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The expansion of gambling across the Americas poses risks to mental health and wellbeing 赌博在美洲各地的扩张给心理健康和幸福带来风险
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-29 DOI: 10.1016/j.lana.2024.100855

The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation’s regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO’s remit.

美洲正面临着严重的心理健康问题。泛美卫生组织的 "改善心理健康和预防自杀地区战略 "是应对这一挑战的重要里程碑。然而,该战略没有关注赌博对健康和福祉的潜在风险,这是一个严重的疏漏。在这一观点中,我们回顾了证明赌博与各种精神健康状况及相关危害之间存在明确联系的现有学术研究。随后,我们以实证为基础,讨论了商业赌博最近是如何在整个地区迅速扩张的,以及这种扩张的风险是如何在政策层面没有得到充分考虑的。然后,我们介绍了该地区新出现的有关赌博扩张对心理健康负面影响的证据。审查最后提出了可能采取的政策行动,以加强对该地区赌博业的控制,减少随之而来的对精神健康和福祉的危害,重点是泛美卫生组织的职权范围。
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引用次数: 0
Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis 在不断变化的气候中进行公共卫生监测的与气候相关的健康影响指标:系统回顾和地方适用性分析
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-29 DOI: 10.1016/j.lana.2024.100854

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.

Funding

This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

气候变化对公共卫生提出了挑战。有效管理与气候相关的健康风险有赖于强有力的公共卫生监测(PHS)和人口健康指标。尽管已有全球和特定国家的指标,但将其纳入当地公共卫生监测系统的程度有限,从而影响了决策。我们对与气候变化影响相关的人口健康指标及其在国家公共卫生监测系统中的适用性进行了系统回顾。在注册协议的指导下,我们搜索了多个数据库,共收录了 41 篇文章。其中 35 篇报告了发病率指标,39 篇报告了死亡率指标。以智利为例,我们为智利的公共卫生服务系统确定了三套指标。优先考虑的指标包括病媒、食物和水传播的疾病,以及与温度相关的健康结果指标,因为这些指标易于整合到现有的公共卫生服务系统中。本综述强调了人口健康指标在监测与气候相关的健康影响方面的重要性,并强调需要根据当地背景因素来指导指标的选择。这些机构均未参与研究的构思、设计或结果解释。
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引用次数: 0
Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis. 巴西小儿脾损伤脾切除术的频率:回顾性分析。
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-28 eCollection Date: 2024-08-01 DOI: 10.1016/j.lana.2024.100844
Luiza Telles, Ayla Gerk, Madeleine Carroll, Matheus Daniel Faleiro, Thais Barbosa de Oliveira, Abbie Naus, Roseanne Ferreira, Fabio Botelho, Joaquim Bustorff-Silva, David P Mooney, Julia Ferreira

Background: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.

Methods: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.

Findings: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.

Interpretation: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

背景:在高收入国家,小儿钝性脾损伤的非手术治疗方法已得到广泛认可,这导致血流动力学稳定的儿童脾切除率较低。脾切除率已成为美国外科学院创伤委员会验证创伤中心的一项质量指标。然而,巴西等不同收入水平国家的儿童脾切除率数据仍然有限。本研究旨在评估过去十年中巴西儿童的创伤后脾脏切除率以及与当地资源的关系:从 FioCruz 数据库中获取了 2008 年至 2019 年小儿脾损伤和脾切除术的数据,包括患者年龄和入院服务(成人或小儿)。儿科外科医生、儿科重症监护室(PICU)床位和计算机断层扫描仪的地区数量来自巴西国家数据库。按入院年份和服务对全国脾脏切除率进行了分析,并按地区资源水平、儿科外科医生数量、儿科重症监护室床位数和计算机断层扫描机数对脾脏切除率进行了分析:共有 4061 名儿童因脾脏损伤住院,其中 2287 名(51.8%)儿童接受了脾脏切除术,这一比例随着时间的推移没有变化。76.8%的脾损伤患者为男性,23.1%为女性。平均年龄为 11.61 岁。与儿科相比,成人外科收治的儿科患者接受脾脏切除术的几率要高出 14.77 倍(OR = 14.77,95% CI 11.75-18.56,P 解释:巴西儿童创伤后脾脏切除率很高,远远超过高收入国家。地区儿科资源的增加与脾切除率的下降并不相称。要了解巴西在采用非手术疗法治疗小儿脾脏损伤方面存在的障碍,必须开展进一步的研究:本研究未从公共、商业或非营利部门的任何资助机构获得特定资助。
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引用次数: 0
The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study 引入快速诊断测试对加拿大北极社区梅毒传播的人群影响--数学建模研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-20 DOI: 10.1016/j.lana.2024.100845

Background

Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.

Methods

To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017–2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023–2032.

Findings

The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16–30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18–43%) and 37% (21–46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.

Interpretation

Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.

Funding

Canadian Institutes of Health Research.

背景加拿大北极地区的社区经历了梅毒的持续传播,诊断率比全国平均水平高出18倍。由于远离实验室设施,导致梅毒筛查和治疗之间出现延误,从而助长了梅毒的传播。快速诊断检测可以通过在医疗点进行检测消除治疗延误。为了评估部署快速诊断检测对人群的影响,我们利用详细的监测数据、人口调查和前瞻性诊断准确性实地研究,建立了一个基于个体的模型。该模型根据一个约有 1050 名性活跃人群的社区的梅毒诊断结果(2017-2022 年)进行了校准。利用 2023-2032 年间累计避免的梅毒新感染病例的年中位数,计算了从 2023 年起实施全血快速诊断检测的影响(感染性梅毒的灵敏度为 92%,非感染性梅毒的灵敏度为 81%;特异性为 99%)。16-30 岁男性的检测率比女性低 51%。在所有干预措施保持 2022 年水平不变的情况下,实施快速诊断检测可在 5 年和 10 年内分别避免 33% (90% 可信区间:18-43%)和 37% (21-46%)的梅毒新发感染。在北极社区实施梅毒快速诊断检测可减少感染并加强对流行病的控制。这种有效的诊断工具可以在护理点提供当天的检测和治疗,从而快速应对疫情。
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引用次数: 0
Prevalence, risk factors, and impact of long COVID in a socially vulnerable community in Brazil: a prospective cohort study 巴西一个社会弱势群体中长期慢性阻塞性肺病的发病率、风险因素和影响:一项前瞻性队列研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-17 DOI: 10.1016/j.lana.2024.100839

Background

Long COVID is an emerging global public health issue. Socially vulnerable communities in low- and-middle-income countries were severely impacted by the pandemic and are underrepresented in research. This prospective study aimed to determine the prevalence of long COVID, its impact on health, and associated risk factors in one such community in Rio de Janeiro, Brazil.

Methods

A total of 710 individuals aged 18 and older, with confirmed SARS-CoV-2 infection at least three months prior, were enrolled between November 25, 2021, and May 5, 2022. Participants were assessed via telephone or in person using a standardized questionnaire to evaluate their perception of recovery, symptoms, quality of life, and functional status.

Findings

Twenty percent of participants did not feel fully recovered, 22% experienced new or persistent symptoms, 26% had worsened functional status, 18% had increased dyspnoea, and 32% reported a worse quality of life. Persistent symptoms included headache, cough, fatigue, muscle pain, and shortness of breath. Dyspnoea during the acute phase was the strongest independent predictor of worsening outcomes. Females and individuals with comorbidities were more likely to report worse recovery, functioning, dyspnoea, and quality of life.

Interpretation

Our findings reveal a high burden of severe and persistent physical and mental health sequelae in a socially vulnerable community following COVID-19.

Funding

UK Foreign, Commonwealth and Development Office and Wellcome Trust Grant (222048/Z/20/Z), Fundação Oswaldo Cruz (FIOCRUZ), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), and the Centers for Disease Control and Prevention (CDC).

背景长期慢性阻塞性肺病是一个新出现的全球公共卫生问题。中低收入国家的社会弱势群体受到了这一流行病的严重影响,但在研究中却没有得到充分的体现。这项前瞻性研究旨在确定巴西里约热内卢的一个此类社区中长期 COVID 的流行率、其对健康的影响以及相关风险因素。方法 在 2021 年 11 月 25 日至 2022 年 5 月 5 日期间,共招募了 710 名年龄在 18 岁及以上、至少在三个月前确诊感染过 SARS-CoV-2 的人。研究结果20%的参与者感觉没有完全康复,22%的参与者出现新的或持续性症状,26%的参与者功能状况恶化,18%的参与者呼吸困难加重,32%的参与者生活质量下降。持续性症状包括头痛、咳嗽、疲劳、肌肉疼痛和呼吸急促。急性期呼吸困难是预示病情恶化的最强独立因素。女性和合并症患者更有可能报告康复、功能、呼吸困难和生活质量的恶化。资助英国外交、联邦和发展办公室和惠康信托基金资助(222048/Z/20/Z)、奥斯瓦尔多-克鲁斯基金会(FIOCRUZ)、里约热内卢州立研究基金会(FAPERJ)和美国疾病控制与预防中心(CDC)。
{"title":"Prevalence, risk factors, and impact of long COVID in a socially vulnerable community in Brazil: a prospective cohort study","authors":"","doi":"10.1016/j.lana.2024.100839","DOIUrl":"10.1016/j.lana.2024.100839","url":null,"abstract":"<div><h3>Background</h3><p>Long COVID is an emerging global public health issue. Socially vulnerable communities in low- and-middle-income countries were severely impacted by the pandemic and are underrepresented in research. This prospective study aimed to determine the prevalence of long COVID, its impact on health, and associated risk factors in one such community in Rio de Janeiro, Brazil.</p></div><div><h3>Methods</h3><p>A total of 710 individuals aged 18 and older, with confirmed SARS-CoV-2 infection at least three months prior, were enrolled between November 25, 2021, and May 5, 2022. Participants were assessed via telephone or in person using a standardized questionnaire to evaluate their perception of recovery, symptoms, quality of life, and functional status.</p></div><div><h3>Findings</h3><p>Twenty percent of participants did not feel fully recovered, 22% experienced new or persistent symptoms, 26% had worsened functional status, 18% had increased dyspnoea, and 32% reported a worse quality of life. Persistent symptoms included headache, cough, fatigue, muscle pain, and shortness of breath. Dyspnoea during the acute phase was the strongest independent predictor of worsening outcomes. Females and individuals with comorbidities were more likely to report worse recovery, functioning, dyspnoea, and quality of life.</p></div><div><h3>Interpretation</h3><p>Our findings reveal a high burden of severe and persistent physical and mental health sequelae in a socially vulnerable community following COVID-19.</p></div><div><h3>Funding</h3><p>UK <span>Foreign, Commonwealth and Development Office</span> and <span>Wellcome Trust</span> Grant (222048/Z/20/Z), <span>Fundação Oswaldo Cruz</span> (FIOCRUZ), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (<span>FAPERJ</span>), and the <span>Centers for Disease Control and Prevention</span> (CDC).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001662/pdfft?md5=d62994519ef425b554e399c73e4f89b2&pid=1-s2.0-S2667193X24001662-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141637795","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
More expansive diagnosis and treatment are urgently needed to eliminate the global burden of HBV 迫切需要更广泛的诊断和治疗,以消除 HBV 在全球造成的负担
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-16 DOI: 10.1016/j.lana.2024.100843
{"title":"More expansive diagnosis and treatment are urgently needed to eliminate the global burden of HBV","authors":"","doi":"10.1016/j.lana.2024.100843","DOIUrl":"10.1016/j.lana.2024.100843","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001704/pdfft?md5=10f7a2f10d8a8c81a18ec36f4e6d0f5f&pid=1-s2.0-S2667193X24001704-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629980","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
Hospital preparedness for one of the worst predicted hurricane seasons on record – why this time is different 医院为有史以来预测最差的飓风季节之一做好准备--为什么这次与以往不同
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-16 DOI: 10.1016/j.lana.2024.100842
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引用次数: 0
Gun-free zones and active shootings in the United States: a matched case-control study 美国的无枪区和主动枪击事件:一项匹配的病例对照研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-13 DOI: 10.1016/j.lana.2024.100837
Paul M. Reeping , Christopher N. Morrison , Ariana N. Gobaud , Sonali Rajan , Douglas J. Wiebe , Charles C. Branas

Background

Most Americans believe that gun-free zones make locations more vulnerable to violent crimes, particularly active shootings. However, there is no empirical evidence regarding the impact of gun-free zones on protecting locations from violence. The objective of this study was to estimate the association between gun-free zones and active shootings.

Methods

We used a pair-matched case-control study where cases were all US establishments where active shootings occurred between 2014 and 2020, and controls were randomly selected US establishments where active shootings could have but did not occur, pair-matched by establishment type, year, and county. Gun-free status of included establishments was determined via local laws, company policy, news reporting, Google Maps and posted signage, and calling establishments.

Findings

Of 150 active shooting cases, 72 (48.0%) were determined to have occurred in a gun-free zone. Of 150 controls where no active shooting occurred, 92 (61.3%) were determined to be gun-free. After accounting for matched pairs, the conditional odds of an active shooting in gun-free establishments were 0.38 times those in non-gun-free establishments, with a 95% confidence interval of 0.19–0.73 (p-value = 0.0038). Several robustness analyses affirmed these findings.

Interpretation

It is unlikely that gun-free zones attract active shooters; gun-free zones may be protective against active shootings. This study challenges the proposition of repealing gun-free zones based on safety concerns.

Funding

This work was funded in part by the National Collaborative on Gun Violence Research and the Arnold Foundation.

背景大多数美国人认为,无枪区使一些地方更容易发生暴力犯罪,尤其是主动枪击事件。然而,关于无枪区对保护地点免受暴力侵害的影响,目前还没有实证证据。本研究的目的是估算无枪区与主动枪击事件之间的关联。方法我们采用了配对病例对照研究,病例是 2014 年至 2020 年期间发生主动枪击事件的所有美国机构,对照是随机选择的可能发生但未发生主动枪击事件的美国机构,并按机构类型、年份和郡进行配对。通过当地法律、公司政策、新闻报道、谷歌地图和张贴的标牌以及拨打电话等方式来确定所包含场所的无枪状态。在 150 个未发生主动枪击事件的对照区中,有 92 个(61.3%)被确定为无枪区。在考虑配对因素后,无枪场所发生主动枪击事件的条件几率是非无枪场所的 0.38 倍,95% 置信区间为 0.19-0.73 (P 值 = 0.0038)。几项稳健性分析证实了这些结果。释义无枪区不太可能吸引主动枪击者;无枪区可能对主动枪击事件具有保护作用。这项研究对基于安全考虑而废除无枪区的主张提出了质疑。资金支持这项工作部分由全国枪支暴力研究合作组织和阿诺德基金会资助。
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引用次数: 0
Human Orthohantavirus disease prevalence and genotype distribution in the U.S., 2008–2020: a retrospective observational study 2008-2020 年美国人类正沟病毒疾病流行率和基因型分布:一项回顾性观察研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-11 DOI: 10.1016/j.lana.2024.100836
Shannon L.M. Whitmer , Amy Whitesell , Melissa Mobley , Emir Talundzic , Elizabeth Shedroff , Caitlin M. Cossaboom , Sharon Messenger , Mojgan Deldari , Julu Bhatnagar , Lindsey Estetter , Sara Zufan , Debi Cannon , Cheng-Feng Chiang , Ardith Gibbons , Inna Krapiunaya , Maria Morales-Betoulle , Mary Choi , Barbara Knust , Brian Amman , Joel M. Montgomery , John D. Klena

Background

In the United States (U.S.), hantavirus pulmonary syndrome (HPS) and non-HPS hantavirus infection are nationally notifiable diseases. Criteria for identifying human cases are based on clinical symptoms (HPS or non-HPS) and acute diagnostic results (IgM+, rising IgG+ titers, RT-PCR+, or immunohistochemistry (IHC)+). Here we provide an overview of diagnostic testing and summarize human Hantavirus disease occurrence and genotype distribution in the U.S. from 2008 to 2020.

Methods

Epidemiological data from the national hantavirus registry was merged with laboratory diagnostic testing results performed at the CDC. Residual hantavirus-positive specimens were sequenced, and the available epidemiological and genetic data sets were linked to conduct a genomic epidemiological study of hantavirus disease in the U.S.

Findings

From 1993 to 2020, 833 human hantavirus cases have been identified, and from 2008 to 2020, 335 human cases have occurred. Among New World (NW) hantavirus cases detected at the CDC diagnostic laboratory (representing 29.2% of total cases), most (85.0%) were detected during acute disease, however, some convalescent cases were detected in states not traditionally associated with hantavirus infections (Connecticut, Missouri, New Jersey, Pennsylvania, Tennessee, and Vermont). From 1993 to 2020, 94.9% (745/785) of U.S. hantaviruses cases were detected west of the Mississippi with 45.7% (359/785) in the Four Corners region of the U.S. From 2008 to 2020, 67.7% of NW hantavirus cases were detected between the months of March and August. Sequencing of RT-PCR-positive cases demonstrates a geographic separation of Orthohantavirus sinnombreense species [Sin Nombre virus (SNV), New York virus, and Monongahela virus]; however, there is a large gap in viral sequence data from the Northwestern and Central U.S. Finally, these data indicate that commercial IgM assays are not concordant with CDC-developed assays, and that “concordant positive” (i.e., commercial IgM+ and CDC IgM+ results) specimens exhibit clinical characteristics of hantavirus disease.

Interpretation

Hantaviral disease is broadly distributed in the contiguous U.S, viral variants are localised to specific geographic regions, and hantaviral disease infrequently detected in most Southeastern states. Discordant results between two diagnostic detection methods highlight the need for an improved standardised testing plan in the U.S. Hantavirus surveillance and detection will continue to improve with clearly defined, systematic reporting methods, as well as explicit guidelines for clinical characterization and diagnostic criteria.

Funding

This work was funded by core funds provided to the Viral Special Pathogens Branch at CDC.

背景在美国,汉坦病毒肺综合征(HPS)和非 HPS 汉坦病毒感染是全国通报的疾病。确定人类病例的标准基于临床症状(HPS 或非 HPS)和急性诊断结果(IgM+、IgG+ 滴度升高、RT-PCR+ 或免疫组化 (IHC) +)。方法将全国汉坦病毒注册中心的流行病学数据与美国疾病预防控制中心的实验室诊断检测结果合并。对残留的汉坦病毒阳性标本进行测序,并将现有的流行病学数据集和基因数据集连接起来,对美国的汉坦病毒疾病进行基因组流行病学研究。研究结果从 1993 年到 2020 年,共发现 833 例人类汉坦病毒病例,从 2008 年到 2020 年,共发现 335 例人类病例。在疾病预防控制中心诊断实验室发现的新世界(NW)汉坦病毒病例(占病例总数的 29.2%)中,大多数(85.0%)是在急性发病期间发现的,但在传统上与汉坦病毒感染无关的州(康涅狄格州、密苏里州、新泽西州、宾夕法尼亚州、田纳西州和佛蒙特州)也发现了一些康复病例。从 1993 年到 2020 年,94.9%(745/785 例)的美国汉坦病毒病例在密西西比河以西地区发现,45.7%(359/785 例)在美国四角地区发现。RT-PCR 阳性病例的测序结果表明,Orthohantavirus sinnombreense 种类[Sin Nombre 病毒 (SNV)、纽约病毒和 Monongahela 病毒]在地理上是分开的;但是,美国西北部和中部的病毒序列数据存在很大差距、解释汉坦病毒病广泛分布于美国毗连地区,病毒变种分布于特定的地理区域,在美国东南部的大多数州很少发现汉坦病毒病。两种诊断检测方法的结果不一致,这突出表明美国需要改进标准化检测计划。通过明确界定、系统化的报告方法以及明确的临床特征描述和诊断标准指南,汉坦病毒监测和检测工作将不断改进。
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引用次数: 0
Karmic suffering in the western world: exploring cultural and spiritual goals at the end of life 西方世界的业力痛苦:探索生命终结时的文化和精神目标
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-09 DOI: 10.1016/j.lana.2024.100822
Sonal Sharda , Seema Rajesh Rao , Edward Christopher Dee , Nishwant Swami
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引用次数: 0
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Lancet Regional Health-Americas
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