Pub Date : 2024-10-23DOI: 10.1016/j.lana.2024.100912
{"title":"Strengthening perinatal mental health is a requirement to reduce maternal and newborn mortality","authors":"","doi":"10.1016/j.lana.2024.100912","DOIUrl":"10.1016/j.lana.2024.100912","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.lana.2024.100920
Background
Intimate partner violence (IPV) against women is a global health issue and a breach of human rights. However, the literature lacks understanding of how socioeconomic and geographic disparities influence women's attitudes toward IPV in Guyana over time. This study aimed to assess trends in women's attitudes about IPV in Guyana.
Methods
Data from three nationally representative surveys from 2009, 2014 to 2019 were analysed. The prevalence of women's attitudes about IPV was assessed, specifically in response to going out without telling their partners, neglecting their children, arguing with their partner, refusing sex with their partner, or burning food prepared for family meals. A series of stratified subgroup analyses were also completed. We assessed trends in IPV using the slope index of inequality (SII) and the concentration index of inequality (CIX). We used multilevel mixed-effects logistic regression to assess factors associated with women's attitudes justifying IPV.
Findings
The prevalence of women's attitudes justifying IPV for any of the five reasons declined from 16.4% (95% CI: 15.1–17.8) in 2009 to 10.8% (95% CI: 9.7–12.0) in 2019. Marked geographic and socioeconomic inequalities were observed among subgroups. The SII for any of the five reasons decreased from −20.02 to −14.28, while the CIX remained constant over time. Key factors associated with women's attitudes about IPV were area of residence, sex of the household head, marital status, respondent's level of education, wealth index quintile, and the frequency of reading newspapers/magazines.
Interpretation
From 2009 to 2019, Guyana was able to reduce women's attitudes justifying IPV against women by 34.1% and shortened subgroup inequalities. However, the prevalence remained high in 2019, with persisted inequalities among subgroups. Effective strategies, including the use of media to raise awareness, promotion of community-based approaches, and educational campaigns focusing on geographic and socioeconomic disparities, are essential for continuing to reduce the prevalence of IPV and associated inequalities.
Funding
The study was funded in part by the National Institutes of Health, Fogarty International Center grant number D43TW012189.
{"title":"Women's attitudes towards intimate partner violence in Guyana: a population-based study","authors":"","doi":"10.1016/j.lana.2024.100920","DOIUrl":"10.1016/j.lana.2024.100920","url":null,"abstract":"<div><h3>Background</h3><div>Intimate partner violence (IPV) against women is a global health issue and a breach of human rights. However, the literature lacks understanding of how socioeconomic and geographic disparities influence women's attitudes toward IPV in Guyana over time. This study aimed to assess trends in women's attitudes about IPV in Guyana.</div></div><div><h3>Methods</h3><div>Data from three nationally representative surveys from 2009, 2014 to 2019 were analysed. The prevalence of women's attitudes about IPV was assessed, specifically in response to going out without telling their partners, neglecting their children, arguing with their partner, refusing sex with their partner, or burning food prepared for family meals. A series of stratified subgroup analyses were also completed. We assessed trends in IPV using the slope index of inequality (SII) and the concentration index of inequality (CIX). We used multilevel mixed-effects logistic regression to assess factors associated with women's attitudes justifying IPV.</div></div><div><h3>Findings</h3><div>The prevalence of women's attitudes justifying IPV for any of the five reasons declined from 16.4% (95% CI: 15.1–17.8) in 2009 to 10.8% (95% CI: 9.7–12.0) in 2019. Marked geographic and socioeconomic inequalities were observed among subgroups. The SII for any of the five reasons decreased from −20.02 to −14.28, while the CIX remained constant over time. Key factors associated with women's attitudes about IPV were area of residence, sex of the household head, marital status, respondent's level of education, wealth index quintile, and the frequency of reading newspapers/magazines.</div></div><div><h3>Interpretation</h3><div>From 2009 to 2019, Guyana was able to reduce women's attitudes justifying IPV against women by 34.1% and shortened subgroup inequalities. However, the prevalence remained high in 2019, with persisted inequalities among subgroups. Effective strategies, including the use of media to raise awareness, promotion of community-based approaches, and educational campaigns focusing on geographic and socioeconomic disparities, are essential for continuing to reduce the prevalence of IPV and associated inequalities.</div></div><div><h3>Funding</h3><div>The study was funded in part by the <span>National Institutes of Health</span>, <span>Fogarty International Center</span> grant number <span><span>D43TW012189</span></span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.lana.2024.100924
{"title":"Inequality through the pipeline: racial and ethnic disparities remain in U.S. kidney transplantation","authors":"","doi":"10.1016/j.lana.2024.100924","DOIUrl":"10.1016/j.lana.2024.100924","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.lana.2024.100910
<div><h3>Background</h3><div>People with disabilities are at elevated risk of adverse short-term outcomes following hospitalization for acute infectious illness. No prior studies have compared long-term healthcare use among this high-risk population. We compared the healthcare use of adults with disabilities in the one year following hospitalization for COVID-19 vs. sepsis vs. influenza.</div></div><div><h3>Methods</h3><div>We performed a population-based cohort study using linked clinical and health administrative databases in Ontario, Canada of all adults with pre-existing disability (physical, sensory, or intellectual) hospitalized for COVID-19 (n = 22,551, median age 69 [IQR 57–79], 47.9% female) or sepsis (n = 100,669, median age 77 [IQR 66–85], 54.8% female) between January 25, 2020, and February 28, 2022, and for influenza (n = 11,216, median age 78 [IQR 67–86], 54% female) or sepsis (n = 49,326, median age 72 [IQR 62–82], 45.8% female) between January 1, 2014 and March 25, 2019. The exposure was hospitalization for laboratory-confirmed SARS-CoV-2 or influenza, or sepsis (not secondary to COVID-19 or influenza). Outcomes were ambulatory care visits, diagnostic testing, emergency department visits, hospitalization, palliative care visits and death within 1 year. Rates of these outcomes were compared across exposure groups using propensity-based overlap weighted Poisson and Cox proportional hazards models.</div></div><div><h3>Findings</h3><div>Among older adults with pre-existing disability, hospitalization for COVID-19 was associated with lower rates of ambulatory care visits (adjusted rate ratio (aRR) 0.88, 95% confidence interval (CI), 0.87–0.90), diagnostic testing (aRR 0.86, 95% CI, 0.84–0.89), emergency department visits (aRR 0.91, 95% CI, 0.84–0.97), hospitalization (aRR 0.74, 95% CI, 0.71–0.77), palliative care visits (aRR 0.71, 95% CI, 0.62–0.81) and low hazards of death (adjusted hazard ratio (aHR) 0.71, 95% 0.68–0.75), compared to hospitalization for sepsis during the COVID-19 pandemic. Rates of healthcare use among those hospitalized for COVID-19 varied compared to those hospitalized for influenza or sepsis prior to the pandemic.</div></div><div><h3>Interpretation</h3><div>This study of older adults with pre-existing disabilities hospitalized for acute infectious illness found that COVID-19 was not associated with higher rates of healthcare use or mortality over the one year following hospital discharge compared to those hospitalized for sepsis. However, hospitalization for COVID-19 was associated with higher rates of ambulatory care use and mortality when compared to influenza. As COVID-19 enters an endemic phase, the associated long-term health resource use and risks in the contemporary era are reassuringly similar to sepsis and influenza, even among people with pre-existing disabilities.</div></div><div><h3>Funding</h3><div>This study was supported by <span>ICES</span>, which is funded by an annual grant from the <span>Ontario
{"title":"Comparison of long-term healthcare use among older adults with disabilities following hospitalization for COVID-19, sepsis, or influenza: a population-based cohort study","authors":"","doi":"10.1016/j.lana.2024.100910","DOIUrl":"10.1016/j.lana.2024.100910","url":null,"abstract":"<div><h3>Background</h3><div>People with disabilities are at elevated risk of adverse short-term outcomes following hospitalization for acute infectious illness. No prior studies have compared long-term healthcare use among this high-risk population. We compared the healthcare use of adults with disabilities in the one year following hospitalization for COVID-19 vs. sepsis vs. influenza.</div></div><div><h3>Methods</h3><div>We performed a population-based cohort study using linked clinical and health administrative databases in Ontario, Canada of all adults with pre-existing disability (physical, sensory, or intellectual) hospitalized for COVID-19 (n = 22,551, median age 69 [IQR 57–79], 47.9% female) or sepsis (n = 100,669, median age 77 [IQR 66–85], 54.8% female) between January 25, 2020, and February 28, 2022, and for influenza (n = 11,216, median age 78 [IQR 67–86], 54% female) or sepsis (n = 49,326, median age 72 [IQR 62–82], 45.8% female) between January 1, 2014 and March 25, 2019. The exposure was hospitalization for laboratory-confirmed SARS-CoV-2 or influenza, or sepsis (not secondary to COVID-19 or influenza). Outcomes were ambulatory care visits, diagnostic testing, emergency department visits, hospitalization, palliative care visits and death within 1 year. Rates of these outcomes were compared across exposure groups using propensity-based overlap weighted Poisson and Cox proportional hazards models.</div></div><div><h3>Findings</h3><div>Among older adults with pre-existing disability, hospitalization for COVID-19 was associated with lower rates of ambulatory care visits (adjusted rate ratio (aRR) 0.88, 95% confidence interval (CI), 0.87–0.90), diagnostic testing (aRR 0.86, 95% CI, 0.84–0.89), emergency department visits (aRR 0.91, 95% CI, 0.84–0.97), hospitalization (aRR 0.74, 95% CI, 0.71–0.77), palliative care visits (aRR 0.71, 95% CI, 0.62–0.81) and low hazards of death (adjusted hazard ratio (aHR) 0.71, 95% 0.68–0.75), compared to hospitalization for sepsis during the COVID-19 pandemic. Rates of healthcare use among those hospitalized for COVID-19 varied compared to those hospitalized for influenza or sepsis prior to the pandemic.</div></div><div><h3>Interpretation</h3><div>This study of older adults with pre-existing disabilities hospitalized for acute infectious illness found that COVID-19 was not associated with higher rates of healthcare use or mortality over the one year following hospital discharge compared to those hospitalized for sepsis. However, hospitalization for COVID-19 was associated with higher rates of ambulatory care use and mortality when compared to influenza. As COVID-19 enters an endemic phase, the associated long-term health resource use and risks in the contemporary era are reassuringly similar to sepsis and influenza, even among people with pre-existing disabilities.</div></div><div><h3>Funding</h3><div>This study was supported by <span>ICES</span>, which is funded by an annual grant from the <span>Ontario","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.lana.2024.100915
Background
Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery.
Methods
The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014–2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported.
Findings
Of 2032 subjects (age: mean = 41.4-years, range = 17–89-years; male = 71% female = 29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale = 6 vs. 15; midline shift ≥5 mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p < 0.0001). Median time-to-craniectomy/craniotomy was 1.8 h (interquartile range = 1.1–5.0 h), and 67% underwent intracranial pressure monitoring. Seventy-three percent of subjects with decompressive craniectomy and 58% of subjects with craniotomy had ≥3 intracranial lesion types. Decompressive craniectomy (vs. craniotomy) was associated with intracranial injury severity (median Rotterdam Score = 4 vs. 3, p < 0.0001), intensive care length of stay (median = 13 vs. 4-days, p = 0.0002), and six-month unfavourable outcome (62% vs. 30%; p = 0.0001). Earlier time-to-craniectomy was associated with intracranial injury severity.
Interpretation
In a large representative cohort of patients hospitalised with TBI, surgical decision-making and time-to-surgery aligned with intracranial injury severity. Multifocal TBIs predominated in patients with cranial surgery. These findings summarise current TBI surgical practice across US trauma centres and provide the foundation for analyses in targeted subpopulations.
Funding
National Institute of Neurological Disorders and Stroke; US Department of Defense; Neurosurgery Research and Education Foundation.
背景当代治疗创伤性脑损伤（TBI）的手术方法仍不明确。方法前瞻性、观察性的 "创伤性脑损伤研究与临床知识转化研究"（2014-2018；ClinicalTrials.gov #NCT02119182）招募了在创伤后 24 小时内前往创伤中心并接受头部计算机断层扫描的受试者。我们对年龄≥17岁的住院受试者进行了二次数据分析。结果在2032名受试者中（年龄：平均=41.4岁，范围=17-89岁；男性=71%，女性=29%），260人接受了颅骨手术，其中65%为减压开颅术，23%为开颅术，12%为其他手术。接受手术的受试者（与未接受手术的受试者相比）的神经损伤更严重（格拉斯哥昏迷量表中位数 = 6 vs. 15；中线移位≥5 mm：48% vs. 2%；蝶骨脱出：61% vs. 4%；P＜0.05）：61% vs. 4%; p < 0.0001）。颅骨切除术/开颅术的中位时间为1.8小时（四分位间范围=1.1-5.0小时），67%的受试者接受了颅内压监测。73%的减压开颅手术受试者和58%的开颅手术受试者颅内病变类型≥3种。减压开颅术（与开颅术相比）与颅内损伤严重程度（鹿特丹评分中位数 = 4 vs. 3，p < 0.0001）、重症监护住院时间（中位数 = 13 vs. 4 天，p = 0.0002）和六个月的不良预后（62% vs. 30%；p = 0.0001）有关。在一个具有代表性的大型创伤性脑损伤住院患者队列中，手术决策和手术时间与颅内损伤严重程度相关。接受颅脑手术的患者以多灶性创伤为主。这些发现总结了目前美国各创伤中心的创伤性脑损伤手术实践，并为有针对性的亚人群分析奠定了基础。
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Pub Date : 2024-10-17DOI: 10.1016/j.lana.2024.100917
{"title":"Confronting Mpox in Brazil amid global spread of clade Ib","authors":"","doi":"10.1016/j.lana.2024.100917","DOIUrl":"10.1016/j.lana.2024.100917","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.lana.2024.100911
{"title":"Promoting climate-resilient health systems through national surgical plans","authors":"","doi":"10.1016/j.lana.2024.100911","DOIUrl":"10.1016/j.lana.2024.100911","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.lana.2024.100913
{"title":"Fires in Brazil: health crises and the failure of government action","authors":"","doi":"10.1016/j.lana.2024.100913","DOIUrl":"10.1016/j.lana.2024.100913","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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