Lancet Regional Health-Americas最新文献

{"title":"Ewing sarcoma and paediatric cancer burden: we need more robust registries","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2026.101683","DOIUrl":"10.1016/j.lana.2026.101683","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"62 ","pages":"Article 101683"},"PeriodicalIF":9.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149159101","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":"Whole-blood point of care biomarker testing following traumatic brain injury","authors":"Daniel P. Whitehouse, Sophie Richter, Virginia F.J. Newcombe","doi":"10.1016/j.lana.2026.101554","DOIUrl":"10.1016/j.lana.2026.101554","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101554"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934510","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":"Reducing opioid exposure after cardiac surgery with parasternal intercostal plane blocks (EPOCH CardioLink-10)—authors' response","authors":"Ahmad Alli, C David Mazer, Subodh Verma, EPOCH CardioLink-10 Investigators","doi":"10.1016/j.lana.2026.101611","DOIUrl":"10.1016/j.lana.2026.101611","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101611"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934511","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":"Mental disorders and self-harm among Brazilian children, adolescents, and young adults: prevalence, disability, and mortality estimates from the Global Burden of Disease Study","authors":"Claudia Buchweitz, Arthur Caye, Jader Piccin, Igor Duarte, Guilherme V. Polanczyk, Luis Augusto Rohde, Giovanni A. Salum, Peter Szatmari, Christian Kieling","doi":"10.1016/j.lana.2026.101583","DOIUrl":"10.1016/j.lana.2026.101583","url":null,"abstract":"<div><h3>Background</h3><div>The period from childhood to young adulthood involves heightened susceptibility to mental health problems, requiring specific health policies. We present the prevalence and burden associated with mental disorders, substance use disorders (SUDs), and self-harm in Brazilian children, adolescents, and young adults.</div></div><div>The period from childhood to young adulthood involves heightened susceptibility to mental health problems, requiring specific health policies. We present the prevalence and burden associated with mental disorders, substance use disorders (SUDs), and self-harm in Brazilian children, adolescents, and young adults.</div><div><h3>Methods</h3><div>Using Global Burden of Disease Study (GBD) data, prevalence and years lived with disability (YLDs) were described for mental disorders and SUDs in ages 5–29 years. Self-harm mortality and years of life lost (YLLs) were described for 10–29 years (reflecting GBD modeling). Analysis was carried out disaggregated by sex. Race/ethnicity data were not available.</div></div><div>Using Global Burden of Disease Study (GBD) data, prevalence and years lived with disability (YLDs) were described for mental disorders and SUDs in ages 5–29 years. Self-harm mortality and years of life lost (YLLs) were described for 10–29 years (reflecting GBD modeling). Analysis was carried out disaggregated by sex. Race/ethnicity data were not available.</div><div><h3>Findings</h3><div>Sixty-six unique sources from Brazil were used in GBD 2023 to model prevalence of mental disorders and SUDs. Mortality was derived from Brazil's Mortality Information System. At least one mental disorder was diagnosable in 15·6 million (20·91%) youths (6·9 million males, 8·7 million females); 2·5 million (3·36%) met criteria for at least one SUD (1·6 million males, 0·9 million females). Mental disorders and SUDs together accounted for over one third of the disability from all GBD causes in this age range. Self-harm accounted for 5402 annual deaths (4149 males, 1253 females) and 361,631 YLLs in 10 to 29-year-olds; annual mortality rate per 100,000 population ranged from 1·24 (95% UI: 1·06–1·46) at 10–14 years to 13·43 (95% UI: 12·29–14·92) at 25–29 years.</div></div><div>Sixty-six unique sources from Brazil were used in GBD 2023 to model prevalence of mental disorders and SUDs. Mortality was derived from Brazil's Mortality Information System. At least one mental disorder was diagnosable in 15·6 million (20·91%) youths (6·9 million males, 8·7 million females); 2·5 million (3·36%) met criteria for at least one SUD (1·6 million males, 0·9 million females). Mental disorders and SUDs together accounted for over one third of the disability from all GBD causes in this age range. Self-harm accounted for 5402 annual deaths (4149 males, 1253 females) and 361,631 YLLs in 10 to 29-year-olds; annual mortality rate per 100,000 population ranged from 1·24 (95% UI: 1·06–1·46) at 10–14 years to 13·43 (95% UI: 12·29–14·92) ","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101583"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148940690","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":"Whole-blood point-of-care glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 biomarkers after traumatic brain injury in the US: a prospective diagnostic prediction of intracranial injury on head CT","authors":"Ava M. Puccio, Michael A. McCrea, David O. Okonkwo, Swati Pradhan-Bhatt, Kenneth Curley, Adam Moss, Manish Gupta, Erica Wyse, Deeksha Pahwa, Damien Hoffman, Claudia Robertson, Joseph Giacino, Ramon Diaz-Arrastia, Nancy Temkin, Esther Yuh, Pratik Mukherjee, Raj Chandran, Geoffrey T. Manley, Krista Caudle, Beth McQuiston","doi":"10.1016/j.lana.2026.101539","DOIUrl":"10.1016/j.lana.2026.101539","url":null,"abstract":"<div><h3>Background</h3><div>Biomarkers like glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) are being globally recommended as a valuable component in the evaluation of acute TBI. Having a regulatory-approved whole-blood test is imperative to provide consistent and democratized approach to healthcare. This prospective, national multicenter cohort trial (NCT04171960) evaluated the performance of a whole-blood, point-of-care (POC) GFAP/UCH-L1 panel in determining need for head computed tomography (CT) in adult patients presenting to the emergency department (ED) with suspected traumatic brain injury (TBI).</div></div><div>Biomarkers like glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) are being globally recommended as a valuable component in the evaluation of acute TBI. Having a regulatory-approved whole-blood test is imperative to provide consistent and democratized approach to healthcare. This prospective, national multicenter cohort trial (NCT04171960) evaluated the performance of a whole-blood, point-of-care (POC) GFAP/UCH-L1 panel in determining need for head computed tomography (CT) in adult patients presenting to the emergency department (ED) with suspected traumatic brain injury (TBI).</div><div><h3>Methods</h3><div>Adults presenting to the ED with suspected TBI, Glasgow Coma Scale score 13–15, completed head CT scan, and blood collected within 24 h of injury were included. GFAP and UCH-L1 measured in whole-blood through a POC TBI biomarker test were analyzed using prespecified cutoffs and combined into a single test result and compared with CT findings.</div></div><div>Adults presenting to the ED with suspected TBI, Glasgow Coma Scale score 13–15, completed head CT scan, and blood collected within 24 h of injury were included. GFAP and UCH-L1 measured in whole-blood through a POC TBI biomarker test were analyzed using prespecified cutoffs and combined into a single test result and compared with CT findings.</div><div><h3>Findings</h3><div>970 enrolled participants [mean age 46.8 (18–97); 36%female; 69%White, 18%Black; 19%Hispanic/Latino] were analyzed. 683 participants (70.4%) had ‘elevated’ and 287 (29.6%) had ‘not elevated’ TBI blood test result. For detection of CT intracranial injury, the whole-blood TBI test had sensitivity of 96.5% (95%CI 93.6–98.1%) and NPV 96.5% (95%CI 93.7–98.1%).</div></div><div>970 enrolled participants [mean age 46.8 (18–97); 36%female; 69%White, 18%Black; 19%Hispanic/Latino] were analyzed. 683 participants (70.4%) had ‘elevated’ and 287 (29.6%) had ‘not elevated’ TBI blood test result. For detection of CT intracranial injury, the whole-blood TBI test had sensitivity of 96.5% (95%CI 93.6–98.1%) and NPV 96.5% (95%CI 93.7–98.1%).</div><div><h3>Interpretation</h3><div>The GFAP/UCH-L1 whole-blood test had high sensitivity and NPV for prediction of intracranial injury within 24 h of TBI. The platform received U.S.-FDA clearance a","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101539"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148940790","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":"Acute rheumatic fever and rheumatic heart disease in Latin America: a contemporary review of epidemiology","authors":"Antonio Mutarelli, Alexandre Negrao Pantaleao, Pilly Chillo, Dorah Nampijja, Sara Campanati, Walderez O. Dutra, Maria Carmo P. Nunes, Robert A. Levine","doi":"10.1016/j.lana.2026.101564","DOIUrl":"10.1016/j.lana.2026.101564","url":null,"abstract":"<div><div>Rheumatic heart disease (RHD) remains a significant public health challenge in Latin America, disproportionately affecting vulnerable populations despite global declines in disease prevalence and mortality. It is known that RHD affects over 55 million individuals worldwide, accounting for more than 390,000 deaths annually. However, region-specific RHD epidemiologic data are scarce, and most clinical studies on RHD epidemiology date back to the 1990s. On the other hand, the emergence of echocardiographic screening initiatives in the last decade reinforced the burden of the disease, revealing alarming rates of subclinical RHD in Latin American schoolchildren and young adults. This comprehensive review focused on epidemiologic data on RHD from Latin America and highlighted subgroups at highest risk for the disease.</div></div><div>Rheumatic heart disease (RHD) remains a significant public health challenge in Latin America, disproportionately affecting vulnerable populations despite global declines in disease prevalence and mortality. It is known that RHD affects over 55 million individuals worldwide, accounting for more than 390,000 deaths annually. However, region-specific RHD epidemiologic data are scarce, and most clinical studies on RHD epidemiology date back to the 1990s. On the other hand, the emergence of echocardiographic screening initiatives in the last decade reinforced the burden of the disease, revealing alarming rates of subclinical RHD in Latin American schoolchildren and young adults. This comprehensive review focused on epidemiologic data on RHD from Latin America and highlighted subgroups at highest risk for the disease.</div><div><div>A cardiopatia reumática (CR) permanece um importante desafio de saúde pública na América Latina, afetando desproporcionalmente populações vulneráveis, apesar da redução global na prevalência e mortalidade da doença. Sabe-se que a CR afeta mais de 55 milhões de indivíduos em todo o mundo, sendo responsável por mais de 390.000 mortes anuais. No entanto, dados epidemiológicos específicos da região são escassos, e a maioria dos estudos clínicos sobre a epidemiologia da CR data da década de 1990. Por outro lado, o surgimento de iniciativas de rastreamento ecocardiográfico na última década reforçou a carga da doença, revelando taxas alarmantes de CR subclínica em escolares e adultos jovens na América Latina. Esta revisão abrangente concentrou-se nos dados epidemiológicos da CR na América Latina e destacou os subgrupos com maior risco para a doença.</div></div><div>A cardiopatia reumática (CR) permanece um importante desafio de saúde pública na América Latina, afetando desproporcionalmente populações vulneráveis, apesar da redução global na prevalência e mortalidade da doença. Sabe-se que a CR afeta mais de 55 milhões de indivíduos em todo o mundo, sendo responsável por mais de 390.000 mortes anuais. No entanto, dados epidemiológicos específicos da região são escassos, e a maioria dos estudos clín","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101564"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148940791","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":"5 years of The Lancet Regional Health – Americas","authors":"Taissa Vila, Gustavo Monnerat, Orison Woolcott, Maria Dario","doi":"10.1016/j.lana.2026.101639","DOIUrl":"10.1016/j.lana.2026.101639","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101639"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148940629","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":"Medical, interventional, and surgical management of rheumatic heart disease","authors":"Sheila L. Klassen,&nbsp;Luiz G. Passaglia,&nbsp;Vicente R. Silva,&nbsp;Bhagawan Koirala,&nbsp;Kunjang Sherpa,&nbsp;Marcelo Martins,&nbsp;Lucas Lodi-Junqueira,&nbsp;Jacob Dal-Bianco,&nbsp;Maria Carmo P. Nunes,&nbsp;Robert A. Levine","doi":"10.1016/j.lana.2026.101565","DOIUrl":"10.1016/j.lana.2026.101565","url":null,"abstract":"<div><div>Rheumatic heart disease (RHD) is a lifelong chronic condition with complex pathogenesis and major management challenges in regions where it is endemic. Therapeutic difficulties stem from the need for prolonged medical treatment and lifelong surgical planning in a predominantly young population. Gaps in our understanding of optimal medical and surgical treatment strategies persist, in part because clinically apparent RHD has become uncommon in high-income countries, where most therapeutic innovations historically originate, limiting research investment in this population. This review summarizes established and emerging aspects of the medical management of RHD, its major complications, and available surgical and transcatheter interventions with a focus on the mitral valve. Ongoing research continues to expand the evidence base for RHD care, but parallel efforts to strengthen health systems are essential to ensure effective delivery of available therapies. Sustained global collaboration, research partnerships, and policy initiatives are critical to improving outcomes for individuals living with RHD worldwide.</div></div><div>Rheumatic heart disease (RHD) is a lifelong chronic condition with complex pathogenesis and major management challenges in regions where it is endemic. Therapeutic difficulties stem from the need for prolonged medical treatment and lifelong surgical planning in a predominantly young population. Gaps in our understanding of optimal medical and surgical treatment strategies persist, in part because clinically apparent RHD has become uncommon in high-income countries, where most therapeutic innovations historically originate, limiting research investment in this population. This review summarizes established and emerging aspects of the medical management of RHD, its major complications, and available surgical and transcatheter interventions with a focus on the mitral valve. Ongoing research continues to expand the evidence base for RHD care, but parallel efforts to strengthen health systems are essential to ensure effective delivery of available therapies. Sustained global collaboration, research partnerships, and policy initiatives are critical to improving outcomes for individuals living with RHD worldwide.</div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101565"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148949994","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":"An echocardiographic appreciation of rheumatic heart disease: phenotypic variability of valvular involvement and its prognostic implications","authors":"Maria Carmo P. Nunes,&nbsp;Pilly Chillo,&nbsp;Sheila Klassen,&nbsp;Dorah Nampijjad,&nbsp;Fernanda de Azevedo Figueiredo,&nbsp;Nayana Flamini Arantes Gomes,&nbsp;Adson Patrik Vieira Carvalho,&nbsp;Carolina K. Soares,&nbsp;Estela Fofano Rodrigues,&nbsp;Antonio Mutarelli,&nbsp;Alexandre Pantaleão,&nbsp;Juan Manuel Díaz,&nbsp;Jacob P. Dal-Bianco,&nbsp;Judy Hung,&nbsp;John K. McCormick,&nbsp;Robert A. Levine","doi":"10.1016/j.lana.2026.101566","DOIUrl":"10.1016/j.lana.2026.101566","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity and premature mortality in low- and middle-income countries. This review examines RHD from an echocardiographic perspective, emphasizing how valve-specific phenotypes, hemodynamic burden, and disease progression shape clinical presentation, prognosis, and management. The evolution of echocardiography, from M-mode and two-dimensional imaging to Doppler, strain, and three-dimensional techniques, has transformed understanding of rheumatic valve disease and established imaging as central to diagnosis, risk stratification, and therapeutic guidance. Rheumatic mitral stenosis, in particular, served as a model for the development of key echocardiographic principles in valve morphology, hemodynamics, and intervention planning. Beyond anatomical severity, physiological variables such as exercise-induced pulmonary pressure changes and net atrioventricular compliance provide important prognostic information and better reflect functional impairment. Across the spectrum of disease, echocardiography remains fundamental for early detection, phenotypic characterization, longitudinal surveillance, and individualized management of RHD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity and premature mortality in low- and middle-income countries. This review examines RHD from an echocardiographic perspective, emphasizing how valve-specific phenotypes, hemodynamic burden, and disease progression shape clinical presentation, prognosis, and management. The evolution of echocardiography, from M-mode and two-dimensional imaging to Doppler, strain, and three-dimensional techniques, has transformed understanding of rheumatic valve disease and established imaging as central to diagnosis, risk stratification, and therapeutic guidance. Rheumatic mitral stenosis, in particular, served as a model for the development of key echocardiographic principles in valve morphology, hemodynamics, and intervention planning. Beyond anatomical severity, physiological variables such as exercise-induced pulmonary pressure changes and net atrioventricular compliance provide important prognostic information and better reflect functional impairment. Across the spectrum of disease, echocardiography remains fundamental for early detection, phenotypic characterization, longitudinal surveillance, and individualized management of RHD.&lt;/div&gt;&lt;div&gt;&lt;div&gt;A cardiopatia reumática (CR) permanece como uma importante causa de morbidade cardiovascular e mortalidade prematura em países de baixa e média renda. Este artigo de revisão avalia a CR sob uma perspectiva ecocardiográfica, enfatizando como fenótipos valvares específicos, a sobrecarga hemodinâmica e a progressão da doença moldam a apresentação clínica, o prognóstico e a conduta clínica. A evolução da ecocardiografia, desde o modo M e a imagem bidimensional até as técnicas Doppler, de strain e tridimensionais, transformou a ","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"61 ","pages":"Article 101566"},"PeriodicalIF":9.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148949995","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":"Mortality and major comorbidities in coeliac disease: implications for long-term care","authors":"Marco Vincenzo Lenti,&nbsp;Gino Roberto Corazza,&nbsp;Antonio Di Sabatino","doi":"10.1016/j.lana.2026.101585","DOIUrl":"10.1016/j.lana.2026.101585","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"60 ","pages":"Article 101585"},"PeriodicalIF":9.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148634578","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}