Lancet Regional Health-Americas最新文献

{"title":"Brazil's health tax at a crossroads: safeguarding the constitutional victory against ultra-processed foods","authors":"Felipe Silva Neves , Larissa Loures Mendes , Eduardo Augusto Fernandes Nilson , Inês Rugani Ribeiro de Castro , Rafael Moreira Claro , Daniela Silva Canella , Ísis Eloah Machado , Ariene Silva do Carmo , Mariana Carvalho de Menezes , Deborah Carvalho Malta","doi":"10.1016/j.lana.2025.101363","DOIUrl":"10.1016/j.lana.2025.101363","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101363"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885801","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":"Oral health in the Americas: progress, gaps, and the path to universal coverage","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2026.101458","DOIUrl":"10.1016/j.lana.2026.101458","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101458"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147449019","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":"Beyond encampments: an evidence-based path to solving Canada's homelessness crisis","authors":"Mohammad Karamouzian , Stephen W. Hwang , Dan Werb","doi":"10.1016/j.lana.2025.101362","DOIUrl":"10.1016/j.lana.2025.101362","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101362"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885802","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":"Mechanisms, symptoms, and exercise modality in fibromyalgia — authors’ response","authors":"Felipe Fregni , Luis Castelo-Branco , Alejandra Cardenas-Rojas , Lucas Camargo , Anna Gianlorenco , Wolnei Caumo","doi":"10.1016/j.lana.2026.101408","DOIUrl":"10.1016/j.lana.2026.101408","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101408"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396901","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":"Differential gastrointestinal mortality in Native Hawaiian/Pacific Islander and Asian subgroups in the U.S.: a cross-sectional analysis of national mortality surveillance data 2018–2023","authors":"Tiange P. Zhang ,&nbsp;Jennifer L. Dodge ,&nbsp;Norah A. Terrault ,&nbsp;Brian P. Lee","doi":"10.1016/j.lana.2026.101372","DOIUrl":"10.1016/j.lana.2026.101372","url":null,"abstract":"<div><h3>Background</h3><div>Asians and Native Hawaiians/Pacific Islanders (NHPIs) comprise 8% of the U.S. population with over 40 subgroups. Health data often aggregate these subpopulations, limiting group-specific estimates. In 2018, modifications to death certificates allowed for the disaggregation of NHPIs from Asians. This study examines differences in gastrointestinal-related mortality between NHPI and Asian adults across all major gastrointestinal disease categories.</div></div><div><h3>Methods</h3><div>We analyzed mortality data for adults aged ≥25 years from the National Center for Health Statistics 2018–2023. Established definitions classified NHPI and Asian individuals based on single or multi-race listings. Gastrointestinal-related deaths were identified using validated ICD-10 codes and categorized into liver diseases, colorectal cancer, upper gastrointestinal cancers, and non-cancer digestive diseases. Age-standardized mortality rates (ASMRs) per 100,000 and rate ratios were calculated.</div></div><div><h3>Findings</h3><div>Between 2018 and 2023, there were 3322 gastrointestinal-related deaths among NHPI adults (mean age 63.9 years, standard deviation 14.4; 1373 [41.3%] female decedents) and 47,275 among Asian adults (mean age 70.2 years, standard deviation 14.6; 20,892 [44.2%] female decedents). Overall gastrointestinal-related ASMR for NHPIs was 66.8 (95% CI: 64.5–69.2) per 100,000 adults. NHPIs exhibited higher mortality rates than Asians in all gastrointestinal disease categories. NHPIs had 24% higher overall gastrointestinal-related mortality rate than Asians (RR: 1.24; 95% CI: 1.20–1.29), with 33% higher for liver diseases (RR: 1.33; 95% CI: 1.24–1.44) and 63% higher for non-cancer digestive diseases (RR: 1.63; 95% CI: 1.49–1.77).</div></div><div><h3>Interpretation</h3><div>NHPIs (vs. Asians) have higher gastrointestinal-related mortality rates, with the greatest disparities observed in liver diseases and non-cancer digestive diseases. By disaggregating data across the full spectrum of gastrointestinal diseases, this study provides a clearer understanding of NHPI-specific disparities and highlights critical areas for targeted public health efforts.</div></div><div><h3>Funding</h3><div><span>U.S. National Institute of Diabetes</span> and <span>Digestive and Kidney Diseases</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101372"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978366","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":"Intention to vaccinate children against measles: findings from a national survey in the United States","authors":"Hannah Melchinger ,&nbsp;Krutika Kuppalli ,&nbsp;Jad A. Elharake ,&nbsp;Saad B. Omer ,&nbsp;Amyn A. Malik","doi":"10.1016/j.lana.2026.101393","DOIUrl":"10.1016/j.lana.2026.101393","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The United States is currently experiencing the largest surge of measles cases since 2000, with over 2855 cases reported across the country since January 2025. Though the measles, mumps, and rubella (MMR) vaccine is recognized as the most effective protection against measles, rates of MMR coverage among children under the age of five have declined in several US states. Across the US, attitudes towards measles and intention to vaccinate are not well understood.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a nationally representative survey assessing measles knowledge, attitudes, and intention to vaccinate among US adults (18+). Our primary outcome was assessing whether respondents would be willing to vaccinate a child under the age of five against measles if recommended to do so by a health professional. We also assessed participant knowledge of measles, their perception of measles risk, the degree to which they believed the threat of measles was being exaggerated, and whether participants indicated they would be willing to receive the MMR vaccine as an adult if recommended to do so by a healthcare professional. Respondents were stratified by whether they had children of any age, and analyses were weighted based on age, sex, and race estimations sourced from the American Community Survey 2022. Proportions, means, and 95% confidence intervals (CI) were calculated for intention to vaccinate, trust in sources of information, self-assessed knowledge, risk perception, perceived exaggeration of threat, self-efficacy, and measles and influenza vaccination status, and adjusted according to survey weights.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 1166 respondents completed the survey. Of those who completed the survey, 53% (weighted percentage, unweighted n = 620) were male, 70% (850) were over the age of 36, 16% (182) were Black or African American, 14% (164) were Hispanic, and 85% (1105) had some college education. Half (50%, 95% CI: 47–53) reported an average knowledge of measles and 81% were aware of the MMR vaccine. Overall, 79% (95% CI: 76–81, 914) were willing to vaccinate a child under five against measles, including 82% of parents with children of any age, and 75% of non-parent respondents. Respondents without children were significantly less likely to vaccinate a child against measles (aOR: 0.67, 95% CI: 0.36–0.98), as were those who believed the threat of measles was being exaggerated (aOR: 0.19, 95% CI: 0.12–0.31). Respondents who reported a higher perceived risk of measles were more likely to vaccinate children against measles (aOR: 1.5, 95% CI: 1.1–2.0) Intention to vaccinate also varied geographically.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;These results show that while childhood measles vaccination remains the social norm with close to 80% intention, there is an important minority of US adults who are not willing to vaccinate children against measles even if recommended to do so. Measles requir","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101393"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187904","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":"Regional inequalities in mortality from colorectal cancer and its indirect economic impact in Brazil from 2001 to 2030: a human capital approach study","authors":"Jonas Eduardo Monteiro dos Santos ,&nbsp;Alison Pearce ,&nbsp;Arn Migowski ,&nbsp;Dyego Leandro Bezerra de Souza ,&nbsp;Isabelle Soerjomataram ,&nbsp;Leonardo Borges Lopes de Souza ,&nbsp;Linda Sharp ,&nbsp;Luís Felipe Leite Martins ,&nbsp;Paul Hanly ,&nbsp;Marianna De Camargo Cancela","doi":"10.1016/j.lana.2026.101383","DOIUrl":"10.1016/j.lana.2026.101383","url":null,"abstract":"<div><h3>Background</h3><div>Brazil contributes to 41% of colorectal cancer (CRC) deaths in Latin America. CRC is the second most incident cancer among males and females in Brazil, with wide regional variation. We aimed to estimate the years of potential life lost (YPLL) and the productivity lost due to mortality from CRC by region, between 2001 and 2030.</div></div><div><h3>Methods</h3><div>We estimated the indirect costs of mortality from CRC using the Human Capital Approach. Mortality data (2001–2016) were obtained from the national Mortality Information System. Economic data were obtained from the Continuous National Household Sample Survey. Productivity lost was calculated for those aged over 15. Results for 2016–2030 were estimated based on the observed data (2001–2015).</div></div><div><h3>Findings</h3><div>We estimated 635,253 deaths from CRC between 2001 and 2030, corresponding to 12·6 million YPLL and Int$22·6 billion in productivity losses. From 2001–2005 (observed) to 2026–2030 (estimated), CRC deaths are expected to increase by 181% and 165% among males and females, respectively. The largest relative increases among males will be observed in the North region, with productivity losses increasing 9·7-fold. Among females, North and Northeast regions will experience the highest increases in productivity lost, 8·7 and 10·3-fold respectively.</div></div><div><h3>Interpretation</h3><div>CRC productivity loss will increase substantially by 2030, primarily due to increasing incidence and mortality, as a consequence of the epidemiological transition and health services access, especially in the North and Northeast regions. Implementing primary prevention, screening, early diagnosis and ensuring timely access to treatment is essential to reduce the economic impact of CRC overall and reduce regional inequities.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>MSD Independent Oncology Policy Grant Program</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101383"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187890","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":"Alcohol- and drug-related mortality in Brazil: an ecological and population-based study on changes observed during the COVID-19 pandemic","authors":"Lucas Almeida Andrade ,&nbsp;Maria Amélia dos Santos Lemos Gurgel ,&nbsp;Wandklebson Silva da Paz ,&nbsp;Glauber Rocha Monteiro ,&nbsp;Karina Conceição Gomes de Araújo ,&nbsp;Allan Dantas dos Santos ,&nbsp;Carlos Dornels Freire de Souza ,&nbsp;Álvaro Francisco Lopes de Sousa ,&nbsp;Lariane Angel Cepas ,&nbsp;Ana Paula Morais Fernandes ,&nbsp;Débora dos Santos Tavares ,&nbsp;Tatiana Rodrigues de Moura ,&nbsp;Márcio Bezerra-Santos","doi":"10.1016/j.lana.2025.101371","DOIUrl":"10.1016/j.lana.2025.101371","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has disrupted healthcare services and intensified socio-economic vulnerabilities, potentially escalating harmful substance use. In Brazil, pre-pandemic mortality from alcohol and drug use was stable. However, the pandemic introduced new risks that may have triggered a significant increase in related deaths. This study, therefore, aims to assess the impact of the COVID-19 pandemic on alcohol- and drug-related deaths in Brazil from 2020 to 2022.</div></div><div><h3>Methods</h3><div>This population-based ecological study analyzed alcohol- and drug-related mortality across Brazil from 2015 to 2022 using data from the Brazilian Mortality Information System (SIM). Temporal trends were examined using Joinpoint regression, while interrupted time-series analyses assessed deviations post-pandemic onset. Spatial variations were visualized using choropleth maps.</div></div><div><h3>Findings</h3><div>Alcohol- and drug-related mortality increased by 18.3% in 2020, 22.4% in 2021, and 26.0% in 2022. The Northeast (2020 = 24.9%; 2021 = 24.0%; 2022 = 31.8%), Southeast (2020 = 18.2%; 2021 = 24.3%; 2022 = 21.0%), and South (2020 = 13.1%; 2021 = 23.6%; 2022 = 35.2%) regions recorded the highest increases, with most states showing significant growth in deaths. We also observed an increase in mortality associated with the use of Psychoactive substances (PAS) in both sexes (male: average annual percentage changes (AAPCs) = 3.6%; female: AAPC = 4.6%), individuals aged 20 to 39 (AAPC = 2.0%), and those aged 60 and above (AAPC = 1.8%). Interrupted time-series analyses confirmed a marked and statistically significant increase in mortality post-March 2020.</div></div><div><h3>Interpretation</h3><div>The findings suggest a collateral epidemic of substance-related deaths fueled by the COVID-19 pandemic's disruptions to harm reduction services, treatment access, and socio-economic stability. These results underscore the urgent need to enhance healthcare systems, reinforce harm reduction services, and develop intersectoral policies targeting social inequalities to mitigate future crises.</div></div><div><h3>Funding</h3><div>This research is part of the PEGA@ACAO study and was funded by the São Paulo Research Foundation (FAPESP, grant #2024/15320-5 and #2025/04763-6); the National Council for Scientific and Technological Development (CNPq, grant #405741/2024-3); and the Coordination for the Improvement of Higher Education Personnel (CAPES, finance code #001).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101371"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078146","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":"Reassessing combined exercise–tDCS strategies in chronic pain","authors":"Stéphane Perrey","doi":"10.1016/j.lana.2026.101379","DOIUrl":"10.1016/j.lana.2026.101379","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101379"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078202","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 ENGAGE study: a randomized trial optimizing uptake of germline cancer genetic services in childhood cancer survivors","authors":"Tara O. Henderson ,&nbsp;Brian Egleston ,&nbsp;Sarah Howe ,&nbsp;Mary Ashley Allen ,&nbsp;Rajia Mim ,&nbsp;Linda G. Fleisher ,&nbsp;Elena B. Elkin ,&nbsp;Kevin C. Oeffinger ,&nbsp;Kevin R. Krull ,&nbsp;Demetrios Ofidis ,&nbsp;Briana McLeod ,&nbsp;Hannah Griffin ,&nbsp;Elisabeth M. Wood ,&nbsp;Cara N. Cacioppo ,&nbsp;Sarah Brown ,&nbsp;Melody Perpich ,&nbsp;Gregory T. Armstrong ,&nbsp;Angela R. Bradbury","doi":"10.1016/j.lana.2026.101375","DOIUrl":"10.1016/j.lana.2026.101375","url":null,"abstract":"<div><h3>Background</h3><div>Identifying childhood cancer survivors who are already at high risk of subsequent neoplasms and may also have an inherited genetic susceptibility is essential for effective surveillance and prevention. This trial evaluated the effectiveness of remote, centralized telehealth genetic services in increasing service uptake.</div></div><div><h3>Methods</h3><div>Childhood Cancer Survivor Study (CCSS) participants at the St. Jude Research Hospital, who were ≥18 years old and survivors of a CNS tumor, sarcoma, or more than one primary cancer, were recruited for the study. After completing a baseline survey, participants were randomly assigned to one of the two arms: remote telehealth genetic services (via phone or videoconference) or usual care. Uptake of genetic services was obtained through study records and the six-month Status Survey. This trial was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT04455698</span><svg><path></path></svg></span>), and accrual has closed.</div></div><div><h3>Findings</h3><div>Of the 391 participants recruited, 262 were assigned to remote telehealth services (via phone or videoconference) and 129 to usual care. At six months, 43% (113/262) of participants in remote telehealth services received genetic services compared to 15% (19/129) in the usual care group (OR = 4.4, 95% CI: 2.5–8.0, p &lt; 0.0001). Uptake of genetic counseling (42% vs. 15%, p &lt; 0.0001) and genetic testing (19% vs. 9%, p = 0.020) were higher in remote telehealth services. Factors associated with higher uptake included not having high-deductible health insurance (OR = 1.67, 95% CI: 1.00–2.91, p = 0.049) and lower perceived cost of testing (OR = 1.51, 95% CI: 1.17–1.96, p = 0.0014). Top barriers included experiencing higher levels of depression (OR = 0.91, 95% CI: 0.85–0.98, p = 0.0067) and anxiety (OR = 0.93, 95% CI: 0.87–1.00, p = 0.036).</div></div><div><h3>Interpretation</h3><div>Remote telehealth genetic services improve genetic counseling and testing uptake in childhood cancer. Addressing remaining barriers could maximize their impact and ensure equitable access for childhood cancer survivors and their families.</div></div><div><h3>Funding</h3><div><span>National Cancer Institute</span> (R01-CA237369, U24-CA55727).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101375"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448883","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}