Lancet Regional Health-Americas最新文献

{"title":"Association between city-level sociodemographic and health factors and the prevalence of antimicrobial-resistant gonorrhea in the US, 2000–2019: a spatial–temporal modeling study","authors":"Jingwen Li ,&nbsp;Rachel E. Murray-Watson ,&nbsp;Sancta B. St Cyr ,&nbsp;Yonatan H. Grad ,&nbsp;Joshua L. Warren ,&nbsp;Reza Yaesoubi","doi":"10.1016/j.lana.2025.101006","DOIUrl":"10.1016/j.lana.2025.101006","url":null,"abstract":"<div><h3>Background</h3><div>Evidence from the surveillance systems of antimicrobial-resistant (AMR) gonorrhea suggests substantial variation in the prevalence of AMR gonorrhea across populations. However, little is known about the extent to which the population-level demographic, socioeconomic, and health factors (e.g., population density, poverty level, or the prevalence of other sexually-transmitted diseases) are associated with the burden of AMR gonorrhea. We developed a hierarchical Bayesian spatial–temporal logistic regression model to investigate the association between multiple spatially- and temporally-varying predictors and the proportion of isolates with resistance to each one of ciprofloxacin, penicillin, and tetracycline between 2000 and 2019 in the United States (US).</div></div><div><h3>Methods</h3><div>The model was informed by data from the Gonococcal Isolate Surveillance Project (GISP), a sentinel surveillance system to monitor trends in the AMR gonorrhea in the US. During our study period, GISP included 112,487 isolates from the first 25 symptomatic men who have been diagnosed with urethral gonorrhea each month after attending participating sexually-transmitted disease clinics in one of about 30 select cities.</div></div><div><h3>Findings</h3><div>Among 112,487 isolates collected between 2000 and 2019, 16.5%, 13.7%, and 22.2% were resistance to ciprofloxacin, penicillin, and tetracycline. Denser populations were associated with higher prevalence of ciprofloxacin and penicillin resistance (odd ratio (OR): 1.5, 95% with credible interval: [1.29, 1.74] and 1.36 [1.22, 1.52], respectively); West was associated with higher prevalence of ciprofloxacin resistance (OR with respect to Midwest: 14.42 [2.02, 59.27]) and Southeast was associated with higher prevalence of ciprofloxacin and penicillin resistance (OR with respect to Midwest: 6.66 [1.59, 18.20] and 7.59 [2.3, 22.94]); higher prevalence of HIV was associated with higher prevalence of ciprofloxacin and tetracycline resistance (OR: 1.18 [1.01, 1.37] and 1.14 [1.02, 1.28]); and higher incidence of gonorrhea was associated with higher prevalence of tetracycline resistance (OR: 1.08 [1.05, 1.11]).</div></div><div><h3>Interpretation</h3><div>Geographic location and certain population-level characteristics including population density and HIV prevalence could provide insight about the population-level risk of AMR gonorrhea at a county-level. These results could guide the expansion of AMR surveillance systems or access to drug susceptibility testing in areas with characteristics associated with increased prevalence of AMR gonorrhea.</div></div><div><h3>Funding</h3><div>US <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101006"},"PeriodicalIF":7.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131554","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":"World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational study","authors":"Laura C. Antochevis ,&nbsp;Camila M. Wilhelm ,&nbsp;Beatriz Arns ,&nbsp;Daniel Sganzerla ,&nbsp;Letícia O. Sudbrack ,&nbsp;Thais C.R.L. Nogueira ,&nbsp;Ricardo D. Guzman ,&nbsp;Amanda S. Martins ,&nbsp;Daniela S. Cappa ,&nbsp;Ândrea C. dos Santos ,&nbsp;Joseani C. Pascual ,&nbsp;Vitor Hugo Perugini ,&nbsp;Eliana C. Vespero ,&nbsp;Maria Helena P. Rigatto ,&nbsp;Dariane C. Pereira ,&nbsp;Larissa Lutz ,&nbsp;Robson S. Leão ,&nbsp;Elizabeth A. Marques ,&nbsp;Danielle M. Henrique ,&nbsp;André A.M. Coelho ,&nbsp;Jailton Santos de Oliveira","doi":"10.1016/j.lana.2025.101004","DOIUrl":"10.1016/j.lana.2025.101004","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenem-resistant <em>Enterobacterales</em> (CRE), <em>Acinetobacter baumannii</em> (CRAB), <em>Pseudomonas aeruginosa</em> (CRPA), methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and vancomycin-resistant <em>Enterococcus faecium</em> (VRE) are listed by World Health Organization (WHO) as priority antimicrobial-resistant bacteria. Data on WHO Priority Antimicrobial resistance Phenotype (WPAP) bacteria from low- and middle-income countries are scarce. In this study, we investigated the occurrence of WPAP in healthcare-associated bloodstream infections (BSI) in Brazil, an upper-middle-income country in South America.</div></div><div><h3>Methods</h3><div>ASCENSION was a prospective, multicentre, observational study conducted in 14 hospitals from four of five Brazilian regions. <em>Enterobacterales</em>, <em>A. baumannii</em>, <em>P. aeruginosa, S. aureus</em> and <em>E. faecium</em> BSIs in hospitalised patients were analysed. The primary outcome was the frequency of WPAP among all bacteria of interest. Secondary outcomes were incidence-density of bacteria isolates in hospitalised patients, WPAP proportions within bacterial species, and 28-day mortality. PCR for carbapenemase genes was performed in carbapenem-resistant Gram-negative bacteria.</div></div><div><h3>Findings</h3><div>Between August 15, 2022, and August 14, 2023, 1350 isolates (1220 BSI episodes) were included. WPAP accounted for 38.8% (n = 524; 95% Confidence Interval 32.0–46.1) of all isolates, with CRE (19.3%) as the most frequent, followed by CRAB (9.6%), MRSA (4.9%), VRE (2.7%), and CRPA (2.4%). Incidence-density of all and WPAP isolates were 1.91 and 0.77/1000 patients-day, respectively. Carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) was the most common CRE, corresponding to 14.2% of all BSIs. <em>A. baumannii</em> isolates presented the highest proportion of WPAP (87.8%). Mortality rates were higher in patients with BSIs by WPAP than non-WPAP isolates. KPC (64.4%) was the predominant carbapenemase in CRE, followed by NDM (28.4%) and KPC + NDM co-production (7.1%). OXA-23 was the most frequent in CRAB.</div></div><div><h3>Interpretation</h3><div>A high frequency of WPAP bacteria, particularly CRKP and CRAB, were found in healthcare-associated BSIs in Brazil, posing them as a major public health problem in this country.</div></div><div><h3>Funding</h3><div><span>National Council for Scientific and Technological Development</span>, Brazil.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101004"},"PeriodicalIF":7.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131555","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 trials to gene therapy development and production in Brazil: a review","authors":"Jonas Alex Morales Saute ,&nbsp;Virginia Picanço-Castro ,&nbsp;Ana Carolina de Freitas Lopes ,&nbsp;João Batista da Silva Júnior ,&nbsp;Johanna Henriques Nehm ,&nbsp;Franciele dos Santos Maciel ,&nbsp;Ida Vanessa Doederlein Schwartz ,&nbsp;Juliana Maria Ferraz Sallum ,&nbsp;Margareth Castro Ozelo ,&nbsp;Roberto Giugliani ,&nbsp;Martin Bonamino ,&nbsp;Hilda Petrs-Silva ,&nbsp;Guilherme Baldo","doi":"10.1016/j.lana.2025.100995","DOIUrl":"10.1016/j.lana.2025.100995","url":null,"abstract":"<div><div>Challenges related to the implementation of gene therapy products are daunting for low-to middle-income countries, such as Brazil, and include the creation of an appropriate technical, regulatory, and economic environment. In this manuscript, we give an overview of historical aspects, as well as the current state of clinical trials and approved gene therapy products for commercialization in Brazil. Focusing on gene replacement and CAR-T cell therapies, we discuss the main advances, limitations, and difficulties faced by the country in the production, approval, and incorporation of such products into the public health system. Finally, we highlight the potential leading role that low-to middle-income countries can have in this industry, not only by providing their own vector supply but also by addressing important issues related to the sustainability and long-term global affordability of gene therapy products.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 100995"},"PeriodicalIF":7.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131160","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":"High-resolution spatiotemporal analysis of chikungunya epidemics between 2019 and 2020 in Salvador, Brazil: a municipality-level transmission dynamics study","authors":"Hernan D. Argibay ,&nbsp;Cristiane W. Cardoso ,&nbsp;William M. de Souza ,&nbsp;Raquel L. Souza ,&nbsp;Maysa Pellizzaro ,&nbsp;Geraldo M. Cunha ,&nbsp;Julie Clennon ,&nbsp;Scott C. Weaver ,&nbsp;Mitermayer G. Reis ,&nbsp;Uriel Kitron ,&nbsp;Guilherme S. Ribeiro","doi":"10.1016/j.lana.2025.101003","DOIUrl":"10.1016/j.lana.2025.101003","url":null,"abstract":"<div><h3>Background</h3><div>Chikungunya virus (CHIKV) continues to cause explosive epidemics in Brazil. We investigated its transmission dynamics in Salvador, Brazil, to understand the factors driving its reemergence and spread.</div></div><div><h3>Methods</h3><div>In this epidemiological study, we analyzed by census tracts the chikungunya cases reported in Salvador during the 2019–2020 epidemics. We used SaTScan software to identify spatiotemporal clusters and assessed how census tract characteristics (socioeconomic, environmental, and prior chikungunya occurrence) influenced chikungunya incidence through a Bayesian spatial model using Integrated Laplace Approximation (INLA).</div></div><div><h3>Findings</h3><div>Citywide, 19,129 cases (mean age: 40.2, range: 0–112; male: 41.8%, female: 58.0%, non-binary: 0.2%) were reported between 2016 and 2020, with a significant increase in 2019 and 2020 (4549 and 13,071 cases, respectively). We found nine spatiotemporal clusters in 2019 and seven in 2020, with 17.2% (387 of 2252) overlap of census tracts between the two years. The chikungunya incidence by census tract was negatively correlated with income and vegetation but positively correlated with land surface temperature. The census tract level incidence in 2020 exhibited a non-linear correlation with the 2019 incidence; up to a certain level, the 2020 risk increased as the 2019 incidence increased, but when the 2019 incidence was extreme, the 2020 risk was reduced.</div></div><div><h3>Interpretation</h3><div>These findings suggest that CHIKV transmission is localized, even during what appeared to be a citywide epidemic, creating high-risk pockets within the city. Socioeconomic factors, environmental conditions, and prior chikungunya incidence, probably reflecting herd immunity, all influence case incidence.</div></div><div><h3>Funding</h3><div><span>Secretary of Health of Salvador</span>, <span>Federal University of Bahia</span>, <span>Oswaldo Cruz Foundation</span>, <span>National Council for Scientific and Technological Development</span>, <span>Foundation for Research Support of the Bahia State</span>, <span>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil</span> (CAPES), <span>Clinical and Applied Research Network in Chikungunya</span>, <span>Global Virus Network</span>, <span>Burroughs Wellcome Fund</span>, <span>Wellcome Trust</span>, and the <span>United States National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101003"},"PeriodicalIF":7.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131552","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 “Community gun violence prevention” The Lancet Regional Health—Americas volume 43, 100990, March 2025","authors":"Melissa Sharer ,&nbsp;Malia H. Duffy ,&nbsp;Grant Tietjen ,&nbsp;NaToshia “Tee” LeShoure ,&nbsp;Joseph Golden ,&nbsp;Nicole Cisne-Durbin","doi":"10.1016/j.lana.2025.101007","DOIUrl":"10.1016/j.lana.2025.101007","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101007"},"PeriodicalIF":7.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125469","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":"Misguided tariffs will not solve the United States’ overdose crisis","authors":"Mohammad Karamouzian ,&nbsp;Dan Werb","doi":"10.1016/j.lana.2025.100997","DOIUrl":"10.1016/j.lana.2025.100997","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 100997"},"PeriodicalIF":7.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080942","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":"Community gun violence prevention","authors":"Melissa Sharer ,&nbsp;Malia H. Duffy ,&nbsp;Grant Tietjen ,&nbsp;Tee LeShoure ,&nbsp;Joseph Golden ,&nbsp;Nicole Cisne-Durbin","doi":"10.1016/j.lana.2024.100990","DOIUrl":"10.1016/j.lana.2024.100990","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 100990"},"PeriodicalIF":7.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080773","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":"Associations of Helicobacter pylori with metabolic dysfunction-associated steatotic liver disease and related conditions: cross-sectional results from the Hispanic Community Health Study/Study of Latinos","authors":"Christian S. Alvarez ,&nbsp;Robert C. Kaplan ,&nbsp;M. Constanza Camargo ,&nbsp;M. Larissa Avilés-Santa ,&nbsp;Martha Daviglus ,&nbsp;Olga Garcia-Bedoya ,&nbsp;Carmen R. Isasi ,&nbsp;Maria S. Pattany ,&nbsp;Bharat Thyagarajan ,&nbsp;Gregory A. Talavera ,&nbsp;Barry I. Graubard ,&nbsp;Katherine A. McGlynn","doi":"10.1016/j.lana.2024.100953","DOIUrl":"10.1016/j.lana.2024.100953","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hispanic/Latino populations have been reported to have high rates of both metabolic dysfunction-associated steatotic liver disease (MASLD) and &lt;em&gt;Helicobacter pylori&lt;/em&gt; infection. Several observational studies, predominantly from Asian populations, have suggested a link between these conditions. Thus, the primary objective of the current study was to examine the association between &lt;em&gt;H. pylori&lt;/em&gt; and MASLD and secondarily, to assess its association with related conditions in the Hispanic Community Health Study/Study of Latinos.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this cross-sectional study, a total of 16,144 participants with baseline data on &lt;em&gt;H. pylori&lt;/em&gt; serology were included. Based on weighted statistics, the median age was 40 years [interquartile range (IQR): 28, 52]; 52.2% women (n = 9661) and 47.8% men (n = 6483). Participants’ Hispanic/Latino heritage included 37.6% Mexicans (n = 6397), 20.1% Cubans (n = 2307), 15.8% Puerto Ricans (n = 2663), 10.0% Dominicans (n = 1447), 7.4% Central Americans (n = 1710), 4.9% South Americans (1052). MASLD was estimated using the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI). Other conditions examined were obesity, central obesity, diabetes and metabolic syndrome. Multivariable logistic regression models were used to calculate the ratios of (adjusted) prevalences (RP) and 95% confidence intervals (CI) for the overall association of &lt;em&gt;H. pylori&lt;/em&gt; seropositivity with MASLD and related conditions. Analyses were also stratified by Hispanic/Latino heritage.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The overall prevalence of MASLD ranged from 47% (FLI) to 65% (HSI). After accounting for age, sex, education, and other key variables, the analysis found a modest association between &lt;em&gt;H. pylori&lt;/em&gt; seropositivity and MASLD as determined by HSI (RP: 1.06, 95% CI: 1.02–1.10) overall, and among individuals of Puerto Rican and Mexican heritages. Furthermore, an overall association between &lt;em&gt;H. pylori&lt;/em&gt; seropositivity and obesity was observed (RP: 1.09, 95% CI: 1.02–1.16).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study provides support for a positive association of &lt;em&gt;H. pylori&lt;/em&gt; seropositivity with MASLD and obesity among Hispanic/Latino populations. However, given the exploratory nature of these findings, caution is warranted in their interpretation. Further research is necessary to establish causality and examine potential mechanisms of these associations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;The &lt;span&gt;Hispanic Community Health&lt;/span&gt; Study/Study of Latinos was carried out as a collaborative study supported by contracts from the &lt;span&gt;National Heart, Lung, and Blood Institute&lt;/span&gt; (NHLBI) to the &lt;span&gt;University of North Carolina&lt;/span&gt; (&lt;span&gt;&lt;span&gt;N01-HC65233&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;University of Miami&lt;/span&gt; (&lt;span&gt;&lt;span&gt;N01-HC65234&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;Albert Einstein College of Medicine&lt;/span&gt; (&lt;span&gt;&lt;span&gt;N01-HC65235&lt;/span&gt;&lt;/span","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100953"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143127809","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":"Perspectives on the intersection of race and ethnicity, immigration status, and sexual and gender minoritised status among clinical and scientific workforces in Latin America","authors":"Rachel A. Zajdel ,&nbsp;Erik J. Rodriquez ,&nbsp;Raúl Mejía ,&nbsp;Eliseo J. Pérez-Stable","doi":"10.1016/j.lana.2024.100975","DOIUrl":"10.1016/j.lana.2024.100975","url":null,"abstract":"<div><div>Latin America is a highly diverse region comprised of populations with multiple intersecting identities. In this paper, we explore how race and ethnicity, immigration status, and sexual and gender minoritised status combine to affect entry into and advancement within clinical and scientific workforces in Latin America. Drawing upon intersectionality theory and existing evidence, we explain how individuals with multiple marginalised identities are particularly disadvantaged in accessing high-level positions and face barriers such as discrimination, poverty, and statistical omission. We also discuss that increasing diversity in the clinical and scientific workforces will likely benefit from system-level changes addressing educational and workplace inequality, creating mentorship opportunities, designing educational campaigns to reduce stigma and discrimination, and improving survey measures to better understand the diversity of populations. Prioritising diversity and inclusion in the clinical and scientific workforces can improve research and healthcare delivery, ultimately reducing existing economic and health inequities in the region.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100975"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143164414","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":"Standardized protocol for labor induction: a type I hybrid effectiveness-implementation trial","authors":"Rebecca F. Hamm ,&nbsp;Janice Benny ,&nbsp;Rinad S. Beidas ,&nbsp;Knashawn H. Morales ,&nbsp;Sindhu K. Srinivas ,&nbsp;Samuel Parry ,&nbsp;Lisa D. Levine","doi":"10.1016/j.lana.2024.100956","DOIUrl":"10.1016/j.lana.2024.100956","url":null,"abstract":"<div><h3>Background</h3><div>Cesarean delivery remains the most common obstetrical procedure with more than 250,000 patients in the US undergoing cesarean following labor induction annually. Here, we evaluated the impact of prospectively implementing a standardized labor induction protocol on cesarean delivery rates.</div></div><div><h3>Methods</h3><div>This multi-site type I hybrid effectiveness-implementation study compared 2 years before (PRE) and 2 years after (POST) implementation of a standardized labor induction protocol at two hospitals within the University of Pennsylvania Health System (2018–2022). The protocol included multiple components and recommended active management of labor induction, including frequent cervical examinations, amniotomy if cervical exam ≥4 cm, and interventions for labor dystocia. The primary effectiveness outcome was cesarean delivery. Secondary effectiveness outcomes included labor length, chorioamnionitis, and maternal and neonatal morbidity. The primary implementation outcome was fidelity, defined as adherence to ≥75% of the protocol components among 8 individual components that could be evaluated discretely. All data was collected via individual chart review.</div></div><div><h3>Findings</h3><div>8509 patients were included (PRE: n = 4214, POST: n = 4295). Our population was of median age of 31 years interquartile range (IQR) [26–35], and 44.6% identified as Black, 40.1% as white, 6.9% as Asian, and 8.4% as other or unknown; 7.4% of the population identified as Latinx. There was no significant difference in cesarean delivery rate between the two time periods overall (PRE: 21.6% vs. POST: 21.8%, p = 0.85; adjusted relative risk (aRR) 0.99 95% confidence interval (CI) [0.90–1.09]). There were no significant differences in labor length, chorioamnionitis, or composite neonatal morbidity. Maternal morbidity decreased PRE to POST (PRE: 9.3% vs. POST: 6.5%, p &lt; 0.001; aRR 0.67 95% CI [0.58–0.79]). POST-implementation, inductions with fidelity to ≥75% of protocol components increased (PRE: 52.4% vs. POST: 59.6%, p &lt; 0.001), evidenced by more frequent cervical examinations, earlier dilation at amniotomy, and increased labor dystocia management.</div></div><div><h3>Interpretation</h3><div>Despite increasing standardized induction management, no significant difference in cesarean delivery was found.</div></div><div><h3>Funding</h3><div><span>NICHD</span> K23HD102523.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100956"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907699","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}