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Impact of a community health worker led intervention for improved blood pressure control in urban Nepal: an open-label cluster randomised controlled trial 由社区卫生工作人员主导的干预措施对改善尼泊尔城市血压控制的影响:开放标签分组随机对照试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1016/j.lansea.2024.100461

Background

Effective control of hypertension remains challenging in low and middle-income countries. We tested the effectiveness of comprehensive approaches to hypertension management including six home visits by community health workers with regular follow up by a trained healthcare provider on blood pressure levels in Nepal.

Methods

We implemented a non-blinded, open-label, parallel-group, two-arm cluster randomised controlled trial, with 1:1 allocation ratio in Budhanilakantha municipality, Kathmandu, Nepal. Ten public health facilities and their catchment area were randomly allocated to receive comprehensive intervention or only usual hypertension care. We recruited 1252 individuals aged 18 years and older with hypertension. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, proportion with controlled blood pressure, waist to hip ratio, body mass index, physical activity, diet quality score, daily salt intake, adherence to antihypertensives, hypertension knowledge and perceived social support. Primary analysis was by intention-to-treat using a linear mixed model.

Findings

Participants were, on average 57 years old, 60% females, 84% married, 54% Brahmin/Chettri ethnicity and 33% were illiterate. The decrease in mean systolic blood pressure (1.7 mm Hg, 95% CI −0.1, 3.4) and diastolic blood pressure (1.6 mm Hg, 95% CI 0.5, 2.6) was more in the intervention arm compared to the control. The proportion with blood pressure control (OR 1.5 95% CI 1.0, 2.1) and engaging in adequate physical activity (≥600 Metabolic equivalents of task per week) (OR 2.2, 95% CI 1.6, 3.1) were higher in the intervention arm compared to control. The change in hypertension knowledge score was higher and daily salt intake was lower in the intervention arm compared to control. Waist to hip ratio increased more and global dietary requirement scores decreased more in the intervention group and there was no effect on the body mass index and adherence to antihypertensives.

Interpretation

Community health workers facilitated home support and routine follow-up care by healthcare providers was effective in controlling blood pressure in urban Nepal. These findings suggest comprehensive interventions targeting individual, community and health system barriers are feasible in low resource settings, but larger implementation trials are needed to inform future scale-up.

Funding

This work was supported by Norwegian University of Science and Technology, Trondheim, Norway (Project number 981023100).

背景在中低收入国家,有效控制高血压仍然是一项挑战。我们在尼泊尔测试了高血压综合管理方法的有效性,其中包括由社区卫生工作者进行六次家访,并由经过培训的医疗服务提供者对血压水平进行定期随访。方法我们在尼泊尔加德满都布达尼拉坎塔市实施了一项非盲、开放标签、平行组、双臂群组随机对照试验,分配比例为 1:1。十家公共医疗机构及其覆盖区域被随机分配到接受综合干预或仅接受常规高血压护理。我们招募了 1252 名 18 岁及以上的高血压患者。主要结果是收缩压。次要结果包括舒张压、血压得到控制的比例、腰臀比、体重指数、体力活动、饮食质量评分、每日食盐摄入量、服用降压药的依从性、高血压知识和感知的社会支持。研究结果参与者平均 57 岁,60% 为女性,84% 已婚,54% 为婆罗门/切特里族,33% 为文盲。与对照组相比,干预组的平均收缩压(1.7 毫米汞柱,95% CI -0.1,3.4)和舒张压(1.6 毫米汞柱,95% CI 0.5,2.6)降幅更大。与对照组相比,干预组的血压控制比例(OR 1.5 95% CI 1.0, 2.1)和参加适当体育活动的比例(每周≥600 代谢当量)(OR 2.2, 95% CI 1.6, 3.1)更高。与对照组相比,干预组的高血压知识评分变化更大,每日食盐摄入量更低。干预组的腰臀比增加较多,总体饮食要求评分减少较多,但对体重指数和服用降压药的依从性没有影响。这些研究结果表明,针对个人、社区和医疗系统障碍的综合干预措施在资源匮乏的环境中是可行的,但需要进行更大规模的实施试验,以便为今后的推广工作提供参考。
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引用次数: 0
Addressing health inequities in Southeast Asia: challenges and opportunities 解决东南亚卫生不平等问题:挑战与机遇
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-03 DOI: 10.1016/j.lansea.2024.100455
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引用次数: 0
Metabolic syndrome among marginalised school-going adolescents: a call for clarity 边缘化在校青少年的代谢综合征:呼吁澄清问题
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-03 DOI: 10.1016/j.lansea.2024.100458
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引用次数: 0
Uniqueness of lung cancer in Southeast Asia 东南亚肺癌的独特性
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lansea.2024.100430

Lung cancer varies between Caucasians and Asians. There have been differences recorded in the epidemiology, genomics, standard therapies and outcomes, with variations according to the geography and ethnicity which affect the decision for optimal treatment of the patients. To better understand the profile of lung cancer in Southeast Asia, with a focus on India, we have comprehensively reviewed the available data, and discuss the challenges and the way forward. A substantial proportion of patients with lung cancer in Southeast Asia are neversmokers, and adenocarcinoma is the common histopathologic subtype, found in approximately a third of the patients. EGFR mutations are noted in 23–30% of patients, and ALK rearrangements are noted in 5–7%. Therapies are similar to global standards, although access to newer modalities and molecules is a challenge. Collaborative research, political will with various policy changes and patient advocacy are urgently needed.

白种人和亚洲人患肺癌的情况各不相同。在流行病学、基因组学、标准疗法和治疗效果方面都存在差异,地理位置和种族的不同也影响了患者的最佳治疗决策。为了更好地了解以印度为重点的东南亚地区的肺癌概况,我们全面回顾了现有数据,并讨论了面临的挑战和未来的发展方向。东南亚的肺癌患者中有相当一部分是不吸烟者,腺癌是常见的组织病理学亚型,约占患者总数的三分之一。23-30%的患者存在表皮生长因子受体(EGFR)突变,5-7%的患者存在ALK重排。治疗方法与全球标准相似,但获得更新的治疗方式和分子是一项挑战。目前迫切需要开展合作研究、改变各种政策的政治意愿以及对患者的宣传。
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引用次数: 0
Patient advocacy and support groups in India: focus on lung cancer 印度的患者宣传和支持团体:关注肺癌
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lansea.2024.100429
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引用次数: 0
Rabies control in Bangladesh and prediction of human rabies cases by 2030: a One Health approach 孟加拉国的狂犬病控制和 2030 年人类狂犬病病例预测:"一体健康 "方法
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lansea.2024.100452

Background

Bangladesh is making progress toward achieving zero dog-mediated rabies deaths by 2030, a global goal set in 2015.

Methods

Drawing from multiple datasets, including patient immunisation record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between 2011 and 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences from GenBank in Bangladesh and other South Asian countries.

Findings

The estimated dog population in Bangladesh was determined to be 1,668,140, with an average dog population density of 12.83 dogs/km2 (95% CI 11.14–14.53) and a human-to-dog ratio of 86.70 (95% CI 76.60–96.80). The MDV campaign has led to the vaccination of an average of 21,295 dogs (95% CI 18,654–23,935) per district annually out of an estimated 26,065 dogs (95% CI 22,898–29,230). A declining trend in predicted and observed human rabies cases has been identified, suggesting that Bangladesh is poised to make substantial progress towards achieving the ‘Zero by 30’ goal, provided the current trajectory continues. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor.

Interpretation

Bangladesh's One Health approach demonstrated that an increase in MDV and anti-rabies vaccine (ARV) resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable.

Funding

The study was supported by the Communicable Disease Control (CDC) Division of the Directorate General of Health Services (DGHS) of the People's Republic of Bangladesh.

背景孟加拉国正朝着到 2030 年实现由犬介导的狂犬病零死亡的目标迈进,这是 2015 年设定的全球目标。方法我们从多个数据集(包括患者免疫记录簿和大规模犬疫苗接种 (MDV) 数据库)中提取数据,在 2011 年至 2023 年期间进行了全面分析,以了解狂犬病控制计划的有效性,并使用时间序列预测模型预测孟加拉国到 2030 年的人类狂犬病病例。我们还比较了孟加拉国和其他南亚国家 GenBank 中的狂犬病病毒序列。研究结果孟加拉国狗的估计数量为 1,668,140 只,狗的平均密度为 12.83 只/平方公里(95% CI 11.14-14.53),人狗比为 86.70(95% CI 76.60-96.80)。在 MDV 运动的推动下,每个地区平均每年为 21,295 只狗(95% CI 18,654-23,935 只)接种疫苗,而狗的数量估计为 26,065 只(95% CI 22,898-29,230 只)。预测和观察到的人类狂犬病病例呈下降趋势,这表明,如果目前的轨迹继续保持下去,孟加拉国有望在实现 "30 年零狂犬病 "目标方面取得实质性进展。系统发育分析表明,孟加拉国的狂犬病病毒属于北极样-1组,与不丹的狂犬病病毒不同,尽管它们有共同的祖先。孟加拉的 "统一健康 "方法表明,MDV和抗狂犬病疫苗(ARV)的增加导致人类狂犬病病例的相对风险下降,这表明消除狗介导的人类狂犬病是可以实现的。资金来源这项研究得到了孟加拉人民共和国卫生服务总局传染病控制处(CDC)的支持。
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引用次数: 0
Time to bring patients to the core of care 是时候让患者成为医疗服务的核心了
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lansea.2024.100459
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引用次数: 0
Early life origins of the epidemic of the double burden of malnutrition: life can only be understood backwards 营养不良双重负担流行病的生命早期起源:只有逆向才能理解生命
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-22 DOI: 10.1016/j.lansea.2024.100453
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引用次数: 0
Geospatial analysis of contagious infection growth and cross-boundary transmission in non-vaccinated districts of North-East Indian states during the COVID-19 pandemic COVID-19 大流行期间印度东北部各邦未接种疫苗地区传染性感染增长和跨境传播的地理空间分析
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-19 DOI: 10.1016/j.lansea.2024.100451

Background

During the initial phase of the COVID-19 pandemic, the Government of India implemented a nationwide lockdown, sealing borders across states and districts. The northeastern region of India, surrounded by three international borders and connected to mainland India by a narrow passage, faced particular isolation. This isolation resulted in these states forming a relatively closed population. Consequently, the availability of population-based data from Indian Council of Medical Research, tracked through national identification cards, offered a distinctive opportunity to understand the spread of the virus among non-vaccinated and non-exposed populations. This research leverages this dataset to comprehend the repercussions within isolated populations.

Methods

The inter-district variability was visualized using geospatial analysis. The patterns do not follow any established grounded theories on disease spread. Out of 7.1 million total data weekly 0.35 million COVID-19-positive northeast data was taken from April 2020 to February 2021 including “date, test result, population density, area, latitude, longitude, district, and state” to identify the spread pattern using a modified reaction-diffusion model (MRD-Model) and Geographic Information System.

Findings

The analysis of the closed population group revealed an initial uneven yet rapidly expanding geographical spread characterized by a high diffusion rate α approximately 0.4503 and a lower reaction rate β approximately 0.0256, which indicated a slower growth trajectory of case numbers rather than exponential escalation. In the latter stages, COVID-19 incidence reached zero in numerous districts, while in others, the reported cases did not exceed 100.

Interpretation

The MRD-Model effectively captured the disease transmission dynamics in the abovementioned setting. This enhanced understanding of COVID-19 spread in remote, isolated regions provided by the MRD modelling framework can guide targeted public health strategies for similar isolated areas.

Funding

This study is Funded by Indian Council of Medical Research (ICMR).

背景在 COVID-19 大流行的初期阶段,印度政府在全国范围内实施了封锁,封闭了各邦和各区的边界。印度东北部地区被三条国际边界所包围,与印度大陆之间只有一条狭窄的通道相连,因此面临着特别的隔离。这种隔离导致这些邦形成了一个相对封闭的人口群体。因此,印度医学研究委员会通过国民身份证追踪的人口数据为了解病毒在未接种疫苗和未暴露人群中的传播情况提供了一个独特的机会。本研究利用这一数据集来了解病毒在孤立人群中的反响。这些模式并不遵循任何既定的疾病传播基础理论。从 2020 年 4 月至 2021 年 2 月的 710 万条总数据中,每周抽取 35 万条 COVID-19 阳性的东北地区数据,包括 "日期、检测结果、人口密度、地区、经纬度、区和州",利用改进的反应-扩散模型(MRD-模型)和地理信息系统确定传播模式。研究结果对封闭人群的分析表明,最初的地理分布不均衡,但迅速扩大,其特点是扩散率高,α 约为 0.4503,反应率较低,β 约为 0.0256,这表明病例数的增长轨迹较慢,而不是指数式增长。在后期阶段,许多地区的 COVID-19 发病率为零,而在其他地区,报告病例不超过 100 例。MRD 模型框架增强了人们对 COVID-19 在偏远、孤立地区传播情况的了解,可为类似孤立地区制定有针对性的公共卫生策略提供指导。
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引用次数: 0
Surveillance of ventilator associated pneumonia in a network of indian hospitals using modified definitions: a pilot study 在印度医院网络中使用修改后的定义监测呼吸机相关肺炎:一项试点研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-18 DOI: 10.1016/j.lansea.2024.100450

Background

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in patients receiving mechanical ventilation in India. Surveillance of VAP is essential to implement data-based preventive measures. Implementation of ventilator-associated events (VAE) criteria for surveillance has major constraints for low resource settings, which can lead to significant underreporting. Surveillance of VAP using common protocols in a large network of hospitals would give meaningful estimates of the burden of VAP in low resource settings. This study leverages a previously established healthcare-associated infections (HAI) surveillance network to develop and test a modified VAP definition adjusted for Indian settings.

Methods

In this observational pilot study, thirteen hospitals from the existing HAI surveillance network were selected for developing and testing a modified VAP definition between February 2021 and April 2023. The criteria used for diagnosing VAP were adapted from the CDC’s Pediatric VAP definition and modified to cater to the needs of Indian hospitals. Designated nurses recorded each VAP event in a case report form (CRF) and also collected denominator data. The data was entered into an indigenously developed database for validation and analysis. At the time of data analysis, a questionnaire was sent to sites to get feedback on the performance of the modified VAP definitions.

Findings

Out of 133,445 patient days and 40,533 ventilator days, 261 VAP events were recorded, with an overall VAP rate of 6.4 per 1000 ventilator days and a device utilization ratio (DUR) of 0.3. A total of 344 organisms were reported from the VAP events. Of these, Acinetobacter spp (29.6%, 102) was the most frequent, followed by Klebsiella spp (26.7%, 92). Isolates of Acinetobacter spp (98%) and Enterobacterales (85.5%) showed very high resistance against Carbapenem. Colistin resistance was observed in 6% of Enterobacterales and 3.2% of Acinetobacter spp.

Interpretation

Data from this pilot study needs to validated in the larger Indian HAI surveillance network so that it can help in wider implementation of this protocol in order to assess its applicability p VAP across India.

Funding

This work was supported by a grant received from the Indian Council of Medical Research (code I-1203).

背景在印度,呼吸机相关肺炎(VAP)是导致接受机械通气患者发病和死亡的主要原因。监测 VAP 对实施基于数据的预防措施至关重要。实施呼吸机相关事件(VAE)监测标准对于资源匮乏的环境有很大的限制,可能导致严重的漏报。如果在大型医院网络中使用通用协议对 VAP 进行监测,就能对低资源环境中的 VAP 负担做出有意义的估计。方法在这项观察性试点研究中,从现有的 HAI 监测网络中挑选了 13 家医院,用于在 2021 年 2 月至 2023 年 4 月期间制定和测试修改后的 VAP 定义。用于诊断 VAP 的标准改编自美国疾病预防控制中心的儿科 VAP 定义,并根据印度医院的需求进行了修改。指定护士在病例报告表(CRF)中记录每例 VAP 事件,同时收集分母数据。数据被输入本地开发的数据库进行验证和分析。在 133,445 个患者日和 40,533 个呼吸机日中,共记录了 261 起 VAP 事件,总体 VAP 发生率为每 1000 个呼吸机日 6.4 例,设备使用率 (DUR) 为 0.3。VAP 事件中共报告了 344 种微生物。其中,最常见的是醋杆菌属(29.6%,102 种),其次是克雷伯菌属(26.7%,92 种)。醋酸杆菌属(98%)和肠杆菌属(85.5%)的分离菌株对卡巴培南的耐药性非常高。这项试点研究的数据需要在更大的印度 HAI 监测网络中进行验证,以帮助更广泛地实施该方案,从而评估其在全印度 VAP 中的适用性。
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引用次数: 0
期刊
The Lancet regional health. Southeast Asia
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