-090923.Peer-Reviewed Original ResearchConceptsWHO packageNon-communicable diseasesPrimary healthcareBody mass indexCardiovascular disease risk-prediction chartsHealthcare workersCardiovascular diseaseRisk prediction chartsPrimary healthcare settingsPrimary healthcare facilitiesPrimary healthcare centresBlood glucose screeningCardiovascular disease riskLow-resource settingsCross-sectional studyAssociated with accessBMI assessmentHealthcare settingsSystemic barriersProvider motivationBlood pressure measurementsAvailability of metforminRisk chartsPrediction chartsHealthcare facilitiesNonparametric Estimation of the Potential Impact Fraction and the Population Attributable Fraction With Individual‐Level and Aggregated Data
Chan C, Zepeda‐Tello R, Camacho‐García‐Formentí D, Cudhea F, Meza R, Rodrigues E, Spiegelman D, Barrientos‐Gutierrez T, Zhou X. Nonparametric Estimation of the Potential Impact Fraction and the Population Attributable Fraction With Individual‐Level and Aggregated Data. Statistics In Medicine 2025, 44: e70214. PMID: 40798868, DOI: 10.1002/sim.70214.Peer-Reviewed Original ResearchConceptsDistributional assumptionsFinite sample performanceImpact of distributional assumptionsPotential impact fractionNonparametric estimationSample performanceDistributional violationsPopulation attributable fractionImpact fractionNonparametric methodsSimulation studyContinuous exposure dataPopulation impact fractionsAttributable fractionSugar-sweetened beverage consumptionIncidence of type 2 diabetesAssumptionsExposure distributionEstimationAggregate dataBeverage consumptionNonparametricType 2 diabetesIndividual-levelTarget populationImplementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda)
Longenecker C, Kiggundu J, Ayebare F, Muddu M, Kayima J, Mutungi G, Ssinabulya I, Schwartz J, Spiegelman D, Tong G, Nugent R, Aifah A, Kagoya F, Cameron D, Hutchinson B, Kamya M, Katahoire A, Semitala F. Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda). BMC Health Services Research 2025, 25: 1060. PMID: 40790739, PMCID: PMC12341278, DOI: 10.1186/s12913-025-13281-9.Peer-Reviewed Original ResearchConceptsCluster randomized trialHypertension careHIV clinicHealth workersWakiso districtStepped-wedge cluster randomized trialRates of HIV viral suppressionImplementation strategiesQuality HIV careClinical health workersBaseline hypertension prevalenceResource intensive strategyFacility-based costsLife expectancy gainsHIV viral suppressionBP controlPatient BP controlHTN careHuman-centered design approachRandomized trialsHIV careImplementation outcomesHypertension prevalencePre-implementationNon-AIDS comorbiditiesExposure Measurement Error Correction in Longitudinal Studies With Discrete Outcomes
Yang C, Zhang N, Li J, Mehta U, Hart J, Spiegelman D, Wang M. Exposure Measurement Error Correction in Longitudinal Studies With Discrete Outcomes. Statistics In Medicine 2025, 44: e70191. PMID: 40680786, PMCID: PMC12274082, DOI: 10.1002/sim.70191.Peer-Reviewed Original ResearchConceptsNurses' Health Study IIError-prone exposureDiscrete outcomesLongitudinal studyMeasurement error correctionEnvironmental epidemiologistsHealth outcomesTime-varying functionCoverage probability improvementStudy designOccurrence of anxiety disordersStudy IIExposure measurementsEstimation procedureSimulation studyBias reductionAnxiety disordersExposure effectsHistory functionOutcomesChronic exposure effectsExposure historyNursesError correctionEpidemiologistsDesign of egocentric network-based studies to estimate causal effects under interference.
Fang J, Spiegelman D, Buchanan A, Forastiere L. Design of egocentric network-based studies to estimate causal effects under interference. Statistical Methods In Medical Research 2025, 9622802251357021. PMID: 40671608, DOI: 10.1177/09622802251357021.Peer-Reviewed Original ResearchPeer education interventionEducational interventionPublic health interventionsCausal effectsHealth interventionsHIV preventionOutcomes FrameworkSample size formulaPotential outcomes frameworkInterventionRegression modelsNetwork membersJoint hypothesis testingWhole populationSize formulaOverall effectBehavioral influencesSpillover effectsIndividualsPeerIdentification strategyUntreated individualsRandomized experimentSpilloverHIVEarly findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study
Kiggundu J, Semitala F, Lipoto C, Giibwa L, Twine R, Mwaka S, Ayebare F, Kiwala C, Magambo E, Mutungi G, Ssinabulya I, Spiegelman D, Kayima J, Muddu M, Schwartz J, Katahoire A, Longenecker C. Early findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed‐method study. Journal Of The International AIDS Society 2025, 28: e26499. PMID: 40622382, PMCID: PMC12232483, DOI: 10.1002/jia2.26499.Peer-Reviewed Original ResearchConceptsHypertension careHealthcare providersExperiences of healthcare providersDSD modelCluster randomised trialRoutine medical recordsInductive thematic analysisGeneralised estimating equationsTime interaction effectsService delivery modelsMixed-methods studyIntegrated careHypertension visitsImplementation researchThematic analysisDelivery modelsPLHIVWakiso districtHypertension managementConsolidation frameworkNational guidelinesQuantitative outcome variablesUganda national guidelinesCareClient educationBarriers and facilitators to patient utilization of noncommunicable disease services in primary healthcare facilities in Nepal: a qualitative study
Mali S, Rhodes E, Nakarmi C, Shrestha S, Dhakal A, Bharati A, Bishwokarma A, Adhikari A, Poudel B, Rai B, Manandhar S, KC S, Timalsena D, Silwal S, Dhimal M, Baral P, Teufel F, Bhattarai S, Spiegelman D, Shrestha A. Barriers and facilitators to patient utilization of noncommunicable disease services in primary healthcare facilities in Nepal: a qualitative study. BMC Health Services Research 2025, 25: 863. PMID: 40598095, PMCID: PMC12217986, DOI: 10.1186/s12913-025-13050-8.Peer-Reviewed Original ResearchNon-communicable diseasesPrimary healthcare facilitiesPatient utilizationNon-communicable disease interventionsHealthcare facilitiesWorld Health OrganizationPurposive sample of patientsQualitative studyPurposive samplingNoncommunicable disease servicesCardiovascular diseaseNCD servicesChronic respiratory diseasesSample of patientsDisease servicesHealth OrganizationDisease interventionRespiratory diseaseFacilitationServicesFacilitiesBarriersNepalInterventionDiseaseStatistical methods for cost-effectiveness analysis of left-truncated and right-censored survival data with treatment delays
Khudyakov P, Xu L, Yang C, Spiegelman D, Wang M. Statistical methods for cost-effectiveness analysis of left-truncated and right-censored survival data with treatment delays. Journal Of The Royal Statistical Society Series C (Applied Statistics) 2025, qlaf035. DOI: 10.1093/jrsssc/qlaf035.Peer-Reviewed Original ResearchIncremental net benefitExcellent finite sample propertiesRight-censored survival dataCost-effectiveness analysisFinite sample propertiesIncremental cost-effectiveness ratioExtensive simulation studyLeft-truncatedSample propertiesSimulation studyNet benefitsSurvival dataCost-effectiveness ratioHealth settingsSwitching treatmentDelay scenariosEstimationPublic health settingsTreatment initiationDelayInferenceStatistical methodsSt. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning
Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Spiegelman D, Carter C. St. Louis enhancing engagement and retention (STEER) in HIV/AIDS care: a participatory intersectional needs assessment for intervention and implementation planning. Frontiers In Public Health 2025, 13: 1589671. PMID: 40567982, PMCID: PMC12187841, DOI: 10.3389/fpubh.2025.1589671.Peer-Reviewed Original ResearchConceptsCommunity health workersNeeds assessmentHealth workersIntegration of community health workersFocus groupsFront-line health workersLack of social supportParticipatory needs assessmentHIV Epidemic initiativeImprove HIV outcomesCommunity engagement principlesContext of HIVDrivers of inequalityPeer specialistsHealth coachingProvider turnoverClinical leadersHealth inequalitiesCare teamHIV/AIDS careHIV outcomesSocial supportCommunity partnersHistory of structural racismOutreach workersHarnessing HIV clinics to deliver integrated hypertension care for People living with HIV in Uganda: A formative mixed methods study
Semitala F, Ayebare F, Kiggundu J, Kiwala C, Senfuma J, Mutungi G, Ssinabulya I, Kayima J, Muddu M, Spiegelman D, Schwartz J, Longenecker C, Katahoire A. Harnessing HIV clinics to deliver integrated hypertension care for People living with HIV in Uganda: A formative mixed methods study. PLOS Global Public Health 2025, 5: e0004701. PMID: 40465676, PMCID: PMC12136366, DOI: 10.1371/journal.pgph.0004701.Peer-Reviewed Original ResearchFragmented care deliveryHypertension careQualitative dataHIV clinicSub-Saharan AfricaCare deliveryConsolidated Framework for Implementation ResearchAnalyzed qualitative dataQualitative interviewsInterruptions due to side effectsSub-SaharanHIV servicesBlood pressureHealthcare accessNon-communicable diseasesMixed methods studyUgandaPeri-urban UgandaChronic careSystolic blood pressureHIV careImplementation researchPocket costsMedication accessAnalyzed quantitative dataValidation of sexually transmitted disease-related stigma and shame scale in Nepalese women
Poudel L, Stangl A, Paneru B, Timsina P, Spiegelman D, Shakya S, Sheth S, Shrestha A. Validation of sexually transmitted disease-related stigma and shame scale in Nepalese women. International Journal Of Surgery Global Health 2025, 8: e00571. DOI: 10.1097/gh9.0000000000000571.Peer-Reviewed Original ResearchConfirmatory factor analysisNepali womenChi-square/degrees of freedom ratioInternal consistencyRoot mean square error of approximationDisease-related stigmaFit indicesEvaluate construct validityNormed fit indexPsychosocial Well-BeingComparative fit indexItem-total correlationsTucker-Lewis indexCronbach's aError of approximationMeasure stigmaNepali versionModel fitTwo-factor structureTelephone interviewsConstruct validityKavrepalanchok district of NepalDistrict of NepalNepalese womenStigmaExposure measurement error in air pollution health effect studies: a pooled analysis of personal exposure validation studies in 17 communities across the United States
Zhang B, Eum K, Szpiro A, Zhang N, Hernández-Ramírez R, Spiegelman D, Wang M, Suh H. Exposure measurement error in air pollution health effect studies: a pooled analysis of personal exposure validation studies in 17 communities across the United States. International Journal Of Environmental Health Research 2025, ahead-of-print: 1-11. PMID: 40191987, PMCID: PMC12353117, DOI: 10.1080/09603123.2025.2488481.Peer-Reviewed Original ResearchAmbient concentrationsNearest monitorExposure measurement errorMeasurements of PM2.5Personal PM2.5Air pollution health effects studiesPersonal exposureHealth effects of air pollutionEffects of air pollutionHealth effects studiesAdverse health effectsExposure surrogatesAir pollutionHealth risksCdExposure indicatorsNiAssociated with health risksLinear mixed modelsQuantify measurement errorMixed modelsConcentrationExposurePbMonthly averagesBarriers and facilitators to a combined strategy of HPV vaccination and cervical cancer screening among Mexican women
León-Maldonado L, Cabral A, Pages G, Brown B, Allen-Leigh B, Lazcano-Ponce E, Bosch F, Spiegelman D, Torres-Ibarra L, Hernández-Ramírez R, Egger E, Rivera-Paredez B, Salmerón J. Barriers and facilitators to a combined strategy of HPV vaccination and cervical cancer screening among Mexican women. Human Vaccines & Immunotherapeutics 2025, 21: 2483018. PMID: 40172917, PMCID: PMC11970787, DOI: 10.1080/21645515.2025.2483018.Peer-Reviewed Original ResearchConceptsInterpersonal-level barriersHigh-quality careFacilitators to participationExperiences of stigmaCervical cancer screeningLack of timeCommunity-level facilitatorsConstant comparative methodPublic health interventionsHealth center personnelInstitutional-level barriersSeverity of cervical cancerHPV-based screeningSemi-structured interviewsCancer screeningHealth interventionsPerceived severity of cervical cancerHealth centersPhone remindersSocioecological modelIntrapersonal levelInconvenient hoursFamily encouragementPerceived severityHPV vaccinationLearn-As-you-GO (LAGO) trials: optimizing treatments and preventing trial failure through ongoing learning
Bing A, Spiegelman D, Nevo D, Lok J. Learn-As-you-GO (LAGO) trials: optimizing treatments and preventing trial failure through ongoing learning. Biometrics 2025, 81: ujaf061. PMID: 40407021, PMCID: PMC12099308, DOI: 10.1093/biomtc/ujaf061.Peer-Reviewed Original ResearchConceptsIntervention packageBinary outcomesIntervention effectsConditional mean modelsOptimal intervention packagesOverall intervention effectContinuous outcomesComplex intervention packagesConfidence bandsInterval estimationImplementation trialLarge-scale intervention trialsMean modelIntervention trialsHypothesis testingInterventionStandard statistical methodsOutcomesTrialsConfidenceTheoryCorrecting for bias due to mismeasured exposure in mediation analysis with a survival outcome
Cheng C, Spiegelman D, Li F. Correcting for bias due to mismeasured exposure in mediation analysis with a survival outcome. Journal Of The Royal Statistical Society Series C (Applied Statistics) 2025, 74: 969-993. PMID: 40837827, PMCID: PMC12364547, DOI: 10.1093/jrsssc/qlaf010.Peer-Reviewed Original ResearchExposure-mediator interactionProtective effect of physical activityHealth Professionals Follow-up StudyEffects of physical activityReduced body mass indexExposure measurement errorRisk of cardiovascular diseaseBody mass indexPhysical activityMismeasured exposureMass indexRare outcomesFollow-up studyCardiovascular diseaseMediation analysisCox regressionOutcomesBias formulaSurvival outcomesHealthPower and Sample Size Calculations for Cluster Randomized Hybrid Type 2 Effectiveness‐Implementation Studies
Owen M, Curran G, Smith J, Tedla Y, Cheng C, Spiegelman D. Power and Sample Size Calculations for Cluster Randomized Hybrid Type 2 Effectiveness‐Implementation Studies. Statistics In Medicine 2025, 44: e70015. PMID: 39930740, DOI: 10.1002/sim.70015.Peer-Reviewed Original ResearchConceptsHybrid type 2 effectiveness-implementation studySample size calculationCluster randomized trialCluster randomized designSize calculationImplementation research outcomesReduce cardiovascular diseaseIssue of multiple testingEffective outcomesImplementation outcomesCommunity interventionsControl blood pressureBinary outcomesOutcomes approachLiterature searchMultiple testingCardiovascular diseaseInterventionRandomized trialsStandard statistical methodsBlood pressureOutcomesType 2 studiesCorrection: Association between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal
Paneru B, Karmacharya A, Bharati A, Makaju S, Adhikari B, Kafle D, Shakya S, Donna S, Seth S, Stangl A, Shrestha A, Shrestha A. Correction: Association between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal. PLOS ONE 2025, 20: e0318367. PMID: 39854385, PMCID: PMC11759993, DOI: 10.1371/journal.pone.0318367.Peer-Reviewed Original Research
2024
Estimation and inference for causal spillover effects in egocentric-network randomized trials in the presence of network membership misclassification
Chao A, Spiegelman D, Buchanan A, Forastiere L. Estimation and inference for causal spillover effects in egocentric-network randomized trials in the presence of network membership misclassification. Biostatistics 2024, 26: kxaf009. PMID: 40159413, PMCID: PMC11955068, DOI: 10.1093/biostatistics/kxaf009.Peer-Reviewed Original ResearchConceptsHIV Prevention Trials NetworkBehavioral changesImpact of interventionsPopulation behavior changePeer-based strategiesRandomized trialsIntervention effectsBehavioral interventionsStudy designSpillover effectsInterventionTrials NetworkInvestigate finite sample propertiesAverage spillover effectFinite sample propertiesBehavioral trainingParticipantsLeverage peer influenceMisclassificationDisseminate informationInterference settingOutcomesPeer influenceSurrogate networksSample propertiesSocio-economic factors associated with cancer stigma among apparently healthy women in two selected municipalities Nepal
Paneru B, Karmacharya A, Makaju S, Kafle D, Poudel L, Mali S, Timsina P, Shrestha N, Timalsena D, Chaudhary K, Bhandari N, Rai P, Shakya S, Spiegelman D, Sheth S, Stangl A, Eastment M, Shrestha A. Socio-economic factors associated with cancer stigma among apparently healthy women in two selected municipalities Nepal. PLOS ONE 2024, 19: e0301059. PMID: 39680514, PMCID: PMC11649127, DOI: 10.1371/journal.pone.0301059.Peer-Reviewed Original ResearchConceptsCancer Stigma ScaleCancer stigmaMean stigma scoreGeneralized Estimating EquationsStigma scoresDomains of stigmaPublic health researchSocio-demographic factorsCross-sectional studyStigma ScaleMultivariate linear regressionHealthy womenLower educationHealth researchMarital statusCause of deathStigmaLow overall prevalenceEstimating EquationsFemale populationLikert scalePrimary cause of deathOverall prevalenceOlder ageScoresBarriers and facilitators for implementing the WHO Safe Childbirth Checklist (SCC) in Mozambique: A qualitative study using the Consolidated Framework for Implementation Research (CFIR)
He A, Kanduma E, Pérez-Escamilla R, Buckshee D, Chaquisse E, Cuco R, Desai M, Munguambe D, Reames S, Manuel I, Spiegelman D, Xu D. Barriers and facilitators for implementing the WHO Safe Childbirth Checklist (SCC) in Mozambique: A qualitative study using the Consolidated Framework for Implementation Research (CFIR). PLOS Global Public Health 2024, 4: e0003174. PMID: 39236014, PMCID: PMC11376584, DOI: 10.1371/journal.pgph.0003174.Peer-Reviewed Original ResearchConsolidated Framework for Implementation ResearchSafe Childbirth ChecklistBirth attendantsImplementation researchFocus group discussionsChildbirth practicesWHO Safe Childbirth ChecklistQualitative studyReduce adverse birth outcomesChildbirth-related complicationsGroup discussionsQuality of careNeonatal deathWeak health systemsAdverse birth outcomesPre-implementation assessmentEvidence-based practiceDeductive thematic analysisLow-resource settingsNeonatal mortality rateHealth systemMaternity carePre-implementationBirth outcomesProvider motivation
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