Lancet Regional Health-Americas最新文献

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Micronutrient deficiencies according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in 2019: a cross–sectional population–based study 2019年巴拿马6至59个月儿童中与社会人口因素和营养状况有关的微量营养素缺乏症：一项基于人口的横断面研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-07 DOI: 10.1016/j.lana.2024.100932

Alicia Sosa Pedreschi , Flavia Fontes , José R. De León C , Reina Roa , Roger Montenegro Mendoza

Background

Micronutrient deficiencies have serious lifelong consequences. This study aimed to estimate the prevalence of anaemia, iron deficiency anaemia, iron deficiency, and vitamin A deficiency, according to sociodemographic factors and nutritional status among Panamanian children aged six to 59 months in 2019.

Methods

We used data from the National Health Survey of Panama (ENSPA), a population–based, cross–sectional study, with a nationally representative subsample to evaluate haemoglobin, C–reactive protein (CRP), ferritin, and retinol levels among children aged six to 59 months. The data are shown weighted.

Findings

A total of 625 children representing a population of 62,100 children (females 45.0%, 27,971/62,100; 95% CI: 37.3–53.1), aged six to 59 months were assessed. Nationally, the prevalence of anaemia was 15.5% (9604/62,100; 95% CI: 11.5–20.6), iron deficiency anaemia was 8.0% (4950/62,100; 95% CI: 5.1–12.2), iron deficiency was 26.2% (16,259/62,100; 95% CI: 20.7–32.5), and vitamin A deficiency was 3.4% (2087/62,100; 95% CI: 2.1–5.3). Children from indigenous areas exhibited a higher prevalence of all micronutrient deficiencies studied, and nationally 40.9% (2316/5656; 95% CI: 22.1–62.9) of the children with overweight/obesity exhibited at least one micronutrient deficiency.

Interpretation

Our results highlight important disparities in the prevalence of nutritional deficiencies among children in different living areas. Public health strategies should focus on these vulnerable populations, as the first years of life are crucial for adequate growth and development.

Funding

This work was supported by an institutional research grant via the Ministry of Economy and Finance of Panama (019910.002). The ENSPA study was funded by the Inter-American Development Bank.

背景微量营养素缺乏会造成严重的终身后果。本研究旨在根据社会人口因素和营养状况，估算2019年巴拿马6至59个月儿童中贫血、缺铁性贫血、缺铁和维生素A缺乏症的患病率。方法我们使用了巴拿马全国健康调查（ENSPA）的数据，这是一项基于人口的横断面研究，在全国范围内具有代表性的子样本中评估了6至59个月儿童的血红蛋白、C反应蛋白（CRP）、铁蛋白和视黄醇水平。对 6 至 59 个月大的 625 名儿童进行了评估，这些儿童代表了 62100 名儿童（女性占 45.0%，27971/62100；95% CI：37.3-53.1）。全国贫血患病率为 15.5%（9604/62100；95% CI：11.5-20.6），缺铁性贫血为 8.0%（4950/62100；95% CI：5.1-12.2），缺铁为 26.2%（16259/62100；95% CI：20.7-32.5），维生素 A 缺乏为 3.4%（2087/62100；95% CI：2.1-5.3）。在全国范围内，40.9%（2316/5656；95% CI：22.1-62.9）的超重/肥胖儿童表现出至少一种微量营养素缺乏。公共卫生策略应重点关注这些弱势群体，因为生命最初几年对于适当的生长和发育至关重要。经费来源这项工作得到了巴拿马经济和财政部机构研究基金（019910.002）的支持。ENSPA 研究由美洲开发银行资助。

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引用次数: 0

Female homicides in Brazil: global burden of disease study, 2000–2018 巴西的女性凶杀案：2000-2018 年全球疾病负担研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-07 DOI: 10.1016/j.lana.2024.100935

Nadia Machado de Vasconcelos , Juliana Bottoni de Souza , Adauto Martins Soares Filho , Polyanna Helena Coelho , Sofia Reinach , Caroline Stein , Crizian Saar Gomes , Luisa Sorio Flor , Emmanuela Gakidou , Antonio Luiz Pinho Ribeiro , Deborah Carvalho Malta

Background

Female homicides are a public health-relevant issue, and its spatial distribution may evidence socioeconomic vulnerabilities. This study aims to analyze the temporal and spatial trends of female homicides in Brazil and investigate socioeconomic-demographic factors associated with it.

Methods

This is an ecological, descriptive, and analytical epidemiological study investigating the age-standardized female homicide rate in all Brazilian municipalities between 2000 and 2018, divided into three periods. Spatial and temporal analyses were conducted using the Global Moran's Index and LISA to identify clusters of high and low rates. Rates were also calculated by population size and means of violence across macro-regions. For the last period, a multivariable linear regression model analyzed the association of female homicide rates with social, economic, and geographic factors.

Findings

Female homicide rates in Brazil remained high during the studied period, with differences in trends between regions. Among the potentially associated factors, it was observed that male homicide rate, the high percentage of violent deaths among black women and those with low levels of education, in addition to the low Gross Domestic Product (GDP) per capita, were positively associated with female homicide, whereas larger cities were negatively associated.

Interpretation

These findings show that Brazil is a country with a high risk of female homicide. Nevertheless, the vulnerability of women is unequally distributed in the country. Female homicides are mostly caused by domestic conflicts but can also be influenced by changes in the urban and social contexts.

Funding

This project is funded by the Bill & Melinda Gates Foundation.

背景女性凶杀案是一个与公共卫生相关的问题，其空间分布可能证明了社会经济的脆弱性。本研究旨在分析巴西女性凶杀案的时间和空间趋势，并调查与之相关的社会经济-人口因素。方法这是一项生态学、描述性和分析性流行病学研究，调查了 2000 年至 2018 年期间巴西所有城市的年龄标准化女性凶杀案发生率，分为三个时期。使用全球莫兰指数和 LISA 进行了空间和时间分析，以确定高比率和低比率的集群。此外，还按人口规模和宏观区域的暴力指数计算了比率。在最后一段时期，一个多变量线性回归模型分析了女性凶杀率与社会、经济和地理因素之间的关联。研究结果在研究期间，巴西的女性凶杀率居高不下，不同地区之间的趋势存在差异。在可能相关的因素中，除了人均国内生产总值（GDP）低之外，男性杀人率、黑人妇女和受教育程度低的妇女暴力死亡比例高与女性杀人案呈正相关，而大城市则呈负相关。然而，妇女的脆弱性在全国的分布并不均衡。女性凶杀案主要由家庭冲突引起，但也可能受到城市和社会环境变化的影响。

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引用次数: 0

Surge of mental health issues of Chinese Americans under both popular and policy-driven racism 在民众和政策驱动的种族主义下，美国华裔的心理健康问题激增

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-06 DOI: 10.1016/j.lana.2024.100941

Xiang Qi

引用次数: 0

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

Orison O. Woolcott

引用次数: 0

Digital mental health interventions: an opportunity to enhance care while preserving human connection 数字心理健康干预：加强护理同时保持人与人之间联系的机会

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-01 DOI: 10.1016/j.lana.2024.100940

Daisy R. Singla

引用次数: 0

Living in a high-tech world yet dragging an ancient problem: water insecurity 生活在高科技世界，却要面对一个古老的问题：水不安全

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-01 DOI: 10.1016/j.lana.2024.100951

The Lancet Regional Health – Americas

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

Elisa Pucu

引用次数: 0

Perinatal risk factors in ex-preterm and/or low birthweight Colombian young adults: a retrospective cohort study on auditory and visual impairments 哥伦比亚早产儿和/或低出生体重儿的围产期风险因素：关于听觉和视觉障碍的回顾性队列研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-11-01 DOI: 10.1016/j.lana.2024.100921

Nathalie Charpak , Adriana Montealegre-Pomar , Lyda Teresa Rosero , Catalina Lince-Rivera , Darwin Cortés

Background

Advances in neonatal care have increased survival rates for premature or low birth weight (LBW) infants but raised concerns about long-term neurosensory and psychomotor challenges. Objective: to investigate perinatal factors linked to visual and auditory problems in ex-preterm or LBW young adults, assessing their long-term quality of life.

Methods

Participants from a 20-year-old randomised controlled trial comparing Kangaroo-Mother Care (KMC) to conventional care were re-enrolled. A group of 50 at term individuals without risk factors was assessed as a reference group.

Findings

5.9% of participants had functional visual issues and 8.1% experienced hearing problems. Those with hearing or visual impairments had longer hospital stays and more neonatal complications. Correlations were found between Griffiths auditory sub-scale results at 6 months and long-term auditory outcomes. Only 27.5% of those with deafness had access to cochlear implants or hearing aids, resulting in lower IQ scores, learning difficulties, and increased risk of depression and self-harm. Participants with visual impairments exhibited lower IQ scores, self-esteem, and HOME test acceptance. However, they did not differ from the group with normal vision in terms of quality of life, depression, or attachment scores. All participants, whether they had issues or not, rated their quality of life higher than their parents did.

Interpretation

Preterm or LBW infants with visual and hearing deficits are more likely to face cognitive and emotional challenges in adulthood. This study underscores the importance of a multidisciplinary approach to promptly address these vulnerabilities, reducing the risk of long-term neurodevelopmental and functional issues.

Funding

The Grand Challenge Canada, Fulbright Colciencias and Colombia Cientifica – Alianza, The World Bank, managed by the Colombian Administrative Department of Science, Technology and Innovation (COLCIENCIAS).

背景：新生儿护理的进步提高了早产儿或低出生体重儿（LBW）的存活率，但也引发了对长期神经感觉和精神运动挑战的担忧。目标：调查与早产儿或低出生体重儿的视觉和听觉问题有关的围产期因素，评估他们的长期生活质量。方法：重新登记一项对比了袋鼠妈妈护理（Kangaroo-Mother Care，KMC）和传统护理的 20 年随机对照试验的参与者。结果5.9%的参与者有功能性视力问题，8.1%的参与者有听力问题。有听力或视力障碍者的住院时间更长，新生儿并发症也更多。6个月时的格里菲斯听力分量表结果与长期听力结果之间存在相关性。只有27.5%的耳聋患者可以使用人工耳蜗或助听器，这导致他们的智商分数较低，学习困难，抑郁和自残的风险增加。视力受损者的智商分数、自尊心和家庭测试接受度都较低。然而，在生活质量、抑郁或依恋评分方面，他们与视力正常的群体并无差异。所有参与者，无论他们是否有问题，对自己生活质量的评价都高于他们的父母。释义有视力和听力缺陷的早产儿或低体重儿在成年后更有可能面临认知和情感方面的挑战。这项研究强调了采用多学科方法及时解决这些问题的重要性，从而降低出现长期神经发育和功能问题的风险。资金来源加拿大大挑战、富布赖特-哥伦比亚和哥伦比亚科学-联盟、世界银行，由哥伦比亚科学、技术和创新管理部（COLCIENCIAS）管理。

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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

Bráulio Evangelista de Lima , Mila Alves Matos Rodrigues , Marília Santos Andrade , Rodrigo Luiz Vancini , Claudio Andre Barbosa de Lira

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

Alice Zwerling , Edwina Veerasingam , Ellen Snyder , Andrea Schertzer , Keith Travers , Carolyn Pim , Chris Pease , Sandy Finn , Linette McElroy , Jean Allen , Mike Patterson , Gonzalo G. Alvarez

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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