Lancet Regional Health-Americas最新文献

{"title":"Mortality trends among Indigenous women of reproductive age in Brazil: a time series analysis","authors":"Guilherme A.T. Ferreira ,&nbsp;Mariângela L. Cherchiglia ,&nbsp;Márcio Valk ,&nbsp;Flávia B. Pilecco","doi":"10.1016/j.lana.2025.101183","DOIUrl":"10.1016/j.lana.2025.101183","url":null,"abstract":"<div><h3>Background</h3><div>Reports on Brazilian Indigenous peoples highlight mortality disparities, yet little is known about death aetiology—particularly among women of reproductive age—or how structural discrimination based on race/skin colour influences mortality rates in this group. This study aimed to assess and compare cause-specific mortality rates between Indigenous and White Brazilian women of reproductive age, identifying health disparities to inform targeted public health interventions.</div></div><div><h3>Methods</h3><div>This ecological study used mortality data from Brazil's Mortality Information System (SIM). Population estimates were based on census projections. We calculated annual age-standardized mortality rates (ASMR) for women of reproductive age (10–49 years) from Indigenous and White groups who died between 2010 and 2019 all over the country. Causes of death were classified by ICD-10. Trends were estimated using Prais-Winsten regression, expressed as annual percentage change.</div></div><div><h3>Findings</h3><div>We analysed 3185 deaths among Indigenous women and 274,393 among White women. ASMR among Indigenous women did not decline for any ICD-10 cause. Unlike White women, Indigenous women exhibited rising ASMR for digestive (+12·36%), circulatory (+8·88%), and respiratory (+4·56%) causes. Both groups experienced rising ASMR due to neoplasms and endocrine, metabolic, and nutritional diseases, with higher increases among Indigenous women. Maternal deaths remained stable in both groups but at different magnitudes. ASMR from external and infectious/parasitic causes remained stable among Indigenous women but declined among White women.</div></div><div><h3>Interpretation</h3><div>Mortality from predominantly chronic circulatory, digestive and respiratory diseases is increasing without a decline in infectious/parasitic, maternal, or external causes. Further investigation into rising chronic disease deaths could reveal inequities driving early mortality. Identifying gaps in Indigenous health policies may guide more effective interventions tailored to Indigenous people needs.</div></div><div><h3>Funding</h3><div>This study was funded by <span>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior</span> (CAPES), <span>Ministério da Educação</span>, and <span>Pró-Reitoria de Pesquisa, Universidade Federal de Minas Gerais</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101183"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605000","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":"H5N1 preparedness must integrate rural and agricultural realities","authors":"Bradley A. Firchow","doi":"10.1016/j.lana.2025.101186","DOIUrl":"10.1016/j.lana.2025.101186","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101186"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604999","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":"Population attributable fractions of modifiable dementia risk factors for cognitive impairment—the ELSA-Brasil cohort study","authors":"Raphael Machado Castilhos ,&nbsp;Vanessa Bielefeldt Leotti ,&nbsp;Natan Feter ,&nbsp;Alessandra C. Goulart ,&nbsp;André Russowsky Brunoni ,&nbsp;Claudia Kimie Suemoto ,&nbsp;Luana Giatti ,&nbsp;Maria Carmen Viana ,&nbsp;Sandhi Maria Barreto ,&nbsp;Sheila Alvim ,&nbsp;Bruce B. Duncan ,&nbsp;Maria Inês Schmidt","doi":"10.1016/j.lana.2025.101184","DOIUrl":"10.1016/j.lana.2025.101184","url":null,"abstract":"<div><h3>Background</h3><div>Population attributable fractions (PAF) of modifiable dementia risk factors are rarely estimated in low- and middle-income countries. We aim to estimate the relative risk (RR) for cognitive impairment and calculate the PAF in the <em>Estudo Longitudinal da Saúde do Adulto</em> (ELSA-Brasil).</div></div><div><h3>Methods</h3><div>We analyzed adults aged 35–74 at the baseline (2008–2010) and wave 3 (2017–2019). We estimated the prevalence of eight modifiable dementia risk factors at baseline: hypertension, physical inactivity, diabetes, depression, obesity, low education, smoking, and excessive alcohol consumption. Cognition was evaluated at baseline and wave 3 using six standardized tests for the Brazilian Portuguese. A global cognitive score from the individual cognitive tests was created using calculated z-scores each test. A global z-score below −1.5 was considered indicative of cognitive impairment. We calculated the RR and PAF for cognitive impairment at wave 3.</div></div><div><h3>Findings</h3><div>We followed 10,058 adults (56.7% women, median age of 50 [IQR: 44–56] years) for 8.1 (0.6) years. The eight-year incidence of cognitive impairment in wave 3 was 5.5% (n = 549). Low education had the largest RR (4.32) followed by hypertension (1.43), diabetes (1.27), and smoking (1.35). Low education had the largest PAF (95% CI), 14.2% (11.2–17.3), followed by hypertension 13% (7–19), diabetes 4.2% (0.7–7.7), and smoking 3.2% (0.45–6). The total PAF for significant risk factors was 34.7% (28.2–41.3).</div></div><div><h3>Interpretation</h3><div>The findings highlight the importance of early-life and midlife prevention strategies in low- and middle-income countries, with a focus on addressing educational and cardiovascular risk factors.</div></div><div><h3>Funding</h3><div>RMC received <span>Alzheimer's Association</span> grant (AARGD-21-846545).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101184"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604831","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":"A qualitative exploration of the downstream impact of a sustained disruption to the methadone supply in Mexico: effects on the mental, financial, and social health of patients with opioid use disorder in Tijuana","authors":"Annick Bórquez ,&nbsp;Jesse Lloyd Goldshear ,&nbsp;Sheryl Muñoz-Mina ,&nbsp;Arturo Tornez ,&nbsp;Alicia Harvey Vera ,&nbsp;María Elena Medina Mora ,&nbsp;Gudelia Rangel ,&nbsp;Steffanie A. Strathdee","doi":"10.1016/j.lana.2025.101176","DOIUrl":"10.1016/j.lana.2025.101176","url":null,"abstract":"<div><h3>Background</h3><div>Medications for opioid use disorder (MOUD) are considered the gold standard long-term treatment for opioid use disorder (OUD) as they have a range of health and psycho-social benefits. Sudden reduction or interruptions in MOUD can have both immediate and long-term consequences for patients. We sought to qualitatively examine the impact of the prolonged closure of Mexico’s main methadone production facility (<em>Psicofarma</em>) in 2023 on MOUD patients in Tijuana, Mexico.</div></div><div><h3>Methods</h3><div>We conducted semi-structured qualitative interviews with 20 MOUD patients in Tijuana, Mexico, from May to August 2023. We transcribed interviews and translated them from Spanish to English for analysis. Our analysis followed a thematic and narrative approach, and code congruency was found by consensus. Analytic and narrative memos provided the foundation for the ultimate findings.</div></div><div><h3>Findings</h3><div>The closure of <em>Psicofarma</em> resulted in a sudden stoppage in MOUD for participants. While some were provided with a benzodiazepine alternative and/or psychotherapy by their clinics, most were completely cut off from medical support. Participants reported returning to the illicit market for solutions to both withdrawal and drug cravings. Increased spending on the illicit market drained participant finances and strained employment and familial relationships.</div></div><div><h3>Interpretation</h3><div>The sudden interruption of MOUD treatment had varied yet predictable effects on our participants. These results demonstrate the need to ensure adequate methadone supply for people with OUD in Mexico and to offer other alternative therapies such as low-threshold buprenorphine.</div></div><div><h3>Funding</h3><div>Support for this study was provided by <span>NIDA</span> (<span><span>R01DA049644-S4</span></span>, <span><span>T32DA023356</span></span> and <span><span>DP2DA049295</span></span>).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101176"},"PeriodicalIF":7.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596290","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":"Gender-responsive HIV prevention and care research with transgender communities: lessons learned from Peru","authors":"Sari L. Reisner ,&nbsp;Alfonso Silva-Santisteban ,&nbsp;Leyla Huerta ,&nbsp;Kelika Konda ,&nbsp;Amaya Perez-Brumer","doi":"10.1016/j.lana.2025.101182","DOIUrl":"10.1016/j.lana.2025.101182","url":null,"abstract":"<div><div>Globally, transgender, nonbinary, and gender diverse (trans) people experience HIV inequities. Calls have been made to engage trans communities in HIV research. Yet few resources exist on how to not only engage with, but center trans communities. We describe our 15+ years of collective experiences partnering on HIV research with trans communities in Peru. Lessons learned include considering context, aspiring for equitable partnerships, continually acknowledging power dynamics, learning from community strengths, practicing reflexivity, building trusting relationships, using a trauma-informed lens, prioritizing knowledge-action, recognizing complex community dynamics, and iteratively implementing gender-responsive praxis. We discuss the need for gender-transformative approaches in HIV epidemiological and interventional research that disrupt existing ideologies and systemic power structures that privilege cisheteropatriarchy (cisgender as the norm) and essentialist understandings of gender (male-female gender binary). The science of community engagement requires more attention in HIV prevention and care research that centers global trans communities' expertise and needs.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101182"},"PeriodicalIF":7.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596291","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":"Salmonella in Chile: an urgent need for timely data and WGS implementation","authors":"Alejandro Piña-Iturbe ,&nbsp;Aiko D. Adell ,&nbsp;Angélica Reyes-Jara ,&nbsp;Magaly Toro ,&nbsp;Andrea I. Moreno-Switt","doi":"10.1016/j.lana.2025.101179","DOIUrl":"10.1016/j.lana.2025.101179","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101179"},"PeriodicalIF":7.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579585","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":"Who gets a seat at the table, and who pays the price: reclaiming hospital boards for health justice","authors":"Bilal Irfan ,&nbsp;Roberto Sirvent","doi":"10.1016/j.lana.2025.101178","DOIUrl":"10.1016/j.lana.2025.101178","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101178"},"PeriodicalIF":7.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579584","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":"Health care utilization following the adoption of U.S. paid sick leave mandates: a cohort study using health insurance claims data","authors":"Kevin Callison ,&nbsp;Michael F. Pesko ,&nbsp;Serena Phillips ,&nbsp;Julie Ann Sosa","doi":"10.1016/j.lana.2025.101174","DOIUrl":"10.1016/j.lana.2025.101174","url":null,"abstract":"<div><h3>Background</h3><div>The U.S. is one of the only developed countries in the world without a federal requirement that employers provide paid sick leave (PSL) to workers. We evaluated the association between state and local PSL mandates and health care utilization among U.S. workers.</div></div><div><h3>Methods</h3><div>We conducted a cohort analysis using administrative health insurance claims for 2.3 million private sector workers aged 40 to 64 from 2011 through 2019. Difference-in-differences models compared health care utilization before and after PSL mandate enactment between workers in areas with and without mandated PSL coverage. Outcomes included visits to primary care physicians (PCP), specialists, preventive care, diagnostic services, emergency department, urgent care visits, and hospitalizations.</div></div><div><h3>Findings</h3><div>PSL mandates were associated with an increased probability of a past year PCP visit (4.79pp; 95% CI, 1.39–8.19), specialist visit (2.71pp, 95% CI, 0.98–4.44), preventive care visit (2.75pp; 95% CI, −0.36 to 5.86), and outpatient diagnostic visits (2.20pp, 95% CI, 1.21–3.19). PSL mandates were also associated with increases in the average annual number of specialist, preventive care, outpatient diagnostic, and urgent care visits. Estimates were generally larger for those working in industries that have historically maintained low rates of PSL coverage in the U.S.</div></div><div><h3>Interpretation</h3><div>PSL mandates were associated with greater use of PCP, specialist, diagnostic, and preventive care services. These findings highlight the role for policies that enhance workplace flexibility, including PSL, to improve access to health care services.</div></div><div><h3>Funding</h3><div>The research was supported by grant R01CA237888 from the <span>National Cancer Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101174"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572273","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":"A time-series analysis of the use of opioid medications in a network of Brazilian hospitals, 2009–2020","authors":"Romulo Mendonça Carvalho ,&nbsp;Francisco Inácio Bastos ,&nbsp;Maria Clara de Magalhães-Barbosa ,&nbsp;Lucas Monteiro Bianchi ,&nbsp;Jaqueline Rodrigues Robaina ,&nbsp;Gustavo Rodrigues-Santos ,&nbsp;Antônio José Ledo Alves da Cunha ,&nbsp;Arnaldo Prata-Barbosa","doi":"10.1016/j.lana.2025.101167","DOIUrl":"10.1016/j.lana.2025.101167","url":null,"abstract":"<div><h3>Background</h3><div>To date, no studies in Brazil have described the profile of hospital opioid use. This study aimed to describe the temporal evolution of opioid consumption in hospitalised patients in a Brazilian hospital network.</div></div><div><h3>Methods</h3><div>This study describes a 12-year time-series (2009–2020) of hospital use of opioids in 28 hospitals of a private network in Brazil. More than four million prescriptions were analyzed using the <em>Joinpoint Regression Program</em>.</div></div><div><h3>Findings</h3><div>Parenteral tramadol was the most consumed opioid, followed by parenteral fentanyl and parenteral morphine. Among enteral opioids, the most commonly used was codeine followed by tramadol. There were several variations in the use patterns for most medications, with periods of significant increases and decreases, but two opioids underwent considerable change: parenteral fentanyl, which doubled in consumption, especially during the COVID-19 pandemic, and enteral tramadol, which had a fourfold reduction over time. Enteral oxycodone, the pivot of the opioid crisis in the USA, was relatively little used in this series. Methadone, both parenteral and enteral, was seldom used at the hospitals under analysis, an indicator of a mild use of other opioids, before and/or during hospitalisation.</div></div><div><h3>Interpretation</h3><div>Knowledge and documentation of the utilisation profile of this class of medication is relevant, given the concern that any increase in consumption at any point in the chain, including during hospitalisations, may trigger events of increased outpatient opioid use and potential misuse.</div></div><div><h3>Funding</h3><div>Carlos Chagas Filho <span>Foundation for Research</span> Support in the State of Rio de Janeiro (FAPERJ, grant E-26/010.002428/2019) and <span>IDOR</span> <span>Department of Pediatrics</span>, Rio de Janeiro, RJ, Brazil.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101167"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570198","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":"Hospitalisation, mortality and years of life lost among chikungunya and dengue cases in Brazil: a nationwide cohort study, 2015–2024","authors":"Thiago Cerqueira-Silva ,&nbsp;Luciana L. Cardim ,&nbsp;Enny Paixão ,&nbsp;Marta Rossi ,&nbsp;Andreia Costa Santos ,&nbsp;André Portela F de Souza ,&nbsp;Gervasio Santos ,&nbsp;Mauricio L. Barreto ,&nbsp;Elizabeth B. Brickley ,&nbsp;Julia M. Pescarini","doi":"10.1016/j.lana.2025.101177","DOIUrl":"10.1016/j.lana.2025.101177","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of infections from arthropod-borne viruses, including chikungunya and dengue, is increasing globally. We used nationwide data collected over a decade in Brazil to examine the factors associated with hospitalisation, in-hospital mortality, and the years of life lost from these diseases in Brazil.</div></div><div><h3>Methods</h3><div>Using nationwide de-identified chikungunya and dengue disease records registered from 1st January 2015 to 31 December 2024, we estimated the risk factors for hospitalisation and in-hospital mortality via logistic regression and the Fine and Gray model, respectively. We also calculated the years of life lost for each disease and the average of years of life lost (aYLL), stratified by geographic region, sex and race/ethnicity.</div></div><div><h3>Findings</h3><div>We studied 1,125,209 chikungunya cases: 21,336 (1.9%) required hospitalisations. Among hospitalised cases, 1044 (4.9%) deaths occurred within 84 days of symptom onset, of which 728 (69.7%) were attributed to chikungunya. We studied 13,741,408 dengue cases: 455,899 (3.3%) required hospitalisation, with 12,969 (2.8%) deaths among the hospitalised cases, with 9989 (77.0%) attributed to dengue. Age (&lt;1 or ≥70 years), sex (male), and the presence of diabetes and kidney disease were risk factors for hospitalisation and in-hospital mortality in both diseases. The aYLL for chikungunya was 16.0 years, and for dengue, 14.5 years; however, the burden was not evenly distributed across the population. For chikungunya, Black participants experienced the highest aYLL of 22.0 years, while White participants were the least affected (aYLL: 13.0). For dengue, the most affected group was Indigenous (aYLL: 22.5) and the least White (aYLL: 12.6).</div></div><div><h3>Interpretation</h3><div>Infants, older people (≥70 years), male sex and the presence of comorbidities are associated with increased severity in cases of chikungunya and dengue. These diseases disproportionately affect historically minoritised populations, with participants who self-identified as Black and Indigenous experiencing significantly greater years of life lost compared to the white population. Mitigating the impacts of chikungunya and dengue necessitates addressing health and social inequities.</div></div><div><h3>Funding</h3><div><span>Royal Society</span>, <span>Wellcome Trust</span>, <span>CNPq</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101177"},"PeriodicalIF":7.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572272","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}