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Global radiotherapy demands and corresponding radiotherapy-professional workforce requirements in 2022 and predicted to 2050: a population-based study. 2022 年及 2050 年全球放射治疗需求及相应的放射治疗专业人员需求预测:一项基于人口的研究。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-11 DOI: 10.1016/s2214-109x(24)00355-3
Hongcheng Zhu,Melvin Lee Kiang Chua,Imjai Chitapanarux,Orit Kaidar-Person,Catherine Mwaba,Majed Alghamdi,Andrés Rodríguez Mignola,Natalia Amrogowicz,Gozde Yazici,Zouhour Bourhaleb,Humera Mahmood,Golam Mohiuddin Faruque,Muthukkumaran Thiagarajan,Abdelkader Acharki,Mingwei Ma,Martin Harutyunyan,Hutcha Sriplung,Yuntao Chen,Rolando Camacho,Zhen Zhang,May Abdel-Wahab
BACKGROUNDAddressing the challenge of cancer control requires a comprehensive, integrated, and global health-system response. We aimed to estimate global radiotherapy demands and requirements for radiotherapy professionals from 2022 to 2050.METHODSWe conducted a population-based study using data from the Global Cancer Observatory (GLOBOCAN) 2022 and predicted global radiotherapy demands and workforce requirements in 2050. We obtained incidence figures for 29 types of cancer across 183 countries and derived the cancer-specific radiotherapy use rate using the 2013 Collaboration for Cancer Outcomes Research and Evaluation model. We delineated the proportion of people with cancer who require radiotherapy and can be accommodated within the existing installed capacity, assuming an optimal use rate of 50% or 64%, in both 2022 and 2050. A use rate of 50% corresponds to the global average and a use rate of 64% considers potential re-treatment scenarios, as indicated by the 2013 Collaboration for Cancer Outcomes Research and Evaluation (CCORE) radiotherapy use rate model. We established specified requirements for teletherapy units at a ratio of 1:450 patients, for radiation oncologists at a ratio of 1:250 patients, for medical physicists at a ratio of 1:450 patients, and for radiation therapists at a ratio of 1:150 patients in all countries and consistently using these ratios. We collected current country-level data on the radiotherapy-professional workforce from national health reports, oncology societies, or other authorities from 32 countries.FINDINGSIn 2022, there were an estimated 20·0 million new cancer diagnoses, with approximately 10·0 million new patients needing radiotherapy at an estimated use rate of 50% and 12·8 million at an estimated use rate of 64%. In 2050, GLOBOCAN 2022 data indicated 33·1 million new cancer diagnoses, with 16·5 million new patients needing radiotherapy at an estimated use rate of 50% and 21·2 million at an estimated use rate of 64%. These findings indicate an absolute increase of 8·4 million individuals requiring radiotherapy from 2022 to 2050 at an estimated use rate of 64%; at an estimated use rate of 50%, the absolute increase would be 6·5 million individuals. Asia was estimated to have the highest radiotherapy demand in 2050 (11 119 478 [52·6%] of 21 161 603 people with cancer), followed by Europe (3 564 316 [16·8%]), North America (2 546 826 [12·0%]), Latin America and the Caribbean (1 837 608 [8·7%]), Africa (1 799 348 [8·5%]), and Oceania (294 026 [1·4%]). We estimated that the global radiotherapy workforce in 2022 needed 51 111 radiation oncologists, 28 395 medical physicists, and 85 184 radiation therapists and 84 646 radiation oncologists, 47 026 medical physicists, and 141 077 radiation therapists in 2050. We estimated that the largest proportion of the radiotherapy workforce in 2050 would be in upper-middle-income countries (101 912 [38·8%] of 262 624 global radiotherapy professionals).INTERPRETATIONUrgent st
背景应对癌症控制的挑战需要一个全面、综合和全球性的医疗系统。我们利用全球癌症观察站(GLOBOCAN)2022 年的数据开展了一项基于人口的研究,并预测了 2050 年全球放疗需求和劳动力需求。我们获得了 183 个国家 29 种癌症的发病率数据,并利用 2013 年癌症结果研究与评估合作组织的模型得出了癌症放疗使用率。假定 2022 年和 2050 年的最佳使用率分别为 50%或 64%,我们划定了需要接受放射治疗的癌症患者在现有装机容量内可容纳的比例。50% 的使用率符合全球平均水平,而 64% 的使用率则考虑了潜在的再治疗情况,如 2013 年癌症结果研究与评估合作组织 (CCORE) 的放射治疗使用率模型所示。我们规定,所有国家的远程治疗单位与患者的比例为 1:450,放射肿瘤学家与患者的比例为 1:250,医学物理学家与患者的比例为 1:450,放射治疗师与患者的比例为 1:150,并始终采用这些比例。我们从 32 个国家的国家健康报告、肿瘤协会或其他权威机构收集了当前国家层面的放射治疗专业人员数据。结果 2022 年,估计有 2,000 万新确诊癌症患者,其中约 1,000 万新患者需要放射治疗,估计使用率为 50%,1,200 万至 800 万患者需要放射治疗,估计使用率为 64%。GLOBOCAN 2022 年的数据显示,2050 年新增癌症诊断病例 3300 万例,其中需要接受放射治疗的新增患者 16500 万例,估计使用率为 50%,2100 万例,估计使用率为 64%。这些结果表明,按64%的估计使用率计算,从2022年到2050年,需要接受放射治疗的绝对人数将增加84万;按50%的估计使用率计算,绝对人数将增加65万。据估计,2050 年亚洲的放射治疗需求量最大(21 161 603 名癌症患者中有 11 119 478 人[52-6%]),其次是欧洲(3 564 316 人[16-8%])、北美洲(2 546 826 人[12-0%])、拉丁美洲和加勒比海地区(1 837 608 人[8-7%])、非洲(1 799 348 人[8-5%])和大洋洲(294 026 人[1-4%])。我们估计,2022 年全球放射治疗人员需要 51 111 名放射肿瘤学家、28 395 名医学物理学家和 85 184 名放射治疗学家,2050 年需要 84 646 名放射肿瘤学家、47 026 名医学物理学家和 141 077 名放射治疗学家。我们估计,到 2050 年,中上收入国家的放射治疗人员将占最大比例(全球 262 624 名放射治疗专业人员中的 101 912 人[38-8%])。为提高全球放射治疗的可及性并应对癌症治疗方面的挑战,所有利益相关方应共同努力,制定创新且成本可控的医疗保健战略。基金资助中国医学会全球卫生领导力发展项目、上海市科委基金、中国科技部国际合作司高层合作与交流项目、复旦大学全球伙伴关系办公室重点项目发展基金。
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引用次数: 0
Modelling vaccination approaches for mpox containment and mitigation in the Democratic Republic of the Congo. 为在刚果民主共和国遏制和缓解麻疹疫苗接种方法建模。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-08 DOI: 10.1016/S2214-109X(24)00384-X
Alexandra Savinkina, Jason Kindrachuk, Isaac I Bogoch, Anne W Rimoin, Nicole A Hoff, Souradet Y Shaw, Virginia E Pitzer, Placide Mbala-Kingebeni, Gregg S Gonsalves

Background: Mpox was first identified in the Democratic Republic of the Congo (DRC) in 1970. In 2023, a historic outbreak of mpox occurred in the country, continuing into 2024. Over 14 000 cases and 600 deaths were reported in 2023 alone, representing a major increase from previous outbreaks. The modified vaccinia Ankara vaccine (brand names JYNNEOS, Imvamune, and Imvanex) was used in the 2022 mpox outbreak in the USA and Europe. However, at the time of the study, vaccination had not been made available in the DRC. We aimed to inform policy and decision makers on the potential benefits of, and resources needed, for mpox vaccination campaigns in the DRC by providing counterfactual scenarios evaluating the short-term effects of various vaccination strategies on mpox cases and deaths, if such a vaccination campaign had been undertaken before the 2023-24 outbreak.

Methods: A dynamic transmission model was used to simulate mpox transmission in the DRC, stratified by age (<5, 5-15, and >15 years) and province. The model was used to simulate potential vaccination strategies, varying by age and region (endemic provinces, non-endemic provinces with historic cases, and all provinces) assessing the effect the strategies would have on deaths and cases in an epidemic year similar to 2023. In addition, we estimated the number of vaccine doses needed to implement each strategy.

Findings: Without vaccination, our model predicted 14 700 cases and 700 deaths from mpox over 365 days. Vaccinating 80% of all children younger than 5 years in endemic regions led to a 27% overall reduction in cases and a 43% reduction in deaths, requiring 10·5 million vaccine doses. Vaccinating 80% of all children younger than 5 years in all regions led to a 29% reduction in cases and a 43% reduction in deaths, requiring 33·1 million doses. Vaccinating 80% of children aged 15 years or younger in endemic provinces led to a 54% reduction in cases and a 71% reduction in deaths, requiring 26·6 million doses.

Interpretation: When resources are limited, vaccinating children aged 15 years or younger, or younger than 5 years, in endemic regions of the DRC would be the most efficient use of vaccines. Further research is needed to explore long-term effects of a one-time or recurrent vaccination campaign.

Funding: Canadian Institutes of Health Research, Canadian International Development Research Centre, US Department of Defense (Defense Threat Reduction Agency, Mpox Threat Reduction Network), Global Affairs Canada (Weapons Threat Reduction Program), US Department for Agriculture (Agriculture Research Service, Non-Assistance Cooperative Agreement).

背景:1970 年,刚果(金)首次发现痘病毒。2023 年,该国爆发了历史性的天花疫情,并一直持续到 2024 年。仅在 2023 年就报告了超过 14 000 例病例和 600 例死亡病例,与之前的疫情相比大幅增加。美国和欧洲在 2022 年爆发的麻疹疫情中使用了改良的安卡拉疫苗(品牌名称为 JYNNEOS、Imvamune 和 Imvanex)。然而,在研究进行时,刚果(金)尚未提供疫苗接种。我们旨在通过提供反事实情景,评估如果在 2023-24 年疫情爆发前开展了水痘疫苗接种活动,各种疫苗接种策略对水痘病例和死亡人数的短期影响,从而让政策制定者和决策者了解在刚果民主共和国开展水痘疫苗接种活动的潜在益处和所需资源:采用动态传播模型模拟刚果(金)的水痘传播情况,并按年龄(15 岁)和省份进行分层。该模型用于模拟潜在的疫苗接种策略,根据年龄和地区(流行省份、有历史病例的非流行省份和所有省份)的不同而有所变化,评估这些策略在类似于 2023 年的流行年对死亡和病例的影响。此外,我们还估算了实施每种策略所需的疫苗剂量:如果不接种疫苗,我们的模型预测在 365 天内会有 14 700 例麻风病病例和 700 例死亡病例。为流行地区 80% 的 5 岁以下儿童接种疫苗可使病例总数减少 27%,死亡人数减少 43%,需要 10-5 百万剂疫苗。为所有地区 80% 的 5 岁以下儿童接种疫苗后,病例减少了 29%,死亡人数减少了 43%,共需要 3300-100 万剂疫苗。在流行省份为 80% 的 15 岁或以下儿童接种疫苗可使病例减少 54%,死亡人数减少 71%,共需要 2,600-600 万剂疫苗:解读:在资源有限的情况下,为刚果民主共和国流行地区 15 岁及以下或 5 岁以下的儿童接种疫苗是对疫苗最有效的利用。需要进一步研究一次性或经常性疫苗接种活动的长期效果:资金来源:加拿大卫生研究院、加拿大国际发展研究中心、美国国防部(国防威胁降低局,减少麻疹威胁网络)、加拿大全球事务部(减少武器威胁计划)、美国农业部(农业研究服务,非援助合作协议)。
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引用次数: 0
Do breastfeeding mothers in DR Congo have access to the mpox vaccine? 刚果民主共和国的母乳喂养母亲是否可以接种麻风腮疫苗?
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-07 DOI: 10.1016/S2214-109X(24)00423-6
Mija Ververs, Prince Imani-Musimwa, Karleen Gribble, David A Schwartz
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引用次数: 0
The potential distraction of a pan-regimen approach to tuberculosis. 对结核病采取泛治疗方法可能会分散注意力。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1016/S2214-109X(24)00328-0
Oxana Rucsineanu, Jennifer Furin
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引用次数: 0
Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study. 2022 年乌干达苏丹病毒引发的埃博拉疫情:描述性流行病学研究。
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-30 DOI: 10.1016/S2214-109X(24)00260-2
Zainah Kabami, Alex R Ario, Julie R Harris, Mackline Ninsiima, Sherry R Ahirirwe, Jane R Aceng Ocero, Diana Atwine, Henry G Mwebesa, Daniel J Kyabayinze, Allan N Muruta, Atek Kagirita, Yonas Tegegn, Miriam Nanyunja, Saudah N Kizito, Daniel Kadobera, Benon Kwesiga, Samuel Gidudu, Richard Migisha, Issa Makumbi, Daniel Eurien, Peter J Elyanu, Alex Ndyabakira, Helen Nelly Naiga, Jane F Zalwango, Brian Agaba, Peter C Kawungezi, Marie G Zalwango, Patrick King, Brenda N Simbwa, Rebecca Akunzirwe, Mercy W Wanyana, Robert Zavuga, Thomas Kiggundu

Background: Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics.

Methods: For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (Ro) estimates.

Findings: Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall Ro was 1·25.

Interpretation: Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low Ro. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control.

Funding: None.

背景:2000 年至 2022 年间,乌干达曾七次爆发埃博拉疫情。2022 年 9 月 20 日,乌干达卫生部宣布乌干达中部穆本德地区爆发苏丹病毒病。我们描述了疫情特点和传播动态:在这项描述性研究中,根据卫生部的病例定义将病例分为疑似、可能或确诊病例。我们对所有报告病例进行了调查,以获得病例患者的人口统计学、接触、体征和症状等数据,并确定了传播链。我们开展了一项描述性流行病学研究,并计算了基本繁殖数(Ro)估计值:2022年8月8日至11月27日期间,146个地区中有9个地区(6%)发现了164例病例(142例确诊,22例可能)。中位年龄为 29 岁(IQR 20-38),164 名患者中有 95 名(58%)为男性,77 名(47%)患者死亡。症状出现时间为 2022 年 8 月 8 日至 11 月 27 日。10岁以下儿童的病死率最高(23名患者中有17人[74%]死亡)。发热(160 名患者中的 135 [84%] 人)、呕吐(93 [58%] 人)、虚弱(89 [56%] 人)和腹泻(81 [51%] 人)是最常见的症状;出血并不常见(21 [13%] 人)。在发现疫情之前,大多数病例患者(43 名患者中的 26 [60%])都在私立医疗机构就诊。中位潜伏期为 6 天(IQR 5-8),从发病到死亡的中位时间为 10 天(7-23)。大多数早期病例为医疗机构相关传播(164 名患者中的 43 例 [26%]);大多数后期病例为家庭传播(109 例 [66%])。总体Ro为1-25:尽管发现较晚,但 2022 年苏丹病毒病的疫情还是得到了迅速控制,这可能要归功于较低的 Ro 值。儿童(年满 15 岁):无:无。
{"title":"Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study.","authors":"Zainah Kabami, Alex R Ario, Julie R Harris, Mackline Ninsiima, Sherry R Ahirirwe, Jane R Aceng Ocero, Diana Atwine, Henry G Mwebesa, Daniel J Kyabayinze, Allan N Muruta, Atek Kagirita, Yonas Tegegn, Miriam Nanyunja, Saudah N Kizito, Daniel Kadobera, Benon Kwesiga, Samuel Gidudu, Richard Migisha, Issa Makumbi, Daniel Eurien, Peter J Elyanu, Alex Ndyabakira, Helen Nelly Naiga, Jane F Zalwango, Brian Agaba, Peter C Kawungezi, Marie G Zalwango, Patrick King, Brenda N Simbwa, Rebecca Akunzirwe, Mercy W Wanyana, Robert Zavuga, Thomas Kiggundu","doi":"10.1016/S2214-109X(24)00260-2","DOIUrl":"10.1016/S2214-109X(24)00260-2","url":null,"abstract":"<p><strong>Background: </strong>Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics.</p><p><strong>Methods: </strong>For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (R<sub>o</sub>) estimates.</p><p><strong>Findings: </strong>Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall R<sub>o</sub> was 1·25.</p><p><strong>Interpretation: </strong>Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low R<sub>o</sub>. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1684-e1692"},"PeriodicalIF":19.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11413514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Population attributable fractions for risk factors for dementia in seven Latin American countries: an analysis using cross-sectional survey data. 七个拉丁美洲国家痴呆症风险因素的人口可归因分数:利用横截面调查数据进行的分析。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00275-4
Regina Silva Paradela,Ismael Calandri,Natalia Pozo Castro,Emanuel Garat,Carolina Delgado,Lucia Crivelli,Kristine Yaffe,Cleusa P Ferri,Naaheed Mukadam,Gill Livingston,Claudia Kimie Suemoto
BACKGROUNDApproximately 40% of dementia cases worldwide are attributable to 12 potentially modifiable risk factors. However, the proportion attributable to these risks in Latin America remains unknown. We aimed to determine the population attributable fraction (PAF) of 12 modifiable risk factors for dementia in seven countries in Latin America.METHODSWe used data from seven cross-sectional, nationally representative surveys with measurements of 12 modifiable risk factors for dementia (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol intake, air pollution, and traumatic brain injury) done in Argentina, Brazil, Bolivia, Chile, Honduras, Mexico, and Peru. Data were collected between 2015 and 2021. Sample sizes ranged from 5995 to 107 907 participants (aged ≥18 years). We calculated risk factor prevalence and communalities in each country and used relative risks from previous meta-analyses to derive weighted PAFs. Pooled PAFs for Latin America were obtained using random effect meta-analyses.FINDINGSThe overall proportion of dementia cases attributed to 12 modifiable risk factors varied across Latin American countries: weighted PAF 61·8% (95% CI 37·9-79·5) in Chile, 59·6% (35·8-77·3) in Argentina, 55·8% (35·7-71·5) in Mexico, 55·5% (35·9-70·4) in Bolivia, 53·6% (33·0-69·3) in Honduras, 48·2% (28·1-63·9) in Brazil, and 44·9% (25·8-61·2) in Peru. The overall PAF for dementia was 54·0% (48·8-59·6) for Latin America. The highest weighted PAFs in Latin American countries overall were for obesity (7%), physical inactivity (6%), and depression (5%).INTERPRETATIONThe estimated PAFs for Latin American countries were higher than previous global estimates. Obesity, physical inactivity, and depression were the main risk factors for dementia across seven Latin American countries. These findings have implications for public health and individually targeted dementia prevention strategies in Latin America. Although these results provide new information about Latin American countries, demographics and representativeness variations across surveys should be considered when interpreting these findings.FUNDINGNone.
背景 全球约 40% 的痴呆症病例可归因于 12 个潜在的可改变风险因素。然而,这些风险因素在拉丁美洲所占的比例仍然未知。我们使用了在阿根廷、巴西、玻利维亚、智利、洪都拉斯、墨西哥和秘鲁进行的七项具有全国代表性的横断面调查数据,这些调查测量了 12 个可改变的痴呆症风险因素(教育程度较低、听力损失、高血压、肥胖、吸烟、抑郁、社会隔离、缺乏运动、糖尿病、酒精摄入过量、空气污染和脑外伤)。数据收集时间为 2015 年至 2021 年。样本量从 5995 到 107 907 名参与者(年龄≥18 岁)不等。我们计算了每个国家的风险因素流行率和共性,并使用先前荟萃分析中的相对风险得出加权 PAF。使用随机效应荟萃分析得出了拉丁美洲的汇总 PAFs。结果拉丁美洲各国归因于 12 个可改变风险因素的痴呆症病例的总体比例各不相同:智利的加权 PAF 为 61-8%(95% CI 为 37-9-79-5),阿根廷为 59-6%(35-8-77-3),墨西哥为 55-8%(35-7-71-5),玻利维亚为 55-5%(35-9-70-4),洪都拉斯为 53-6%(33-0-69-3),巴西为 48-2%(28-1-63-9),秘鲁为 44-9%(25-8-61-2)。拉丁美洲痴呆症的总体 PAF 为 54-0%(48-8-59-6)。拉丁美洲国家总体加权 PAF 最高的疾病是肥胖症(7%)、缺乏运动(6%)和抑郁症(5%)。肥胖、缺乏运动和抑郁是七个拉美国家痴呆症的主要风险因素。这些发现对拉丁美洲的公共卫生和有针对性的痴呆症预防策略具有重要意义。尽管这些结果提供了有关拉美国家的新信息,但在解释这些发现时,应考虑人口统计学和不同调查的代表性差异。
{"title":"Population attributable fractions for risk factors for dementia in seven Latin American countries: an analysis using cross-sectional survey data.","authors":"Regina Silva Paradela,Ismael Calandri,Natalia Pozo Castro,Emanuel Garat,Carolina Delgado,Lucia Crivelli,Kristine Yaffe,Cleusa P Ferri,Naaheed Mukadam,Gill Livingston,Claudia Kimie Suemoto","doi":"10.1016/s2214-109x(24)00275-4","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00275-4","url":null,"abstract":"BACKGROUNDApproximately 40% of dementia cases worldwide are attributable to 12 potentially modifiable risk factors. However, the proportion attributable to these risks in Latin America remains unknown. We aimed to determine the population attributable fraction (PAF) of 12 modifiable risk factors for dementia in seven countries in Latin America.METHODSWe used data from seven cross-sectional, nationally representative surveys with measurements of 12 modifiable risk factors for dementia (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol intake, air pollution, and traumatic brain injury) done in Argentina, Brazil, Bolivia, Chile, Honduras, Mexico, and Peru. Data were collected between 2015 and 2021. Sample sizes ranged from 5995 to 107 907 participants (aged ≥18 years). We calculated risk factor prevalence and communalities in each country and used relative risks from previous meta-analyses to derive weighted PAFs. Pooled PAFs for Latin America were obtained using random effect meta-analyses.FINDINGSThe overall proportion of dementia cases attributed to 12 modifiable risk factors varied across Latin American countries: weighted PAF 61·8% (95% CI 37·9-79·5) in Chile, 59·6% (35·8-77·3) in Argentina, 55·8% (35·7-71·5) in Mexico, 55·5% (35·9-70·4) in Bolivia, 53·6% (33·0-69·3) in Honduras, 48·2% (28·1-63·9) in Brazil, and 44·9% (25·8-61·2) in Peru. The overall PAF for dementia was 54·0% (48·8-59·6) for Latin America. The highest weighted PAFs in Latin American countries overall were for obesity (7%), physical inactivity (6%), and depression (5%).INTERPRETATIONThe estimated PAFs for Latin American countries were higher than previous global estimates. Obesity, physical inactivity, and depression were the main risk factors for dementia across seven Latin American countries. These findings have implications for public health and individually targeted dementia prevention strategies in Latin America. Although these results provide new information about Latin American countries, demographics and representativeness variations across surveys should be considered when interpreting these findings.FUNDINGNone.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"10 1","pages":"e1600-e1610"},"PeriodicalIF":34.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial. 马拉维渔民艾滋病毒和血吸虫病检测与治疗联合干预:三臂群随机试验。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00283-3
Augustine T Choko,Kathryn L Dovel,Sekeleghe Kayuni,Donaldson F Conserve,Anthony Buttterworth,Amaya L Bustinduy,J Russell Stothard,Wala Kamchedzera,Madalo Mukoka-Thindwa,James Jafali,Peter MacPherson,Katherine Fielding,Nicola Desmond,Elizabeth L Corbett
BACKGROUNDUndiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi.METHODSWe conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324.FINDINGSBetween March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE int
背景非洲大湖区的渔民中艾滋病和血吸虫病的诊断率很高。我们的目的是评估整合了艾滋病和男性生殖器血吸虫病服务的湖边干预措施对马拉维渔民中血吸虫病流行率、艾滋病抗逆转录病毒疗法(ART)接受率和自愿男性包皮环切术(VMMC)的影响。集群的地理定义是以渔民离开渔船的地方(即上岸地点)为母社区。符合条件的参与者为居住在集群中的男性渔民(年龄≥18 岁)。群组是通过电脑随机分配的(1:1:通过计算机生成的随机数字,各群组被随机分配(1:1:1)到以下两种方案中的一种:强化标准护理方案(SOC),即邀请渔民携带宣传单页到海滩诊所接受艾滋病毒检测和转诊,并使用吡喹酮对血吸虫病进行假定性治疗;同伴教育方案(PE),即由指定的渔民负责向其船员解释研究宣传单页以推广服务;或同伴分发教育方案(PDE),即由同伴教育者向其船员解释宣传单页并分发艾滋病毒自我检测包。海滩诊所团队和渔民在干预分配时不戴面具,但调查人员在最终分析前戴面具。主要综合结果是:从 10 毫升尿液滤液中用光学显微镜观察到至少一个血吸虫虫卵的参与者比例,以及在第 28 天之前自述开始接受抗逆转录病毒疗法或安排了 VMMC 的参与者比例。试验结果按意向治疗进行分析;对缺失结果进行多重估算;使用随机效应二叉模型对基线不平衡和聚类进行调整,以计算每种结果的未调整和调整后风险差异、风险比 (RR) 和 95% CI 以及聚类内相关系数。该试验已在 ISRCTN 注册,ISRCTN14354324.研究结果在 2022 年 3 月 1 日至 2023 年 1 月 29 日期间,经评估符合条件的 69 个群组中有 45 个(65%-2%)被纳入试验,每个臂有 15 个群组。在基线筛查的 6036 名渔民中,有 5207 人(86-3%)符合参与条件:在 1991 年的强化 SOC 组中,有 1745 人(87-6%)符合条件;在 2061 年的 PE 组中,有 1687 人(81-9%)符合条件;在 1984 年的 PDE 组中,有 1775 人(89-5%)符合条件。与强化 SOC 组的活动性血吸虫病流行率(1745 人中的 292 人 [16-7%])相比,PDE 组 1775 名渔民中的 241 人(13-6%)(调整后 RR 0-80 [95% CI 0-69-0-94];p=0-0054)和 PE 组 1687 名渔民中的 263 人(15-6%)(0-92 [0-79-1-07];p=0-28)在第 28 天感染了血吸虫病。强化 SOC 组中有 230 人(13-2%)、PE 组中有 281 人(16-7%)和 PDE 组中有 215 人(12-1%)开始接受抗逆转录病毒疗法或安排了 VMMC。与增强型 SOC 组相比,PDE 干预未显著增加抗逆转录病毒疗法的启动或 VMMC 计划(0-88 [0-74-1-05]; p=0-15),而 PE 干预则略有增加(1-16 [0-99-1-37]; p=0-069)。本试验未报告严重不良事件。解释我们发现,使用同伴教育来提高抗逆转录病毒疗法和自愿监测母婴传播率的证据不足,但增加分发艾滋病毒自我检测包以促进对服务的高度参与并降低活动性血吸虫病流行率的证据确凿,这表明在马拉维各地难以到达的社区推广的潜力很大。
{"title":"Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial.","authors":"Augustine T Choko,Kathryn L Dovel,Sekeleghe Kayuni,Donaldson F Conserve,Anthony Buttterworth,Amaya L Bustinduy,J Russell Stothard,Wala Kamchedzera,Madalo Mukoka-Thindwa,James Jafali,Peter MacPherson,Katherine Fielding,Nicola Desmond,Elizabeth L Corbett","doi":"10.1016/s2214-109x(24)00283-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(24)00283-3","url":null,"abstract":"BACKGROUNDUndiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi.METHODSWe conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324.FINDINGSBetween March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE int","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"36 1","pages":"e1673-e1683"},"PeriodicalIF":34.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating national infection prevention and control minimum requirements: evidence from global cross-sectional surveys, 2017-22. 评估国家感染预防和控制最低要求:2017-22 年全球横断面调查证据。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00277-8
Ermira Tartari,Sara Tomczyk,Anthony Twyman,Ana Paula Coutinho Rehse,Mohamed Gomaa,Maha Talaat,Aparna Singh Shah,Howard Sobel,Joao Paulo Toledo,Benedetta Allegranzi
BACKGROUNDWHO infection prevention and control (IPC) minimum requirements provide standards to reduce the risk of infection during health-care delivery. We aimed to investigate the global implementation of these requirements at national levels and the progress of doing so across 2021-22 compared with 2017-18 to identify future directions for interventions.METHODSNational IPC focal points were invited to complete an online survey measuring IPC minimum requirements from July 19, 2021, to Jan 31, 2022. The primary outcome was the proportion of countries meeting IPC minimum requirements. Country characteristics associated with this outcome were assessed with beta regression. Subset analyses were conducted to compare the 2021-22 indicators with a WHO IPC survey conducted in 2017-18 and to assess the correlation of the proportion of IPC minimum requirements met with the results of other WHO metrics.FINDINGS106 countries (ie, 13 low income, 27 lower-middle income, 33 upper-middle income, and 33 high income) participated in the survey (56% response rate). Four (4%) of 106 met all IPC minimum requirements. The highest scoring IPC core component was multimodal improvement strategies and the lowest was IPC education and training. The odds of meeting IPC minimum requirements was higher among high-income countries compared with low-income countries (adjusted odds ratio 2·7, 95% CI 1·3-5·8; p=0·020). Compared with the 2017-18 survey, there was a significant increase in the proportion of countries reporting an active national IPC programme (65% to 82%, p=0·037) and a dedicated budget (26% to 44%, p=0·037). Evaluation of the IPC minimum requirements compared with other survey instruments revealed a low positive correlation.INTERPRETATIONTo build resilient health systems capable of withstanding future health threats, urgently scaling up adherence to WHO IPC minimum requirements is essential.FUNDINGWHO.TRANSLATIONSFor the French and Spanish translations of the abstract see Supplementary Materials section.
背景世界卫生组织(WHO)感染预防与控制(IPC)最低要求为降低医疗服务过程中的感染风险提供了标准。我们旨在调查这些要求在国家层面的全球实施情况,以及与 2017-18 年相比,2021-22 年期间的实施进展,以确定未来的干预方向。方法邀请各国 IPC 联络点完成一项在线调查,以衡量 2021 年 7 月 19 日至 2022 年 1 月 31 日期间的 IPC 最低要求。主要结果是达到 IPC 最低要求的国家比例。通过贝塔回归评估了与这一结果相关的国家特征。进行了子集分析,将 2021-22 年的指标与 2017-18 年进行的世卫组织 IPC 调查进行比较,并评估达到 IPC 最低要求的国家比例与世卫组织其他指标结果的相关性。106 个国家中有 4 个(4%)达到了 IPC 的所有最低要求。得分最高的 IPC 核心内容是多模式改进策略,得分最低的是 IPC 教育和培训。与低收入国家相比,高收入国家达到 IPC 最低要求的几率更高(调整后的几率比 2-7,95% CI 1-3-5-8;P=0-020)。与 2017-18 年调查相比,报告有积极的国家 IPC 计划(65% 至 82%,p=0-037)和专项预算(26% 至 44%,p=0-037)的国家比例显著增加。与其他调查工具相比,对IPC最低要求的评估显示出较低的正相关性。FUNDINGWHO.TRANSLATIONS有关摘要的法文和西班牙文译文,请参见补充材料部分。
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引用次数: 0
Revolution in microbiological diagnostics needs LMIC solutions. 微生物诊断的革命需要低收入国家的解决方案。
IF 34.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 DOI: 10.1016/s2214-109x(24)00362-0
William Calero-Cáceres
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引用次数: 0
Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? 在选定的南亚国家通过初级保健提供非传染性疾病服务:卫生系统做好准备了吗?
IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1016/S2214-109X(24)00118-9
Syed Masud Ahmed, Anand Krishnan, Obaida Karim, Kashif Shafique, Nahitun Naher, Sanjida Ahmed Srishti, Aravind Raj, Sana Ahmed, Lal Rawal, Alayne Adams

In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service.

在南亚地区,迫切需要通过现有的初级卫生保健(PHC)设施提供非传染性疾病(NCD)预防和控制服务,但这一工作目前仍面临挑战。作为与医疗保健系统的第一个接触点,初级卫生保健为预防和生命过程中的连续性护理提供了一个理想的窗口,但初级卫生保健在应对非传染性疾病方面的实施还不够充分。本综述考虑了五个南亚国家的证据,为设计包括非传染性疾病护理在内的综合初级保健系统提出了与政策相关的建议。研究结果表明,在初级卫生保健层面应对慢性疾病的政治承诺很高,但多部门参与和卫生系统准备不足。缺乏熟练的人力资源、必要的基础设施、基本的非传染性疾病药物和技术以及专项资金。尽管存在支持综合干预的创新措施,例如以社区为中心的创新方法,但扩大规模仍然是个问题。为了可持续地提供非传染性疾病服务,政府必须以增加资金和重新设计初级保健服务为目标。
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引用次数: 0
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Lancet Global Health
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