Pub Date : 2024-09-28DOI: 10.1016/j.lana.2024.100900
Jessé Lopes da Silva , Lívia Costa de Oliveira , Lucas Zanetti de Albuquerque , Luiz Claudio Santos Thuler , Andréia Cristina de Melo
{"title":"Home death as a negative indicator of end-of-life care in Brazil: author's response to Hong et al.","authors":"Jessé Lopes da Silva , Lívia Costa de Oliveira , Lucas Zanetti de Albuquerque , Luiz Claudio Santos Thuler , Andréia Cristina de Melo","doi":"10.1016/j.lana.2024.100900","DOIUrl":"10.1016/j.lana.2024.100900","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100900"},"PeriodicalIF":7.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357628","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 : 2024-09-27DOI: 10.1016/j.lana.2024.100898
Tse Yang Lim , Huiru Dong , Erin Stringfellow , Zeynep Hasgul , Ju Park , Lukas Glos , Reza Kazemi , Mohammad S. Jalali
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.
{"title":"Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis","authors":"Tse Yang Lim , Huiru Dong , Erin Stringfellow , Zeynep Hasgul , Ju Park , Lukas Glos , Reza Kazemi , Mohammad S. Jalali","doi":"10.1016/j.lana.2024.100898","DOIUrl":"10.1016/j.lana.2024.100898","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall <em>p</em> < 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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div>This work was partly supported by <span>FDA</span> 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.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100898"},"PeriodicalIF":7.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327451","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 : 2024-09-26DOI: 10.1016/j.lana.2024.100882
Orlando Vieira Gomes , Carlos Dornels Freire de Souza , Jandir Mendonça Nicacio , Rodrigo Feliciano do Carmo , Vanessa Cardoso Pereira , Dinani Matoso Fialho de Oliveira Armstrong , Manoel Barral-Netto , Anderson da Costa Armstrong
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.
{"title":"Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study","authors":"Orlando Vieira Gomes , Carlos Dornels Freire de Souza , Jandir Mendonça Nicacio , Rodrigo Feliciano do Carmo , Vanessa Cardoso Pereira , Dinani Matoso Fialho de Oliveira Armstrong , Manoel Barral-Netto , Anderson da Costa Armstrong","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":"38 ","pages":"Article 100882"},"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}
Pub Date : 2024-09-25DOI: 10.1016/j.lana.2024.100887
Yann Savina , Aurélien P. Pichon , Lucas Lemaire , Connor A. Howe , Mathilde Ulliel-Roche , Sarah Skinner , Elie Nader , Nicolas Guillot , Émeric Stauffer , Matthieu Roustit , Ivan Hancco , Paul Robach , François Esteve , Vincent Pialoux , Elisa Perger , Gianfranco Parati , Philip N. Ainslie , Stéphane Doutreleau , Philippe Connes , Samuel Verges , Julien V. Brugniaux
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”.
{"title":"Micro- and macrovascular function in the highest city in the world: a cross sectional study","authors":"Yann Savina , Aurélien P. Pichon , Lucas Lemaire , Connor A. Howe , Mathilde Ulliel-Roche , Sarah Skinner , Elie Nader , Nicolas Guillot , Émeric Stauffer , Matthieu Roustit , Ivan Hancco , Paul Robach , François Esteve , Vincent Pialoux , Elisa Perger , Gianfranco Parati , Philip N. Ainslie , Stéphane Doutreleau , Philippe Connes , Samuel Verges , Julien V. Brugniaux","doi":"10.1016/j.lana.2024.100887","DOIUrl":"10.1016/j.lana.2024.100887","url":null,"abstract":"<div><h3>Background</h3><div>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-<em>dependent</em> and -<em>independent</em> responses in both the micro- and macrocirculation, in healthy Andeans at different altitudes and in CMS patients, was examined.</div></div><div><h3>Methods</h3><div>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-<em>independent</em> function (glyceryl trinitrate) was also assessed only in La Rinconada.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>Both micro and macrovascular function are affected by chronic exposure to hypoxia, the latter being further compounded by CMS.</div></div><div><h3>Funding</h3><div>The “Fonds de dotation AGIR pour les maladies chroniques”, the “Air Liquide Foundation”, and the “French National Research Agency”.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100887"},"PeriodicalIF":7.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319139","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 : 2024-09-21DOI: 10.1016/j.lana.2024.100888
Carolina Rosadas , Draurio Barreira , Pamela C. Gaspar , Mayra G. Aragón , Adijeane Oliveira , Tatiane Assone , Angelica E. Miranda
{"title":"Brazil takes a leap towards the elimination of HTLV-1 vertical transmission","authors":"Carolina Rosadas , Draurio Barreira , Pamela C. Gaspar , Mayra G. Aragón , Adijeane Oliveira , Tatiane Assone , Angelica E. Miranda","doi":"10.1016/j.lana.2024.100888","DOIUrl":"10.1016/j.lana.2024.100888","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100888"},"PeriodicalIF":7.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002151/pdfft?md5=af3e0b899406e71f89e28096e8e0828b&pid=1-s2.0-S2667193X24002151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274157","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 : 2024-09-15DOI: 10.1016/j.lana.2024.100883
Hélène Tréhard , Lise Musset , Yassamine Lazrek , Michael White , Stéphane Pelleau , Ivo Mueller , Felix Djossou , Alice Sanna , Jordi Landier , Jean Gaudart , Emilie Mosnier
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.
{"title":"Which diagnostic test to use for Testing and Treatment strategies in Plasmodium vivax low-transmission settings: a secondary analysis of a longitudinal interventional study","authors":"Hélène Tréhard , Lise Musset , Yassamine Lazrek , Michael White , Stéphane Pelleau , Ivo Mueller , Felix Djossou , Alice Sanna , Jordi Landier , Jean Gaudart , Emilie Mosnier","doi":"10.1016/j.lana.2024.100883","DOIUrl":"10.1016/j.lana.2024.100883","url":null,"abstract":"<div><h3>Background</h3><p>The lack of sensitive field tests to diagnose blood stages and hypnozoite carriers prevents Testing and Treatment (TAT) strategies to achieve <em>Plasmodium vivax</em> 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 <em>P. vivax</em> carriers.</p></div><div><h3>Methods</h3><p>The PALUSTOP cohort study implemented in SGO (September 2017 to December 2018) screened participants for <em>P. vivax</em> using PCR tests and treated positive cases. Serology was also performed. Passive detection of <em>P. vivax</em> 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.</p></div><div><h3>Findings</h3><p>In 2017, 1567 inhabitants were included, aged 0–92 years. A total of 90 (6%) were <em>P. vivax</em> 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.</p></div><div><h3>Interpretation</h3><p>Serology and PCR are promising tools for targeted treatment strategies in <em>P. vivax</em> 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.</p></div><div><h3>Funding</h3><p>Supported by <span>European Funds for Regional Development</span>, <span>French Guiana Regional Health Agency</span>, <span>Pan American Health Organization</span>, <span>WHO</span>, <span>French Ministry for Research</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100883"},"PeriodicalIF":7.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002102/pdfft?md5=b76863e227d785e1a018441a19b4dead&pid=1-s2.0-S2667193X24002102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233826","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 : 2024-09-11DOI: 10.1016/j.lana.2024.100886
Marni Brownell , Nathan C. Nickel , Kayla Frank , Lisa Flaten , Scott Sinclair , Stephanie Sinclair , Nora Murdock , Jennifer E. Enns , Jamie Pfau , Anita Durksen , Colette Scatliff , Heather Prior , Randy Walld , Lorna Turnbull , Karine Levasseur , Teresa Mayer , Jennifer Chartrand , Chris Nash , Elizabeth Decaire , Hygiea Casiano , Therese A. Stukel
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).
{"title":"Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada","authors":"Marni Brownell , Nathan C. Nickel , Kayla Frank , Lisa Flaten , Scott Sinclair , Stephanie Sinclair , Nora Murdock , Jennifer E. Enns , Jamie Pfau , Anita Durksen , Colette Scatliff , Heather Prior , Randy Walld , Lorna Turnbull , Karine Levasseur , Teresa Mayer , Jennifer Chartrand , Chris Nash , Elizabeth Decaire , Hygiea Casiano , Therese A. Stukel","doi":"10.1016/j.lana.2024.100886","DOIUrl":"10.1016/j.lana.2024.100886","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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).</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p><span>Social Sciences and Humanities Research Council</span> (no. 890-2018-0029).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100886"},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002138/pdfft?md5=19b5b66c6bc19406a9c25c9a929cd5f7&pid=1-s2.0-S2667193X24002138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168460","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 : 2024-09-11DOI: 10.1016/j.lana.2024.100884
Muhammad Jawad Noon , Xinshu She , Benjamin Mason Meier
{"title":"The US elections as a determinant of global health","authors":"Muhammad Jawad Noon , Xinshu She , Benjamin Mason Meier","doi":"10.1016/j.lana.2024.100884","DOIUrl":"10.1016/j.lana.2024.100884","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100884"},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002114/pdfft?md5=101d30eca7201a5d9881ecf08fc3096a&pid=1-s2.0-S2667193X24002114-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167743","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 : 2024-09-11DOI: 10.1016/j.lana.2024.100889
David T. Zhu , Simar S. Bajaj , Thomas Kerr
{"title":"Supervised safe consumption sites — lessons and opportunities for North America","authors":"David T. Zhu , Simar S. Bajaj , Thomas Kerr","doi":"10.1016/j.lana.2024.100889","DOIUrl":"10.1016/j.lana.2024.100889","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100889"},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002163/pdfft?md5=43d20199c6e3563ae82a46929d0cc148&pid=1-s2.0-S2667193X24002163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167744","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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