3842. Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trial.
作者: Anurag Bhargava.;Madhavi Bhargava.;Ajay Meher.;Andrea Benedetti.;Banurekha Velayutham.;G Sai Teja.;Basilea Watson.;Ganesh Barik.;Rajeev Ranjan Pathak.;Ranjit Prasad.;Rakesh Dayal.;Adarsh Kibballi Madhukeshwar.;Vineet Chadha.;Madhukar Pai.;Rajendra Joshi.;Dick Menzies.;Soumya Swaminathan.
来源: Lancet. 2023年402卷10402期627-640页
In India, tuberculosis and undernutrition are syndemics with a high burden of tuberculosis coexisting with a high burden of undernutrition in patients and in the population. The aim of this study was to determine the effect of nutritional supplementation on tuberculosis incidence in household contacts of adults with microbiologically confirmed pulmonary tuberculosis.
3846. Setbacks in the quest for universal health coverage in Mexico: polarised politics, policy upheaval, and pandemic disruption.
作者: Felicia Marie Knaul.;Hector Arreola-Ornelas.;Michael Touchton.;Tim McDonald.;Merike Blofield.;Leticia Avila Burgos.;Octavio Gómez-Dantés.;Pablo Kuri.;Adolfo Martinez-Valle.;Oscar Méndez-Carniado.;Renu Sara Nargund.;Thalia Porteny.;Sandra Gabriela Sosa-Rubí.;Edson Serván-Mori.;Maya Symes.;Valentina Vargas Enciso.;Julio Frenk.
来源: Lancet. 2023年402卷10403期731-746页
2023 marks the 20-year anniversary of the creation of Mexico's System of Social Protection for Health and the Seguro Popular, a model for the global quest to achieve universal health coverage through health system reform. We analyse the success and challenges after 2012, the consequences of reform ageing, and the unique coincidence of systemic reorganisation during the COVID-19 pandemic to identify strategies for health system disaster preparedness. We document that population health and financial protection improved as the Seguro Popular aged, despite erosion of the budget and absent needed reforms. The Seguro Popular closed in January, 2020, and Mexico embarked on a complex, extensive health system reorganisation. We posit that dismantling the Seguro Popular while trying to establish a new programme in 2020-21 made the Mexican health system more vulnerable in the worst pandemic period and shows the precariousness of evidence-based policy making to political polarisation and populism. Reforms should be designed to be flexible yet insulated from political volatility and constructed and managed to be structurally permeable and adaptable to new evidence to face changing health needs. Simultaneously, health systems should be grounded to withstand systemic shocks of politics and natural disasters.
3854. Cause-specific mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.
Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions.
3856. Multidisciplinary end-of-life care for a patient with amyotrophic lateral sclerosis requesting euthanasia.
作者: Willeke J Kruithof.;Esther Kruitwagen-van Reenen.;Remko M van Eenennaam.;Maaike C M Ronda.;Marjon J Lamers.;Johanna M A Visser-Meily.;Anita Beelen.;Leonard H van den Berg.
来源: Lancet. 2023年402卷10400期484页 |