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Comprehensive exploration of factors and trends in place of death for cancer patients 全面探讨癌症患者死亡地点的因素和趋势
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lana.2024.100846
Hujian Hong , Yijiang He , Yanli Qu
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引用次数: 0
Forecasting the impact of means restriction on the suicide mortality rate in the Region of the Americas: an ecological modeling study 预测限制经济手段对美洲地区自杀死亡率的影响:生态模型研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lana.2024.100831
Shannon Lange , Kawon V. Kim , Huan Jiang , Kevin D. Shield , Jürgen Rehm , Anselm J.M. Hennis , Renato Oliveira e Souza

Background

The suicide mortality rate has been increasing in Region of the Americas, despite decreasing in all other World Health Organization (WHO) regions. Means restriction is an effective evidence-based intervention for suicide prevention. The objective of the current study was to estimate the impact of implementing national-level means restriction policies (i.e., firearm and pesticide restrictions) on the suicide mortality rate in the Region of the Americas.

Methods

In this ecological modeling study, two counterfactual scenarios were investigated using sex-specific suicide mortality data from the WHO Global Health Estimates database for 2000 to 2019. Forecasted sex-specific age-standardized suicide mortality rates were then estimated for each country for 2020 to 2030. Counterfactual scenario 1 involved modeling the impact of a firearm or pesticide restriction implemented in 2020 for those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, while in counterfactual scenario 2 this threshold was reduced to 20% or more.

Findings

It was estimated that if a firearm or pesticide restriction had been implemented in 2020 in those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, by 2030 the male and female suicide mortality rate in the Region of the Americas would be 20.5% (from 14.5 [95% Confidence Interval [CI]: 14.1, 15.0] per 100,000 males to 11.5 [95% CI: 11.1, 12.0] per 100,000 males) and 11.1% (from 4.5 [95% CI: 4.4, 4.7] per 100,000 females to 4.0 [95% CI: 3.9, 4.2] per 100,000 females) lower than the rate if no such restrictions were implemented, respectively. When the threshold was reduced to 20% or more, minimal additional gains in terms of number of suicides avoided and suicide mortality rate reduction would be achieved.

Interpretation

The implementation of a firearm or pesticide restriction policy in countries where the respective means account for a large proportion of suicides (e.g., at least 40%) could aid the Region of the Americas in achieving the WHO target of a one third reduction in the suicide mortality rate by 2030.

Funding

This work received no funding.

背景世界卫生组织(WHO)所有其他地区的自杀死亡率都在下降,而美洲地区的自杀死亡率却在上升。经济限制是一种有效的预防自杀的循证干预措施。本研究旨在估算实施国家级手段限制政策(即枪支和杀虫剂限制)对美洲地区自杀死亡率的影响。方法在这项生态建模研究中,我们使用世界卫生组织全球健康估计数据库中 2000 年至 2019 年按性别分列的自杀死亡率数据,对两种反事实情景进行了调查。然后对每个国家 2020 年至 2030 年的性别年龄标准化自杀死亡率进行了预测。反事实情景 1 包括模拟 2020 年实施的枪支或杀虫剂限制措施对这些国家的影响,这些国家在 2019 年至少有一种性别的自杀人数中,枪支或杀虫剂占 40% 或以上,而在反事实情景 2 中,这一门槛降低到 20% 或以上。研究结果据估计,如果在 2020 年对 2019 年至少有一种性别的自杀率达到或超过 40% 的国家实施枪支或杀虫剂限制,那么到 2030 年,美洲地区的男性和女性自杀死亡率将为 20.5%(从 14.5 [95% 置信区间 [CI]:14.1, 15.0]):到 2030 年,美洲地区男性和女性自杀死亡率将分别比不实施此类限制的情况下低 20.5%(从每 10 万名男性 14.5 [95% 置信区间 [CI]:14.1,15.0] 降至每 10 万名男性 11.5 [95% CI:11.1,12.0])和 11.1%(从每 10 万名女性 4.5 [95% CI:4.4,4.7] 降至每 10 万名女性 4.0 [95% CI:3.9,4.2])。当阈值降低到 20% 或更高时,在避免自杀人数和降低自杀死亡率方面所取得的额外收益将微乎其微。
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引用次数: 0
Setting the standards for safeguarding health and wellbeing in US Immigration and Customs Enforcement detention facilities 为保障美国移民和海关执法局拘留设施中的健康和福利制定标准
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lana.2024.100851
Rohan Borschmann , Stuart A. Kinner , Kyli Hedrick
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引用次数: 0
María Teresa Bourlon – leading oncology care with compassion and innovation 玛丽亚-特雷莎-布龙--以爱心和创新引领肿瘤治疗
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lana.2024.100858
Taissa Vila
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引用次数: 0
Steatotic liver disease and diabetes: prolific nomenclature, insufficient data, and poor treatment options 脂肪肝与糖尿病:术语繁多、数据不足、治疗方案不佳
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lana.2024.100865
The Lancet Regional Health – Americas
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引用次数: 0
Family financial toxicity of cancer in the United States: implications beyond the individual 美国癌症的家庭财务毒性:超越个人的影响
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-31 DOI: 10.1016/j.lana.2024.100849
Stephanie Wang , Kaitlyn Lapen , Khushi Kohli , Fumiko Chino , Edward Christopher Dee
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引用次数: 0
The expansion of gambling across the Americas poses risks to mental health and wellbeing 赌博在美洲各地的扩张给心理健康和幸福带来风险
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-29 DOI: 10.1016/j.lana.2024.100855
Daria Ukhova , Virve Marionneau , Rachel Volberg , Heather Wardle

The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation’s regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO’s remit.

美洲正面临着严重的心理健康问题。泛美卫生组织的 "改善心理健康和预防自杀地区战略 "是应对这一挑战的重要里程碑。然而,该战略没有关注赌博对健康和福祉的潜在风险,这是一个严重的疏漏。在这一观点中,我们回顾了证明赌博与各种精神健康状况及相关危害之间存在明确联系的现有学术研究。随后,我们以实证为基础,讨论了商业赌博最近是如何在整个地区迅速扩张的,以及这种扩张的风险是如何在政策层面没有得到充分考虑的。然后,我们介绍了该地区新出现的有关赌博扩张对心理健康负面影响的证据。审查最后提出了可能采取的政策行动,以加强对该地区赌博业的控制,减少随之而来的对精神健康和福祉的危害,重点是泛美卫生组织的职权范围。
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引用次数: 0
Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis 在不断变化的气候中进行公共卫生监测的与气候相关的健康影响指标:系统回顾和地方适用性分析
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-29 DOI: 10.1016/j.lana.2024.100854
Yasna Palmeiro-Silva , Raúl Aravena-Contreras , José Izcue Gana , Rocío González Tapia , Ilan Kelman

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.

Funding

This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

气候变化对公共卫生提出了挑战。有效管理与气候相关的健康风险有赖于强有力的公共卫生监测(PHS)和人口健康指标。尽管已有全球和特定国家的指标,但将其纳入当地公共卫生监测系统的程度有限,从而影响了决策。我们对与气候变化影响相关的人口健康指标及其在国家公共卫生监测系统中的适用性进行了系统回顾。在注册协议的指导下,我们搜索了多个数据库,共收录了 41 篇文章。其中 35 篇报告了发病率指标,39 篇报告了死亡率指标。以智利为例,我们为智利的公共卫生服务系统确定了三套指标。优先考虑的指标包括病媒、食物和水传播的疾病,以及与温度相关的健康结果指标,因为这些指标易于整合到现有的公共卫生服务系统中。本综述强调了人口健康指标在监测与气候相关的健康影响方面的重要性,并强调需要根据当地背景因素来指导指标的选择。这些机构均未参与研究的构思、设计或结果解释。
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引用次数: 0
Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis. 巴西小儿脾损伤脾切除术的频率:回顾性分析。
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-28 eCollection Date: 2024-08-01 DOI: 10.1016/j.lana.2024.100844
Luiza Telles, Ayla Gerk, Madeleine Carroll, Matheus Daniel Faleiro, Thais Barbosa de Oliveira, Abbie Naus, Roseanne Ferreira, Fabio Botelho, Joaquim Bustorff-Silva, David P Mooney, Julia Ferreira

Background: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.

Methods: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.

Findings: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.

Interpretation: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

背景:在高收入国家,小儿钝性脾损伤的非手术治疗方法已得到广泛认可,这导致血流动力学稳定的儿童脾切除率较低。脾切除率已成为美国外科学院创伤委员会验证创伤中心的一项质量指标。然而,巴西等不同收入水平国家的儿童脾切除率数据仍然有限。本研究旨在评估过去十年中巴西儿童的创伤后脾脏切除率以及与当地资源的关系:从 FioCruz 数据库中获取了 2008 年至 2019 年小儿脾损伤和脾切除术的数据,包括患者年龄和入院服务(成人或小儿)。儿科外科医生、儿科重症监护室(PICU)床位和计算机断层扫描仪的地区数量来自巴西国家数据库。按入院年份和服务对全国脾脏切除率进行了分析,并按地区资源水平、儿科外科医生数量、儿科重症监护室床位数和计算机断层扫描机数对脾脏切除率进行了分析:共有 4061 名儿童因脾脏损伤住院,其中 2287 名(51.8%)儿童接受了脾脏切除术,这一比例随着时间的推移没有变化。76.8%的脾损伤患者为男性,23.1%为女性。平均年龄为 11.61 岁。与儿科相比,成人外科收治的儿科患者接受脾脏切除术的几率要高出 14.77 倍(OR = 14.77,95% CI 11.75-18.56,P 解释:巴西儿童创伤后脾脏切除率很高,远远超过高收入国家。地区儿科资源的增加与脾切除率的下降并不相称。要了解巴西在采用非手术疗法治疗小儿脾脏损伤方面存在的障碍,必须开展进一步的研究:本研究未从公共、商业或非营利部门的任何资助机构获得特定资助。
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引用次数: 0
The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study 引入快速诊断测试对加拿大北极社区梅毒传播的人群影响--数学建模研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-20 DOI: 10.1016/j.lana.2024.100845
Yiqing Xia , Chelsea Caya , Véronique Morin , Ameeta E. Singh , Bouchra Serhir , Michael Libman , David M. Goldfarb , Tom Wong , Fanyu Xiu , Richard Bélanger , Jean-Sébastien Touchette , Cédric P. Yansouni , Mathieu Maheu-Giroux

Background

Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.

Methods

To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017–2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023–2032.

Findings

The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16–30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18–43%) and 37% (21–46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.

Interpretation

Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.

Funding

Canadian Institutes of Health Research.

背景加拿大北极地区的社区经历了梅毒的持续传播,诊断率比全国平均水平高出18倍。由于远离实验室设施,导致梅毒筛查和治疗之间出现延误,从而助长了梅毒的传播。快速诊断检测可以通过在医疗点进行检测消除治疗延误。为了评估部署快速诊断检测对人群的影响,我们利用详细的监测数据、人口调查和前瞻性诊断准确性实地研究,建立了一个基于个体的模型。该模型根据一个约有 1050 名性活跃人群的社区的梅毒诊断结果(2017-2022 年)进行了校准。利用 2023-2032 年间累计避免的梅毒新感染病例的年中位数,计算了从 2023 年起实施全血快速诊断检测的影响(感染性梅毒的灵敏度为 92%,非感染性梅毒的灵敏度为 81%;特异性为 99%)。16-30 岁男性的检测率比女性低 51%。在所有干预措施保持 2022 年水平不变的情况下,实施快速诊断检测可在 5 年和 10 年内分别避免 33% (90% 可信区间:18-43%)和 37% (21-46%)的梅毒新发感染。在北极社区实施梅毒快速诊断检测可减少感染并加强对流行病的控制。这种有效的诊断工具可以在护理点提供当天的检测和治疗,从而快速应对疫情。
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