Lancet Global Health最新文献

{"title":"Announcing the Lancet Global Health Commission on artificial intelligence (AI) and HIV: leveraging AI for equitable and sustainable impact.","authors":"Michael J A Reid, Benedette A Otieno, Alastair van Heerden, Izukanji Sikazwe, Solange L Baptiste, Rouella Mendonca, Geoffrey Tasi, Maaya Sundaram","doi":"10.1016/S2214-109X(25)00049-X","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00049-X","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e611-e612"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury: a neglected global health challenge in low-income and middle-income countries.","authors":"Simon Matthew Graham, Linda Chokotho, Nyengo Mkandawire, Maritz Laubscher, Sithombo Maqungo, Billy Haonga, George Njambilo, William J Harrison, Matt L Costa","doi":"10.1016/S2214-109X(25)00074-9","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00074-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e613-e615"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient outcomes after surgery in 17 Latin American countries (LASOS): a 7 day prospective cohort study.","authors":"","doi":"10.1016/S2214-109X(24)00558-8","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00558-8","url":null,"abstract":"<p><strong>Background: </strong>Access to safe surgical treatment across Latin America is limited by underfunded and fragmented health systems. Epidemiological data are required to describe surgical activity and patient outcomes.</p><p><strong>Methods: </strong>We did this 7 day prospective cohort study in 17 Latin American countries, collecting data describing inpatient surgery in adults (aged ≥18 years). The primary outcome was in-hospital postoperative complications within 30 days after surgery. Secondary outcomes were in-hospital mortality, duration of hospital stay, and admission to critical care within 30 days after surgery. This study is registered with ClinicalTrials.gov, NCT05169164.</p><p><strong>Findings: </strong>Between June 1, 2022, and April 30, 2023, we included 22 126 patients (mean age 49·7 years [SD 18·2]; 9260 [41·9%] male and 12 866 [58·1%] female; 10 180 [46·0%] White) from 284 hospitals. Of the 22 126 patients, 657 (3·0%) patients for the outcome of complications and 380 (1·7%) patients for mortality had missing data. Most patients were low risk (American Society of Anesthesiologists [ASA] grade I or II: 17 311 [78·7%] of 21 979 patients), undergoing non-major surgery (14 944 [68·0%] of 21 986 patients), and on an elective basis (14 837 [67·5%] of 21 988 patients). Despite this low-risk profile, 3163 (14·6%) of 21 632 patients developed postoperative complications resulting in 477 (2·2%) deaths. The most frequent complication category was infection, affecting 1795 (8·2%) patients. The high mortality from complications (failure to rescue) of 15·1% (477 deaths in 3163 patients with complications) suggests significant problems with postoperative care. 2978 (13·6%) patients were admitted to a critical unit immediately after surgery, but 180 (37·7%) of 477 patients who died never received critical care. Patients with complications had a median hospital stay of 8 days (IQR 3-18), compared with 2 days (1-3) for patients without complications. Postoperative mortality and complications were strongly associated with increasing ASA grade, urgency of surgery, and grade of surgery (intermediate and major).</p><p><strong>Interpretation: </strong>Patients receiving inpatient surgery in Latin America experienced high mortality rates, likely relating to standards of ward care after surgery. Given the rising demand for surgical treatments, resource-efficient measures are urgently needed to improve patient outcomes after surgery across Latin America.</p><p><strong>Funding: </strong>None.</p><p><strong>Translations: </strong>For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e635-e645"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for an Africa-centric health research ethics framework: a way forward for shaping global health research.","authors":"Mosoka Papa Fallah, Nebiyu Dereje, Elvis Temfack, Raji Tajudeen, Jean Kaseya","doi":"10.1016/S2214-109X(25)00097-X","DOIUrl":"10.1016/S2214-109X(25)00097-X","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e616-e617"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The devastating impact of the Taliban's ban on midwifery and nursing schools.","authors":"Wahid Majrooh","doi":"10.1016/S2214-109X(25)00063-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00063-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e622-e623"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Glob Health 2025; 13: e345-54.","authors":"","doi":"10.1016/S2214-109X(25)00057-9","DOIUrl":"10.1016/S2214-109X(25)00057-9","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e625"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards equity: the unfinished crisis of medical oxygen.","authors":"Adegoke G Falade, Rami Subhi","doi":"10.1016/S2214-109X(25)00015-4","DOIUrl":"10.1016/S2214-109X(25)00015-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e602-e603"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A roadmap for fostering timely regulatory and ethics approvals of international clinical trials in support of global health research systems.","authors":"Marco Cavaleri, Claudiosvam M Alves de Sousa, Adam Hacker, Elisabeth S Higgs, Murray M Lumpkin, Christiane S Maia, Roli Mathur, Adam M Fimbo, Andreas Reis, Kyoung Seung Shin, David W Vaughn, Wei Zhang, Vasee Moorthy","doi":"10.1016/S2214-109X(24)00515-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00515-1","url":null,"abstract":"<p><p>The global clinical research ecosystem faced highs and lows during the COVID-19 pandemic. Key issues included research waste from poor-quality trials and fragmented regulatory and ethical reviews. Streamlining and harmonising these review processes is crucial for efficient, robust, and timely multinational trials, ensuring rigorous scientific standards, proper safety, and ethical oversight. Robust regulatory and ethics review systems thrive on continuous learning and efficient processes, crucial for high-quality research. Enhancing trial design and implementation, and guiding innovative approaches including decentralised trials and patient-centric designs are essential for the regulatory and ethics authorities to advance public health. These approaches are built on the principles of global guidance outlined in International Coalition for Harmonization Good Clinical Practice guidelines and the WHO guidance for best practice for clinical trials. To realise the agreed vision at the first WHO Global Clinical Trials Forum in 2023, a panel of international experts in clinical research, including representatives from national and regional regulatory and ethics authorities, proposes key actions to improve coordination and streamlining of regulatory and ethics review. The actions emphasise: leveraging existing trial networks and capacity-building initiatives; advancing joint and parallel regulatory and ethics reviews and single national ethics review; improving transparency on approval requirements; simplifying and standardising informed consent forms and processes; and developing mechanisms to improve efficiency for trial site contracting as well as exportation and importation of investigational products for trials. The proposed actions for the reform are urgent and key to generate evidence to enable access to safe and effective interventions for populations most in need.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e769-e777"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of intrapartum azithromycin to prevent infections in planned vaginal births in low-income and middle-income countries: a post-hoc analysis of data from a multicentre, randomised, double-blind, placebo-controlled trial.","authors":"Waldemar A Carlo, Alan T N Tita, Janet L Moore, Musaku Mwenechanya, Elwyn Chomba, Jennifer J Hemingway-Foday, Avinash Kavi, Mrityunjay C Metgud, Shivaprasad S Goudar, Richard J Derman, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Jackie K Patterson, Poonam Shivkumar, Manju Waikar, Archana Patel, Patricia L Hibberd, Paul Nyongesa, Fabian Esamai, Osayame Austine Ekhaguere, Sherri Bucher, Saleem Jessani, Shiyam Sunder Tikmani, Sarah Saleem, Robert L Goldenberg, Sk Masum Billah, Ruth Lennox, Rashidul Haque, William Petri, Manolo Mazariegos, Nancy F Krebs, Denise C Babineau, Elizabeth M McClure, Marion Koso-Thomas","doi":"10.1016/S2214-109X(24)00562-X","DOIUrl":"https://doi.org/10.1016/S2214-109X(24)00562-X","url":null,"abstract":"<p><strong>Background: </strong>In 2023, the Azithromycin Prevention in Labor Use (A-PLUS) trial showed intrapartum azithromycin reduces maternal sepsis or death in women with planned vaginal delivery in low-resource settings, but whether it reduces maternal infection is unknown. We aimed to evaluate the effectiveness of intrapartum azithromycin in reducing maternal infection.</p><p><strong>Methods: </strong>We performed a post-hoc analysis of the multicentre, facility-based, randomised, double-blind, placebo-controlled A-PLUS trial. This trial compared prophylactic intrapartum single oral dose of 2 g azithromycin versus placebo on maternal morbidity and mortality in low-resource settings in southeast Asia and Africa from Sept 9, 2020, to Aug 18, 2022. The trial enrolled women in labour at 28 weeks' gestation (or later) at eight sites in the Democratic Republic of the Congo, Kenya, Zambia, Bangladesh, India, Pakistan, and Guatemala and found that azithromycin reduced the incidence of maternal sepsis or death. The primary outcome of the present analysis was the incidence of any maternal infection in the azithromycin versus placebo groups, which was defined as one or more of these infections after randomisation: chorioamnionitis, endometritis, perineal or caesarean wound infection, abdominopelvic abscess, mastitis or breast abscess, and other infections. Any neonatal infection was also analysed. All analyses were by intention to treat in all those with data available for that outcome. Relative risks (RRs) and 95% CIs were estimated with a Poisson model adjusted for treatment group and site. Subgroup analyses included a two-way interaction test between intervention group and subgroup. A-PLUS was registered at ClinicalTrials.gov, number NCT03871491.</p><p><strong>Findings: </strong>29 278 women were randomly assigned to groups: 14 590 to receive azithromycin, 14 688 to receive placebo. Baseline characteristics were similar between the azithromycin and placebo groups (43·3% vs 43·4% primiparous, 8·5% vs 8·7% high risk for infection). The presence of any maternal infection occurred less often in the azithromycin group (580 [4·0%] of 14 558) compared with the placebo group (824 [5·6%] of 14 661 women; RR 0·71, 95% CI 0·64-0·79, p<0·0001). Any neonatal infection did not differ between treatment groups. Adverse events were not detected.</p><p><strong>Interpretation: </strong>Among women planning vaginal delivery, this analysis provides evidence indicating that intrapartum azithromycin is associated with a lower incidence of maternal infections than placebo.</p><p><strong>Funding: </strong>The Eunice Kennedy Shriver National Institute of Child Health and Human Development and Bill and Melinda Gates Foundation via Foundation of National Institutes of Health.</p><p><strong>Translations: </strong>For the French and Spanish translations of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e689-e697"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging resistance to dolutegravir: implications for the treatment and prevention programme in South Africa.","authors":"Gillian Hunt","doi":"10.1016/S2214-109X(25)00104-4","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00104-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e606-e607"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}