Lancet Regional Health-Americas最新文献

{"title":"Impact of strategic public health interventions to reduce tuberculosis incidence in Brazil: a Bayesian structural time-series scenario analysis","authors":"Klauss Villalva-Serra ,&nbsp;Beatriz Barreto-Duarte ,&nbsp;Moreno M. Rodrigues ,&nbsp;Artur T.L. Queiroz ,&nbsp;Leonardo Martinez ,&nbsp;Julio Croda ,&nbsp;Valeria C. Rolla ,&nbsp;Afrânio L. Kritski ,&nbsp;Marcelo Cordeiro-Santos ,&nbsp;Timothy R. Sterling ,&nbsp;Mariana Araújo-Pereira ,&nbsp;Bruno B. Andrade","doi":"10.1016/j.lana.2024.100963","DOIUrl":"10.1016/j.lana.2024.100963","url":null,"abstract":"<div><h3>Background</h3><div>Despite government efforts, tuberculosis (TB) remains a major public health threat in Brazil. In 2023, TB incidence was 39.8 cases per 100,000 population, far above the WHO’s target of 6.7 cases per 100,000. Using national-level datasets, we investigated and forecasted the potential impact of proposed public health interventions aimed at reducing TB incidence in Brazil.</div></div><div><h3>Methods</h3><div>Monthly TB surveillance data (January 2018–December 2023) were collected from Brazilian national reporting systems: SINAN-TB (TB cases), SITE-TB (TB drug resistance), and IL-TB (preventive therapy). These data were used to create a multivariable Bayesian Structural Time-Series (BSTS) model, with 5000 Monte-Carlo simulations, which identified key predictors of TB incidence and forecasted these rates from 2024 to 2030 under various scenarios.</div></div><div><h3>Findings</h3><div>Vulnerabilities including incarceration, TB-HIV coinfection and TB-diabetes mellitus, as well as coverages of directly observed therapy (DOT), contact investigation and preventive treatment (TPT) completion rates, were identified as key predictors of TB incidence. Under current trends, we forecasted TB incidence in Brazil to be 42.1 [34.1–49.8] per 100,000 person-years by 2030 (mean [95% prediction intervals]). A scenario considering decreases in TB cases among vulnerable populations resulted in an absolute reduction of −10.6 [−9.4 to −12.0] in projected TB incidence. Additional reductions were seen with increased coverage of DOT, TPT adherence, and contact investigation rates (−14.4 [−13 to −16.2]), and by combining these with efforts to reduce TB cases among vulnerable populations (−23.6 [−26.3 to −41.4]), potentially lowering incidence to 18.5 [7.8–28.4] per 100,000, though still above WHO targets.</div></div><div><h3>Interpretation</h3><div>Our findings demonstrate that interventions focused on enhancing health policies focused on decreasing TB cases among vulnerable populations, such as individuals with TB-HIV coinfection, incarcerated populations, and those with TB-diabetes comorbidity, along with improvements in health management indicators such as DOT implementation, contact investigation coverage, and TPT completion rates, are effective in reducing TB incidence nationwide.</div></div><div><h3>Funding</h3><div><span>Oswaldo Cruz Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100963"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932715","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":"Mexico’s physician shortage: struggling to bridge the gap","authors":"Diego Ramonfaur ,&nbsp;Octavio Gómez-Dantés","doi":"10.1016/j.lana.2024.100966","DOIUrl":"10.1016/j.lana.2024.100966","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100966"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932719","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":"Prevalence of hepatitis C virus co-infection in adults living with HIV in Mexico: a cross-sectional, seroprevalence study in a nationally representative sample","authors":"Pablo F. Belaunzarán-Zamudio ,&nbsp;Juan L. Mosqueda-Gómez ,&nbsp;J. Oggún Cano-Torres ,&nbsp;Claudia Guillén-López ,&nbsp;Teresa Muñoz-Trejo ,&nbsp;Kenia Escobedo-López ,&nbsp;Alejandro Rivera-Marroquín ,&nbsp;Akio Murakami-Ogasawara ,&nbsp;José L. Sánchez-Bello ,&nbsp;Margarita M. Rosas-Dossetti ,&nbsp;Elizabeth Papaqui-Limón ,&nbsp;Alethse De la Torre-Rosas ,&nbsp;Juana Díaz-García ,&nbsp;Juan G. Sierra-Madero","doi":"10.1016/j.lana.2024.100965","DOIUrl":"10.1016/j.lana.2024.100965","url":null,"abstract":"<div><h3>Background</h3><div>The proportion of people living with HIV (PLWHIV) co-infected with HCV in Mexico was unknown. Our aim was to estimate the seroprevalence of HCV among adults with HIV in Mexico.</div></div><div><h3>Methods</h3><div>Using a complex-survey design, we collected blood samples and applied structured questionnaires between May 2nd, 2019 and February 17th, 2020 in a nationally, representative sample of adults receiving care for HIV-infection in 24 randomly selected HIV-care centres in 8 socio-demographically regions in Mexico. We tested serum for anti-HCV IgG antibodies and collected data on risky exposures. We estimated the seroprevalence of HCV and associated exposures using regression models and the Taylor linearization method to account for the cluster effect by region and centre.</div></div><div><h3>Findings</h3><div>We collected blood samples of 2545 participants. Most participants were men (75.8%) with a median age of 37 years. The estimated seroprevalence of HCV is 3.9% (95% CI 3.1%–4.7%). Only 39 of 99 participants (40%) with HCV antibodies had active replication determined by RNA quantification. Seroprevalence of HCV was significantly higher among people with life-time history of imprisonment (9%, 95% CI 4.4%–13.6%), tattoo use (5.9%, 95% CI 3.9%–8%), and lifetime (22.3%, 95% CI 12.1%–32.6%) and recent (49.3%, 95% CI 18.3%–80.3%) injecting-drug use.</div></div><div><h3>Interpretation</h3><div>Seroprevalence of HCV infection among PLWHIV in Mexico is ten times as high as the seroprevalence for the general population. The national program for HCV elimination focused in PLWHIV should target people that use injecting drugs and living in prisons.</div></div><div><h3>Funding</h3><div><span>Abbvie Farmacéuticos</span>, S.A de C.V Mexico through Investigator Initiated Study (2018).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100965"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984829","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":"Integrated programs for common mental illnesses within primary care and community settings in Latin America: a scoping review of components and implementation strategies","authors":"Alejandra Paniagua-Avila ,&nbsp;Charles Branas ,&nbsp;Ezra Susser ,&nbsp;Meredith P. Fort ,&nbsp;Rachel Shelton ,&nbsp;Lourdes Trigueros ,&nbsp;Barbara Camara ,&nbsp;Elen Costigan ,&nbsp;Lina Demis ,&nbsp;Ana Florence ,&nbsp;Maria Flores ,&nbsp;Lucy Miller-Suchet ,&nbsp;Angela Paredes-Montero ,&nbsp;Mariana Rodrigues ,&nbsp;Jeremy Kane","doi":"10.1016/j.lana.2024.100931","DOIUrl":"10.1016/j.lana.2024.100931","url":null,"abstract":"<div><div>Integrated programs for common mental illnesses are evidence-informed practices yet to be routinely implemented in Latin America. It synthesizes the literature on integrated programs for common mental illnesses (anxiety, depression, and posttraumatic stress disorder) in Latin American primary care and community settings. It maps program components (the ‘what’) to the collaborative care model core components and implementation strategies (the ‘how’) to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Results from 18 programs across six countries (Belize, Brazil, Chile, Colombia, Mexico, Peru) show wide heterogeneity in component and strategy combinations. Overall, provider-level components and strategies were more common than family- or community-level ones. ‘Team-based care’ was the most commonly reported component, and ‘family/user engagement’ the least. The most common implementation strategy was ‘supporting clinicians,’ while ‘changing infrastructure’ was the least. Programs commonly addressed depression and only four followed experimental designs. We found limited evidence on the potential mechanisms of integrated program components and strategies.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"41 ","pages":"Article 100931"},"PeriodicalIF":7.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883107","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":"Navigating the intricate links between migration, climate change, and food insecurity in Latin America and the Caribbean","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2024.100967","DOIUrl":"10.1016/j.lana.2024.100967","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100967"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151206","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":"Intersections between gender approaches, migration and health in Latin America and the Caribbean: a discussion based on a scoping review","authors":"Baltica Cabieses ,&nbsp;Benelli Velázquez ,&nbsp;Alice Blukacz ,&nbsp;Sofia Farante ,&nbsp;Ietza Bojórquez ,&nbsp;Edward Mezones-Holguín","doi":"10.1016/j.lana.2023.100538","DOIUrl":"10.1016/j.lana.2023.100538","url":null,"abstract":"<div><div>Gender is a sociocultural construct that assigns forms of behaviour, power, and roles to individuals based on their sexual differentiation. There are multiple gender approaches that help distinguish risks, health conditions and behaviours related to the body, health-disease processes, and differential opportunities to access health care. Based on a scoping review of scientific and grey literature in LAC, we discuss existing understandings of international migrants’ health in LAC with a focus on gender approaches. Our discussion covers the following seven dimensions: gender-based violence, sexual and reproductive health, sexually transmitted diseases, mental health, barriers to healthcare services, and emerging patterns of health and healthcare among men and LGBTIQA+. The evidence indicates the urgent need to adopt gender approaches when addressing migrant and refugee health in LAC. Including gender approaches into ongoing strategies for promoting and protecting the health and rights of migrants and refugees is a pending challenge in the region.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100538"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46236041","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":"Long-term prescription opioid use following surgery in the US (2017–2022): a population-based study","authors":"Andrew J. Schoenfeld ,&nbsp;Zara Cooper ,&nbsp;Amanda Banaag ,&nbsp;Jonathan Gong ,&nbsp;Matthew R. Bryan ,&nbsp;Christian Coles ,&nbsp;Tracey P. Koehlmoos","doi":"10.1016/j.lana.2024.100948","DOIUrl":"10.1016/j.lana.2024.100948","url":null,"abstract":"<div><h3>Background</h3><div>Over the last decade, numerous efforts have been made to combat the opioid crisis globally. The impact of these strategies has not been adequately measured and may differ across populations depending on baseline risk. We compared changes in long-term prescription opioid use following surgery within a national US cohort, between 2017 and 2022.</div></div><div><h3>Methods</h3><div>We used TRICARE claims data to identify individuals undergoing one of 14 representative surgical procedures. The rate of post-operative long-term prescription opioid use during 2020–22 was compared to 2017–19. We used modified Poisson regression analyses to adjust for confounding. We performed secondary analyses that accounted for interactions between the time period and race, pre-operative opioid use, surgical care setting and our proxy for socioeconomic status.</div></div><div><h3>Findings</h3><div>Our data derived from TRICARE claims. We included 410,326 surgical events. Across both time periods, there were 213,212 females (52%), with a median age of 53 (IQR 22) and 207,188 individuals of White race (50%). The median co-morbidity index was 0 (IQR = 0). The rate of long-term post-operative opioid use was 11% in 2017–19, which reduced to 6% in 2020–22 (risk ratio [RR] 0.51; 95% CI 0.50, 0.52). Reductions were appreciated across all census divisions in the US and across all racial minorities, those of lower socioeconomic background and pre-operative chronic opioid users. Following multivariable analysis, there was a significant reduction in long-term prescription opioid use (RR 0.61; 95% CI 0.60, 0.63) after surgery in 2020–22 as compared to 2017–19.</div></div><div><h3>Interpretation</h3><div>This investigation represents one of the largest and most comprehensive longitudinal assessments of opioid use following surgery. We found clinically relevant reductions in post-operative prescription opioid use in 2020–22 as compared to 2017–19. Given the representative nature of the study cohort, we believe these results are reflective of national trends.</div></div><div><h3>Funding</h3><div>U.S. <span>Department of Defense</span>, <span>Defense Health Agency</span> (award # HU00012120089).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100948"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150709","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":"Addressing migrant-specific barriers to accessing health services through primary health care in host countries in Latin American and the Caribbean","authors":"James Fitzgerald,&nbsp;Ernesto Báscolo,&nbsp;Gustavo Rosell de Almeida,&nbsp;Natalia Houghton,&nbsp;Rachel Jarboe,&nbsp;Julie Issa","doi":"10.1016/j.lana.2024.100957","DOIUrl":"10.1016/j.lana.2024.100957","url":null,"abstract":"<div><div>The Region of Latin America and the Caribbean (LAC) is a culturally rich region marked by significant bio- and sociocultural diversity, including approximately 50 million Indigenous People. However, LAC faces deep inequalities and vast disparities between social development and economic progress, including in access to healthcare for migrant populations. Migration has historically always existed in the region with current movements characterized by a south-south pattern within LAC combined with a south-north pattern from LAC, moving towards North America. Furthermore, environmental degradation and climate change have increasingly contributed to a substantial rise in migration as well as health risks for migrants in the Region, and it is predicted to accelerate in coming years.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100957"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744139","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":"Zulma M. Cucunubá — shaping public health with mathematical modelling","authors":"Taissa Vila","doi":"10.1016/j.lana.2024.100958","DOIUrl":"10.1016/j.lana.2024.100958","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100958"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759415","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 response of health systems to the needs of migrants and refugees in the COVID-19 pandemic: a comparative case study between Mexico, Colombia and Peru","authors":"Ietza Bojorquez ,&nbsp;Andres Cubillos-Novella ,&nbsp;Juan Arroyo-Laguna ,&nbsp;Luis Alberto Martinez-Juarez ,&nbsp;Ana Cristina Sedas ,&nbsp;Oscar Franco-Suarez ,&nbsp;Zuly Suárez-Morales ,&nbsp;Edith Adame-Avilés ,&nbsp;Marcela Barragán-León ,&nbsp;Angela Suarez ,&nbsp;Miriam Orcutt ,&nbsp;Paul Spiegel","doi":"10.1016/j.lana.2024.100763","DOIUrl":"10.1016/j.lana.2024.100763","url":null,"abstract":"<div><h3>Background</h3><div>Protecting the health of migrants and refugees during the pandemic was a significant challenge in the Latin American region. We aimed to describe and contrast the response of the health systems of Mexico, Colombia and Perú to migrants' and refugees’ health needs during the COVID-19 pandemic, and to situate the response in the context of the migration and health policies of each country.</div></div><div><h3>Methods</h3><div>We conducted case studies of the three countries. The data collected for each case included: 1) policy documents; 2) peer-reviewed and grey literature; 3) qualitative interviews with key informants.</div></div><div><h3>Findings</h3><div>The three countries issued policies to detect COVID-19 cases among migrants and refugees, and granted them access to COVID-19 care regardless of their migration status or facilitated regularization as a way to improve access to care. However, other health care needs were not considered, some groups of migrants remained invisible in the policies, and policies rarely considered the increased social and economic vulnerability of migrants and refugees during this period. Pre-existing barriers to care were made worse during the pandemic. All three countries’ response to migrants was reliant on non-governmental organizations, with international cooperation being especially active in Colombia, and local civil society organizations in Mexico.</div></div><div><h3>Interpretation</h3><div>The response of each country was a continuation of their previous approach to migration and health. Developing plans for pandemic response that consider migrants and refugees’ particular needs will be important to improve response capacities in the future.</div></div><div><h3>Funding</h3><div>Funding was provided by USA for the <span>International Organization</span> for Migration (IOM) under an agreement with the <span>Johns Hopkins Center</span> for Humanitarian Health.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"40 ","pages":"Article 100763"},"PeriodicalIF":7.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033117","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}