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将实验台带到现场:即时检测在农村/偏远地区、原住民和资源有限环境中增强健康研究和利益相关者参与的作用。

Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts.

机构信息

Department of Anthropology, Queens College (CUNY), New York, USA.

New York Consortium of Evolutionary Primatology (NYCEP), CUNY Graduate Center, New York, USA.

出版信息

Am J Hum Biol. 2022 Nov;34(11):e23808. doi: 10.1002/ajhb.23808. Epub 2022 Sep 27.

Abstract

Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.

摘要

即时检测(POCT)使研究人员和医疗保健提供者能够将实验室带到现场,提供关键的健康信息,这些信息可以用于改善临床和研究环境中的医疗保健、可及性和理解。在我们所谓的 RIR 环境中,即农村/偏远地区、涉及原住民以及/或资源有限的环境中,医疗服务获取方面的差距最为明显。在这些情况下,由于众多地理、经济、政治和社会历史因素,传染病和非传染性疾病的发病率和死亡率不成比例地更高。人类生物学家和全球健康学者处于有利地位,可以提供实地层面的见解,有助于减少全球健康不平等,而 POCT 有可能增强这些方法。虽然 POCT 的临床益处包括通过将检测、快速诊断和治疗带到服务不足的社区,这些社区通往集中实验室检测的途径有限,从而增加医疗服务的可及性,但 POCT 也为关注健康的研究人员及其参与者提供了额外的好处。通过便携式、微创设备,研究人员可以通过将 POCT 与特定人群的健康教育相结合,为参与者提供可操作的健康数据,讨论结果及其影响,为参与者提供表达关注的空间,并促进与治疗的联系。POCT 还可以通过阐明具有进化和生物文化重要性的问题来加强人类生物学研究。在这里,我们扩展了 POCT 在利益相关者(即参与者、社区、健康研究人员和受训人员)中的流行病学和研究价值,以及实际和伦理挑战。最后,我们强调了 POCT 在促进合作研究和增强健康服务提供和信息获取方面的巨大机会,从而有助于缓解持续存在的全球健康不平等。

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