Pub Date : 2024-07-29DOI: 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.
{"title":"The expansion of gambling across the Americas poses risks to mental health and wellbeing","authors":"","doi":"10.1016/j.lana.2024.100855","DOIUrl":"10.1016/j.lana.2024.100855","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001820/pdfft?md5=4a1952795cf341051193cd5898958804&pid=1-s2.0-S2667193X24001820-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951790","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 : 2024-07-29DOI: 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.
{"title":"Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis","authors":"","doi":"10.1016/j.lana.2024.100854","DOIUrl":"10.1016/j.lana.2024.100854","url":null,"abstract":"<div><p>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.</p></div><div><h3>Funding</h3><p>This research project was partly funded by <span>ANID</span> Chile and <span>University College London</span>. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001819/pdfft?md5=41c1d86c011e57f74e49abcd2e0a4fc3&pid=1-s2.0-S2667193X24001819-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951108","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 : 2024-07-28eCollection Date: 2024-08-01DOI: 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.
{"title":"Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis.","authors":"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","doi":"10.1016/j.lana.2024.100844","DOIUrl":"10.1016/j.lana.2024.100844","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</p>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018896","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 : 2024-07-20DOI: 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.
{"title":"The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study","authors":"","doi":"10.1016/j.lana.2024.100845","DOIUrl":"10.1016/j.lana.2024.100845","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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.</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p><span>Canadian Institutes of Health Research</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001728/pdfft?md5=f00de69eed4118bf8eb42f27fb2fbea5&pid=1-s2.0-S2667193X24001728-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731856","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 : 2024-07-17DOI: 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).
{"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}
Pub Date : 2024-07-16DOI: 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}
Pub Date : 2024-07-16DOI: 10.1016/j.lana.2024.100842
{"title":"Hospital preparedness for one of the worst predicted hurricane seasons on record – why this time is different","authors":"","doi":"10.1016/j.lana.2024.100842","DOIUrl":"10.1016/j.lana.2024.100842","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/S2667193X24001698/pdfft?md5=ec0cb7934197c72f272b297c4214087f&pid=1-s2.0-S2667193X24001698-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630670","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 : 2024-07-13DOI: 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.
{"title":"Gun-free zones and active shootings in the United States: a matched case-control study","authors":"Paul M. Reeping , Christopher N. Morrison , Ariana N. Gobaud , Sonali Rajan , Douglas J. Wiebe , Charles C. Branas","doi":"10.1016/j.lana.2024.100837","DOIUrl":"https://doi.org/10.1016/j.lana.2024.100837","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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.</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p>This work was funded in part by the <span>National Collaborative on Gun Violence Research</span> and the <span>Arnold Foundation</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001649/pdfft?md5=ba1b1cd67365cd29dd2fa132192e0206&pid=1-s2.0-S2667193X24001649-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141607810","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 : 2024-07-11DOI: 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.
{"title":"Human Orthohantavirus disease prevalence and genotype distribution in the U.S., 2008–2020: a retrospective observational study","authors":"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","doi":"10.1016/j.lana.2024.100836","DOIUrl":"https://doi.org/10.1016/j.lana.2024.100836","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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 <em>Orthohantavirus sinnombreense</em> 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.</p></div><div><h3>Interpretation</h3><p>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.</p></div><div><h3>Funding</h3><p>This work was funded by core funds provided to the Viral Special Pathogens Branch at <span>CDC</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001637/pdfft?md5=63c7e516d5fbc1da30775b3d327c5a75&pid=1-s2.0-S2667193X24001637-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594480","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 : 2024-07-09DOI: 10.1016/j.lana.2024.100822
Sonal Sharda , Seema Rajesh Rao , Edward Christopher Dee , Nishwant Swami
{"title":"Karmic suffering in the western world: exploring cultural and spiritual goals at the end of life","authors":"Sonal Sharda , Seema Rajesh Rao , Edward Christopher Dee , Nishwant Swami","doi":"10.1016/j.lana.2024.100822","DOIUrl":"https://doi.org/10.1016/j.lana.2024.100822","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001492/pdfft?md5=ef34e52795516b91d06a10dbbdf40e3a&pid=1-s2.0-S2667193X24001492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141593719","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}