Lancet Regional Health-Americas最新文献

英文中文

Leticia de Oliveira — a voice against gender-biased research opportunities 莱蒂西亚-德奥利维拉--反对有性别偏见的研究机会的代言人

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-01 DOI: 10.1016/j.lana.2024.100934

引用次数: 0

HIVR4P conference 2024 2024 年艾滋病毒预防大会

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-01 DOI: 10.1016/j.lana.2024.100937

引用次数: 0

Brazil's tax exemption on ultra-processed foods: a public health setback 巴西对超加工食品免税：公共卫生的倒退

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-30 DOI: 10.1016/j.lana.2024.100927

引用次数: 0

Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community 加拿大北极地区消除结核病的机遇：在北极偏远社区开展全社区筛查的成本效益

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-30 DOI: 10.1016/j.lana.2024.100916

Background

In response to a tuberculosis (TB) outbreak in the remote community of Qikiqtarjuaq Nunavut, Canada, community leaders and the territorial government initiated community-wide screening (CWS) for tuberculosis, an expensive undertaking given the high cost of providing medical services in the Canadian arctic. Our study aim was to assess the cost-effectiveness of the Qikiqtarjuaq CWS.

Methods

We developed a hybrid decision analysis and Markov model to replicate the experience and extrapolate CWS outcomes over a 20-year time horizon. Following a hypothetical cohort with patient characteristics reflecting the demographic and testing data available from the CWS, the model compared a one-time CWS intervention with the reference case of ‘no community-wide screening’.

Findings

CWS resulted in improved health gains through prevention of active tuberculosis cases compared with no CWS. It also resulted in increased costs (measured in Canadian dollars), with a very low estimated incremental cost-effectiveness ratio (ICER) of $25.10 (95% URs: cost savings-$15,874) per additional quality adjusted life year (QALY) gained compared with current standard of care approach (no CWS). Community-wide screening in this context would be considered highly cost-effective in this setting. In probabilistic sensitivity analysis, we found >99% of iterations were cost-effective at a willingness to pay threshold of $50,000/QALY gained.

Interpretation

While costly, coordinated and intensive community-wide tuberculosis screening activities are highly cost-effective in remote arctic communities when utilized in an outbreak context.

Funding

Government of Nunavut.

背景针对加拿大努纳武特地区偏远社区 Qikiqtarjuaq 爆发的结核病（TB）疫情，社区领导和地区政府启动了全社区结核病筛查（CWS），由于在加拿大北极地区提供医疗服务的成本高昂，这项工作耗资巨大。我们的研究目的是评估 Qikiqtarjuaq CWS 的成本效益。方法我们开发了一个混合决策分析和马尔可夫模型，以复制经验并推断 20 年时间范围内的 CWS 结果。该模型以一个假定的队列为基础，患者特征反映了 CWS 所提供的人口统计和检测数据，并将一次性 CWS 干预与 "无社区范围筛查 "的参考情况进行了比较。与目前的标准护理方法（不进行社区卫生服务）相比，该方法也增加了成本（以加元计算），估计增量成本效益比为 25.10 加元（95% URs：节约成本-15,874 加元）。在这种情况下，全社区筛查被认为具有很高的成本效益。在概率敏感性分析中，我们发现在 50,000 美元/QALY 收益的支付意愿阈值下，99% 的迭代具有成本效益。

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引用次数: 0

Active shooters and gun-free zones: emotional versus legal motivations – author's reply 主动枪手和无枪区：情感动机与法律动机--作者的回复

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-29 DOI: 10.1016/j.lana.2024.100929

引用次数: 0

Alignment of countries in the Americas with the latest WHO guidelines for hepatitis B virus (HBV) infection: a review 美洲国家与世界卫生组织最新乙型肝炎病毒（HBV）感染指南的一致性：综述

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-28 DOI: 10.1016/j.lana.2024.100925

Evidence is lacking on alignment of current guidance from the Region of the Americas (AMR) countries with the new guidelines for people with hepatitis B virus (HBV) infection published by the World Health Organization (WHO) in March 2024. We gathered the most updated guidance on HBV infection from organisations/societies and seven countries from AMR. Most guidelines were aligned with the new WHO recommendation to treat persons with elevated ALT and HBV-DNA levels ≥2,000 IU/ml or with HIV-coinfection, hepatocellular carcinoma family history, extra-hepatic manifestations, or immunosuppression. The new WHO 2024 guidelines introduced treatment for persistently abnormal ALT in the absence of HBV-DNA, with TDF and/or entecavir as first-line therapy. TDF in pregnant women with high HBV-DNA levels was recommended to prevent mother-to-child transmission (MTCT). These guidelines advised prophylaxis to pregnant women with positive HBsAg where HBV-DNA is unavailable. WHO 2024 and updated guidelines from most AMR countries had simplified and expanded criteria for HBV treatment and MTCT prevention.

美洲地区（AMR）国家的现行指南与世界卫生组织（WHO）于 2024 年 3 月发布的乙型肝炎病毒（HBV）感染者新指南的一致性缺乏证据。我们收集了美洲地区七个国家的组织/协会提供的有关 HBV 感染的最新指南。大多数指南都与世卫组织的新建议保持一致，即对谷丙转氨酶（ALT）升高、HBV-DNA 水平≥2,000 IU/ml 或合并 HIV 感染、肝细胞癌家族史、肝外表现或免疫抑制的患者进行治疗。世卫组织 2024 年新指南引入了对无 HBV DNA 的 ALT 持续异常的治疗，将 TDF 和/或恩替卡韦作为一线疗法。建议对 HBV DNA 水平较高的孕妇使用 TDF，以预防母婴传播（MTCT）。这些指南建议，在没有 HBV-DNA 的情况下，对 HBsAg 阳性的孕妇进行预防治疗。世卫组织 2024 年指导方针和大多数 AMR 国家更新的指导方针简化并扩大了 HBV 治疗和母婴传播预防的标准。

引用次数: 0

Burden of infant group B Streptococcus disease and impact of maternal screening and antibiotic prophylaxis in Ontario, Canada: a population-based cohort study 加拿大安大略省婴儿 B 群链球菌疾病负担及产妇筛查和抗生素预防的影响：基于人群的队列研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-24 DOI: 10.1016/j.lana.2024.100914

Background

Group B Streptococcus (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35–37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.

Methods

Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data. GBS cases were ascertained through culture results and diagnostic codes. We calculated incidence rates for early-onset disease (EOD: 0–6 days), late-onset disease (LOD: 7–89 days), and ultra-LOD (ULOD: 90–365 days). Adjusted incidence rate ratios (aIRR) were derived via log-binomial regression to compare infant GBS rates according to screening and IAP-receipt.

Findings

Among 776,148 liveborn infants, we identified 803 with GBS, with multiples exhibiting a threefold incidence increase. Incidence rates of EOD, LOD and ULOD were 0.49, 0.46 and 0.07 per 1000 livebirths, respectively. Of eligible pregnancies, 94% were screened; 23% screened positive, and 81% of them received IAP. Nearly 12% of term EOD infants had mothers who missed IAP despite screening positive. Maternal screening was associated with lower rates of any infant GBS disease (aIRR: 0.60; 95% CI: 0.45, 0.80). Among screen-positive births, IAP-receipt was associated with reduced rates of EOD (aIRR: 0.72, 95% CI: 0.48, 1.29) and LOD/ULOD (aIRR: 0.69; 95% CI: 0.46, 1.05), but confidence intervals included 1.0.

Interpretation

Our study, the largest Canadian investigation into infant GBS disease, highlights both widespread adoption and ongoing challenges of the current prevention strategy.

Funding

Canadian Institutes of Health Research.

背景B群链球菌（GBS）是新生儿败血症和脑膜炎的重要致病菌，全球报告的发病率各不相同，基于人群的数据也很有限。我们估算了加拿大安大略省的婴儿 GBS 疾病负担，并评估了孕产妇 GBS 筛查（妊娠 35-37 周）和产前抗生素预防（IAP）与婴儿患病率的关系。通过培养结果和诊断代码确定了 GBS 病例。我们计算了早发症（EOD：0-6 天）、晚发症（LOD：7-89 天）和超晚发症（ULOD：90-365 天）的发病率。通过对数二项式回归得出调整后的发病率比 (aIRR)，以比较筛查和接受 IAP 的婴儿 GBS 发病率。EOD、LOD 和 ULOD 的发病率分别为每 1000 例活产 0.49、0.46 和 0.07。在符合条件的孕妇中，94%接受了筛查；23%筛查结果呈阳性，其中81%接受了IAP。尽管筛查结果呈阳性，但近 12% 的足月排卵期婴儿的母亲错过了 IAP。母体筛查与较低的婴儿 GBS 患病率相关（aIRR：0.60；95% CI：0.45，0.80）。在筛查呈阳性的新生儿中，接受 IAP 与 EOD（aIRR：0.72；95% CI：0.48；1.29）和 LOD/ULOD （aIRR：0.69；95% CI：0.46；1.05）发病率的降低有关，但置信区间包括 1.0。

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引用次数: 0

Clinical and functional assessment of SARS-CoV-2 sequelae among young marines – a panel study 年轻海军陆战队员 SARS-CoV-2 后遗症的临床和功能评估 - 小组研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-24 DOI: 10.1016/j.lana.2024.100909

Background

Long-term SARS-CoV-2 adverse health outcomes are of significant concern, especially among young adults with the potential for the greatest long-term morbidity. We sought to assess and characterize these outcomes in a cohort of Marines.

Methods

We used a cohort of US Marines from a previous longitudinal, prospective observational study of acute SARS-CoV-2, most of whom were enrolled prior to infection. A panel study was established to assess for post-acute sequelae of COVID-19 (PASC), defined as symptoms at least 4 weeks after symptom onset or diagnosis. Symptoms were assessed through questionnaires and validated quality of health metrics. Periodic US Marine Corps fitness testing metrics provided an additional standardized functional assessment and were compared to a pre-pandemic cohort.

Findings

Globally dispersed Marine participants (n = 899) seen an average of 330 days following initial enrollment were predominately male (n = 825, 91.7%), White (n = 613, 71.6%) or Black (n = 149, 17.4%) with a median age of 18 years (interquartile range: 18–19). Among 798 SARS-CoV-2 infected participants, 197 (24.7%) developed PASC. The most prevalent symptoms were loss of taste and/or smell (n = 82; 41.6%), shortness of breath (n = 74; 37.6%), and cough (n = 45; 22.8%). Those with PASC had higher rates and severity of somatic (p < 0.0001), general depressive (p < 0.0001), and anxiety (p = 0.005) symptoms. Compared to a historic cohort of Marines, participants with PASC scored worse on their physical fitness assessments due to slower run times (p = 0.002). Those with PASC continued to have decreased physical performance one year after completing initial training.

Interpretation

In this population of healthy young adult US Marines with mostly either asymptomatic or mild acute COVID-19, one fourth reported physical, cognitive, or psychiatric long-term sequelae of infection. The Marines affected with PASC showed evidence of long-term decrease in functional performance suggesting that SARS-CoV-2 infection may negatively affect health for a significant proportion of young adults.

Funding

Defense Health Agency and Defense Advanced Research Projects Agency.

背景SARS-CoV-2对健康造成的长期不利影响令人深感忧虑，尤其是在可能造成最大长期发病率的年轻成年人中。我们试图对海军陆战队队列中的这些结果进行评估和描述。方法我们使用了以前对急性 SARS-CoV-2 进行的纵向前瞻性观察研究中的美国海军陆战队队列，其中大多数人是在感染之前加入的。为了评估 COVID-19 急性后遗症 (PASC)，我们开展了一项小组研究，PASC 的定义是症状出现或确诊后至少 4 周出现的症状。症状通过调查问卷和经过验证的健康质量指标进行评估。定期进行的美国海军陆战队体能测试指标提供了额外的标准化功能评估，并与疫情发生前的队列进行了比较。研究结果全球分散的海军陆战队参与者（n = 899）在首次注册后平均 330 天就诊，他们主要为男性（n = 825，91.7%）、白人（n = 613，71.6%）或黑人（n = 149，17.4%），中位年龄为 18 岁（四分位间范围：18-19）。在 798 名感染 SARS-CoV-2 的参与者中，197 人（24.7%）出现 PASC。最常见的症状是味觉和/或嗅觉丧失（82 人；41.6%）、呼吸急促（74 人；37.6%）和咳嗽（45 人；22.8%）。PASC 患者的躯体症状（p < 0.0001）、一般抑郁症状（p < 0.0001）和焦虑症状（p = 0.005）的发生率和严重程度都较高。与历史上的海军陆战队队列相比，患有 PASC 的参与者在体能评估中得分较低，因为跑步时间较慢（p = 0.002）。在这群健康的年轻成年美国海军陆战队员中，大部分人都患有无症状或轻度急性 COVID-19，其中四分之一的人报告了身体、认知或精神方面的长期感染后遗症。感染 PASC 的海军陆战队员显示出功能表现长期下降的证据，这表明 SARS-CoV-2 感染可能会对相当一部分年轻人的健康产生负面影响。

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引用次数: 0

Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial) 巴西公共卫生系统中 2 型糖尿病患者的远程会诊：随机、实用、开放标签、第 2 阶段、非劣效试验（TELECONSULTA 糖尿病试验）

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100923

Background

This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS.

Methods

TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register—REBEC, under the code RBR-8gpgyd. Study status is “Completed”.

Findings

This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54–68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was −0.6% (90% CI −1.0; −0.1) at 3-months and −0.5% (90% CI −0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups.

Interpretation

The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic.

Funding

This study was funded by the Brazilian Ministry of Health, through the Unified Health System–Institutional Development Support Program (PROADI-SUS).

背景本研究针对 2 型糖尿病日益加重的负担，探讨了远程会诊作为糖尿病管理替代方法的潜力。研究的主要目的是验证一个假设，即对于从初级医疗机构转诊到统一卫生系统内专科医疗机构的 2 型糖尿病患者，在以糖化血红蛋白 (HbA1c) 为指标的血糖控制方面，远程会诊并不优于面对面会诊（两组间 HbA1c 差异的置信区间上限为 0.5%）。方法TELECONSULTA 是一项随机、务实、第 2 阶段、单中心、开放标签、非劣效试验，在巴西儒安维尔进行。共有 278 名确诊为 2 型糖尿病的患者通过初级保健医疗单位的强制性远程咨询服务接受了随机治疗。远程会诊或面对面会诊的随机分配比例为 1:1。该研究已在巴西临床试验注册中心注册，代码为 RBR-8gpgyd。研究状态为 "已完成"。研究结果这项研究的意向治疗（ITT）分析包括 278 名参与者。中位年龄为 61（54-68）岁，167（60%）人为女性。在修正意向治疗（mITT）人群中，组间比较的 HbA1c 平均降幅在 3 个月时为 -0.6% (90% CI -1.0; -0.1)，在 6 个月时为 -0.5% (90% CI -0.9; 0.0)。无缺失数据估算和按方案人群的结果相似。结果强调了远程医疗在全民医疗保健系统框架内解决糖尿病管理复杂问题的变革潜力，为医疗保健政策制定者和从业人员寻求创新解决方案以应对日益严重的糖尿病流行病提供了宝贵的见解。

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引用次数: 0

Elimination of lymphatic filariasis in Brazil: a public health milestone for citizenship 在巴西消灭淋巴丝虫病：公民公共卫生的里程碑

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100922

引用次数: 0

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