Lancet Regional Health-Americas最新文献

{"title":"Continuity of care during severe civil unrest with a model of community-based HIV care: a retrospective cohort study from Haiti","authors":"Patrice Joseph ,&nbsp;Rochelle Sun ,&nbsp;Colette Guiteau ,&nbsp;Marc Antoine Jean Juste ,&nbsp;Nancy Dorvil ,&nbsp;Stalz Vilbrun ,&nbsp;Rode Secours ,&nbsp;Karine Severe ,&nbsp;Parnel Raymond ,&nbsp;Fernande Cetoute ,&nbsp;Wilnide Jean Baptiste ,&nbsp;Guyrlaine Forestal ,&nbsp;Stanley Cadet ,&nbsp;Adias Marcelin ,&nbsp;Marie Marcelle Deschamps ,&nbsp;Margaret L. McNairy ,&nbsp;Akanksha Dua ,&nbsp;Hoi Ching Cheung ,&nbsp;Jean William Pape ,&nbsp;Serena P. Koenig","doi":"10.1016/j.lana.2024.100847","DOIUrl":"10.1016/j.lana.2024.100847","url":null,"abstract":"<div><h3>Background</h3><p>There are limited data on the effectiveness of differentiated service delivery (DSD) for HIV care during sociopolitical turmoil. We assessed outcomes with a DSD model of care that includes patient choice between community-based antiretroviral therapy (ART) centres, home-based ART dispensing, or facility-based care at GHESKIO clinic during a period of severe civil unrest in Port-au-Prince, Haiti.</p></div><div><h3>Methods</h3><p>This retrospective analysis included data on patients with at least one HIV visit at GHESKIO between May 1, 2019, and December 31, 2021. Multivariable logistic regression models were used to assess predictors of attending ≥1 community visit during the study period, and failure to attend timely visits. HIV-1 RNA test results were reported among patients who had been ART for ≥3 months at last visit.</p></div><div><h3>Findings</h3><p>Of the 18,625 patients included in the analysis, 9659 (51.9%) attended at least one community visit. The proportion of community visits ranged from 0.3% (2019) to 44.1% (2021). Predictors of ≥1 community visit included male sex (aOR: 1.13; 95% CI: 1.06, 1.20), secondary education (aOR: 1.07; 95% CI: 1.01, 1.14), income &gt; $USD 1.00/day (aOR: 1.24; 95% CI: 1.14, 1.35), longer duration on ART (aOR: 1.08 per additional year; 95% CI: 1.07, 1.09), and residence in Carrefour/Gressier (p &lt; 0.0001 in comparisons with all other zones). Younger age and shorter time on ART were associated with late visits and loss to follow-up. Among 12,586 patients with an on-time final visit who had been on ART for ≥3 months, 11,131 (88.4%) received a viral load test and 9639 (86.6%) had HIV-1 RNA &lt; 1000 copies/mL.</p></div><div><h3>Interpretation</h3><p>The socio-political situation in Haiti has presented extraordinary challenges to the health care system, but retention and viral suppression rates remain high with a model of community-based HIV care. Additional interventions are needed to improve outcomes for younger patients, and those with shorter time on ART.</p></div><div><h3>Funding</h3><p>No funding.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100847"},"PeriodicalIF":7.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001741/pdfft?md5=662e9b57b723532d410291979055d748&pid=1-s2.0-S2667193X24001741-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953931","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}

{"title":"Will they always be living the Sisyphus punishment? The triple whammy for racialized women: a qualitative investigation of primary care researchers in Canada","authors":"Monica Aggarwal ,&nbsp;Sabrina T. Wong","doi":"10.1016/j.lana.2024.100848","DOIUrl":"10.1016/j.lana.2024.100848","url":null,"abstract":"<div><h3>Background</h3><p>Existing literature overlooks the role of gender and race on research productivity, particularly in the context of primary care research. This study examines how gender and race influence the research productivity of primary care researchers in Canada, addressing a gap in existing literature.</p></div><div><h3>Methods</h3><p>Qualitative, descriptive methods were used, involving 60-min interviews with 23 Canadian primary care researchers. 13 participants were female (57%) and 10 participants (43%) were male. Fourteen participants were White (non-racialized; 61%), 8 were racialized (35%) and 1 did not comment on race (4%). Reflexive thematic analysis captured participant perceptions of factors influencing research productivity, including individual, professional, institutional, and systemic aspects.</p></div><div><h3>Findings</h3><p>Systemic bias and institutional culture, including racism, sexism, and unconscious biases against racialized women, emerge as key barriers to research productivity. The parenting life stage further compounds these biases. Barriers include lack of representation in faculty roles, toxic work environments, research productivity metrics, and exclusion by colleagues. Participants indicated that institutional reforms and systemic interventions are needed to foster a diverse, equitable, and inclusive environment. Strategies include recruiting equity-focused leaders, increasing representation of racialized female faculty, diversity training, mentorship programs, providing meaningful support, flexible work arrangements, and protected research time. Sponsors can offer more targeted grants for female and racialized researchers. Adjusting metrics for gender, race, parenthood, and collaborative metrics is proposed to enhance diversity and inclusion among researchers.</p></div><div><h3>Interpretation</h3><p>This study underscores the importance of addressing systemic bias at institutional and systemic levels to create a fair and supportive environment for primary care researchers. A multitude of strategies are needed including increasing representation of racialized female faculty, creating supportive and psychologically safe work environments, and public reporting of data on faculty composition for accreditation and funding decisions. Together, these strategies can alleviate the triple whammy and free these researchers from the <em>Sisyphus Punishment</em> – the absurdity of being asked to climb a hill while pushing a boulder with no hope of reaching the top.</p></div><div><h3>Funding</h3><p><span>College of Family Physicians of Canada</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100848"},"PeriodicalIF":7.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001753/pdfft?md5=31b80e813e7e438a8b08c0b4d108c8a7&pid=1-s2.0-S2667193X24001753-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141964350","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}

{"title":"Appalachia’s worsening disparities in cancer mortality should be viewed as a regional manifestation of widening global disparities in health outcomes rather than a uniquely American phenomena","authors":"Kennedy Sabharwal ,&nbsp;Oscar Garcia ,&nbsp;Robert C. Miller","doi":"10.1016/j.lana.2024.100861","DOIUrl":"10.1016/j.lana.2024.100861","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100861"},"PeriodicalIF":7.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001881/pdfft?md5=b7fec6dcfcb2e4a2a5ab24ceb5590bd5&pid=1-s2.0-S2667193X24001881-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978923","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}

{"title":"Rural hospital closures in Kansas, United States: can inpatient tele-consultation services improve care and hospital finances?","authors":"Catherine Goetz","doi":"10.1016/j.lana.2024.100853","DOIUrl":"10.1016/j.lana.2024.100853","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100853"},"PeriodicalIF":7.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001807/pdfft?md5=ce47276ecebf8e89382b1b6ff32f256b&pid=1-s2.0-S2667193X24001807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952420","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}

{"title":"Correction to “Changes in cannabis involvement in emergency department visits for anxiety disorders after cannabis legalization: a repeated cross-sectional study” – The Lancet Regional Health – Americas 2024; 36: 100815","authors":"Stephen D.S. McCarthy ,&nbsp;Jennifer Xiao ,&nbsp;Michael Pugliese ,&nbsp;Laurent Perrault-Sequeira ,&nbsp;Daniel T. Myran","doi":"10.1016/j.lana.2024.100857","DOIUrl":"10.1016/j.lana.2024.100857","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100857"},"PeriodicalIF":7.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001844/pdfft?md5=71ece169cd13191f1912f6d2631e1f13&pid=1-s2.0-S2667193X24001844-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951785","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}

{"title":"No voice, no choice","authors":"Stephanie Wang","doi":"10.1016/j.lana.2024.100850","DOIUrl":"10.1016/j.lana.2024.100850","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100850"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001777/pdfft?md5=9077fb04bbde4a161cb3a2b0d8f4f29d&pid=1-s2.0-S2667193X24001777-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960709","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}

{"title":"Comprehensive exploration of factors and trends in place of death for cancer patients","authors":"Hujian Hong ,&nbsp;Yijiang He ,&nbsp;Yanli Qu","doi":"10.1016/j.lana.2024.100846","DOIUrl":"10.1016/j.lana.2024.100846","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100846"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400173X/pdfft?md5=a9ec8d50a5847e232bc56dad6e616a93&pid=1-s2.0-S2667193X2400173X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954462","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}

{"title":"Forecasting the impact of means restriction on the suicide mortality rate in the Region of the Americas: an ecological modeling study","authors":"Shannon Lange ,&nbsp;Kawon V. Kim ,&nbsp;Huan Jiang ,&nbsp;Kevin D. Shield ,&nbsp;Jürgen Rehm ,&nbsp;Anselm J.M. Hennis ,&nbsp;Renato Oliveira e Souza","doi":"10.1016/j.lana.2024.100831","DOIUrl":"10.1016/j.lana.2024.100831","url":null,"abstract":"<div><h3>Background</h3><p>The suicide mortality rate has been increasing in Region of the Americas, despite decreasing in all other World Health Organization (WHO) regions. Means restriction is an effective evidence-based intervention for suicide prevention. The objective of the current study was to estimate the impact of implementing national-level means restriction policies (i.e., firearm and pesticide restrictions) on the suicide mortality rate in the Region of the Americas.</p></div><div><h3>Methods</h3><p>In this ecological modeling study, two counterfactual scenarios were investigated using sex-specific suicide mortality data from the WHO Global Health Estimates database for 2000 to 2019. Forecasted sex-specific age-standardized suicide mortality rates were then estimated for each country for 2020 to 2030. Counterfactual scenario 1 involved modeling the impact of a firearm or pesticide restriction implemented in 2020 for those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, while in counterfactual scenario 2 this threshold was reduced to 20% or more.</p></div><div><h3>Findings</h3><p>It was estimated that if a firearm or pesticide restriction had been implemented in 2020 in those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, by 2030 the male and female suicide mortality rate in the Region of the Americas would be 20.5% (from 14.5 [95% Confidence Interval [CI]: 14.1, 15.0] per 100,000 males to 11.5 [95% CI: 11.1, 12.0] per 100,000 males) and 11.1% (from 4.5 [95% CI: 4.4, 4.7] per 100,000 females to 4.0 [95% CI: 3.9, 4.2] per 100,000 females) lower than the rate if no such restrictions were implemented, respectively. When the threshold was reduced to 20% or more, minimal additional gains in terms of number of suicides avoided and suicide mortality rate reduction would be achieved.</p></div><div><h3>Interpretation</h3><p>The implementation of a firearm or pesticide restriction policy in countries where the respective means account for a large proportion of suicides (e.g., at least 40%) could aid the Region of the Americas in achieving the WHO target of a one third reduction in the suicide mortality rate by 2030.</p></div><div><h3>Funding</h3><p>This work received no funding.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100831"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001583/pdfft?md5=d755a8591b642f181f4a725457840780&pid=1-s2.0-S2667193X24001583-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715074","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}

{"title":"Setting the standards for safeguarding health and wellbeing in US Immigration and Customs Enforcement detention facilities","authors":"Rohan Borschmann ,&nbsp;Stuart A. Kinner ,&nbsp;Kyli Hedrick","doi":"10.1016/j.lana.2024.100851","DOIUrl":"10.1016/j.lana.2024.100851","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100851"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001789/pdfft?md5=ca4039f5405a228aa907e4e1b36f262f&pid=1-s2.0-S2667193X24001789-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950277","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}

{"title":"María Teresa Bourlon – leading oncology care with compassion and innovation","authors":"Taissa Vila","doi":"10.1016/j.lana.2024.100858","DOIUrl":"10.1016/j.lana.2024.100858","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100858"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001856/pdfft?md5=49419e88b2111bb665ba0dc987073120&pid=1-s2.0-S2667193X24001856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950278","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}