Pub Date : 2024-10-23DOI: 10.1016/j.lana.2024.100924
Laura C. Plantinga
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Pub Date : 2024-10-17DOI: 10.1016/j.lana.2024.100910
John M. Lapp , Thérèse A. Stukel , Hannah Chung , Samantha Lee , Yona Lunsky , Chaim M. Bell , Angela M. Cheung , Allan S. Detsky , Susie Goulding , Margaret Herridge , Aisha Ahmad , Fahad Razak , Amol A. Verma , Hilary K. Brown , Pavlos Bobos , Kieran L. Quinn
<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
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Pub Date : 2024-10-17DOI: 10.1016/j.lana.2024.100915
John K. Yue , John H. Kanter , Jason K. Barber , Michael C. Huang , Thomas A. van Essen , Mahmoud M. Elguindy , Brandon Foreman , Frederick K. Korley , Patrick J. Belton , Dana Pisică , Young M. Lee , Ryan S. Kitagawa , Mary J. Vassar , Xiaoying Sun , Gabriela G. Satris , Justin C. Wong , Adam R. Ferguson , J. Russell Huie , Kevin K.W. Wang , Hansen Deng , Ross D. Zafonte
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。
{"title":"Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study","authors":"John K. Yue , John H. Kanter , Jason K. Barber , Michael C. Huang , Thomas A. van Essen , Mahmoud M. Elguindy , Brandon Foreman , Frederick K. Korley , Patrick J. Belton , Dana Pisică , Young M. Lee , Ryan S. Kitagawa , Mary J. Vassar , Xiaoying Sun , Gabriela G. Satris , Justin C. Wong , Adam R. Ferguson , J. Russell Huie , Kevin K.W. Wang , Hansen Deng , Ross D. Zafonte","doi":"10.1016/j.lana.2024.100915","DOIUrl":"10.1016/j.lana.2024.100915","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014–2018; <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> #<span><span>NCT02119182</span><svg><path></path></svg></span>) 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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div><span>National Institute of Neurological Disorders</span> and Stroke; US <span>Department of Defense</span>; <span>Neurosurgery Research and Education Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100915"},"PeriodicalIF":7.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445379","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
Ayla Gerk , Callum Forbes , Taylor Wurdeman , Nikathan Kumar , Elizabeth J. McLeod , John G. Meara , Ruth Jimbo-Sotomayor , Craig D. McClain , Maria Jose Garcia Fuentes , Tarsicio Uribe-Leitz , Alfredo Borrero Vega
{"title":"Promoting climate-resilient health systems through national surgical plans","authors":"Ayla Gerk , Callum Forbes , Taylor Wurdeman , Nikathan Kumar , Elizabeth J. McLeod , John G. Meara , Ruth Jimbo-Sotomayor , Craig D. McClain , Maria Jose Garcia Fuentes , Tarsicio Uribe-Leitz , Alfredo Borrero Vega","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":"40 ","pages":"Article 100911"},"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
Weeberb J. Requia
{"title":"Fires in Brazil: health crises and the failure of government action","authors":"Weeberb J. Requia","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":"39 ","pages":"Article 100913"},"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}
Pub Date : 2024-10-16DOI: 10.1016/j.lana.2024.100908
Letícia Nunes Campos , Mayte Bryce-Alberti , Ayla Gerk , Sarah K. Hill , Chrystal Calderon , Mehreen Zaigham , Diana D. del Valle , Carol Mita , Sabrina Juran , Júlia Loyola Ferreira , Tarsicio Uribe-Leitz
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":"Letícia Nunes Campos , Mayte Bryce-Alberti , Ayla Gerk , Sarah K. Hill , Chrystal Calderon , Mehreen Zaigham , Diana D. del Valle , Carol Mita , Sabrina Juran , Júlia Loyola Ferreira , Tarsicio Uribe-Leitz","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":"40 ","pages":"Article 100908"},"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
Ovidiu Tatar , Ben Haward , Samara Perez , Patricia Zhu , Julia Brotherton , Kathleen Decker , Aisha K. Lofters , Marie-Hélène Mayrand , Emily McBride , Gina Ogilvie , Gilla K. Shapiro , Laurie W. Smith , Marc Steben , Jo Waller , Gregory D. Zimet , Zeev Rosberger
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":"Ovidiu Tatar , Ben Haward , Samara Perez , Patricia Zhu , Julia Brotherton , Kathleen Decker , Aisha K. Lofters , Marie-Hélène Mayrand , Emily McBride , Gina Ogilvie , Gilla K. Shapiro , Laurie W. Smith , Marc Steben , Jo Waller , Gregory D. Zimet , Zeev Rosberger","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":"39 ","pages":"Article 100901"},"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
Joshua Petimar , Christina A. Roberto , Jason P. Block , Nandita Mitra , Emily F. Gregory , Emma K. Edmondson , Gary Hettinger , Laura A. Gibson
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":"Joshua Petimar , Christina A. Roberto , Jason P. Block , Nandita Mitra , Emily F. Gregory , Emma K. Edmondson , Gary Hettinger , Laura A. Gibson","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":"39 ","pages":"Article 100906"},"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
Jessica L. Castilho , Fernanda F. Fonseca , Ahra Kim , Emilia Jalil , Shengxin Tu , Andréa M.B. Beber , Adele S. Benzaken , Valdiléa G. Veloso , Beatriz Grinsztejn , Bryan E. Shepherd , Angélica E.B. Miranda , National Cohort Study of Dolutegravir and Pregnancy Outcomes in Brazil
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":"Jessica L. Castilho , Fernanda F. Fonseca , Ahra Kim , Emilia Jalil , Shengxin Tu , Andréa M.B. Beber , Adele S. Benzaken , Valdiléa G. Veloso , Beatriz Grinsztejn , Bryan E. Shepherd , Angélica E.B. Miranda , National Cohort Study of Dolutegravir and Pregnancy Outcomes in Brazil","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":"39 ","pages":"Article 100894"},"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}
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