Lancet Regional Health-Americas最新文献

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Identifying when racial and ethnic disparities arise along the continuum of transplant care: a national registry study 确定移植护理过程中何时出现种族和民族差异：一项全国登记研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-01 DOI: 10.1016/j.lana.2024.100895

Background

Fewer minoritized patients with end-stage kidney disease (ESKD) receive kidney transplantation (KT); efforts to mitigate disparities have thus far failed. Pinpointing the specific stage(s) within the transplant care continuum (being informed of KT options, joining the waiting list, to receiving KT) where disparities emerge among each minoritized population is pivotal for achieving equity. We therefore quantified racial and ethnic disparities across the KT care continuum.

Methods

We conducted a retrospective cohort study (2015–2020), with follow-up through 12/10/2021. Patients with incident dialysis were identified using the US national registry data. The exposure was race and ethnicity (Asian, Black, Hispanic, and White). We used adjusted modified Poisson regression to quantify the adjusted prevalence ratio (aPR) of being informed of KT, and cause-specific hazards models to calculate adjusted hazard ratios (aHR) of listing, and transplantation after listing.

Findings

Among 637,951 adults initiating dialysis, the mean age (SD) was 63.8 (14.6), 41.8% were female, 5.4% were Asian, 26.3% were Black, 16.6% were Hispanic, and 51.7% were White (median follow-up in years [IQR]:1.92 [0.97–3.39]). Black and Hispanic patients were modestly more likely to be informed of KT (Black: aPR = 1.02, 95% confidence interval [CI]:1.01–1.02; Hispanic: aPR = 1.03, 95% CI: 1.02–1.03) relative to White patients. Asian patients were more likely to be listed (aHR = 1.18, 95% CI: 1.15–1.21) but less likely to receive KT (aHR = 0.56, 95% CI: 0.54–0.58). Both Black and Hispanic patients were less likely to be listed (Black: aHR = 0.87, 95% CI: 0.85–0.88; Hispanic: aHR = 0.85, 95% CI: 0.85–0.88) and receive KT (Black: aHR = 0.61, 95% CI: 0.60–0.63; Hispanic: aHR = 0.64, 95% CI: 0.63–0.66).

Interpretation

Improved characterization of the barriers in KT access specific to each racial and ethnic group, and the interventions to address these distinct challenges throughout the KT care continuum are needed; our findings identify specific stages most in need of mitigation.

Funding

National Institutes of Health.

背景少数群体终末期肾病（ESKD）患者接受肾移植（KT）的人数较少；迄今为止，为缩小差距所做的努力均以失败告终。要实现公平，关键在于准确定位移植护理连续体（获知肾移植选择、加入候选名单到接受肾移植）中各少数群体出现差异的具体阶段。因此，我们对整个 KT 治疗过程中的种族和民族差异进行了量化。方法我们进行了一项回顾性队列研究（2015-2020 年），随访至 2021 年 10 月 12 日。通过美国国家登记数据确定了发生透析的患者。种族和民族（亚裔、黑人、西班牙裔和白人）是暴露的因素。我们使用调整后的修正泊松回归来量化获知 KT 的调整患病率比 (aPR)，并使用特定病因危险模型来计算列名和列名后移植的调整危险比 (aHR)。研究结果在 637,951 名开始透析的成人中，平均年龄（SD）为 63.8 (14.6)，女性占 41.8%，亚裔占 5.4%，黑人占 26.3%，西班牙裔占 16.6%，白人占 51.7%（中位随访年数 [IQR]：1.92 [0.97-3.39]）。相对于白人患者，黑人和西班牙裔患者被告知 KT 的可能性略高（黑人：aPR = 1.02，95% 置信区间 [CI]：1.01-1.02；西班牙裔：aPR = 1.03，95% 置信区间 [CI]：1.02-1.03）。亚裔患者更有可能被列名（aHR = 1.18，95% CI：1.15-1.21），但接受 KT 的可能性较低（aHR = 0.56，95% CI：0.54-0.58）。黑人和西班牙裔患者被列入名单（黑人：aHR = 0.87，95% CI：0.85-0.88；西班牙裔：aHR = 0.85，95% CI：0.85-0.88）和接受 KT 的可能性都较低（黑人：aHR = 0.61，95% CI：0.60-0.63；西班牙裔：aHR = 0.64，95% CI：0.63-0.66）。解释需要进一步确定每个种族和族裔群体在接受 KT 方面所面临的障碍，以及在整个 KT 治疗过程中应对这些不同挑战的干预措施；我们的研究结果确定了最需要缓解的特定阶段。

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引用次数: 0

Facilitators of and barriers to buprenorphine initiation in the emergency department: a scoping review 急诊科开始使用丁丙诺啡的促进因素和障碍：范围界定审查

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-01 DOI: 10.1016/j.lana.2024.100899

Buprenorphine initiation in the Emergency Department (ED) has been hailed as an evidence-based strategy to mitigate the opioid overdose crisis, but its implementation has been limited. This scoping review synthesizes barriers and facilitators to buprenorphine initiation in the ED, and uses the Consolidated Framework for Implementation Research and a critical lens to analyze the literature. Results demonstrate an immense effort across the U.S. and Canada to implement ED-initiated buprenorphine. Facilitators include multidisciplinary addiction teams and co-located, low-barrier, harm reduction-informed services to support transitions. Barriers include a failure to address structural stigma, client complexity, and an increasingly toxic drug supply. The literature also misses the opportunity to include the perspectives of service users, health administrators, and learners. Increased coordination of implementation efforts, and a shift to equitable and inclusive opioid agonist therapy initiation pathways are needed across the U.S. and Canada.

在急诊科（ED）启动丁丙诺啡治疗被誉为缓解阿片类药物过量危机的循证策略，但其实施却十分有限。这篇范围综述综述了在急诊科启动丁丙诺啡的障碍和促进因素，并使用实施研究综合框架和批判性视角对文献进行了分析。研究结果表明，美国和加拿大在实施急诊室启动丁丙诺啡方面做出了巨大努力。促进因素包括多学科戒毒团队和同地、低障碍、减低伤害的服务，以支持过渡。障碍包括未能解决结构性污名化、客户复杂性以及日益有毒的药物供应。文献中也没有纳入服务使用者、健康管理者和学习者的观点。美国和加拿大需要加强对实施工作的协调，并转向公平、包容的阿片类激动剂治疗启动途径。

引用次数: 0

Ending violence against Indigenous peoples in Canada: a healthcare responsibility 消除加拿大土著人民遭受的暴力：医疗保健的责任

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-01 DOI: 10.1016/j.lana.2024.100893

By foregrounding the embodiment of colonial dispossession–how the body feels colonialism–this article theorises violence against Indigenous peoples in Canada, positioning it firmly within the purview of healthcare. The article critically questions the discourse of reconciliation currently shaping Indigenisation policies and Indigenous health research in the country’s public institutions. It contends that a narrow application of “closing the Indigenous health gap,” described more robustly by the Truth and Reconciliation Commission of Canada, falls short of addressing the root problem: “ending colonial violence.” Aligning with critical Indigenous studies scholarship, I redirect representations of Indigenous health away from the presumption of deficit. I argue that health care in Canada is responsible for recognising and confronting colonial violence as a matter of public health. As a starting point, this responsibility involves implementing the relevant Calls for Justice outlined in Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls.

通过强调殖民剥夺的体现--身体如何感受殖民主义--这篇文章从理论上论述了加拿大土著居民遭受的暴力，并将其牢牢地定位在医疗保健的范畴内。文章对目前影响加拿大公共机构土著化政策和土著健康研究的和解话语提出了批判性质疑。文章认为，狭隘地应用加拿大真相与和解委员会（Truth and Reconciliation Commission of Canada）所描述的 "缩小土著人健康差距"，并不能解决根本问题："结束殖民暴力"。根据批判性土著研究的学术观点，我将土著健康的表述从赤字假定中重新定位。我认为，加拿大的医疗保健机构有责任承认并正视殖民暴力，将其视为公共卫生问题。作为起点，这一责任包括落实《重获权力与地位》中概述的相关正义呼吁：失踪和遇害土著妇女和女童全国调查最终报告》中概述的相关正义呼吁。

引用次数: 0

Burning amazon: the dire consequences of climate inaction 燃烧的亚马逊：气候不作为的可怕后果

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-10-01 DOI: 10.1016/j.lana.2024.100918

引用次数: 0

Home death as a negative indicator of end-of-life care in Brazil: author's response to Hong et al. 家庭死亡作为巴西临终关怀的负面指标：作者对Hong等人的回应

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-28 DOI: 10.1016/j.lana.2024.100900

引用次数: 0

Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis 美国非法药物供应中芬太尼共存的时间和空间趋势：序列横截面分析

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-27 DOI: 10.1016/j.lana.2024.100898

Background

Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs.

Methods

We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023.

Findings

We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017–2023.

Interpretation

Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose.

Funding

This work was partly supported by FDA grant U01FD00745501. This article reflects the views of the authors and does not represent the views or policies of the FDA or US Department of Health and Human Services.

背景芬太尼及其类似物是造成美国吸毒过量死亡的主要原因。人们担心吸毒者会在不知情的情况下接触到芬太尼，从而增加他们吸毒过量死亡的风险。本研究探讨了芬太尼与其他缉获毒品共存的时间趋势和空间变化。方法我们确定了 9 种相关物质或物质类别中的芬太尼共存情况（非芬太尼物质样本中同时含有芬太尼的比例）：甲基苯丙胺、大麻、可卡因、海洛因、俱乐部毒品、致幻剂以及处方类阿片、兴奋剂和苯二氮卓。我们使用了 2013 年 1 月至 2023 年 12 月期间美国 50 个州和哥伦比亚特区从国家法医实验室信息系统（美国现有最大的非法药物供应数据库）获得的毒品报告序列横截面数据。随着时间的推移，芬太尼与所有受检物质的共存率呈单调上升趋势（Mann-Kendall p < 0.0001）。在全国范围内，芬太尼与海洛因样本的共存率最高（约 50%），但与甲基苯丙胺（≤1%）、可卡因（≤4%）和其他毒品样本的共存率相对较低。然而，2017-2023年，东北部几个州的可卡因和甲基苯丙胺共存率已增至10%以上。释义芬太尼最常与海洛因共存，但在某些地区，芬太尼在兴奋剂供应中的出现率正在上升，可能会带来不成比例的高过量风险。本文仅代表作者观点，不代表美国食品药品管理局或美国卫生与公众服务部的观点或政策。

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引用次数: 0

Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study 巴西卡布罗博特鲁卡土著成年人慢性肾病的患病率和相关因素：一项基于人口的研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-26 DOI: 10.1016/j.lana.2024.100882

Background

The prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in developing countries, due to factors such as lifestyle changes and the rise of non-communicable diseases. Populations living in socioeconomically disadvantaged areas are subject to a higher burden of CKD. However, the burden of CKD on Brazilian Indigenous people, especially those undergoing an advanced urbanisation process, has not yet been described.

Methods

This cross-sectional study included 1715 Truká Indigenous adults from Cabrobó, Brazil. CKD was defined according to the Kidney Disease Improving Global Outcomes guidelines classification as a urinary albumin/creatinine ratio ≥30 mg/g and/or an estimated glomerular filtration rate <60 mL/min/1.73 m². Univariate and multiple logistic regression models were used to evaluate factors associated with CKD. Odds ratio (OR) with a 95% confidence interval (CI) was used to measure association.

Findings

Out of the 1654 participants analysed (61 excluded due to missing data), the prevalence of CKD was 10% (95% CI, 8.6%–11.5%), with a higher prevalence in women compared to men (12.4% versus 6.9%, p < 0.001). The mean age was 40.5 years, with 55.6% being women. In univariate analysis, female sex (OR, 1.9; 95% CI, 1.3–2.7), age ≥60 years (OR, 4.6; 95% CI, 3.2–6.6), cardiovascular disease (OR, 2.1; 95% CI, 1.1–4.1), and dyslipidemia (OR, 1.6; 95% CI, 1.1–2.4) were identified as associated factors with CKD. Multiple logistic regression analysis identified age ≥60 years, female sex, and dyslipidemia as independently associated factors with CKD.

Interpretation

The prevalence of CKD among Truká Indigenous adults analysed is high and affects a higher proportion of women. Our study found no association between hypertension, diabetes, obesity, and CKD risk, despite their high prevalence. These findings assist in developing early CKD detection strategies in Brazilian Indigenous communities, supporting disease treatment and prevention.

Funding

National Council for Scientific and Technological Development (CNPq)–Ministry of Science, Technology, and Innovation of Brazil, and the Maria Emília Foundation.

背景由于生活方式的改变和非传染性疾病的增加等因素，慢性肾脏病（CKD）的发病率在全球范围内不断上升，尤其是在发展中国家。生活在社会经济条件较差地区的人群患慢性肾脏病的几率更高。这项横断面研究纳入了巴西卡布罗博的 1715 名特鲁卡土著成年人。根据肾病改善全球结果指南的分类，CKD 的定义为尿白蛋白/肌酐比值≥30 毫克/克和/或估计肾小球滤过率 <60 mL/min/1.73 m2。采用单变量和多元逻辑回归模型评估与 CKD 相关的因素。结果在分析的 1654 名参与者中（61 人因数据缺失而被排除），CKD 患病率为 10%（95% CI，8.6%-11.5%），女性患病率高于男性（12.4% 对 6.9%，p < 0.001）。平均年龄为 40.5 岁，女性占 55.6%。在单变量分析中，女性（OR，1.9；95% CI，1.3-2.7）、年龄≥60 岁（OR，4.6；95% CI，3.2-6.6）、心血管疾病（OR，2.1；95% CI，1.1-4.1）和血脂异常（OR，1.6；95% CI，1.1-2.4）被认为是与 CKD 相关的因素。多重逻辑回归分析表明，年龄≥60 岁、女性和血脂异常是导致慢性肾脏病的独立相关因素。我们的研究发现，尽管高血压、糖尿病、肥胖症的发病率很高，但它们与慢性肾脏病的风险之间没有关联。这些发现有助于在巴西原住民社区制定早期 CKD 检测策略，支持疾病治疗和预防。

{"title":"Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study","authors":"","doi":"10.1016/j.lana.2024.100882","DOIUrl":"10.1016/j.lana.2024.100882","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in developing countries, due to factors such as lifestyle changes and the rise of non-communicable diseases. Populations living in socioeconomically disadvantaged areas are subject to a higher burden of CKD. However, the burden of CKD on Brazilian Indigenous people, especially those undergoing an advanced urbanisation process, has not yet been described.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 1715 Truká Indigenous adults from Cabrobó, Brazil. CKD was defined according to the Kidney Disease Improving Global Outcomes guidelines classification as a urinary albumin/creatinine ratio ≥30 mg/g and/or an estimated glomerular filtration rate <60 mL/min/1.73 m<sup>2</sup>. Univariate and multiple logistic regression models were used to evaluate factors associated with CKD. Odds ratio (OR) with a 95% confidence interval (CI) was used to measure association.</div></div><div><h3>Findings</h3><div>Out of the 1654 participants analysed (61 excluded due to missing data), the prevalence of CKD was 10% (95% CI, 8.6%–11.5%), with a higher prevalence in women compared to men (12.4% versus 6.9%, p < 0.001). The mean age was 40.5 years, with 55.6% being women. In univariate analysis, female sex (OR, 1.9; 95% CI, 1.3–2.7), age ≥60 years (OR, 4.6; 95% CI, 3.2–6.6), cardiovascular disease (OR, 2.1; 95% CI, 1.1–4.1), and dyslipidemia (OR, 1.6; 95% CI, 1.1–2.4) were identified as associated factors with CKD. Multiple logistic regression analysis identified age ≥60 years, female sex, and dyslipidemia as independently associated factors with CKD.</div></div><div><h3>Interpretation</h3><div>The prevalence of CKD among Truká Indigenous adults analysed is high and affects a higher proportion of women. Our study found no association between hypertension, diabetes, obesity, and CKD risk, despite their high prevalence. These findings assist in developing early CKD detection strategies in Brazilian Indigenous communities, supporting disease treatment and prevention.</div></div><div><h3>Funding</h3><div><span>National Council for Scientific and Technological Development</span> (<span>CNPq</span>)–<span>Ministry of Science, Technology, and Innovation of Brazil</span>, and the <span>Maria Emília Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323646","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}

引用次数: 0

Micro- and macrovascular function in the highest city in the world: a cross sectional study 世界海拔最高城市的微血管和大血管功能：一项横断面研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-25 DOI: 10.1016/j.lana.2024.100887

Background

Since vascular responses to hypoxia in both healthy high-altitude natives and chronic mountain sickness (a maladaptive high-altitude pathology characterised by excessive erythrocytosis and the presence of symptoms—CMS) remain unclear, the role of inflammation and oxidative/nitrosative stress on the endothelium-dependent and -independent responses in both the micro- and macrocirculation, in healthy Andeans at different altitudes and in CMS patients, was examined.

Methods

94 men were included: 18 lowlanders (LL), 38 healthy highlanders permanently living at 3800 m (n = 21—HL-3800) or in La Rinconada, the highest city in the world (5100–5300 m) (n = 17—HL-5100/No CMS). Moreover, 14 participants with mild (Mild CMS) and 24 with moderate to severe CMS (Mod/Sev CMS) were recruited. All undertook two reactivity tests: i) local thermal hyperaemia (microcirculation) and ii) flow-mediated dilation (macrocirculation). Endothelium-independent function (glyceryl trinitrate) was also assessed only in La Rinconada.

Findings

Conductance and skin blood flow velocity during the microcirculation test, as well as macrocirculation progressively decreased with altitude (LL > HL-3800 > HL-5100/No CMS). CMS also induced a decrease in macrocirculation (HL-5100/No CMS > Mild CMS = Mod/Sev CMS), while glyceryl trinitrate restored vascular function. Both oxidative stress and nitric oxide metabolites increased with altitude only. Principal component analysis revealed that increasing inflammation with altitude was associated with a progressive decline in both micro- and macrovascular function in healthy highlanders.

Interpretation

Both micro and macrovascular function are affected by chronic exposure to hypoxia, the latter being further compounded by CMS.

Funding

The “Fonds de dotation AGIR pour les maladies chroniques”, the “Air Liquide Foundation”, and the “French National Research Agency”.

背景由于健康的高海拔当地人和慢性高山病（一种适应不良的高海拔病理，以红细胞增多和出现症状为特征--CMS）患者的血管对低氧的反应仍不清楚，因此研究了不同海拔的健康安第斯人和慢性高山病患者的炎症和氧化/亚硝基应激对微循环和大循环中内皮依赖性和非依赖性反应的作用：研究对象包括 94 名男性：18 名低地人（LL）、38 名长期生活在海拔 3800 米（n = 21-HL-3800）或世界上海拔最高的城市拉林科纳达（5100-5300 米）的健康高地人（n = 17-HL-5100/无 CMS）。此外，还招募了 14 名轻度（Mild CMS）和 24 名中度至重度（Mod/Sev CMS）CMS 患者。所有人都进行了两项反应性测试：i）局部热高血压（微循环）和 ii）血流介导的扩张（大循环）。结果微循环测试中的传导性和皮肤血流速度以及大循环随着海拔高度的升高而逐渐降低（LL > HL-3800 > HL-5100/无 CMS）。CMS 也会导致大循环减少（HL-5100/无 CMS >；轻度 CMS = 中度/重度 CMS），而三硝酸甘油则可恢复血管功能。氧化应激和一氧化氮代谢物仅随海拔升高而增加。主成分分析表明，随着海拔的升高，炎症的增加与健康高原人微血管和大血管功能的逐渐衰退有关。

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引用次数: 0

Oropouche fever fatalities and vertical transmission in South America: implications of a potential new mode of transmission 南美洲的奥罗普切热死亡病例和垂直传播：潜在新传播方式的影响

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-25 DOI: 10.1016/j.lana.2024.100896

引用次数: 0

Brazil takes a leap towards the elimination of HTLV-1 vertical transmission 巴西在消除 HTLV-1 垂直传播方面实现飞跃

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas

Pub Date : 2024-09-21 DOI: 10.1016/j.lana.2024.100888

引用次数: 0

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