Yann Savina , Aurélien P. Pichon , Lucas Lemaire , Connor A. Howe , Mathilde Ulliel-Roche , Sarah Skinner , Elie Nader , Nicolas Guillot , Émeric Stauffer , Matthieu Roustit , Ivan Hancco , Paul Robach , François Esteve , Vincent Pialoux , Elisa Perger , Gianfranco Parati , Philip N. Ainslie , Stéphane Doutreleau , Philippe Connes , Samuel Verges , Julien V. Brugniaux
{"title":"Micro- and macrovascular function in the highest city in the world: a cross sectional study","authors":"Yann Savina , Aurélien P. Pichon , Lucas Lemaire , Connor A. Howe , Mathilde Ulliel-Roche , Sarah Skinner , Elie Nader , Nicolas Guillot , Émeric Stauffer , Matthieu Roustit , Ivan Hancco , Paul Robach , François Esteve , Vincent Pialoux , Elisa Perger , Gianfranco Parati , Philip N. Ainslie , Stéphane Doutreleau , Philippe Connes , Samuel Verges , Julien V. Brugniaux","doi":"10.1016/j.lana.2024.100887","DOIUrl":"10.1016/j.lana.2024.100887","url":null,"abstract":"<div><h3>Background</h3><div>Since vascular responses to hypoxia in both healthy high-altitude natives and chronic mountain sickness (a maladaptive high-altitude pathology characterised by excessive erythrocytosis and the presence of symptoms—CMS) remain unclear, the role of inflammation and oxidative/nitrosative stress on the endothelium-<em>dependent</em> and -<em>independent</em> responses in both the micro- and macrocirculation, in healthy Andeans at different altitudes and in CMS patients, was examined.</div></div><div><h3>Methods</h3><div>94 men were included: 18 lowlanders (LL), 38 healthy highlanders permanently living at 3800 m (n = 21—HL-3800) or in La Rinconada, the highest city in the world (5100–5300 m) (n = 17—HL-5100/No CMS). Moreover, 14 participants with mild (Mild CMS) and 24 with moderate to severe CMS (Mod/Sev CMS) were recruited. All undertook two reactivity tests: i) local thermal hyperaemia (microcirculation) and ii) flow-mediated dilation (macrocirculation). Endothelium-<em>independent</em> function (glyceryl trinitrate) was also assessed only in La Rinconada.</div></div><div><h3>Findings</h3><div>Conductance and skin blood flow velocity during the microcirculation test, as well as macrocirculation progressively decreased with altitude (LL > HL-3800 > HL-5100/No CMS). CMS also induced a decrease in macrocirculation (HL-5100/No CMS > Mild CMS = Mod/Sev CMS), while glyceryl trinitrate restored vascular function. Both oxidative stress and nitric oxide metabolites increased with altitude only. Principal component analysis revealed that increasing inflammation with altitude was associated with a progressive decline in both micro- and macrovascular function in healthy highlanders.</div></div><div><h3>Interpretation</h3><div>Both micro and macrovascular function are affected by chronic exposure to hypoxia, the latter being further compounded by CMS.</div></div><div><h3>Funding</h3><div>The “Fonds de dotation AGIR pour les maladies chroniques”, the “Air Liquide Foundation”, and the “French National Research Agency”.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100887"},"PeriodicalIF":7.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319139","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}
Carolina Rosadas , Draurio Barreira , Pamela C. Gaspar , Mayra G. Aragón , Adijeane Oliveira , Tatiane Assone , Angelica E. Miranda
{"title":"Brazil takes a leap towards the elimination of HTLV-1 vertical transmission","authors":"Carolina Rosadas , Draurio Barreira , Pamela C. Gaspar , Mayra G. Aragón , Adijeane Oliveira , Tatiane Assone , Angelica E. Miranda","doi":"10.1016/j.lana.2024.100888","DOIUrl":"10.1016/j.lana.2024.100888","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"39 ","pages":"Article 100888"},"PeriodicalIF":7.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002151/pdfft?md5=af3e0b899406e71f89e28096e8e0828b&pid=1-s2.0-S2667193X24002151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274157","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}
Hélène Tréhard , Lise Musset , Yassamine Lazrek , Michael White , Stéphane Pelleau , Ivo Mueller , Felix Djossou , Alice Sanna , Jordi Landier , Jean Gaudart , Emilie Mosnier
{"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":"Hélène Tréhard , Lise Musset , Yassamine Lazrek , Michael White , Stéphane Pelleau , Ivo Mueller , Felix Djossou , Alice Sanna , Jordi Landier , Jean Gaudart , Emilie Mosnier","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":"38 ","pages":"Article 100883"},"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}
Marni Brownell , Nathan C. Nickel , Kayla Frank , Lisa Flaten , Scott Sinclair , Stephanie Sinclair , Nora Murdock , Jennifer E. Enns , Jamie Pfau , Anita Durksen , Colette Scatliff , Heather Prior , Randy Walld , Lorna Turnbull , Karine Levasseur , Teresa Mayer , Jennifer Chartrand , Chris Nash , Elizabeth Decaire , Hygiea Casiano , Therese A. Stukel
{"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":"Marni Brownell , Nathan C. Nickel , Kayla Frank , Lisa Flaten , Scott Sinclair , Stephanie Sinclair , Nora Murdock , Jennifer E. Enns , Jamie Pfau , Anita Durksen , Colette Scatliff , Heather Prior , Randy Walld , Lorna Turnbull , Karine Levasseur , Teresa Mayer , Jennifer Chartrand , Chris Nash , Elizabeth Decaire , Hygiea Casiano , Therese A. Stukel","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":"38 ","pages":"Article 100886"},"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}
Muhammad Jawad Noon , Xinshu She , Benjamin Mason Meier
{"title":"The US elections as a determinant of global health","authors":"Muhammad Jawad Noon , Xinshu She , Benjamin Mason Meier","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":"39 ","pages":"Article 100884"},"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":"David T. Zhu , Simar S. Bajaj , Thomas Kerr","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":"39 ","pages":"Article 100889"},"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}
Maria Carmo P. Nunes , Caryn Bern , Eva H. Clark , Antonio L. Teixeira , Israel Molina
{"title":"Clinical features of Chagas disease progression and severity","authors":"Maria Carmo P. Nunes , Caryn Bern , Eva H. Clark , Antonio L. Teixeira , Israel Molina","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":"37 ","pages":"Article 100832"},"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}
Emilie Finch , Eric J. Nilles , Cecilia Then Paulino , Ronald Skewes-Ramm , Colleen L. Lau , Rachel Lowe , Adam J. Kucharski
{"title":"Effects of mobility, immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic: a modelling study","authors":"Emilie Finch , Eric J. Nilles , Cecilia Then Paulino , Ronald Skewes-Ramm , Colleen L. Lau , Rachel Lowe , Adam J. Kucharski","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":"37 ","pages":"Article 100860"},"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}
Zulma M. Cucunubá , Sebastián A. Gutiérrez-Romero , Juan-David Ramírez , Natalia Velásquez-Ortiz , Soledad Ceccarelli , Gabriel Parra-Henao , Andrés F. Henao-Martínez , Jorge Rabinovich , María-Gloria Basáñez , Pierre Nouvellet , Fernando Abad-Franch
{"title":"The epidemiology of Chagas disease in the Americas","authors":"Zulma M. Cucunubá , Sebastián A. Gutiérrez-Romero , Juan-David Ramírez , Natalia Velásquez-Ortiz , Soledad Ceccarelli , Gabriel Parra-Henao , Andrés F. Henao-Martínez , Jorge Rabinovich , María-Gloria Basáñez , Pierre Nouvellet , Fernando Abad-Franch","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":"37 ","pages":"Article 100881"},"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}