Pub Date : 2024-10-16DOI: 10.1016/j.lana.2024.100908
This scoping review assessed the surgical backlog in Latin America and the Caribbean (LAC) due to COVID-19 and identified mitigation strategies. We searched seven databases for citations from December 2019 to December 2022, focusing on LAC patients with cancelled or postponed procedures. We registered our protocol at Open Science Framework (https://osf.io/x2nd8) and adhered to PRISMA-ScR guidelines. We included 83 citations covering 23 LAC countries and 19 surgical specialities, with Brazil (67%, 56/83) and transplant surgery (24%, 20/83) being the most documented. Surgical backlogs were mainly reported at the hospital (44%, 37/83) and national levels (38%, 32/83). We identified 58 citations that reported a total of 42 strategies to mitigate the backlog, the most cited being establishing prioritisation criteria for surgical cases (41%, 24/58). Our findings highlight challenges across differing healthcare systems in LAC, including disparities in data availability, surgical capacity, and resource allocation. For instance, while countries like Brazil had extensive data on national surgical backlogs, others lacked comprehensive national-level data. Our review can help inform policymakers and healthcare stakeholders to implement targeted interventions to prepare LAC-based surgical systems for future health emergencies.
{"title":"Examining the surgical backlog due to COVID-19 in Latin America and the Caribbean: insights from a scoping review","authors":"","doi":"10.1016/j.lana.2024.100908","DOIUrl":"10.1016/j.lana.2024.100908","url":null,"abstract":"<div><div>This scoping review assessed the surgical backlog in Latin America and the Caribbean (LAC) due to COVID-19 and identified mitigation strategies. We searched seven databases for citations from December 2019 to December 2022, focusing on LAC patients with cancelled or postponed procedures. We registered our protocol at Open Science Framework (<span><span>https://osf.io/x2nd8</span><svg><path></path></svg></span>) and adhered to PRISMA-ScR guidelines. We included 83 citations covering 23 LAC countries and 19 surgical specialities, with Brazil (67%, 56/83) and transplant surgery (24%, 20/83) being the most documented. Surgical backlogs were mainly reported at the hospital (44%, 37/83) and national levels (38%, 32/83). We identified 58 citations that reported a total of 42 strategies to mitigate the backlog, the most cited being establishing prioritisation criteria for surgical cases (41%, 24/58). Our findings highlight challenges across differing healthcare systems in LAC, including disparities in data availability, surgical capacity, and resource allocation. For instance, while countries like Brazil had extensive data on national surgical backlogs, others lacked comprehensive national-level data. Our review can help inform policymakers and healthcare stakeholders to implement targeted interventions to prepare LAC-based surgical systems for future health emergencies.</div></div>","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":"142441047","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 : 2024-10-15DOI: 10.1016/j.lana.2024.100901
Background
HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening.
Methods
We conducted a nationwide web-based survey of individuals aged 21–70 years in 2022 and oversampled under-screened individuals. We used five Canadian-validated scales to measure HPV test-based screening knowledge, attitudes, and beliefs. Using the multistage Precaution Adoption Process Model, we assessed women's stage of intentions to participate in HPV testing and self-sampling. We estimated associations of psychosocial factors with intentions' stage using multinomial logistic regression.
Findings
In both groups (adequately screened n = 1778; under-screened n = 1570), higher HPV knowledge was associated with intention for HPV testing and more personal barriers to the HPV test were associated with lower intentions to participate in HPV testing or use of self-sampling. In both groups, higher self-sampling concerns were associated with lower intentions for self-sampling and higher women's need for autonomy was associated with increased intentions for self-sampling. In the under-screened group, increased age was associated with lower intentions for HPV testing and self-sampling, while living in Canada for <10 years was associated with higher intentions.
Interpretation
Our results could be used by policymakers and healthcare professionals to design communication strategies and ensure a smooth transition to HPV-based primary cervical screening, especially for under-screened individuals.
Funding
Canadian Institutes of Health Research project grant 165905.
{"title":"On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening","authors":"","doi":"10.1016/j.lana.2024.100901","DOIUrl":"10.1016/j.lana.2024.100901","url":null,"abstract":"<div><h3>Background</h3><div>HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening.</div></div><div><h3>Methods</h3><div>We conducted a nationwide web-based survey of individuals aged 21–70 years in 2022 and oversampled under-screened individuals. We used five Canadian-validated scales to measure HPV test-based screening knowledge, attitudes, and beliefs. Using the multistage Precaution Adoption Process Model, we assessed women's stage of intentions to participate in HPV testing and self-sampling. We estimated associations of psychosocial factors with intentions' stage using multinomial logistic regression.</div></div><div><h3>Findings</h3><div>In both groups (adequately screened n = 1778; under-screened n = 1570), higher HPV knowledge was associated with intention for HPV testing and more personal barriers to the HPV test were associated with lower intentions to participate in HPV testing or use of self-sampling. In both groups, higher self-sampling concerns were associated with lower intentions for self-sampling and higher women's need for autonomy was associated with increased intentions for self-sampling. In the under-screened group, increased age was associated with lower intentions for HPV testing and self-sampling, while living in Canada for <10 years was associated with higher intentions.</div></div><div><h3>Interpretation</h3><div>Our results could be used by policymakers and healthcare professionals to design communication strategies and ensure a smooth transition to HPV-based primary cervical screening, especially for under-screened individuals.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span> project grant 165905.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441474","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 : 2024-10-12DOI: 10.1016/j.lana.2024.100906
Background
Sweetened beverage taxes are associated with large decreases in sugar-sweetened beverage sales, but their effects on weight outcomes are unclear. We examined associations of the 2017 Philadelphia beverage tax with changes in adult weight outcomes.
Methods
We obtained electronic health record data on adults 18–65 years old in Philadelphia (intervention) and other areas of Pennsylvania and New Jersey (control) from 2014 to 2019. Controlled interrupted time series models compared post-tax changes in trends of body mass index (BMI, primary outcome) and obesity prevalence (secondary outcome). A panel sample comprised 175,675 adults with at least one BMI measure in both the pre-tax (2014–2016) and post-tax (2017–2019) periods. A cross-sectional sample comprised 587,121 adults with at least one BMI measure from 2014 to 2019.
Findings
Before tax implementation, Philadelphia panel patients had a mean BMI of 30.4 kg/m2 and an obesity prevalence of 44.5%. After implementation, in the panel sample, there was a −0.03 kg/m2 (95% CI: −0.07, 0.02) per quarter decrease in BMI vs. control, implying a −0.32 kg/m2 (−0.85, 0.20) change at the end of the 3-year study period. In the cross-sectional sample, there was a −0.05 kg/m2 (95% CI: −0.09, −0.01) per quarter decrease in BMI vs. control, implying a −0.60 kg/m2 (−1.04, −0.16) change at the end of the study period. Results for obesity prevalence were consistent with the BMI results.
Interpretation
There was some limited evidence of a decrease in BMI and obesity prevalence in Philadelphia 3 years after beverage tax implementation. Replication of these results is needed.
{"title":"Associations of the Philadelphia sweetened beverage tax with changes in adult body weight: an interrupted time series analysis","authors":"","doi":"10.1016/j.lana.2024.100906","DOIUrl":"10.1016/j.lana.2024.100906","url":null,"abstract":"<div><h3>Background</h3><div>Sweetened beverage taxes are associated with large decreases in sugar-sweetened beverage sales, but their effects on weight outcomes are unclear. We examined associations of the 2017 Philadelphia beverage tax with changes in adult weight outcomes.</div></div><div><h3>Methods</h3><div>We obtained electronic health record data on adults 18–65 years old in Philadelphia (intervention) and other areas of Pennsylvania and New Jersey (control) from 2014 to 2019. Controlled interrupted time series models compared post-tax changes in trends of body mass index (BMI, primary outcome) and obesity prevalence (secondary outcome). A panel sample comprised 175,675 adults with at least one BMI measure in both the pre-tax (2014–2016) and post-tax (2017–2019) periods. A cross-sectional sample comprised 587,121 adults with at least one BMI measure from 2014 to 2019.</div></div><div><h3>Findings</h3><div>Before tax implementation, Philadelphia panel patients had a mean BMI of 30.4 kg/m<sup>2</sup> and an obesity prevalence of 44.5%. After implementation, in the panel sample, there was a −0.03 kg/m<sup>2</sup> (95% CI: −0.07, 0.02) per quarter decrease in BMI vs. control, implying a −0.32 kg/m<sup>2</sup> (−0.85, 0.20) change at the end of the 3-year study period. In the cross-sectional sample, there was a −0.05 kg/m<sup>2</sup> (95% CI: −0.09, −0.01) per quarter decrease in BMI vs. control, implying a −0.60 kg/m<sup>2</sup> (−1.04, −0.16) change at the end of the study period. Results for obesity prevalence were consistent with the BMI results.</div></div><div><h3>Interpretation</h3><div>There was some limited evidence of a decrease in BMI and obesity prevalence in Philadelphia 3 years after beverage tax implementation. Replication of these results is needed.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428556","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 : 2024-10-10DOI: 10.1016/j.lana.2024.100894
Background
We aimed to examine factors associated with prenatal syphilis, including prenatal care, and pregnancy outcomes of pregnant women with HIV in Brazil.
Methods
Retrospective data were gathered from a national cohort of Brazilian women with HIV on antiretroviral therapy who became pregnant between January 2015 and May 2018. Prenatal syphilis was defined by clinical diagnoses with treatment or any positive syphilis laboratory result between 30 days before conception and pregnancy conclusion. Multivariable logistic regression models examined factors associated with prenatal syphilis risk and adverse pregnancy outcomes (including stillbirth, abortion, preterm delivery, small for gestational age, and congenital abnormalities). Receipt of recommended prenatal syphilis screening and adequacy of prenatal care were also evaluated.
Findings
Among 2169 women, 166 (7.77% [95% CI: 6.5–8.8%]) had prenatal syphilis, of whom 151 (91%) had documented treatment. Prevalence of prenatal syphilis was higher among women of Black/Pardo/Indigenous race (13.7/7.7/8.3% vs. 5.8% in White women), those of younger age (median age 25.9 years vs. 27.6 in total cohort) and those with crack/cocaine use during/before pregnancy (20%). Of 1042/2169 women with prenatal care and screening data, 475 (46%) received inadequate prenatal care and only 301 (29%) received the recommended antenatal syphilis screening. Prenatal syphilis was not associated with adverse pregnancy outcomes (aOR 0.91 [0.64–1.30]).
Interpretation
Prenatal syphilis was prevalent in this cohort of pregnant women with HIV. Prenatal syphilis was not associated with adverse pregnancy outcomes. Attention to syphilis prevention and treatment is especially needed in marginalised women.
Funding
Brazilian Ministry of Health and United States’ National Institutes of Health.
{"title":"Prenatal syphilis and adverse pregnancy outcomes in women with HIV receiving ART in Brazil: a population-based study","authors":"","doi":"10.1016/j.lana.2024.100894","DOIUrl":"10.1016/j.lana.2024.100894","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to examine factors associated with prenatal syphilis, including prenatal care, and pregnancy outcomes of pregnant women with HIV in Brazil.</div></div><div><h3>Methods</h3><div>Retrospective data were gathered from a national cohort of Brazilian women with HIV on antiretroviral therapy who became pregnant between January 2015 and May 2018. Prenatal syphilis was defined by clinical diagnoses with treatment or any positive syphilis laboratory result between 30 days before conception and pregnancy conclusion. Multivariable logistic regression models examined factors associated with prenatal syphilis risk and adverse pregnancy outcomes (including stillbirth, abortion, preterm delivery, small for gestational age, and congenital abnormalities). Receipt of recommended prenatal syphilis screening and adequacy of prenatal care were also evaluated.</div></div><div><h3>Findings</h3><div>Among 2169 women, 166 (7.77% [95% CI: 6.5–8.8%]) had prenatal syphilis, of whom 151 (91%) had documented treatment. Prevalence of prenatal syphilis was higher among women of Black/<em>Pardo</em>/Indigenous race (13.7/7.7/8.3% vs. 5.8% in White women), those of younger age (median age 25.9 years vs. 27.6 in total cohort) and those with crack/cocaine use during/before pregnancy (20%). Of 1042/2169 women with prenatal care and screening data, 475 (46%) received inadequate prenatal care and only 301 (29%) received the recommended antenatal syphilis screening. Prenatal syphilis was not associated with adverse pregnancy outcomes (aOR 0.91 [0.64–1.30]).</div></div><div><h3>Interpretation</h3><div>Prenatal syphilis was prevalent in this cohort of pregnant women with HIV. Prenatal syphilis was not associated with adverse pregnancy outcomes. Attention to syphilis prevention and treatment is especially needed in marginalised women.</div></div><div><h3>Funding</h3><div><span>Brazilian Ministry of Health</span> and <span>United States’ National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428562","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 : 2024-10-10DOI: 10.1016/j.lana.2024.100905
Background
Tuberculosis (TB) remains a global challenge and disproportionately affecting vulnerable populations. This study analyses the economic burden of pulmonary TB in Brazil, focusing on direct healthcare costs. It also evaluates the cost-effectiveness of the Directly Observed Treatment (DOT) strategy and the economic effort required to achieve a 90% probability of cure.
Methods
A nationwide retrospective study utilized data from the Brazilian Information System for Notifiable Diseases (SINAN) between 2015 and 2022. The cost per pulmonary TB case was estimated, encompassing expenses related to healthcare professionals, medication, laboratory exams, and the duration of treatment reported in SINAN. The population was stratified based on the presence of social vulnerabilities or a history of previous anti-TB treatment. Number Needed to Treat (NNT) analyses assessed the effectiveness of DOT implementation. Additionally, the study calculated the cost needed to achieve a 90% probability of cure through binomial regression models.
Findings
The total direct cost for pulmonary TB in Brazil during the seven years exceeded $1.3 billion, with retreatment cases accounting for $23.5 million. The lowest NNT of DOT were homeless (3.0), people who use drugs (3.72), and retreatment (4.56) subpopulations. These groups also presented the highest cost to achieve a 90% probability of cure.
Interpretation
This study highlights the economic impact of pulmonary TB on the Brazilian healthcare system. It underscores the effectiveness of DOT across various patient groups, regardless of their vulnerabilities or previous anti-TB treatment history. NNT analyses highlighted retreatment, homeless, and people who use drugs subpopulations as the most effective for DOT implementation.
Funding
Intramural Research Program-Oswaldo Cruz Foundation.
{"title":"Nationwide economic analysis of pulmonary tuberculosis in the Brazilian healthcare system over seven years (2015–2022): a population-based study","authors":"","doi":"10.1016/j.lana.2024.100905","DOIUrl":"10.1016/j.lana.2024.100905","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a global challenge and disproportionately affecting vulnerable populations. This study analyses the economic burden of pulmonary TB in Brazil, focusing on direct healthcare costs. It also evaluates the cost-effectiveness of the Directly Observed Treatment (DOT) strategy and the economic effort required to achieve a 90% probability of cure.</div></div><div><h3>Methods</h3><div>A nationwide retrospective study utilized data from the Brazilian Information System for Notifiable Diseases (SINAN) between 2015 and 2022. The cost per pulmonary TB case was estimated, encompassing expenses related to healthcare professionals, medication, laboratory exams, and the duration of treatment reported in SINAN. The population was stratified based on the presence of social vulnerabilities or a history of previous anti-TB treatment. Number Needed to Treat (NNT) analyses assessed the effectiveness of DOT implementation. Additionally, the study calculated the cost needed to achieve a 90% probability of cure through binomial regression models.</div></div><div><h3>Findings</h3><div>The total direct cost for pulmonary TB in Brazil during the seven years exceeded $1.3 billion, with retreatment cases accounting for $23.5 million. The lowest NNT of DOT were homeless (3.0), people who use drugs (3.72), and retreatment (4.56) subpopulations. These groups also presented the highest cost to achieve a 90% probability of cure.</div></div><div><h3>Interpretation</h3><div>This study highlights the economic impact of pulmonary TB on the Brazilian healthcare system. It underscores the effectiveness of DOT across various patient groups, regardless of their vulnerabilities or previous anti-TB treatment history. NNT analyses highlighted retreatment, homeless, and people who use drugs subpopulations as the most effective for DOT implementation.</div></div><div><h3>Funding</h3><div><span>Intramural Research Program-Oswaldo Cruz Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428561","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 : 2024-10-07DOI: 10.1016/j.lana.2024.100897
Background
Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil.
Methods
PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the ‘Viva Vida’ digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd.
Findings
Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants’ mean age was 65.3 years (SD 5.0) and 64.0% (n = 292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference: −0.61; 95% CI: −1.75, 0.53; p = 0.29).
Interpretation
These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal.
Funding
São Paulo Research Foundation and UK Joint Global Health Trials.
{"title":"A self-help mobile messaging intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial","authors":"","doi":"10.1016/j.lana.2024.100897","DOIUrl":"10.1016/j.lana.2024.100897","url":null,"abstract":"<div><h3>Background</h3><div>Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil.</div></div><div><h3>Methods</h3><div>PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the ‘Viva Vida’ digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd.</div></div><div><h3>Findings</h3><div>Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants’ mean age was 65.3 years (SD 5.0) and 64.0% (n = 292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference: −0.61; 95% CI: −1.75, 0.53; <em>p</em> = 0.29).</div></div><div><h3>Interpretation</h3><div>These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal.</div></div><div><h3>Funding</h3><div><span>São Paulo Research Foundation</span> and <span>UK Joint Global Health Trials</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428560","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 : 2024-10-04DOI: 10.1016/j.lana.2024.100902
Background
Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase.
Methods
The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs <20 vs ≥26 per 100,000 live births in 2018–2021); and in California vs Texas (populous states with low vs high MMRs). Cause-specific MMRs included those due to unambiguous causes (e.g., selected obstetric causes such as pre-eclampsia/eclampsia) and less-specific/potentially incidental causes (e.g., “other specified pregnancy-related conditions”, chronic hypertension, and malignant neoplasms).
Findings
MMRs increased from 9.60 (n = 1543) in 1999–2002 to 23.5 (n = 3478) per 100,000 live births in 2018–2021. The temporal increase in MMRs was smaller in low-MMR states (from 7.82 to 14.1 per 100,000 live births) compared with high-MMR states (from 11.1 to 31.4 per 100,000 live births). MMRs due to selected obstetric causes decreased to a similar extent in low-vs high-MMR states, whereas the increase in MMRs from less-specific/potentially incidental causes was smaller in low- vs high-MMR states (MMR ratio (RR) 5.57, 95% CI 4.28, 7.25 vs 7.07, 95% CI 5.91, 8.46), and in California vs Texas (RR 1.67, 95% CI 1.03, 2.69 vs 10.8, 95% CI 6.55, 17.7). The change in malignant neoplasm-associated MMRs was smaller in California vs Texas (RR 1.21, 95% CI 0.08, 19.3 vs 91.2, 95% CI 89.2, 94.8). MMRs from less-specific/potentially incidental causes increased in all race/ethnicity groups.
Interpretation
Spatiotemporal patterns of cause-specific MMRs, including similar reductions in unambiguous obstetric causes of death and variable increases in less-specific/potentially incidental causes, suggest misclassified maternal deaths and overestimated maternal mortality in some US states.
Funding
This work received no funding.
背景据报道，美国孕产妇死亡率（MMR）居高不下且不断上升，引起了人们的严重关注。我们研究了特定病因的孕产妇死亡率的时空模式，以深入了解孕产妇死亡率上升的原因。方法该研究包括美国疾病控制和预防中心从 1999 年到 2021 年记录的所有孕产妇死亡案例。对全国、低MMR州与高MMR州（即2018-2021年每10万活产的MMR<20 vs ≥26）以及加利福尼亚州与德克萨斯州（低MMR州与高MMR州）的总体和特定原因MMR的变化进行了量化。病因特异性MMR包括由明确病因（如选定的产科病因，如先兆子痫/子痫）和不太特异性/可能偶然的病因（如 "其他特定的妊娠相关疾病"、慢性高血压和恶性肿瘤）引起的MMR.研究结果MMR从1999-2002年的每10万活产9.60例（n=1543）增加到2018-2021年的23.5例（n=3478）。与高MMR州（从每10万活产11.1例增至31.4例）相比，低MMR州（从每10万活产7.82例增至14.1例）MMR的时间增幅较小。在低MMR州与高MMR州中，选定的产科原因导致的MMR下降幅度相似，而在低MMR州与高MMR州中，非特异性/潜在偶然原因导致的MMR增加幅度较小（MMR比值（RR）为5.57，95% CI为4.28，7.25 vs 7.07，95% CI为5.91，8.46），在加利福尼亚州与得克萨斯州中也是如此（RR为1.67，95% CI为1.03，2.69 vs 10.8，95% CI为6.55，17.7）。加利福尼亚州与得克萨斯州相比，恶性肿瘤相关 MMR 的变化较小（RR 1.21，95% CI 0.08，19.3 vs 91.2，95% CI 89.2，94.8）。在所有种族/民族群体中，非特异性/潜在偶发原因导致的孕产妇死亡率均有所上升。释义特异性原因导致的孕产妇死亡率的时空模式，包括非明确产科死因的类似减少和非特异性/潜在偶发原因的不同增加，表明美国一些州对孕产妇死亡进行了错误分类，并高估了孕产妇死亡率。
{"title":"Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study","authors":"","doi":"10.1016/j.lana.2024.100902","DOIUrl":"10.1016/j.lana.2024.100902","url":null,"abstract":"<div><h3>Background</h3><div>Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase.</div></div><div><h3>Methods</h3><div>The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs <20 vs ≥26 per 100,000 live births in 2018–2021); and in California vs Texas (populous states with low vs high MMRs). Cause-specific MMRs included those due to unambiguous causes (e.g., selected obstetric causes such as pre-eclampsia/eclampsia) and less-specific/potentially incidental causes (e.g., “other specified pregnancy-related conditions”, chronic hypertension, and malignant neoplasms).</div></div><div><h3>Findings</h3><div>MMRs increased from 9.60 (n = 1543) in 1999–2002 to 23.5 (n = 3478) per 100,000 live births in 2018–2021. The temporal increase in MMRs was smaller in low-MMR states (from 7.82 to 14.1 per 100,000 live births) compared with high-MMR states (from 11.1 to 31.4 per 100,000 live births). MMRs due to selected obstetric causes decreased to a similar extent in low-vs high-MMR states, whereas the increase in MMRs from less-specific/potentially incidental causes was smaller in low- vs high-MMR states (MMR ratio (RR) 5.57, 95% CI 4.28, 7.25 vs 7.07, 95% CI 5.91, 8.46), and in California vs Texas (RR 1.67, 95% CI 1.03, 2.69 vs 10.8, 95% CI 6.55, 17.7). The change in malignant neoplasm-associated MMRs was smaller in California vs Texas (RR 1.21, 95% CI 0.08, 19.3 vs 91.2, 95% CI 89.2, 94.8). MMRs from less-specific/potentially incidental causes increased in all race/ethnicity groups.</div></div><div><h3>Interpretation</h3><div>Spatiotemporal patterns of cause-specific MMRs, including similar reductions in unambiguous obstetric causes of death and variable increases in less-specific/potentially incidental causes, suggest misclassified maternal deaths and overestimated maternal mortality in some US states.</div></div><div><h3>Funding</h3><div>This work received no funding.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428558","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 : 2024-10-04DOI: 10.1016/j.lana.2024.100904
Background
Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil.
Methods
We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs = CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time.
Findings
From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD.
Interpretation
An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil.
Funding
National Council for Scientific and Technological Development (CNPq).
{"title":"Transition towards cancer mortality predominance over cardiovascular disease mortality in Brazil, 2000–2019: a population-based study","authors":"","doi":"10.1016/j.lana.2024.100904","DOIUrl":"10.1016/j.lana.2024.100904","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil.</div></div><div><h3>Methods</h3><div>We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs = CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time.</div></div><div><h3>Findings</h3><div>From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD.</div></div><div><h3>Interpretation</h3><div>An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil.</div></div><div><h3>Funding</h3><div><span>National Council for Scientific and Technological Development</span> (CNPq).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428559","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 : 2024-10-03DOI: 10.1016/j.lana.2024.100903
{"title":"Brazil has a problem: therapeutic itinerary, research and data about eating disorders","authors":"","doi":"10.1016/j.lana.2024.100903","DOIUrl":"10.1016/j.lana.2024.100903","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428557","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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