Pub Date : 2024-09-01DOI: 10.1016/j.lana.2024.100832
Maria Carmo P. Nunes , Caryn Bern , Eva H. Clark , Antonio L. Teixeira , Israel Molina
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.
{"title":"Clinical features of Chagas disease progression and severity","authors":"Maria Carmo P. Nunes , Caryn Bern , Eva H. Clark , Antonio L. Teixeira , Israel Molina","doi":"10.1016/j.lana.2024.100832","DOIUrl":"10.1016/j.lana.2024.100832","url":null,"abstract":"<div><p>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.</p><p>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.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100832"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001595/pdfft?md5=1e1c3795e760a4f6d873f3394953c4bf&pid=1-s2.0-S2667193X24001595-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229272","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100860
Emilie Finch , Eric J. Nilles , Cecilia Then Paulino , Ronald Skewes-Ramm , Colleen L. Lau , Rachel Lowe , Adam J. Kucharski
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.
{"title":"Effects of mobility, immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic: a modelling study","authors":"Emilie Finch , Eric J. Nilles , Cecilia Then Paulino , Ronald Skewes-Ramm , Colleen L. Lau , Rachel Lowe , Adam J. Kucharski","doi":"10.1016/j.lana.2024.100860","DOIUrl":"10.1016/j.lana.2024.100860","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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.</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p><span>Medical Research Council</span>, <span>Wellcome Trust</span>, <span>Royal Society</span>, <span>US CDC</span> and Australian <span>National Health and Medical Research Council</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100860"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400187X/pdfft?md5=97443b4e7e5bd7d4ce03d546e8419abe&pid=1-s2.0-S2667193X2400187X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097211","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100881
Zulma M. Cucunubá , Sebastián A. Gutiérrez-Romero , Juan-David Ramírez , Natalia Velásquez-Ortiz , Soledad Ceccarelli , Gabriel Parra-Henao , Andrés F. Henao-Martínez , Jorge Rabinovich , María-Gloria Basáñez , Pierre Nouvellet , Fernando Abad-Franch
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.
{"title":"The epidemiology of Chagas disease in the Americas","authors":"Zulma M. Cucunubá , Sebastián A. Gutiérrez-Romero , Juan-David Ramírez , Natalia Velásquez-Ortiz , Soledad Ceccarelli , Gabriel Parra-Henao , Andrés F. Henao-Martínez , Jorge Rabinovich , María-Gloria Basáñez , Pierre Nouvellet , Fernando Abad-Franch","doi":"10.1016/j.lana.2024.100881","DOIUrl":"10.1016/j.lana.2024.100881","url":null,"abstract":"<div><p>Chagas disease is a complex parasitic zoonosis that still threatens public health across the Americas. Initiatives to control <em>Trypanosoma cruzi</em> transmission <em>via</em> 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 <em>T. cruzi</em> 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.</p><p>This is the first in a <strong>Series</strong> of five papers about Chagas Disease. All papers in the Series are available at <span><span>https://www.thelancet.com/series/chagasdisease</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100881"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002084/pdfft?md5=3b3d3adb1184fab8fadcaa8b45a6048e&pid=1-s2.0-S2667193X24002084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229273","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100859
Kenny Mendoza , Stephanie A. Smith-Warner , Sinara Laurini Rossato , Neha Khandpur , JoAnn E. Manson , Lu Qi , Eric B. Rimm , Kenneth J. Mukamal , Walter C. Willett , Molin Wang , Frank B. Hu , Josiemer Mattei , Qi Sun
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.
{"title":"Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies","authors":"Kenny Mendoza , Stephanie A. Smith-Warner , Sinara Laurini Rossato , Neha Khandpur , JoAnn E. Manson , Lu Qi , Eric B. Rimm , Kenneth J. Mukamal , Walter C. Willett , Molin Wang , Frank B. Hu , Josiemer Mattei , Qi Sun","doi":"10.1016/j.lana.2024.100859","DOIUrl":"10.1016/j.lana.2024.100859","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; <em>n</em> = 75,735), Nurses’ Health Study II (NHSII; <em>n</em> = 90,813), and Health Professionals Follow-Up Study (HPFS; <em>n</em> = 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.</p></div><div><h3>Findings</h3><p>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.</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p><span>National Institutes of Health</span> (NIH) grants supported the <span>NHS</span>, <span>NHSII</span>, and <span>HPFS</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100859"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001868/pdfft?md5=9b24e7ed4689fcb880b35fd318a274e0&pid=1-s2.0-S2667193X24001868-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121660","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100885
Elisa Pucu
{"title":"Dagmar García Rivera—a career of passion and resilience","authors":"Elisa Pucu","doi":"10.1016/j.lana.2024.100885","DOIUrl":"10.1016/j.lana.2024.100885","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100885"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002126/pdfft?md5=3d639b5110162bcd580d5c4dbb170cb0&pid=1-s2.0-S2667193X24002126-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229859","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100852
Yusen Zhai , Mengchen Fan , Baocheng Geng , Xue Du , Scott Snyder , Larrell Wilkinson
Background
Existing research lacks information on the potential impacts of multi-phased coronavirus disease 2019 (COVID-19) vaccine rollouts on population mental health. This study aims to evaluate the impact of various COVID-19 vaccine rollout phases on trends and prevalence of anxiety and depression among US adults at a population level.
Methods
We performed a US population-based multi-intervention interrupted time series analysis through Deep Learning and autoregressive integrated moving average (ARIMA) approaches, analyzing 4 waves of US CDC's Behavioral Risk Factor Surveillance System (BRFSS) data (January 2019–February 2023) to assess changes in the weekly prevalence of anxiety and depression following interruptions, including all major COVID-19 vaccine rollout phases from 2020 to early 2023 while considering pandemic-related events.
Findings
Among 1,615,643 US adults (1,011,300 [76.4%] aged 18–64 years, 867,826 [51.2%] female, 126,594 [16.9%] Hispanic, 120,380 [11.9%] non-Hispanic Black, 1,191,668 [61.7%] non-Hispanic White, and 113,461 [9.5%] other non-Hispanic people of color), we found that three COVID-19 vaccine rollout phases (ie, prioritization for educational/childcare workers, boosters for all US adults, authorization for young children) were associated with a 0.93 percentage-point (95% CI −1.81 to −0.04, p = 0.041), 1.28 percentage-point (95% CI −2.32 to −0.24, p = 0.017), and 0.89 percentage-point (95% CI −1.56 to −0.22, p = 0.010) reduction, respectively, in anxiety and depression prevalence among the general US adult population despite an upward trend in the prevalence of anxiety and depression from 2019 to early 2023. Among different population groups, Phase 1 was associated with increases in anxiety and depression prevalence among Black/African Americans (2.26 percentage-point, 95% CI 0.24–4.28, p = 0.029), other non-Hispanic people of color (2.68 percentage-point, 95% CI 0.36–5.00, p = 0.024), and lower-income individuals (3.95 percentage-point, 95% CI 2.20–5.71, p < 0.0001).
Interpretation
Our findings suggest disparate effects of phased COVID-19 vaccine rollout on mental health across US populations, underlining the need for careful planning in future strategies for phased disease prevention and interventions.
Funding
None.
背景现有研究缺乏有关分阶段推广 2019 年冠状病毒病(COVID-19)疫苗对人群心理健康的潜在影响的信息。本研究旨在评估不同阶段的 COVID-19 疫苗推广对美国成年人焦虑症和抑郁症的趋势和患病率的影响。方法我们通过深度学习和自回归综合移动平均(ARIMA)方法进行了基于美国人口的多干预中断时间序列分析,分析了美国疾病预防控制中心行为风险因素监测系统(BRFSS)的4波数据(2019年1月至2023年2月),以评估中断后焦虑症和抑郁症每周患病率的变化,包括2020年至2023年初的所有主要COVID-19疫苗推广阶段,同时考虑了大流行相关事件。研究结果在 1,615,643 名美国成年人中(1,011,300 [76.4%] 18-64 岁,867,826 [51.2%]女性、126,594 [16.9%] 西班牙裔、120,380 [11.9%] 非西班牙裔黑人、1,191,668 [61.7%] 非西班牙裔白人和 113,461 [9.5%] 其他非西班牙裔有色人种)中,我们发现 COVID-19 疫苗的三个推广阶段(即教育/保育工作者优先、所有美国成年人加强接种、幼儿授权)与 0.93个百分点(95% CI -1.81至-0.04,p = 0.041)、1.28个百分点(95% CI -2.32至-0.24,p = 0.017)和0.89个百分点(95% CI -1.56至-0.22,p = 0.010),尽管焦虑和抑郁患病率在2019年至2023年初呈上升趋势。在不同人群中,第 1 阶段与美国黑人/非洲裔(2.26 个百分点,95% CI 0.24-4.28,p = 0.029)、其他非西班牙裔有色人种(2.68 个百分点,95% CI 0.36-5.00,p = 0.024)和低收入人群(3.95个百分点,95% CI 2.20-5.71,p < 0.0001).Interpretation我们的研究结果表明,COVID-19疫苗的分阶段推广对美国不同人群的心理健康产生了不同的影响,这强调了在未来的分阶段疾病预防和干预策略中需要谨慎规划.FundingNone.
{"title":"Impact of phased COVID-19 vaccine rollout on anxiety and depression among US adult population, January 2019–February 2023: a population-based interrupted time series analysis","authors":"Yusen Zhai , Mengchen Fan , Baocheng Geng , Xue Du , Scott Snyder , Larrell Wilkinson","doi":"10.1016/j.lana.2024.100852","DOIUrl":"10.1016/j.lana.2024.100852","url":null,"abstract":"<div><h3>Background</h3><p>Existing research lacks information on the potential impacts of multi-phased coronavirus disease 2019 (COVID-19) vaccine rollouts on population mental health. This study aims to evaluate the impact of various COVID-19 vaccine rollout phases on trends and prevalence of anxiety and depression among US adults at a population level.</p></div><div><h3>Methods</h3><p>We performed a US population-based multi-intervention interrupted time series analysis through Deep Learning and autoregressive integrated moving average (ARIMA) approaches, analyzing 4 waves of US CDC's Behavioral Risk Factor Surveillance System (BRFSS) data (January 2019–February 2023) to assess changes in the weekly prevalence of anxiety and depression following interruptions, including all major COVID-19 vaccine rollout phases from 2020 to early 2023 while considering pandemic-related events.</p></div><div><h3>Findings</h3><p>Among 1,615,643 US adults (1,011,300 [76.4%] aged 18–64 years, 867,826 [51.2%] female, 126,594 [16.9%] Hispanic, 120,380 [11.9%] non-Hispanic Black, 1,191,668 [61.7%] non-Hispanic White, and 113,461 [9.5%] other non-Hispanic people of color), we found that three COVID-19 vaccine rollout phases (ie, prioritization for educational/childcare workers, boosters for all US adults, authorization for young children) were associated with a 0.93 percentage-point (95% CI −1.81 to −0.04, p = 0.041), 1.28 percentage-point (95% CI −2.32 to −0.24, p = 0.017), and 0.89 percentage-point (95% CI −1.56 to −0.22, p = 0.010) reduction, respectively, in anxiety and depression prevalence among the general US adult population despite an upward trend in the prevalence of anxiety and depression from 2019 to early 2023. Among different population groups, Phase 1 was associated with increases in anxiety and depression prevalence among Black/African Americans (2.26 percentage-point, 95% CI 0.24–4.28, p = 0.029), other non-Hispanic people of color (2.68 percentage-point, 95% CI 0.36–5.00, p = 0.024), and lower-income individuals (3.95 percentage-point, 95% CI 2.20–5.71, p < 0.0001).</p></div><div><h3>Interpretation</h3><p>Our findings suggest disparate effects of phased COVID-19 vaccine rollout on mental health across US populations, underlining the need for careful planning in future strategies for phased disease prevention and interventions.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100852"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001790/pdfft?md5=dd0d0b606e523542a83f32d5e2684a7d&pid=1-s2.0-S2667193X24001790-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229271","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 : 2024-09-01DOI: 10.1016/j.lana.2024.100830
Rodrigo Moreno-Serra , Ivan Ochoa-Moreno , Misael Anaya-Montes , Luis Cardoso Fernandes , Thaiza Gomes , Maria Do Carmo Leal , Cristóbal Cuadrado
Background
Millions of Venezuelans have been displaced because of deteriorating socio-economic conditions in their country. We examine key domains of universal health coverage among migrant Venezuelan women in Brazil: healthcare access, care quality and financial risk protection.
Methods
We collected primary data on 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021, in the cities of Boa Vista and Manaus, along with secondary data for Brazilian women. We used linear regression with entropy balance matching to estimate associations between migrant status and healthcare spending, utilisation and quality indicators.
Findings
Our sample had a mean age of 29.5 years (S.D. 8.9), 64% (1286/2011) of mixed ethnicity, 29% (577/2011) white, 4% (71/2011) black, 3% (62/2011) indigenous and 1% (15/2011) other ethnicities. Compared to Brazilian women, migrant women had 9.5 percentage points (pp) (95% CI: 6 pp–13 pp; p < 0.0001) higher catastrophic health expenditure incidence. Migrants were 27 pp (95% CI: 11 pp–43 pp; p = 0.0008) more likely to receive healthcare when sought, but 37 pp (95% CI: −45 pp to −29 pp; p < 0.0001) less likely to have had a pap smear in the last three years. Migrants were as likely as non-migrants to have received pap smear results within three months (95% CI: −9 pp to 22 pp; p = 0.39) and clinically appropriate antenatal consultations (95% CI: −10 pp to 40 pp; p = 0.23).
Interpretation
Migrant women in Brazil have relatively good healthcare access and quality outcomes. Yet a potential backlog of unmet sexual and reproductive healthcare needs and inadequate financial risk protection require policy attention.
Funding
UK Economic and Social Research Council (ES/T00441X/1).
{"title":"Healthcare access, quality and financial risk protection among displaced Venezuelan women living in Brazil: a cross-sectional study","authors":"Rodrigo Moreno-Serra , Ivan Ochoa-Moreno , Misael Anaya-Montes , Luis Cardoso Fernandes , Thaiza Gomes , Maria Do Carmo Leal , Cristóbal Cuadrado","doi":"10.1016/j.lana.2024.100830","DOIUrl":"10.1016/j.lana.2024.100830","url":null,"abstract":"<div><h3>Background</h3><p>Millions of Venezuelans have been displaced because of deteriorating socio-economic conditions in their country. We examine key domains of universal health coverage among migrant Venezuelan women in Brazil: healthcare access, care quality and financial risk protection.</p></div><div><h3>Methods</h3><p>We collected primary data on 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021, in the cities of Boa Vista and Manaus, along with secondary data for Brazilian women. We used linear regression with entropy balance matching to estimate associations between migrant status and healthcare spending, utilisation and quality indicators.</p></div><div><h3>Findings</h3><p>Our sample had a mean age of 29.5 years (S.D. 8.9), 64% (1286/2011) of mixed ethnicity, 29% (577/2011) white, 4% (71/2011) black, 3% (62/2011) indigenous and 1% (15/2011) other ethnicities. Compared to Brazilian women, migrant women had 9.5 percentage points (pp) (95% CI: 6 pp–13 pp; p < 0.0001) higher catastrophic health expenditure incidence. Migrants were 27 pp (95% CI: 11 pp–43 pp; p = 0.0008) more likely to receive healthcare when sought, but 37 pp (95% CI: −45 pp to −29 pp; p < 0.0001) less likely to have had a pap smear in the last three years. Migrants were as likely as non-migrants to have received pap smear results within three months (95% CI: −9 pp to 22 pp; p = 0.39) and clinically appropriate antenatal consultations (95% CI: −10 pp to 40 pp; p = 0.23).</p></div><div><h3>Interpretation</h3><p>Migrant women in Brazil have relatively good healthcare access and quality outcomes. Yet a potential backlog of unmet sexual and reproductive healthcare needs and inadequate financial risk protection require policy attention.</p></div><div><h3>Funding</h3><p>UK <span>Economic and Social Research Council</span> (ES/T00441X/1).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100830"},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001571/pdfft?md5=3e39411067621a588bb6658820d0021f&pid=1-s2.0-S2667193X24001571-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229860","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 : 2024-08-30DOI: 10.1016/j.lana.2024.100876
Melissa T. Wardle , Samantha E. Allen , Ricardo Gamboa , Percy Vilchez , Seth E. O'Neal , Claudio Muro , Andrés G. Lescano , Luz M. Moyano , Guillermo E. Gonzalvez , Armando E. González , Robert H. Gilman , Héctor H. García
Background
Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru.
Methods
Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness.
Findings
During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure.
Interpretation
MDA with NSM is safe in Taenia solium endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts.
{"title":"Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness","authors":"Melissa T. Wardle , Samantha E. Allen , Ricardo Gamboa , Percy Vilchez , Seth E. O'Neal , Claudio Muro , Andrés G. Lescano , Luz M. Moyano , Guillermo E. Gonzalvez , Armando E. González , Robert H. Gilman , Héctor H. García","doi":"10.1016/j.lana.2024.100876","DOIUrl":"10.1016/j.lana.2024.100876","url":null,"abstract":"<div><h3>Background</h3><p>Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru.</p></div><div><h3>Methods</h3><p>Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness.</p></div><div><h3>Findings</h3><p>During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure.</p></div><div><h3>Interpretation</h3><p>MDA with NSM is safe in <em>Taenia solium</em> endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts.</p></div><div><h3>Funding</h3><p>The <span>Bill and Melinda Gates Foundation</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100876"},"PeriodicalIF":7.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002035/pdfft?md5=5aae0ff9adb1fbfbdaaecd8652189b58&pid=1-s2.0-S2667193X24002035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096387","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 : 2024-08-30DOI: 10.1016/j.lana.2024.100880
Maria Elena Crespo-Lopez , Amanda Lopes-Araújo , Paulo Cesar Basta , Isabela Soares-Silva , Carlos B.A. de Souza , Caio Gustavo Leal-Nazaré , Letícia Santos-Sacramento , Jean Ludger Barthelemy , Gabriela P. Arrifano , Marcus Augusto-Oliveira
Pollution, causing millions of deaths annually, disproportionally affects low- and middle-income countries (LMICs). Mercury ranks among the three main chemicals of major public health concern, and even low levels can cause cardiovascular and nervous outcomes, with children and indigenous populations being especially vulnerable. Nearly 80% of all emissions in South America originate from the Amazon. Brazil, the fifth-largest contributor to global mercury emissions, exemplifies the challenges faced by LMICs in effectively monitoring and addressing mercury exposure/intoxication. Despite having powerful tools such as SINAN (a digital platform for compulsory disease reporting), and Community Health Agents, data reveals significant underreporting, especially in the Amazon. Furthermore, SINAN has important delays in its update: for instance, 196 cases of Munduruku Indigenous people in 2019 have only been included in 2023. In this Personal View, we outline insightful recommendations to enhance public health surveillance and implement enduring, effective strategies to monitor, report and address mercury exposure/intoxication, focusing on the Brazilian Amazon. Although these recommendations are tailored to the challenges of this country, they hold potential for adaptation by other Amazonian countries facing similar issues (high mercury emissions and the presence of vulnerable populations, among others).
{"title":"Environmental pollution challenges public health surveillance: the case of mercury exposure and intoxication in Brazil","authors":"Maria Elena Crespo-Lopez , Amanda Lopes-Araújo , Paulo Cesar Basta , Isabela Soares-Silva , Carlos B.A. de Souza , Caio Gustavo Leal-Nazaré , Letícia Santos-Sacramento , Jean Ludger Barthelemy , Gabriela P. Arrifano , Marcus Augusto-Oliveira","doi":"10.1016/j.lana.2024.100880","DOIUrl":"10.1016/j.lana.2024.100880","url":null,"abstract":"<div><p>Pollution, causing millions of deaths annually, disproportionally affects low- and middle-income countries (LMICs). Mercury ranks among the three main chemicals of major public health concern, and even low levels can cause cardiovascular and nervous outcomes, with children and indigenous populations being especially vulnerable. Nearly 80% of all emissions in South America originate from the Amazon. Brazil, the fifth-largest contributor to global mercury emissions, exemplifies the challenges faced by LMICs in effectively monitoring and addressing mercury exposure/intoxication. Despite having powerful tools such as SINAN (a digital platform for compulsory disease reporting), and Community Health Agents, data reveals significant underreporting, especially in the Amazon. Furthermore, SINAN has important delays in its update: for instance, 196 cases of Munduruku Indigenous people in 2019 have only been included in 2023. In this Personal View, we outline insightful recommendations to enhance public health surveillance and implement enduring, effective strategies to monitor, report and address mercury exposure/intoxication, focusing on the Brazilian Amazon. Although these recommendations are tailored to the challenges of this country, they hold potential for adaptation by other Amazonian countries facing similar issues (high mercury emissions and the presence of vulnerable populations, among others).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100880"},"PeriodicalIF":7.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002072/pdfft?md5=c3e8459fdf6cd02d6dc9764de17b53bb&pid=1-s2.0-S2667193X24002072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096186","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}