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Which diagnostic test to use for Testing and Treatment strategies in Plasmodium vivax low-transmission settings: a secondary analysis of a longitudinal interventional study 在间日疟原虫低传播环境中使用哪种诊断检测来制定检测和治疗策略:对一项纵向干预研究的二次分析
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-15 DOI: 10.1016/j.lana.2024.100883

Background

The lack of sensitive field tests to diagnose blood stages and hypnozoite carriers prevents Testing and Treatment (TAT) strategies to achieve Plasmodium vivax elimination in low-transmission settings, but recent advances in Polymerase Chain Reaction (PCR) and serology position them as promising tools. This study describes a PCR-based TAT strategy (PCRTAT) implemented in Saint Georges (SGO), French Guiana, and explores alternative strategies (seroTAT and seroPCRTAT) to diagnose and treat P. vivax carriers.

Methods

The PALUSTOP cohort study implemented in SGO (September 2017 to December 2018) screened participants for P. vivax using PCR tests and treated positive cases. Serology was also performed. Passive detection of P. vivax infection occurred during follow-up. Participants were categorised into overlapping treatment groups based on 2017 PCR and serological results. Strategies were described in terms of participants targeted or missed, primaquine contraindications (pregnancy, G6PD severe or intermediate deficiency), and sociodemographic characteristics.

Findings

In 2017, 1567 inhabitants were included, aged 0–92 years. A total of 90 (6%) were P. vivax carriers and 390 seropositive (25%). PCRTAT missed 282 seropositive individuals while seroTAT would have missed 21 PCR-positive cases. Primaquine contraindications ranged from 12% to 17% across strategies.

Interpretation

Serology and PCR are promising tools for targeted treatment strategies in P. vivax low-transmission settings, when field compatible sensitive tests will be available. Both seem necessary to capture blood stages and potential hypnozoite carriers, while avoiding mass treatment. However, high primaquine contraindications rates need consideration for successful elimination.

Funding

Supported by European Funds for Regional Development, French Guiana Regional Health Agency, Pan American Health Organization, WHO, French Ministry for Research.

背景由于缺乏敏感的现场检测方法来诊断血期和虫下带原体,因此检测和治疗(TAT)策略无法在低传播环境中消灭间日疟原虫,但聚合酶链式反应(PCR)和血清学的最新进展使它们成为有前途的工具。本研究描述了在法属圭亚那圣乔治(SGO)实施的基于 PCR 的 TAT 策略(PCRTAT),并探讨了诊断和治疗间日疟原虫携带者的替代策略(seroTAT 和 seroPCRTAT)。方法在 SGO 实施的 PALUSTOP 队列研究(2017 年 9 月至 2018 年 12 月)使用 PCR 测试筛查参与者是否携带间日疟原虫,并治疗阳性病例。同时还进行了血清学检测。在随访过程中被动检测了间日疟原虫感染。根据 2017 年 PCR 和血清学结果,将参与者分为重叠治疗组。从目标人群或遗漏人群、伯氨喹禁忌症(怀孕、G6PD重度或中度缺乏)以及社会人口学特征等方面对策略进行了描述。共有 90 人(6%)为间日疟原虫携带者,390 人血清阳性(25%)。PCRTAT 漏检了 282 名血清阳性者,而血清 TAT 会漏检 21 例 PCR 阳性病例。血清学和 PCR 是在间日疟原虫低传播环境中采取有针对性的治疗策略的有效工具。这两种方法似乎对捕获血液阶段和潜在的低原虫携带者都很必要,同时还能避免大规模治疗。然而,要想成功消灭病毒,还需考虑伯氨喹的高禁忌率。
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引用次数: 0
Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada 接受家庭外照料的影响:对加拿大马尼托巴省原住民和其他儿童福利机构的纵向队列研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-11 DOI: 10.1016/j.lana.2024.100886

Background

Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes.

Methods

In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007–2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors.

Findings

Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40–9.77; other aOR 5.10, 1.83–14.25), teen birth (First Nations aOR 3.23, 1.10–9.49; other aOR 5.06, 1.70–15.03), and sexually transmitted infections (other aOR 7.21, 3.63–14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27–5.75), a victim (other aOR 1.68, 1.10–2.56), charged with a crime (other aOR 2.68, 1.21–5.96), or incarcerated (First Nations aOR 3.64, 1.95–6.80; other aOR 1.19, 1.19–8.04).

Interpretation

Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored.

Funding

Social Sciences and Humanities Research Council (no. 890-2018-0029).

背景在加拿大各地,儿童保护服务机构(CPS)以惊人的高比率逮捕土著儿童,从而破坏土著家庭。家庭外照料(OoHC)对儿童造成的伤害已被广泛记录在案。我们研究了家庭外照料对马尼托巴省儿童的健康和法律系统结果的影响,为儿童保护机构的自由裁量权决策如何影响这些结果提供了严谨的证据。我们比较了那些被纳入 OoHC 的儿童(n = 19,324 人)和那些从未被照料但因儿童保护问题而有开放 CPS 档案的儿童(n = 27,290 人)。我们使用工具变量分析法(以 CPS 机构的 OoHC 使用率为工具)得出了几率比(aOR)和 95% 的置信区间,并对儿童、母亲和家庭因素进行了调整。研究结果 首次接触 CPS 的 OoHC 儿童的平均年龄(岁 ± 标准差)为 2.8 ± 3.7(原住民)和 3.0 ± 3.8(其他),从未接受过照料的儿童的平均年龄为 4.5 ± 4.5(原住民)和 5.1 ± 4.7(其他)。在由原住民机构提供服务的儿童中,男性占 OoHC 儿童的 50.6%(n = 5496),占从未接受过照料儿童的 51.0%(n = 6579)。在由其他机构提供服务的儿童中,男性在 OoHC 中占 51.0%(n = 4324),在从未接受过照料的儿童中占 51.0%(n = 7428)。受照料儿童的少女怀孕几率(原住民 aOR 3.69,1.40-9.77;其他 aOR 5.10,1.83-14.25)、少女生育几率(原住民 aOR 3.23,1.10-9.49;其他 aOR 5.06,1.70-15.03)和性传播感染几率(其他 aOR 7.21,3.63-14.32)均高于从未受照料儿童,被指控几率也是如此(其他 aOR 2.71,1.27-5.75)。其他 aOR 2.71,1.27-5.75)、受害者(其他 aOR 1.68,1.10-2.56)、被指控犯罪(其他 aOR 2.68,1.21-5.96)或被监禁(原住民 aOR 3.64,1.95-6.80;其他 aOR 1.19,1.19-8.04)。在向省政府和原住民政府介绍情况时,强调了减少被收留儿童人数的重要性。将对政府的回应进行监督。资助社会科学与人文科学研究委员会(编号:890-2018-0029)。
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引用次数: 0
The US elections as a determinant of global health 美国大选是全球健康的决定因素
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-11 DOI: 10.1016/j.lana.2024.100884
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引用次数: 0
Supervised safe consumption sites — lessons and opportunities for North America 有监督的安全消费场所--北美的经验教训和机遇
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-11 DOI: 10.1016/j.lana.2024.100889
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引用次数: 0
Clinical features of Chagas disease progression and severity 南美锥虫病进展和严重程度的临床特征
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100832

Chagas disease, the most common form of nonischaemic cardiomyopathy globally, is one of the leading causes of morbidity and mortality in Latin America. Chagas cardiomyopathy has a wide clinical spectrum and prognosis, which is primarily determined by the severity of left ventricular dysfunction. Chagas disease also affects the brain, particularly manifesting as cardioembolic strokes and cognitive impairments. Disease progression is influenced by various factors such as anti-parasite treatments, host–parasite interactions, and other determinants.

This review explores Chagas disease, covering clinical presentations, the range of severity of Chagas cardiomyopathy, and neurological manifestations. We investigate factors that influence the progression of cardiomyopathy, including anti-parasitic treatments, interactions between hosts and parasites, and the influence of social determinants on the course of the disease. This review analyses key prognostic factors associated with the progression and mortality of Chagas cardiomyopathy, offering insights into this potentially fatal illness.

南美锥虫病是全球最常见的非缺血性心肌病,也是拉丁美洲发病和死亡的主要原因之一。南美锥虫病心肌病的临床表现和预后广泛,主要取决于左心室功能障碍的严重程度。恰加斯病还会影响大脑,尤其表现为心肌栓塞性中风和认知障碍。本综述探讨南美锥虫病,涵盖临床表现、南美锥虫心肌病的严重程度范围以及神经系统表现。我们研究了影响心肌病进展的因素,包括抗寄生虫治疗、宿主与寄生虫之间的相互作用以及社会决定因素对病程的影响。这篇综述分析了与南美锥虫病心肌病进展和死亡率相关的主要预后因素,为人们深入了解这种可能致命的疾病提供了参考。
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引用次数: 0
Effects of mobility, immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic: a modelling study 流动性、免疫力和疫苗接种对多米尼加共和国 SARS-CoV-2 传播的影响:模拟研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100860

Background

COVID-19 dynamics are driven by a complex interplay of factors including population behaviour, new variants, vaccination and immunity from prior infections. We quantify drivers of SARS-CoV-2 transmission in the Dominican Republic, an upper-middle income country of 10.8 million people. We then assess the impact of the vaccination campaign implemented in February 2021, primarily using CoronaVac, in saving lives and averting hospitalisations.

Methods

We fit an age-structured, multi-variant transmission dynamic model to reported deaths, hospital bed occupancy, and seroprevalence data until December 2021, and simulate epidemic trajectories under different counterfactual scenarios.

Findings

We estimate that vaccination averted 7210 hospital admissions (95% credible interval, CrI: 6830–7600), 2180 intensive care unit admissions (95% CrI: 2080–2280) and 766 deaths (95% CrI: 694–859) in the first 6 months of the campaign. If no vaccination had occurred, we estimate that an additional decrease of 10–20% in population mobility would have been required to maintain equivalent death and hospitalisation outcomes. We also found that early vaccination with CoronaVac was preferable to delayed vaccination using a product with higher efficacy.

Interpretation

SARS-CoV-2 transmission dynamics in the Dominican Republic were driven by a substantial accumulation of immunity during the first two years of the pandemic but, despite this, vaccination was essential in enabling a return to pre-pandemic mobility levels without considerable additional morbidity and mortality.

Funding

Medical Research Council, Wellcome Trust, Royal Society, US CDC and Australian National Health and Medical Research Council.

背景CoVID-19 的动态受多种因素的复杂影响,包括人口行为、新变种、疫苗接种和先前感染产生的免疫力。多米尼加共和国是一个拥有 1080 万人口的中高收入国家,我们对该国 SARS-CoV-2 传播的驱动因素进行了量化。然后,我们评估了 2021 年 2 月实施的疫苗接种活动(主要使用 CoronaVac)在挽救生命和避免住院治疗方面的影响。方法我们将 2021 年 12 月之前报告的死亡人数、医院病床占用率和血清流行率数据与年龄结构、多变体传播动态模型相匹配,并模拟了不同反事实情景下的流行轨迹。研究结果我们估计,在疫苗接种活动的前 6 个月,共避免了 7210 例入院(95% 可信区间:6830-7600)、2180 例入住重症监护室(95% 可信区间:2080-2280)和 766 例死亡(95% 可信区间:694-859)。如果不接种疫苗,我们估计人口流动性需要额外降低 10-20% 才能维持同等的死亡和住院结果。我们还发现,早期接种 CoronaVac 优于延迟接种疗效更高的产品。解释SARS-CoV-2 在多米尼加共和国的传播动态是由大流行头两年中免疫力的大量积累所驱动的,但尽管如此,接种疫苗对恢复大流行前的人口流动水平至关重要,而且不会增加大量的发病率和死亡率。
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引用次数: 0
Chagas disease: 115 years of neglect 恰加斯病115年的忽视
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100891
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引用次数: 0
The epidemiology of Chagas disease in the Americas 恰加斯病在美洲的流行病学
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100881

Chagas disease is a complex parasitic zoonosis that still threatens public health across the Americas. Initiatives to control Trypanosoma cruzi transmission via blood transfusion and non-native triatomine-bug vectors have yielded crucial advances; native vectors, however, actively bridge wild and domestic/peri-domestic transmission cycles throughout the region, and tens of thousands of people become infected each year. Oral-transmission outbreaks, urbanisation, and vertical transmission are additional/emerging issues calling for innovative strategic thinking. While critical for advocacy and sustained public health action, assessing Chagas disease burden remains difficult; the often-asymptomatic nature of T. cruzi infection, healthcare access limitations, pervasive underreporting, and other methodological hurdles inherent to reliably measuring incidence, prevalence, and disease progression all contribute to the difficulty. Whether and how parasite, vector, and host genetic makeups affect transmission dynamics and epidemiology is also unclear. Continued high-quality research and long-term, adaptive strategies combining vector control surveillance with enhanced case detection and integral patient care remain critical to effectively address the ethical and societal challenge of Chagas disease control.

This is the first in a Series of five papers about Chagas Disease. All papers in the Series are available at https://www.thelancet.com/series/chagasdisease.

南美锥虫病是一种复杂的寄生虫人畜共患病,目前仍威胁着整个美洲的公共健康。通过输血和非本地三带喙昆虫载体控制南美锥虫病传播的举措取得了重大进展;然而,本地载体在整个地区的野生和家养/近家养传播循环中发挥着积极的桥梁作用,每年有数以万计的人受到感染。口腔传播疫情、城市化和垂直传播是新出现的问题,需要创新的战略思维。尽管评估恰加斯病的负担对宣传和持续的公共卫生行动至关重要,但评估恰加斯病的负担仍然十分困难;恰加斯病感染通常无症状,医疗保健服务有限,报告普遍不足,以及可靠测量发病率、流行率和疾病进展所固有的其他方法障碍,都是造成评估困难的原因。寄生虫、病媒和宿主的基因构成是否以及如何影响传播动态和流行病学也尚不清楚。继续开展高质量的研究并制定长期的适应性策略,将病媒控制监测与加强病例检测和患者综合护理相结合,对于有效应对恰加斯病控制所带来的伦理和社会挑战仍然至关重要。该系列的所有论文均可在 https://www.thelancet.com/series/chagasdisease 上查阅。
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引用次数: 0
Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies 超加工食品与心血管疾病:对美国三个大型前瞻性队列的分析以及对前瞻性队列研究的系统回顾和荟萃分析
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100859

Background

Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.

Methods

UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; n = 75,735), Nurses’ Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle–Ottawa Scale, funnel plots, and Egger’s tests, and meta-evidence was evaluated using NutriGrade.

Findings

The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06–1.16), 1.16 (1.09–1.24), and 1.04 (0.96–1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%–24%), 23% (12%–34%), and 9% (3%–15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.

Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.

Funding

National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

背景超加工食品(UPF)总量和组别与心血管疾病(CVD)之间的前瞻性关联仍有待确定。我们的目的是在三个大型美国成年人前瞻性队列中评估超高加工食品的总摄入量和特定组别摄入量与心血管疾病、冠心病(CHD)和中风之间的关系。方法在护士健康研究(NHS;n = 75,735)、护士健康研究II(NHSII;n = 90,813)和卫生专业人员随访研究(HPFS;n = 40,409)中通过食物频率问卷评估UPF摄入量。Cox 回归估算了总摄入量和特定组群的 UPF 摄入量与心血管疾病(病例数 = 16800 例)、冠心病(病例数 = 10401 例)和中风(病例数 = 6758 例)风险的队列特异性关联,随后通过固定效应模型进行了汇总。随机效应荟萃分析汇集了截至2024年4月5日在Medline和Embase上发现的有关UPF与心血管疾病关系的现有前瞻性研究结果,没有语言限制。使用纽卡斯尔-渥太华量表、漏斗图和Egger检验评估偏倚风险,并使用NutriGrade评估荟萃证据。研究结果NHS的基线平均(标清)年龄为50.8岁(7.2),NHSII为36.7岁(4.6),HPFS为53.4岁(9.6)。在 NHS 中,白种人的比例为 97.7%,在 NHSII 中为 96.4%,在 HPFS 中为 94.9%。在三个队列中,UPF 总摄入量最高(与最低)五分位数的心血管疾病、冠心病和中风的多变量调整危险比[HRs (95% CIs)]分别为 1.11 (1.06-1.16)、1.16 (1.09-1.24) 和 1.04 (0.96-1.12)。UPF组显示出不同的关联性。加糖/人工甜味饮料和加工肉类与较高的心血管疾病风险相关,而面包/冷谷物、酸奶/乳制品甜点和咸味零食则呈反向关系。对22项前瞻性研究进行的元分析表明,UPF总摄入量最高类别(与最低类别相比)与心血管疾病、冠心病和中风风险分别增加17%(11%-24%)、23%(12%-34%)和9%(3%-15%)有关。解读UPF总摄入量与美国成年人的心血管疾病和冠心病风险呈负相关,多个国家的前瞻性研究也证实了这一点,同时还表明中风风险略有增加。针对心血管健康的营养建议应考虑到特定群体UPF的不同后果。需要在种族/民族多样化的人群中进行重复研究。
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引用次数: 0
Dagmar García Rivera—a career of passion and resilience 达格玛-加西亚-里维拉--激情与坚韧的职业生涯
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lana.2024.100885
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引用次数: 0
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Lancet Regional Health-Americas
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