Lancet Regional Health-Americas最新文献

{"title":"Group B Streptococcus disease during infancy and risk of subsequent neurodevelopmental impairments in young children: a population-based cohort study in Ontario, Canada","authors":"Romina Fakhraei ,&nbsp;Deshayne B. Fell ,&nbsp;Darine El-Chaâr ,&nbsp;Nisha Thampi ,&nbsp;Beate Sander ,&nbsp;Kevin Antoine Brown ,&nbsp;Natasha Crowcroft ,&nbsp;Shelly Bolotin ,&nbsp;Jon Barrett ,&nbsp;Elizabeth K. Darling ,&nbsp;Nahuel Fittipaldi ,&nbsp;Theresa Lamagni ,&nbsp;Allison McGeer ,&nbsp;Michelle Murti ,&nbsp;Manish Sadarangani ,&nbsp;Kevin L. Schwartz ,&nbsp;Abdool Yasseen ,&nbsp;Matthew Tunis ,&nbsp;William Petrcich ,&nbsp;Kumanan Wilson","doi":"10.1016/j.lana.2025.101170","DOIUrl":"10.1016/j.lana.2025.101170","url":null,"abstract":"<div><h3>Background</h3><div>Group B <em>Streptococcus</em> (GBS) is a leading infectious cause of neonatal morbidity and mortality worldwide, yet data on longer-term outcomes in children remain limited. We aimed to assess the risk of neurodevelopmental impairments (NDIs) in GBS survivors and to explore effect modification by sex and prematurity.</div></div><div><h3>Methods</h3><div>We performed a population-based cohort study of liveborn infants in Ontario between April 2012 and March 2018, using linked birth registry, laboratory, and health administrative databases. GBS disease in the first year of life was ascertained through culture results and diagnostic codes. NDIs, encompassing cognitive, motor, sensory (hearing, vision), and social/behavioural domains, were ascertained up to five years of age using diagnostic codes. Cox regression was used to estimate adjusted hazard ratios (aHR) for overall, domain-specific, and multidomain NDIs, comparing children with and without GBS disease during infancy.</div></div><div><h3>Findings</h3><div>Of 764,934 infants, 771 had a history of GBS disease. GBS survivors had a twofold increased risk of any NDI (adjusted hazard ratio [aHR]: 2.18 [95% CI: 1.88, 2.54]) and higher rates of cognitive (aHR: 2.79 [95% CI: 2.37, 3.30]), motor (aHR: 7.08 [95% CI: 2.93, 17.08]), social/behavioural (aHR: 1.60 [95% CI: 1.20, 2.14]), and sensory (aHR: 1.64 [95% CI: 1.02, 2.64]) impairments. Male children and those born preterm (&lt;37 weeks) had disproportionately higher risks of GBS-associated NDIs.</div></div><div><h3>Interpretation</h3><div>GBS disease in infancy is associated with a higher risk of NDIs by age five years, particularly for male children and those born preterm. Primary prevention strategies are needed to mitigate long-term developmental impacts of early-life GBS disease.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101170"},"PeriodicalIF":7.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural adaptation of a digital therapeutic for insomnia for Spanish-speaking Hispanic adults in the United States: a qualitative study","authors":"Carmela Alcántara ,&nbsp;Luciana Giorgio Cosenzo ,&nbsp;Sarah V. Diaz ,&nbsp;Darwin Arias ,&nbsp;Joseph E. Schwartz ,&nbsp;Ian M. Kronish ,&nbsp;Nathalie Moise","doi":"10.1016/j.lana.2025.101158","DOIUrl":"10.1016/j.lana.2025.101158","url":null,"abstract":"<div><h3>Background</h3><div>Digital therapeutics represent an innovative and scalable means for addressing inequities in access to behavioural healthcare. However, the adaptation of digital health technologies for minoritised communities to promote equitable uptake remains elusive, and the procedures and outcomes are often not systematically detailed. Our aim was to describe the equity-centred, theory-informed process we undertook to culturally adapt, for Spanish-speaking Hispanic adults, the first Food and Drug Administration authorized, self-guided, prescription digital therapeutic for insomnia.</div></div><div><h3>Methods</h3><div>We used an integrated four-stage model of cultural adaptation to guide the process and a cultural adaptation taxonomy of common elements to report findings. A bilingual (Spanish/English) community advisory board provided critical input. In Stages 1–3, ten focus groups and 13 individual interviews were conducted to obtain feedback on cultural adaptations and digital components. In Stage 4, a pilot study was undertaken to assess usability of the adaptations. Qualitative data were analysed using thematic content analysis and coded by type of adaptation.</div></div><div><h3>Findings</h3><div>53 Hispanic adults with chronic insomnia were invited to participate in all stages; Mean age = 53.6 years (SD = 11.4), 64.2% women, 49% less than college, and 62.3% reported low technological confidence. Cultural adaptations were made in each taxonomy component (83 total); the adapted program had high usability (System Usability Scale = 95/100). Surface-level adaptations (34.9% of changes made based on observable characteristics), which included changes to the characters (storylines, images), activities, and content to reflect the within-Hispanic group heterogeneity. Deep-level adaptations (65.1% of changes made based on sociocultural factors) included the integration of sociocultural values (<em>familismo</em>) and environment/burdens (stressors, social determinants, immigrant status) into the intervention content, and more in-App guidance/instruction to facilitate navigation for low health and digital literacy.</div></div><div><h3>Interpretation</h3><div>We produced a digital therapeutic for insomnia for Hispanic adults across the digital literacy spectrum with high acceptability, usability, and potential to confer clinical benefits.</div></div><div><h3>Funding</h3><div>This project was supported by <span>AHRQ</span> HS024274 and a Provost Grant from <span>Columbia University</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101158"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to fight against cancer in the amazon: ideas and perspectives from the oncology 2025","authors":"Paulo Assumpção ,&nbsp;Elisa Pucu","doi":"10.1016/j.lana.2025.101181","DOIUrl":"10.1016/j.lana.2025.101181","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101181"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating vitamin A for measles management in high-income settings","authors":"Parminder S. Suchdev ,&nbsp;Nancy F. Krebs ,&nbsp;Sherry A. Tanumihardjo","doi":"10.1016/j.lana.2025.101168","DOIUrl":"10.1016/j.lana.2025.101168","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101168"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No safe line: the human cost of dismantling LGBTQ+ youth support services","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101191","DOIUrl":"10.1016/j.lana.2025.101191","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101191"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could rituximab revolutionize multiple sclerosis treatment in Brazil? The missed opportunity for fewer relapses and lower costs","authors":"Guilherme Diogo Silva,&nbsp;Leonardo Zumerkorn Pipek,&nbsp;Mateus Boaventura de Oliveira,&nbsp;Samira Luisa Apóstolos-Pereira,&nbsp;Tarso Adoni,&nbsp;Angelina Maria Martins Lino,&nbsp;Dagoberto Callegaro,&nbsp;Luiz Henrique Martins Castro","doi":"10.1016/j.lana.2025.101171","DOIUrl":"10.1016/j.lana.2025.101171","url":null,"abstract":"<div><div>Multiple sclerosis (MS) is a leading cause of neurological disability in young adults, affecting an estimated 2.8 million people worldwide. Early treatment with high-efficacy therapies is associated with better long-term outcomes, yet access to these therapies remains limited in many countries, including Brazil. Rituximab, a B-cell depleting agent, has emerged as a highly effective, safe, and cost-saving treatment for MS. A randomized trial and observational studies demonstrate that rituximab is superior in reducing relapse rates compared to commonly used first-line therapies. Rituximab also has a well-established safety profile and is associated with lower overall treatment costs. Although rituximab remains off-label for MS, it is supported by expert societies, endorsed by patient organizations, and has been added to the World Health Organization’s list of essential medicines. We strongly recommend rituximab as an early treatment option for MS in Brazil, where its adoption could improve outcomes, reduce health inequities and lower healthcare system costs.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101171"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on the American Psychiatric Association 2025 Annual Meeting","authors":"Orison O. Woolcott","doi":"10.1016/j.lana.2025.101164","DOIUrl":"10.1016/j.lana.2025.101164","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101164"},"PeriodicalIF":7.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional study","authors":"Deborah S. Hasin ,&nbsp;Carol Malte ,&nbsp;Melanie M. Wall ,&nbsp;Daniel Alschuler ,&nbsp;Tracy L. Simpson ,&nbsp;Mark Olfson ,&nbsp;Ofir Livne ,&nbsp;Zachary L. Mannes ,&nbsp;David S. Fink ,&nbsp;Katherine M. Keyes ,&nbsp;Magdalena Cerdá ,&nbsp;Charles C. Maynard ,&nbsp;Salomeh Keyhani ,&nbsp;Silvia S. Martins ,&nbsp;Scott Sherman ,&nbsp;Andrew J. Saxon","doi":"10.1016/j.lana.2025.101155","DOIUrl":"10.1016/j.lana.2025.101155","url":null,"abstract":"<div><h3>Background</h3><div>We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did not have common psychiatric disorders.</div></div><div><h3>Methods</h3><div>Electronic medical record data (2005–2022) were analyzed on patients aged 18–75 with ≥1 VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given year (sample sizes ranging from 3,234,382 in 2005 to 4,436,883 in 2022). Patients were predominantly male (&gt;80%) and non-Hispanic White (&gt;60%). Utilizing all 18 years of data, CUD prevalence increases attributable to MCL or RCL enactment were estimated among patients with affective, anxiety, psychotic-spectrum disorders, and Any Psychiatric Disorder (APD) using staggered difference-in-difference (DiD) models and 99% Confidence Intervals (CIs), testing differences between patient groups with and without psychiatric disorders via non-overlap in the 99% CIs of their DiD estimates.</div></div><div><h3>Findings</h3><div>Among APD-negative patients, CUD prevalence was &lt;1.0% in all years, while among APD-positive patients, CUD prevalence increased from 3.26% in 2005 to 5.68% in 2022 in no-CL states, from 3.51% to 6.35% in MCL-only states, and from 3.41% to 6.35% in MCL/RCL states. Among the APD group, DiD estimates of MCL-only and MCL/RCL effects were modest-sized, but the lower bound of the 99% CI for the DiD estimate for MCL-only and MCL/RCL effects was larger than the upper bound of the 99% CI among the no-APD group, indicating significantly stronger MCL-only and MCL/RCL effects among patients with APD. Results were similar for MCL-only and MCL/RCL effects among disorder-specific groups (depression, post-traumatic stress disorder [PTSD], anxiety or bipolar disorders) and for MCL/RCL effects among patients with psychotic-spectrum disorders.</div></div><div><h3>Interpretation</h3><div>Cannabis legalization contributed to greater CUD prevalence increases among patients with psychiatric disorders. However, modest-sized DiD estimates suggested operation of other factors, e.g., commercialization, changing attitudes, expectancies. As cannabis legalization widens, recognizing and treating CUD in patients with psychiatric disorders becomes increasingly important.</div></div><div><h3>Funding</h3><div>This study was supported by <span>National Institute on Drug Abuse</span> grant <span><span>R01DA048860</span></span>, the <span>New York State Psychiatric Institute</span>, and the <span>VA Centers of Excellence in Substance Addiction Treatment and Education</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101155"},"PeriodicalIF":7.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing ethnicity in pediatrics must be combined with addressing poverty and access to care: the experience of the French West Indies and French Guiana","authors":"Arthur Felix ,&nbsp;Narcisse Elenga ,&nbsp;Lindsay Osei","doi":"10.1016/j.lana.2025.101169","DOIUrl":"10.1016/j.lana.2025.101169","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101169"},"PeriodicalIF":7.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2024 South America ablaze: health impacts and policy imperatives for protecting population health in an era of wildfires","authors":"Yasna Palmeiro-Silva ,&nbsp;Camila Llerena-Cayo ,&nbsp;Luciana Blanco-Villafuerte ,&nbsp;David Rojas-Rueda ,&nbsp;Nicolas Borchers Arriagada ,&nbsp;Zoila Vela-Clavo ,&nbsp;Tatiana de Camargo ,&nbsp;Matilde Rusticucci ,&nbsp;Armando Valdes-Velasquez ,&nbsp;Stella M. Hartinger","doi":"10.1016/j.lana.2025.101160","DOIUrl":"10.1016/j.lana.2025.101160","url":null,"abstract":"<div><div>The 2024 wildfires in South America, particularly in the Amazon and Pantanal, were not only a disaster for ecosystems, but also for public health and people's health and wellbeing. These record-breaking fires were likely driven by overlapping triggers: climate change-related heat and droughts and human-driven land-use change. We documented that rapidly evolving wildfires together with limited preparedness and slow responses from emergency and health agencies resulted in severe health impacts, including several fatalities and thousands people displaced, injured, and/or with cardiorespiratory symptoms. These, however, partially represent the situation as mental health outcomes were largely unrecorded and other impacts are yet to be seen. In a climate increasingly prone to severe wildfires, comprehensive action is key. Integrated disaster risk reduction strategies, strengthened health systems, and improved risk communication are essential to protect human health from this escalating threat.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101160"},"PeriodicalIF":7.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}