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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
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.

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
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.

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
The Lancet Regional Health – Americas
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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
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.

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
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.

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。
{"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 ,&nbsp;Stephanie A. Smith-Warner ,&nbsp;Sinara Laurini Rossato ,&nbsp;Neha Khandpur ,&nbsp;JoAnn E. Manson ,&nbsp;Lu Qi ,&nbsp;Eric B. Rimm ,&nbsp;Kenneth J. Mukamal ,&nbsp;Walter C. Willett ,&nbsp;Molin Wang ,&nbsp;Frank B. Hu ,&nbsp;Josiemer Mattei ,&nbsp;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}
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
Elisa Pucu
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引用次数: 0
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 分阶段推广 COVID-19 疫苗对 2019 年 1 月至 2023 年 2 月美国成年人焦虑和抑郁情绪的影响:基于人群的间断时间序列分析
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 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.
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引用次数: 0
Healthcare access, quality and financial risk protection among displaced Venezuelan women living in Brazil: a cross-sectional study 居住在巴西的流离失所委内瑞拉妇女获得医疗保健的机会、质量和财务风险保护:一项横断面研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 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).

背景由于委内瑞拉的社会经济状况不断恶化,数百万委内瑞拉人流离失所。我们研究了巴西境内委内瑞拉移民妇女全民医保的关键领域:医疗服务的获取、医疗质量和财务风险保护。方法我们收集了博阿维斯塔市和马瑙斯市 2018 年至 2021 年期间移民到巴西的 2012 名 15-49 岁委内瑞拉妇女的原始数据,以及巴西妇女的二手数据。我们使用线性回归与熵平衡匹配来估算移民身份与医疗支出、利用率和质量指标之间的关联。研究结果我们的样本平均年龄为 29.5 岁(S.D. 8.9),64%(1286/2011)为混合种族,29%(577/2011)为白人,4%(71/2011)为黑人,3%(62/2011)为土著人,1%(15/2011)为其他种族。与巴西妇女相比,移民妇女的灾难性医疗支出发生率高出 9.5 个百分点 (pp) (95% CI: 6 pp-13 pp; p < 0.0001)。移民在求医时接受医疗保健的可能性要高 27 个百分点(95% CI:11 个百分点至 43 个百分点;p = 0.0008),但在过去三年中接受子宫颈抹片检查的可能性要低 37 个百分点(95% CI:-45 个百分点至-29 个百分点;p < 0.0001)。移民与非移民一样有可能在三个月内获得子宫颈抹片检查结果(95% CI:-9 pp 至 22 pp;P = 0.39),并获得临床适当的产前咨询(95% CI:-10 pp 至 40 pp;P = 0.23)。然而,未满足的性保健和生殖保健需求的潜在积压以及财务风险保护的不足需要政策关注。
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引用次数: 0
Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness 使用烟酰胺进行大规模化疗以控制疟原虫:基于人群的安全性和治疗效果
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-30 DOI: 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.

Funding

The Bill and Melinda Gates Foundation.

背景使用尼可刹米(NSM)进行大规模给药可用于控制泰纳丝虫病,泰纳丝虫病是神经囊虫病的病因。尼可刹米对泰纳丝虫病的有效率为84.3%,由于不会被肠道吸收,因此被认为是安全的。然而,有关其在 MDA 期间的安全性和有效性的信息却很有限。我们评估了在秘鲁通贝斯(Tumbes)开展的消除囊尾蚴病计划期间,NSM的有效性和报告的不良事件(AEs)。方法为77397名符合条件的居民提供了三轮NSM,每轮间隔4个月。每轮治疗后 72 小时,我们都会再次访问所有参与者的住所,收集有关不良反应的信息。我们还收集了治疗后的粪便样本,以便在第一轮治疗后诊断taeniasis,并在30天后对感染者进行第二次样本采集,以评估NSM的效果。研究结果在实施期间,68751人至少接受了一剂NSM治疗(平均年龄29岁,SD 20;52%为男性),65551人(95.3%)在治疗后接受了访问。988人(1.5%)报告至少出现过一次AE。几乎所有的不良反应(99.2%)都是轻微的,没有严重不良反应的记录。在 211 名确诊患有泰纳丝虫病的参与者中,188 人在治疗 30 天后提供了粪便样本,141 人治愈(治疗有效率为 75.0%)。年龄较大和共抗原水平较高与治疗失败有明显关系。然而,一次用药后的疗效低于预期,这表明可能需要额外的治疗来加强感染控制工作。
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引用次数: 0
Environmental pollution challenges public health surveillance: the case of mercury exposure and intoxication in Brazil 环境污染对公共卫生监测的挑战:巴西的汞暴露和汞中毒案例
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-30 DOI: 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).

污染每年造成数百万人死亡,对中低收入国家的影响尤为严重。汞是引起重大公共卫生问题的三大主要化学品之一,即使含量很低,也会导致心血管和神经系统疾病,儿童和土著居民尤其容易受到影响。南美洲近 80% 的汞排放源于亚马逊地区。巴西是全球第五大汞排放国,它充分体现了低收入和中等收入国家在有效监测和处理汞暴露/汞中毒方面所面临的挑战。尽管拥有 SINAN(强制报告疾病的数字平台)和社区健康代理等强大工具,但数据显示报告严重不足,尤其是在亚马逊地区。此外,SINAN 的更新也存在重大延误:例如,2019 年 Munduruku 土著居民的 196 例病例直到 2023 年才被纳入。在这篇《个人观点》中,我们概述了一些有见地的建议,以加强公共卫生监测,实施持久、有效的战略来监测、报告和解决汞暴露/汞中毒问题,重点关注巴西亚马逊地区。尽管这些建议是针对巴西所面临的挑战而提出的,但对于面临类似问题(汞排放量高、存在弱势人群等)的其他亚马逊国家来说,这些建议也具有适应潜力。
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引用次数: 0
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Lancet Regional Health-Americas
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