Lancet Regional Health-Americas最新文献

{"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}

{"title":"Helicobacter pylori infection in the United States beyond NHANES: a scoping review of seroprevalence estimates by racial and ethnic groups","authors":"Mercedes V. McMahon ,&nbsp;Chelsea S. Taylor ,&nbsp;Zachary J. Ward ,&nbsp;Fernando Alarid-Escudero ,&nbsp;M. Constanza Camargo ,&nbsp;Monika Laszkowska ,&nbsp;Jorge Roa ,&nbsp;Jennifer M. Yeh","doi":"10.1016/j.lana.2024.100890","DOIUrl":"10.1016/j.lana.2024.100890","url":null,"abstract":"<div><div>Gastric cancer in the United States is characterised by marked racial and ethnic disparities. Widespread declines in <em>Helicobacter pylori</em> prevalence have contributed to declining gastric cancer incidence. However, <em>H pylori</em> prevalence shows the same persistent racial and ethnic disparities seen in gastric cancer. The most recent population estimates of <em>H pylori</em> prevalence in the United States are from the late 1990s and early 2000s and only include three specific racial and ethnic groups. We conducted a scoping review to supplement existing population estimates and assess <em>H pylori</em> seroprevalence trends over by age and birth cohort with available data. We found the extant data suggest considerable variation in <em>H pylori</em> prevalence between racial and ethnic groups in the United States and evidence that age and birth cohort trends may differ between groups. We also found that the extant data were limited in generalizability and insufficient to describe trends in many cases.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100890"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143164412","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":"Advancing Universal Health Coverage for refugees and migrants: highlights from the fifth edition of the Global School","authors":"Candelaria Araoz,&nbsp;Claudia Marotta,&nbsp;Santino Severoni","doi":"10.1016/j.lana.2024.100983","DOIUrl":"10.1016/j.lana.2024.100983","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100983"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013098","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":"Exploring the impact of prenatal syphilis on maternal and neonatal health in the context of HIV and ART in Brazil","authors":"Wei-Zhen Tang,&nbsp;Qin-Yu Cai,&nbsp;Tai-Hang Liu","doi":"10.1016/j.lana.2024.100972","DOIUrl":"10.1016/j.lana.2024.100972","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100972"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013100","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":"Intersectionality and diversity, equity, and inclusion in the healthcare and scientific workforces","authors":"Trenell J. Mosley ,&nbsp;Rachel A. Zajdel ,&nbsp;Ethel Alderete ,&nbsp;Janine A. Clayton ,&nbsp;Shirin Heidari ,&nbsp;Eliseo J. Pérez-Stable ,&nbsp;Karen Salt ,&nbsp;Marie A. Bernard","doi":"10.1016/j.lana.2024.100973","DOIUrl":"10.1016/j.lana.2024.100973","url":null,"abstract":"<div><div>Enhancing diversity, equity, and inclusion (DEI) in the scientific and healthcare workforces∗ promotes research innovation and equitable access to quality healthcare. Efforts to advance DEI within the global scientific and healthcare workforces have assumed a new urgency given the strain caused by the COVID-19 pandemic, the aging of the global population, and the persistent shortages in the healthcare workforce, particularly in low- and middle-income countries. Yet, these fields continue to struggle to promote DEI. Considering the impact of intersectionality—how multiple identities interact to create unique experiences of privilege and power—within these workforces will enhance efforts to promote DEI. This series explores the impact of intersectionality on scientific and healthcare workforce DEI and how prominent institutional and structural factors (e.g., sexism and racism), as well as their interpersonal manifestations, can create barriers for workers with multiple intersecting marginalised identities. This paper, the first in a three-part series, describes how intersecting identities interact with workplace inequities and suggests ways to incorporate intersectionality into DEI efforts within the scientific and healthcare workforces.</div><div>∗We use the phrase <em>scientific and healthcare workforces</em> throughout this article to broadly encompass individuals associated with the biomedical, clinical, behavioral, and population science workforce.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100973"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143164411","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":"Intersectionality and interseccionalidad—the best of both worlds","authors":"Jamie White ,&nbsp;Amanda Cordova-Gomez ,&nbsp;Raul Mejía ,&nbsp;Janine A. Clayton","doi":"10.1016/j.lana.2024.100974","DOIUrl":"10.1016/j.lana.2024.100974","url":null,"abstract":"<div><div>In this personal view paper, we contrast an early form of intersectionality within Latin American social medicine in the early 20th century to a form of identity-based intersectionality advanced in the USA in the latter half of the same century. The proponents of social medicine grasped and applied the principles of intersectionality from the 1930s onward, focusing on the influence of intersectional contextual factors on health. We distinguish this form of intersectionality as “<em>interseccionalidad</em>.” It foregrounds characteristics of oppressive systems or contexts and their effects on health. Although social medicine shares some similarities with social determinants of health, their approaches and interventions differ. Intersectionality and interseccionalidad both emphasize the role of power and oppressive systems, but systems dynamics are rarely discussed in the medical literature; therefore, we discuss systems change within healthcare and the health innovation ecosystem by using an established systems theoretic approach. Lastly, we give examples of and call for further development of ways to integrate the best of intersectionality and interseccionalidad in research and innovation.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100974"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143164415","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":"Opioid toxicity deaths in Indigenous people who experienced incarceration in Ontario, Canada 2015–2020: a whole population retrospective cohort study","authors":"Tenzin Butsang ,&nbsp;Natalie Owl ,&nbsp;Amanda Butler ,&nbsp;Hollie Sabourin ,&nbsp;Ruth Croxford ,&nbsp;Lacey Gislason ,&nbsp;Fiona G. Kouyoumdjian","doi":"10.1016/j.lana.2024.100961","DOIUrl":"10.1016/j.lana.2024.100961","url":null,"abstract":"<div><h3>Background</h3><div>While Indigenous people are overrepresented in Canada's prisons and in the toxic drug supply crisis, we lack data on the harms related to opioids for Indigenous people with experiences of incarceration. We aimed to examine opioid toxicity deaths in Indigenous peoples who experienced incarceration and to compare opioid toxicity mortality rates with rates for people with no incarceration.</div></div><div><h3>Methods</h3><div>This retrospective cohort study linked correctional data for all people who were incarcerated in provincial correctional facilities and coronial data for all people who died from opioid toxicity in Ontario, Canada between 2015 and 2020. We calculated opioid mortality rates for Indigenous people who experienced incarceration and for people who did not experience incarceration using publicly available population data and calculated age-standardized mortality rates for Indigenous and non-Indigenous people who experienced incarceration compared with people who did not experience incarceration.</div></div><div><h3>Findings</h3><div>Of 14,885 Indigenous people who experienced incarceration, 2% (N = 242) died from opioid toxicity in custody or post-release, representing 2.9% of all opioid toxicity deaths in Ontario during this period. The crude opioid toxicity mortality rate per 100 person-years was 0.53 for Indigenous females and 0.36 for Indigenous males who experienced incarceration, compared with 0.0060 for females and 0.0132 for males who did not experience incarceration. Rates of opioid toxicity death were highest in the month post-release for Indigenous people who experienced incarceration, at 1.13 per 100 person-years. Standardized for age and compared with people with no incarceration, the mortality ratio was 81.0 (95% CI 62.1–100.0) for Indigenous females who experienced incarceration and 23.6 (95% CI 20.1–27.1) for Indigenous males who experienced incarceration. The SMRs for Indigenous and non-Indigenous females who experienced incarceration were not significantly different, at 81.0 compared with 76.4, and were significantly different for Indigenous and non-Indigenous males who experienced incarceration, at 23.6 compared with 28.5.</div></div><div><h3>Interpretation</h3><div>This whole-population study identified a substantial and inequitable burden of opioid toxicity death for Indigenous people who experienced incarceration, similar to the burden for non-Indigenous people who experienced incarceration. The large burden is particularly concerning in the context of the overrepresentation of Indigenous people in correctional facilities. Focus is warranted to prevent substance use harms for Indigenous people, including through community- and custody-based interventions to support health.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span> through the <span>Canadian Research Initiative in Substance Misuse</span> (SMN-139150 and REN-181677).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100961"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972331","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":"Cost evaluation of acute ischemic stroke in Latin America: a multicentric study","authors":"Luiza Borba Dittrich ,&nbsp;Ana Paula Beck da Silva Etges ,&nbsp;Joana Siqueira de Souza ,&nbsp;Miriam Allein Zago Marcolino ,&nbsp;Eva Rocha ,&nbsp;Pablo Amaya ,&nbsp;Miguel A. Barboza ,&nbsp;Andrés Gaye Saavedra ,&nbsp;Gonzalo Pérez Hornos ,&nbsp;Carlos Abanto ,&nbsp;Ana Lucía Castillo-Soto ,&nbsp;Natalia Llanos-Leyton ,&nbsp;Virginia Pujol Lereis ,&nbsp;María Soledad Rodriguez Pérez ,&nbsp;Matías Alet ,&nbsp;Victor Navia ,&nbsp;Solange Lopez ,&nbsp;Antonio Arauz ,&nbsp;Fabiola Serrano ,&nbsp;Bruna Chwal ,&nbsp;Ana Cláudia de Souza","doi":"10.1016/j.lana.2024.100959","DOIUrl":"10.1016/j.lana.2024.100959","url":null,"abstract":"<div><h3>Background</h3><div>Current literature highlights a gap in precise stroke cost data for Latin America. This study measures the real costs associated with acute ischemic stroke care in Latin America using Time–Driven Activity-Based Costing (TDABC). The findings aim to lay a solid foundation for adopting value-based healthcare (VBHC) strategies in the region.</div></div><div><h3>Methods</h3><div>The study is an observational, multicenter, international analysis of direct costs and outcomes for patients hospitalised with acute ischemic stroke from December 2021 to December 2022. Data from stroke centres in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay were analysed. Costs were stratified by country. Factors such as favourable outcomes based on the modified Rankin Scale (mRS 0–2), clinical risk levels, and treatment interventions were considered for the analysis. Generalized Estimating Equation (GEE) models were utilised to assess the relationship of clinical variables with the total cost per patient.</div></div><div><h3>Findings</h3><div>A total of 1106 patients were included in the study. Among these patients, 74% received medical treatment alone, 18% received intravenous thrombolysis (IVT), 4% underwent mechanical thrombectomy (MT), and 3% received combined IVT plus MT. The mean cost per patient was I$ 12,203 (SD I$ 15,055), with 49% achieving a favourable functional outcome. Compared to medical treatment alone, MT incurred costs 3.1 times higher, with an incremental cost of I$ 20,418 per patient (p &lt; 0.0001). Across all countries, costs increased according to patients' clinical risk and treatment options, with length of hospital stay emerging as the primary cost driver.</div></div><div><h3>Interpretation</h3><div>Our study highlights significant disparities in stroke costs across healthcare services in Latin America, influenced by variations in treatment accessibility, patient outcomes, and clinical risk profiles. These findings offer essential insights for shaping health policy decisions to enhance the long-term sustainability of stroke care in the region.</div></div><div><h3>Funding</h3><div>The project received funding from the <span>World Stroke Organization</span> and <span>Boehringer Ingelheim</span> (BI) <span><span>IS 0135-0352</span></span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100959"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883101","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":"Birth cohort and age-specific trends in global Helicobacter pylori seroprevalence: a scoping review","authors":"Chelsea S. Taylor ,&nbsp;Mercedes V. McMahon ,&nbsp;Zachary J. Ward ,&nbsp;Fernando Alarid-Escudero ,&nbsp;M. Constanza Camargo ,&nbsp;Monika Laszkowska ,&nbsp;Jorge Roa ,&nbsp;Jennifer M. Yeh","doi":"10.1016/j.lana.2024.100877","DOIUrl":"10.1016/j.lana.2024.100877","url":null,"abstract":"<div><div>Gastric cancer persists around the world as one of the leading causes of cancer-related death, despite declines in recent years. The declining prevalence of <em>H pylori</em>, the primary risk factor for gastric cancer, has contributed to this reduction and understanding changes in seroprevalence trends over time may yield further insight into gastric cancer incidence trends. We conducted a scoping review to compile data on <em>H pylori</em> seroprevalence in asymptomatic populations to assess global trends by age and birth cohort. We found that published data suggest <em>H pylori</em> seroprevalence declined among recent birth cohorts and increased with age, with trends differing between regions and sub-regions subject to data availability. The Americas lacked sufficient data to enable more robust assessment of <em>H pylori</em> trends by both age and birth cohort.</div></div><div><h3>Funding</h3><div>NCI: U01CA265729, P30 CA008748; NIDDK: K08 DK125876.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100877"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143164413","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":"Beyond equity, diversity and inclusion: the power of intersectionality in transforming workforces","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.100991","DOIUrl":"10.1016/j.lana.2025.100991","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100991"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143165401","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}