Lancet Regional Health-Americas最新文献

{"title":"Which diagnostic test to use for Testing and Treatment strategies in Plasmodium vivax low-transmission settings: a secondary analysis of a longitudinal interventional study","authors":"","doi":"10.1016/j.lana.2024.100883","DOIUrl":"10.1016/j.lana.2024.100883","url":null,"abstract":"<div><h3>Background</h3><p>The lack of sensitive field tests to diagnose blood stages and hypnozoite carriers prevents Testing and Treatment (TAT) strategies to achieve <em>Plasmodium vivax</em> elimination in low-transmission settings, but recent advances in Polymerase Chain Reaction (PCR) and serology position them as promising tools. This study describes a PCR-based TAT strategy (PCRTAT) implemented in Saint Georges (SGO), French Guiana, and explores alternative strategies (seroTAT and seroPCRTAT) to diagnose and treat <em>P. vivax</em> carriers.</p></div><div><h3>Methods</h3><p>The PALUSTOP cohort study implemented in SGO (September 2017 to December 2018) screened participants for <em>P. vivax</em> using PCR tests and treated positive cases. Serology was also performed. Passive detection of <em>P. vivax</em> infection occurred during follow-up. Participants were categorised into overlapping treatment groups based on 2017 PCR and serological results. Strategies were described in terms of participants targeted or missed, primaquine contraindications (pregnancy, G6PD severe or intermediate deficiency), and sociodemographic characteristics.</p></div><div><h3>Findings</h3><p>In 2017, 1567 inhabitants were included, aged 0–92 years. A total of 90 (6%) were <em>P. vivax</em> carriers and 390 seropositive (25%). PCRTAT missed 282 seropositive individuals while seroTAT would have missed 21 PCR-positive cases. Primaquine contraindications ranged from 12% to 17% across strategies.</p></div><div><h3>Interpretation</h3><p>Serology and PCR are promising tools for targeted treatment strategies in <em>P. vivax</em> low-transmission settings, when field compatible sensitive tests will be available. Both seem necessary to capture blood stages and potential hypnozoite carriers, while avoiding mass treatment. However, high primaquine contraindications rates need consideration for successful elimination.</p></div><div><h3>Funding</h3><p>Supported by <span>European Funds for Regional Development</span>, <span>French Guiana Regional Health Agency</span>, <span>Pan American Health Organization</span>, <span>WHO</span>, <span>French Ministry for Research</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002102/pdfft?md5=b76863e227d785e1a018441a19b4dead&pid=1-s2.0-S2667193X24002102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233826","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":"Impact of being taken into out-of-home care: a longitudinal cohort study of First Nations and other child welfare agencies in Manitoba, Canada","authors":"","doi":"10.1016/j.lana.2024.100886","DOIUrl":"10.1016/j.lana.2024.100886","url":null,"abstract":"<div><h3>Background</h3><p>Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes.</p></div><div><h3>Methods</h3><p>In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007–2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors.</p></div><div><h3>Findings</h3><p>Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40–9.77; other aOR 5.10, 1.83–14.25), teen birth (First Nations aOR 3.23, 1.10–9.49; other aOR 5.06, 1.70–15.03), and sexually transmitted infections (other aOR 7.21, 3.63–14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27–5.75), a victim (other aOR 1.68, 1.10–2.56), charged with a crime (other aOR 2.68, 1.21–5.96), or incarcerated (First Nations aOR 3.64, 1.95–6.80; other aOR 1.19, 1.19–8.04).</p></div><div><h3>Interpretation</h3><p>Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored.</p></div><div><h3>Funding</h3><p><span>Social Sciences and Humanities Research Council</span> (no. 890-2018-0029).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002138/pdfft?md5=19b5b66c6bc19406a9c25c9a929cd5f7&pid=1-s2.0-S2667193X24002138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168460","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":"The US elections as a determinant of global health","authors":"","doi":"10.1016/j.lana.2024.100884","DOIUrl":"10.1016/j.lana.2024.100884","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002114/pdfft?md5=101d30eca7201a5d9881ecf08fc3096a&pid=1-s2.0-S2667193X24002114-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167743","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":"Supervised safe consumption sites — lessons and opportunities for North America","authors":"","doi":"10.1016/j.lana.2024.100889","DOIUrl":"10.1016/j.lana.2024.100889","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002163/pdfft?md5=43d20199c6e3563ae82a46929d0cc148&pid=1-s2.0-S2667193X24002163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167744","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":"Clinical features of Chagas disease progression and severity","authors":"","doi":"10.1016/j.lana.2024.100832","DOIUrl":"10.1016/j.lana.2024.100832","url":null,"abstract":"<div><p>Chagas disease, the most common form of nonischaemic cardiomyopathy globally, is one of the leading causes of morbidity and mortality in Latin America. Chagas cardiomyopathy has a wide clinical spectrum and prognosis, which is primarily determined by the severity of left ventricular dysfunction. Chagas disease also affects the brain, particularly manifesting as cardioembolic strokes and cognitive impairments. Disease progression is influenced by various factors such as anti-parasite treatments, host–parasite interactions, and other determinants.</p><p>This review explores Chagas disease, covering clinical presentations, the range of severity of Chagas cardiomyopathy, and neurological manifestations. We investigate factors that influence the progression of cardiomyopathy, including anti-parasitic treatments, interactions between hosts and parasites, and the influence of social determinants on the course of the disease. This review analyses key prognostic factors associated with the progression and mortality of Chagas cardiomyopathy, offering insights into this potentially fatal illness.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001595/pdfft?md5=1e1c3795e760a4f6d873f3394953c4bf&pid=1-s2.0-S2667193X24001595-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229272","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":"Effects of mobility, immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic: a modelling study","authors":"","doi":"10.1016/j.lana.2024.100860","DOIUrl":"10.1016/j.lana.2024.100860","url":null,"abstract":"<div><h3>Background</h3><p>COVID-19 dynamics are driven by a complex interplay of factors including population behaviour, new variants, vaccination and immunity from prior infections. We quantify drivers of SARS-CoV-2 transmission in the Dominican Republic, an upper-middle income country of 10.8 million people. We then assess the impact of the vaccination campaign implemented in February 2021, primarily using CoronaVac, in saving lives and averting hospitalisations.</p></div><div><h3>Methods</h3><p>We fit an age-structured, multi-variant transmission dynamic model to reported deaths, hospital bed occupancy, and seroprevalence data until December 2021, and simulate epidemic trajectories under different counterfactual scenarios.</p></div><div><h3>Findings</h3><p>We estimate that vaccination averted 7210 hospital admissions (95% credible interval, CrI: 6830–7600), 2180 intensive care unit admissions (95% CrI: 2080–2280) and 766 deaths (95% CrI: 694–859) in the first 6 months of the campaign. If no vaccination had occurred, we estimate that an additional decrease of 10–20% in population mobility would have been required to maintain equivalent death and hospitalisation outcomes. We also found that early vaccination with CoronaVac was preferable to delayed vaccination using a product with higher efficacy.</p></div><div><h3>Interpretation</h3><p>SARS-CoV-2 transmission dynamics in the Dominican Republic were driven by a substantial accumulation of immunity during the first two years of the pandemic but, despite this, vaccination was essential in enabling a return to pre-pandemic mobility levels without considerable additional morbidity and mortality.</p></div><div><h3>Funding</h3><p><span>Medical Research Council</span>, <span>Wellcome Trust</span>, <span>Royal Society</span>, <span>US CDC</span> and Australian <span>National Health and Medical Research Council</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400187X/pdfft?md5=97443b4e7e5bd7d4ce03d546e8419abe&pid=1-s2.0-S2667193X2400187X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097211","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":"Chagas disease: 115 years of neglect","authors":"","doi":"10.1016/j.lana.2024.100891","DOIUrl":"10.1016/j.lana.2024.100891","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002187/pdfft?md5=3b3f9af05419ff6d8f8d77700d30d4ad&pid=1-s2.0-S2667193X24002187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229858","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":"The epidemiology of Chagas disease in the Americas","authors":"","doi":"10.1016/j.lana.2024.100881","DOIUrl":"10.1016/j.lana.2024.100881","url":null,"abstract":"<div><p>Chagas disease is a complex parasitic zoonosis that still threatens public health across the Americas. Initiatives to control <em>Trypanosoma cruzi</em> transmission <em>via</em> blood transfusion and non-native triatomine-bug vectors have yielded crucial advances; native vectors, however, actively bridge wild and domestic/peri-domestic transmission cycles throughout the region, and tens of thousands of people become infected each year. Oral-transmission outbreaks, urbanisation, and vertical transmission are additional/emerging issues calling for innovative strategic thinking. While critical for advocacy and sustained public health action, assessing Chagas disease burden remains difficult; the often-asymptomatic nature of <em>T. cruzi</em> infection, healthcare access limitations, pervasive underreporting, and other methodological hurdles inherent to reliably measuring incidence, prevalence, and disease progression all contribute to the difficulty. Whether and how parasite, vector, and host genetic makeups affect transmission dynamics and epidemiology is also unclear. Continued high-quality research and long-term, adaptive strategies combining vector control surveillance with enhanced case detection and integral patient care remain critical to effectively address the ethical and societal challenge of Chagas disease control.</p><p>This is the first in a <strong>Series</strong> of five papers about Chagas Disease. All papers in the Series are available at <span><span>https://www.thelancet.com/series/chagasdisease</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002084/pdfft?md5=3b3d3adb1184fab8fadcaa8b45a6048e&pid=1-s2.0-S2667193X24002084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229273","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":"Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies","authors":"","doi":"10.1016/j.lana.2024.100859","DOIUrl":"10.1016/j.lana.2024.100859","url":null,"abstract":"<div><h3>Background</h3><p>Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.</p></div><div><h3>Methods</h3><p>UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; <em>n</em> = 75,735), Nurses’ Health Study II (NHSII; <em>n</em> = 90,813), and Health Professionals Follow-Up Study (HPFS; <em>n</em> = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle–Ottawa Scale, funnel plots, and Egger’s tests, and meta-evidence was evaluated using NutriGrade.</p></div><div><h3>Findings</h3><p>The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06–1.16), 1.16 (1.09–1.24), and 1.04 (0.96–1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%–24%), 23% (12%–34%), and 9% (3%–15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.</p></div><div><h3>Interpretation</h3><p>Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.</p></div><div><h3>Funding</h3><p><span>National Institutes of Health</span> (NIH) grants supported the <span>NHS</span>, <span>NHSII</span>, and <span>HPFS</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001868/pdfft?md5=9b24e7ed4689fcb880b35fd318a274e0&pid=1-s2.0-S2667193X24001868-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121660","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":"Dagmar García Rivera—a career of passion and resilience","authors":"","doi":"10.1016/j.lana.2024.100885","DOIUrl":"10.1016/j.lana.2024.100885","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002126/pdfft?md5=3d639b5110162bcd580d5c4dbb170cb0&pid=1-s2.0-S2667193X24002126-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229859","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}