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Brazil's tax exemption on ultra-processed foods: a public health setback 巴西对超加工食品免税:公共卫生的倒退
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-30 DOI: 10.1016/j.lana.2024.100927
{"title":"Brazil's tax exemption on ultra-processed foods: a public health setback","authors":"","doi":"10.1016/j.lana.2024.100927","DOIUrl":"10.1016/j.lana.2024.100927","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community 加拿大北极地区消除结核病的机遇:在北极偏远社区开展全社区筛查的成本效益
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-30 DOI: 10.1016/j.lana.2024.100916
{"title":"Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community","authors":"","doi":"10.1016/j.lana.2024.100916","DOIUrl":"10.1016/j.lana.2024.100916","url":null,"abstract":"<div><h3>Background</h3><div>In response to a tuberculosis (TB) outbreak in the remote community of Qikiqtarjuaq Nunavut, Canada, community leaders and the territorial government initiated community-wide screening (CWS) for tuberculosis, an expensive undertaking given the high cost of providing medical services in the Canadian arctic. Our study aim was to assess the cost-effectiveness of the Qikiqtarjuaq CWS.</div></div><div><h3>Methods</h3><div>We developed a hybrid decision analysis and Markov model to replicate the experience and extrapolate CWS outcomes over a 20-year time horizon. Following a hypothetical cohort with patient characteristics reflecting the demographic and testing data available from the CWS, the model compared a one-time CWS intervention with the reference case of ‘no community-wide screening’.</div></div><div><h3>Findings</h3><div>CWS resulted in improved health gains through prevention of active tuberculosis cases compared with no CWS. It also resulted in increased costs (measured in Canadian dollars), with a very low estimated incremental cost-effectiveness ratio (ICER) of $25.10 (95% URs: cost savings-$15,874) per additional quality adjusted life year (QALY) gained compared with current standard of care approach (no CWS). Community-wide screening in this context would be considered highly cost-effective in this setting. In probabilistic sensitivity analysis, we found &gt;99% of iterations were cost-effective at a willingness to pay threshold of $50,000/QALY gained.</div></div><div><h3>Interpretation</h3><div>While costly, coordinated and intensive community-wide tuberculosis screening activities are highly cost-effective in remote arctic communities when utilized in an outbreak context.</div></div><div><h3>Funding</h3><div>Government of Nunavut.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Active shooters and gun-free zones: emotional versus legal motivations – author's reply 主动枪手和无枪区:情感动机与法律动机--作者的回复
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-29 DOI: 10.1016/j.lana.2024.100929
{"title":"Active shooters and gun-free zones: emotional versus legal motivations – author's reply","authors":"","doi":"10.1016/j.lana.2024.100929","DOIUrl":"10.1016/j.lana.2024.100929","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alignment of countries in the Americas with the latest WHO guidelines for hepatitis B virus (HBV) infection: a review 美洲国家与世界卫生组织最新乙型肝炎病毒(HBV)感染指南的一致性:综述
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-28 DOI: 10.1016/j.lana.2024.100925
{"title":"Alignment of countries in the Americas with the latest WHO guidelines for hepatitis B virus (HBV) infection: a review","authors":"","doi":"10.1016/j.lana.2024.100925","DOIUrl":"10.1016/j.lana.2024.100925","url":null,"abstract":"<div><div>Evidence is lacking on alignment of current guidance from the Region of the Americas (AMR) countries with the new guidelines for people with hepatitis B virus (HBV) infection published by the World Health Organization (WHO) in March 2024. We gathered the most updated guidance on HBV infection from organisations/societies and seven countries from AMR. Most guidelines were aligned with the new WHO recommendation to treat persons with elevated ALT and HBV-DNA levels ≥2,000 IU/ml or with HIV-coinfection, hepatocellular carcinoma family history, extra-hepatic manifestations, or immunosuppression. The new WHO 2024 guidelines introduced treatment for persistently abnormal ALT in the absence of HBV-DNA, with TDF and/or entecavir as first-line therapy. TDF in pregnant women with high HBV-DNA levels was recommended to prevent mother-to-child transmission (MTCT). These guidelines advised prophylaxis to pregnant women with positive HBsAg where HBV-DNA is unavailable. WHO 2024 and updated guidelines from most AMR countries had simplified and expanded criteria for HBV treatment and MTCT prevention.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Burden of infant group B Streptococcus disease and impact of maternal screening and antibiotic prophylaxis in Ontario, Canada: a population-based cohort study 加拿大安大略省婴儿 B 群链球菌疾病负担及产妇筛查和抗生素预防的影响:基于人群的队列研究
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-24 DOI: 10.1016/j.lana.2024.100914
{"title":"Burden of infant group B Streptococcus disease and impact of maternal screening and antibiotic prophylaxis in Ontario, Canada: a population-based cohort study","authors":"","doi":"10.1016/j.lana.2024.100914","DOIUrl":"10.1016/j.lana.2024.100914","url":null,"abstract":"<div><h3>Background</h3><div>Group B <em>Streptococcus</em> (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35–37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.</div></div><div><h3>Methods</h3><div>Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data. GBS cases were ascertained through culture results and diagnostic codes. We calculated incidence rates for early-onset disease (EOD: 0–6 days), late-onset disease (LOD: 7–89 days), and ultra-LOD (ULOD: 90–365 days). Adjusted incidence rate ratios (aIRR) were derived via log-binomial regression to compare infant GBS rates according to screening and IAP-receipt.</div></div><div><h3>Findings</h3><div>Among 776,148 liveborn infants, we identified 803 with GBS, with multiples exhibiting a threefold incidence increase. Incidence rates of EOD, LOD and ULOD were 0.49, 0.46 and 0.07 per 1000 livebirths, respectively. Of eligible pregnancies, 94% were screened; 23% screened positive, and 81% of them received IAP. Nearly 12% of term EOD infants had mothers who missed IAP despite screening positive. Maternal screening was associated with lower rates of any infant GBS disease (aIRR: 0.60; 95% CI: 0.45, 0.80). Among screen-positive births, IAP-receipt was associated with reduced rates of EOD (aIRR: 0.72, 95% CI: 0.48, 1.29) and LOD/ULOD (aIRR: 0.69; 95% CI: 0.46, 1.05), but confidence intervals included 1.0.</div></div><div><h3>Interpretation</h3><div>Our study, the largest Canadian investigation into infant GBS disease, highlights both widespread adoption and ongoing challenges of the current prevention strategy.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and functional assessment of SARS-CoV-2 sequelae among young marines – a panel study 年轻海军陆战队员 SARS-CoV-2 后遗症的临床和功能评估 - 小组研究
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-24 DOI: 10.1016/j.lana.2024.100909
{"title":"Clinical and functional assessment of SARS-CoV-2 sequelae among young marines – a panel study","authors":"","doi":"10.1016/j.lana.2024.100909","DOIUrl":"10.1016/j.lana.2024.100909","url":null,"abstract":"<div><h3>Background</h3><div>Long-term SARS-CoV-2 adverse health outcomes are of significant concern, especially among young adults with the potential for the greatest long-term morbidity. We sought to assess and characterize these outcomes in a cohort of Marines.</div></div><div><h3>Methods</h3><div>We used a cohort of US Marines from a previous longitudinal, prospective observational study of acute SARS-CoV-2, most of whom were enrolled prior to infection. A panel study was established to assess for post-acute sequelae of COVID-19 (PASC), defined as symptoms at least 4 weeks after symptom onset or diagnosis. Symptoms were assessed through questionnaires and validated quality of health metrics. Periodic US Marine Corps fitness testing metrics provided an additional standardized functional assessment and were compared to a pre-pandemic cohort.</div></div><div><h3>Findings</h3><div>Globally dispersed Marine participants (n = 899) seen an average of 330 days following initial enrollment were predominately male (n = 825, 91.7%), White (n = 613, 71.6%) or Black (n = 149, 17.4%) with a median age of 18 years (interquartile range: 18–19). Among 798 SARS-CoV-2 infected participants, 197 (24.7%) developed PASC. The most prevalent symptoms were loss of taste and/or smell (n = 82; 41.6%), shortness of breath (n = 74; 37.6%), and cough (n = 45; 22.8%). Those with PASC had higher rates and severity of somatic (p &lt; 0.0001), general depressive (p &lt; 0.0001), and anxiety (p = 0.005) symptoms. Compared to a historic cohort of Marines, participants with PASC scored worse on their physical fitness assessments due to slower run times (p = 0.002). Those with PASC continued to have decreased physical performance one year after completing initial training.</div></div><div><h3>Interpretation</h3><div>In this population of healthy young adult US Marines with mostly either asymptomatic or mild acute COVID-19, one fourth reported physical, cognitive, or psychiatric long-term sequelae of infection. The Marines affected with PASC showed evidence of long-term decrease in functional performance suggesting that SARS-CoV-2 infection may negatively affect health for a significant proportion of young adults.</div></div><div><h3>Funding</h3><div><span>Defense Health Agency</span> and <span>Defense Advanced Research</span> Projects Agency.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial) 巴西公共卫生系统中 2 型糖尿病患者的远程会诊:随机、实用、开放标签、第 2 阶段、非劣效试验(TELECONSULTA 糖尿病试验)
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100923
{"title":"Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial)","authors":"","doi":"10.1016/j.lana.2024.100923","DOIUrl":"10.1016/j.lana.2024.100923","url":null,"abstract":"<div><h3>Background</h3><div>This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS.</div></div><div><h3>Methods</h3><div>TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register—REBEC, under the code RBR-8gpgyd. Study status is “Completed”.</div></div><div><h3>Findings</h3><div>This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54–68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was −0.6% (90% CI −1.0; −0.1) at 3-months and −0.5% (90% CI −0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups.</div></div><div><h3>Interpretation</h3><div>The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>Brazilian Ministry of Health</span>, through the <span>Unified Health System</span>–<span>Institutional Development Support Program</span> (PROADI-SUS).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Elimination of lymphatic filariasis in Brazil: a public health milestone for citizenship 在巴西消灭淋巴丝虫病:公民公共卫生的里程碑
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100922
{"title":"Elimination of lymphatic filariasis in Brazil: a public health milestone for citizenship","authors":"","doi":"10.1016/j.lana.2024.100922","DOIUrl":"10.1016/j.lana.2024.100922","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Strengthening perinatal mental health is a requirement to reduce maternal and newborn mortality 加强围产期心理健康是降低孕产妇和新生儿死亡率的必要条件
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100912
{"title":"Strengthening perinatal mental health is a requirement to reduce maternal and newborn mortality","authors":"","doi":"10.1016/j.lana.2024.100912","DOIUrl":"10.1016/j.lana.2024.100912","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Active shooters and gun-free zones: emotional versus legal motivations 主动开枪者和无枪区:情感动机与法律动机
IF 7
Lancet Regional Health-Americas Pub Date : 2024-10-23 DOI: 10.1016/j.lana.2024.100928
{"title":"Active shooters and gun-free zones: emotional versus legal motivations","authors":"","doi":"10.1016/j.lana.2024.100928","DOIUrl":"10.1016/j.lana.2024.100928","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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