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Actions against the double burden of malnutrition in Peru: a community-informed system dynamics model 应对秘鲁营养不良双重负担的行动:社区知情的系统动力学模型
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-21 DOI: 10.1016/j.lana.2025.101102
Paraskevi Seferidi , Laura Guzman-Abello , Ellis Ballard , Hilary M. Creed-Kanashiro , Luis Huicho , J Jaime Miranda , Christopher Millett , Antonio Bernabe-Ortiz
{"title":"Actions against the double burden of malnutrition in Peru: a community-informed system dynamics model","authors":"Paraskevi Seferidi ,&nbsp;Laura Guzman-Abello ,&nbsp;Ellis Ballard ,&nbsp;Hilary M. Creed-Kanashiro ,&nbsp;Luis Huicho ,&nbsp;J Jaime Miranda ,&nbsp;Christopher Millett ,&nbsp;Antonio Bernabe-Ortiz","doi":"10.1016/j.lana.2025.101102","DOIUrl":"10.1016/j.lana.2025.101102","url":null,"abstract":"<div><h3>Background</h3><div>Peru's progress in reducing stunting has stagnated since 2018, while the country is facing increasing levels of overnutrition, leading to a double burden of malnutrition. However, this shift in nutrition burden is not reflected in Peru's nutrition policy agenda. This study aims to identify leverage points for actions against population-level double burden of malnutrition in Peru.</div></div><div><h3>Methods</h3><div>We developed a system dynamics model that simulates changes in overweight and stunting over time in Peru through changes in food system drivers. The model was conceptually informed by policymakers, practitioners and community members in Peru and used quantitative and qualitative data from secondary sources and published literature.</div></div><div><h3>Findings</h3><div>The model indicated that several overnutrition policies, including policies targeting food availability and affordability, may decelerate but not halt the increase of overweight in the country, mainly due to industry resistance. However, in the long term, the reallocation of resources towards overnutrition policies may inadvertently hinder progress towards stunting targets. Transforming nutrition policy governance, from siloed overnutrition and undernutrition policies towards a common policy framework against the double burden of malnutrition was the only modelled scenario that halted the rise in overnutrition, while keeping Peru on course to reach its stunting goals.</div></div><div><h3>Interpretation</h3><div>Transition away from policy landscapes that focus on single nutrition outcomes towards synergistic actions that target malnutrition in all forms is a long-term solution towards achieving global nutrition goals. Such policy transitions are especially important in low and middle-income countries like Peru, which are affected by the double burden of malnutrition.</div></div><div><h3>Funding</h3><div>This study was supported by a research grant from the <span>Biotechnology and Biological Sciences Research Council</span> (BBSRC) (grant reference: BB/T009004/1).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101102"},"PeriodicalIF":7.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854696","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}
引用次数: 0
Implications of adverse and benevolent childhood experiences on the physical and mental health of Mexican adults: a population-based study 不良和善意的童年经历对墨西哥成年人身心健康的影响:一项基于人群的研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-19 DOI: 10.1016/j.lana.2025.101092
Daniela León Rojas , Fabiola Castorena Torres , Nissa Yaing Torres-Soto , Irene Martín-Estal , Veronica Mundo Rosas , Brenda Martinez Tapia , Julieta Rodríguez-de-Ita
{"title":"Implications of adverse and benevolent childhood experiences on the physical and mental health of Mexican adults: a population-based study","authors":"Daniela León Rojas ,&nbsp;Fabiola Castorena Torres ,&nbsp;Nissa Yaing Torres-Soto ,&nbsp;Irene Martín-Estal ,&nbsp;Veronica Mundo Rosas ,&nbsp;Brenda Martinez Tapia ,&nbsp;Julieta Rodríguez-de-Ita","doi":"10.1016/j.lana.2025.101092","DOIUrl":"10.1016/j.lana.2025.101092","url":null,"abstract":"<div><h3>Background</h3><div>Adverse childhood experiences (ACEs) are linked to negative physical and mental health outcomes. Limited information on their influence exists in Latin America and middle-income countries like Mexico. This study aimed to determine the prevalence and impact of ACEs and benevolent childhood experiences (BCEs) on Mexican population health.</div></div><div><h3>Methods</h3><div>From September to November 2023, this cross-sectional study recruited a nationally representative sample of adults aged 18–65, randomly selected from urban and rural areas. Sociodemographic data, ACEs, BCEs, physical and mental health history, and clinical assessments for depression, anxiety, post-traumatic stress disorder, and eating disorders were collected.</div></div><div><h3>Findings</h3><div>Of 1448 participants recruited, 1115 (77%) were women, 1278 (88·2%) reported at least one ACE, while 328 (22·6%) had four or more. Physical (840; 58·6%) and emotional neglect (518; 35·7%) were the most frequent. Four or more ACEs increased the odds of obesity (OR 1·8, 95% CI 1·2–2·8), hypertension (OR 1·6, 95% CI 1·1–2·2), depression (OR 4·7, 95% CI 3·6–6·1) and anxiety (OR 4·1, 95% CI 3·2–5·3) among others. Common BCEs included having at least one supportive caregiver (1298; 89·6%) and feeling comfortable with oneself (1272; 87·8%). BCEs decreased the odds of physical and mental health diagnoses.</div></div><div><h3>Interpretation</h3><div>ACEs are highly prevalent and significantly impact the health of Mexican population. BCEs protect against these effects. Considering ACEs in public policies can help establish interventions to prevent adversity and promote positive childhood experiences.</div></div><div><h3>Funding</h3><div><span>Fundación FEMSA</span>, Centro de Primera Infancia from <span>Tecnológico de Monterrey and Fundación FEMSA</span> and <span>Tecnologico de Monterrey Challenge-Based Research Funding Program</span> 2022.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101092"},"PeriodicalIF":7.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850867","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}
引用次数: 0
Understanding the broader impacts of non-fatal firearm violence trauma in the United States: a scoping review 了解美国非致命枪支暴力创伤的更广泛影响:范围审查
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-19 DOI: 10.1016/j.lana.2025.101091
Deanna M. Giraldi , Susan Swingler , David S. Kirk , Sara F. Jacoby , G.J. Melendez-Torres , Elinore J. Kaufman , David K. Humphreys
{"title":"Understanding the broader impacts of non-fatal firearm violence trauma in the United States: a scoping review","authors":"Deanna M. Giraldi ,&nbsp;Susan Swingler ,&nbsp;David S. Kirk ,&nbsp;Sara F. Jacoby ,&nbsp;G.J. Melendez-Torres ,&nbsp;Elinore J. Kaufman ,&nbsp;David K. Humphreys","doi":"10.1016/j.lana.2025.101091","DOIUrl":"10.1016/j.lana.2025.101091","url":null,"abstract":"<div><div>Exposure to firearm violence produces ripples of impact that extend far beyond the physical wounds of direct survivors. This scoping review aimed to describe the breadth of the last 25 years of literature on short-term, long-term, and cumulative impacts of firearm violence in the United States across physical, psychological, social, and economic domains. We searched PubMed, Embase, Scopus, PsycINFO, CINAHL, ProQuest Social Science Premium (ASSIA, NCJRS, and ERIC) and Web of Science until March 2024. Among 3172 articles, 87 met inclusion criteria. Our findings suggest that research most often explores short-term and psychological impacts on direct survivor-witnesses. The review highlights notable gaps, particularly regarding long-term and cumulative impacts among both the immediate social networks of survivor-witnesses and their wider communities. Further research is necessary for the effective development of trauma-informed interventions and the provision of economic resources aimed at supporting a growing population of survivors and communities affected by violence.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101091"},"PeriodicalIF":7.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848002","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}
引用次数: 0
Prediction of mammographic breast density based on clinical breast ultrasound images using deep learning: a retrospective analysis 基于临床乳腺超声图像使用深度学习预测乳房x线摄影乳腺密度:回顾性分析
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-18 DOI: 10.1016/j.lana.2025.101096
Arianna Bunnell , Dustin Valdez , Thomas K. Wolfgruber , Brandon Quon , Kailee Hung , Brenda Y. Hernandez , Todd B. Seto , Jeffrey Killeen , Marshall Miyoshi , Peter Sadowski , John A. Shepherd
{"title":"Prediction of mammographic breast density based on clinical breast ultrasound images using deep learning: a retrospective analysis","authors":"Arianna Bunnell ,&nbsp;Dustin Valdez ,&nbsp;Thomas K. Wolfgruber ,&nbsp;Brandon Quon ,&nbsp;Kailee Hung ,&nbsp;Brenda Y. Hernandez ,&nbsp;Todd B. Seto ,&nbsp;Jeffrey Killeen ,&nbsp;Marshall Miyoshi ,&nbsp;Peter Sadowski ,&nbsp;John A. Shepherd","doi":"10.1016/j.lana.2025.101096","DOIUrl":"10.1016/j.lana.2025.101096","url":null,"abstract":"<div><h3>Background</h3><div>Breast density, as derived from mammographic images and defined by the Breast Imaging Reporting &amp; Data System (BI-RADS), is one of the strongest risk factors for breast cancer. Breast ultrasound is an alternative breast cancer screening modality, particularly useful in low-resource, rural contexts. To date, breast ultrasound has not been used to inform risk models that need breast density. The purpose of this study is to explore the use of artificial intelligence (AI) to predict BI-RADS breast density category from clinical breast ultrasound imaging.</div></div><div><h3>Methods</h3><div>We compared deep learning methods for predicting breast density directly from breast ultrasound imaging, as well as machine learning models from breast ultrasound image gray-level histograms alone. The use of AI-derived breast ultrasound breast density as a breast cancer risk factor was compared to clinical BI-RADS breast density. Retrospective (2009–2022) breast ultrasound data were split by individual into 70/20/10% groups for training, validation, and held-out testing for reporting results.</div></div><div><h3>Findings</h3><div>405,120 clinical breast ultrasound images from 14,066 women (mean age 53 years, range 18–99 years) with clinical breast ultrasound exams were retrospectively selected for inclusion from three institutions: 10,393 training (302,574 images), 2593 validation (69,842), and 1074 testing (28,616). The AI model achieves AUROC 0.854 in breast density classification and statistically significantly outperforms all image statistic-based methods. In an existing clinical 5-year breast cancer risk model, breast ultrasound AI and clinical breast density predict 5-year breast cancer risk with 0.606 and 0.599 AUROC (DeLong’s test p-value: 0.67), respectively.</div></div><div><h3>Interpretation</h3><div>BI-RADS breast density can be estimated from breast ultrasound imaging with high accuracy. The AI model provided superior estimates to other machine learning approaches. Furthermore, we demonstrate that age-adjusted, AI-derived breast ultrasound breast density provides similar predictive power to mammographic breast density in our population. Estimated breast density from ultrasound may be useful in performing breast cancer risk assessment in areas where mammography may not be available.</div></div><div><h3>Funding</h3><div><span>National Cancer Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101096"},"PeriodicalIF":7.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848005","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}
引用次数: 0
Prescription opioid use and substance use disorder in US women (2006–2022): a retrospective cohort study 美国女性处方阿片类药物使用和物质使用障碍(2006-2022):一项回顾性队列研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-18 DOI: 10.1016/j.lana.2025.101108
Andrew J. Schoenfeld , Kaitlyn E. Holly , Matthew R. Bryan , Malina O. Hatton , Matthew Wien , Tracey P. Koehlmoos
{"title":"Prescription opioid use and substance use disorder in US women (2006–2022): a retrospective cohort study","authors":"Andrew J. Schoenfeld ,&nbsp;Kaitlyn E. Holly ,&nbsp;Matthew R. Bryan ,&nbsp;Malina O. Hatton ,&nbsp;Matthew Wien ,&nbsp;Tracey P. Koehlmoos","doi":"10.1016/j.lana.2025.101108","DOIUrl":"10.1016/j.lana.2025.101108","url":null,"abstract":"<div><h3>Background</h3><div>Research has shown that multiple deployments may have adverse effects on active-duty servicewomen and women civilian dependents of active-duty servicemembers. There is concern that the associated stress could induce sustained prescription opioid use and substance use disorder (SUD). We sought to evaluate the incidence of sustained opioid use and SUD among servicewomen and women civilian dependents during 2006–2013, a period of increased operational intensity, compared to similar individuals in 2014–2022.</div></div><div><h3>Methods</h3><div>We employed Military Health System claims data to identify servicewomen and dependents who were diagnosed with SUD or demonstrated sustained prescription opioid use (i.e., six months of uninterrupted use). The incidence of sustained opioid use (primary outcome) and SUD associated (secondary outcome) with 2006–2013 was compared to 2014–2022 among servicewomen and dependents. Multivariable log binomial regression was used to adjust for confounding. Ethnicity was not available in our dataset.</div></div><div><h3>Findings</h3><div>4,876,209 individuals were included. The average age (standard deviation [SD]) of the cohorts under study were 26.6 (SD 8.2) for active duty 2006–2013, 26.0 (SD 8.0) for active duty 2014–2022, 35.3 (SD 13.1) for dependents 2006–2013 and 33.6 (SD 12.1) for dependents 2014–2022. Compared to civilian dependents in 2014–2022, servicewomen from 2006 to 2013 demonstrated an increased risk of sustained prescription opioid use (RR 1.49, 95% CI 1.46–1.53). In 2014–2022, servicewomen had a lower risk compared to dependents (RR 0.47, 95% CI 0.45–0.49), while dependents in 2006–2013 were also at higher risk (RR 1.58, 95% CI 1.56–1.60). Servicewomen in 2006–2013 were at significantly greater risk of developing SUD (RR 1.07, 95% CI 1.06–1.08). During 2014–2022, servicewomen displayed a lower risk when compared to dependents (RR 0.80, 95% CI 0.79–0.81). Dependents in 2006–2013 showed a higher risk (RR 1.24, 95% CI 1.24–1.25).</div></div><div><h3>Interpretation</h3><div>We found significant increases in the risks of sustained opioid use and SUD among servicewomen and civilian dependents during a period of increased operational intensity (2006–2013). We believe these findings reflect the deleterious effects of emotional stress, insufficient support structures, and military sexual trauma.</div></div><div><h3>Funding</h3><div><span>U.S. Department of Defense, Defense Health Agency</span> (#HU00012320021).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101108"},"PeriodicalIF":7.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848006","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}
引用次数: 0
Immunologic changes in the peripheral blood transcriptome of individuals with early-stage chronic Chagas cardiomyopathy: a cross-sectional study 早期慢性恰加斯心肌病患者外周血转录组的免疫学变化:一项横断面研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-17 DOI: 10.1016/j.lana.2025.101090
Carolina Duque , Jaime So , Yagahira E. Castro-Sesquen , Kelly DeToy , Sneider A. Gutierrez Guarnizo , Fatemeh Jahanbakhsh , Edith Malaga Machaca , Monica Miranda-Schaeubinger , Indira Chakravarti , Virginia Cooper , Mary E. Schmidt , Luigi Adamo , Rachel Marcus , Kawsar R. Talaat , Robert H. Gilman , Monica R. Mugnier , the Chagas Working Group
{"title":"Immunologic changes in the peripheral blood transcriptome of individuals with early-stage chronic Chagas cardiomyopathy: a cross-sectional study","authors":"Carolina Duque ,&nbsp;Jaime So ,&nbsp;Yagahira E. Castro-Sesquen ,&nbsp;Kelly DeToy ,&nbsp;Sneider A. Gutierrez Guarnizo ,&nbsp;Fatemeh Jahanbakhsh ,&nbsp;Edith Malaga Machaca ,&nbsp;Monica Miranda-Schaeubinger ,&nbsp;Indira Chakravarti ,&nbsp;Virginia Cooper ,&nbsp;Mary E. Schmidt ,&nbsp;Luigi Adamo ,&nbsp;Rachel Marcus ,&nbsp;Kawsar R. Talaat ,&nbsp;Robert H. Gilman ,&nbsp;Monica R. Mugnier ,&nbsp;the Chagas Working Group","doi":"10.1016/j.lana.2025.101090","DOIUrl":"10.1016/j.lana.2025.101090","url":null,"abstract":"<div><h3>Background</h3><div>Chagas disease, caused by the protozoan parasite <em>Trypanosoma cruzi,</em> is a neglected disease that affects approximately 6 million individuals worldwide. Of those infected, 20–30% will go on to develop chronic Chagas cardiomyopathy (CCC), and many ultimately to advanced heart failure. The mechanisms by which this progression occurs are poorly understood. In this exploratory study, we sought to provide insight into the physiologic changes associated with the development of early CCC.</div></div><div><h3>Methods</h3><div>We used RNA sequencing to analyse the gene expression changes in the peripheral blood of six patients with Chagas disease with early structural heart disease, four patients with Chagas disease without any signs or symptoms of disease, thirteen patients without Chagas disease with early structural heart disease, and ten patients without Chagas disease or signs of heart disease. Pathway analyses and immune cell deconvolution were employed to further elucidate the biological processes underlying early CCC development.</div></div><div><h3>Findings</h3><div>Our analysis suggests that early CCC is associated with a downregulation of various peripheral immune response genes, including changes suggestive of reduced antigen presentation and T cell activation. Notably, these genes and processes appear to be distinct from those of non-Chagas cardiomyopathies.</div></div><div><h3>Interpretation</h3><div>This work highlights the potential importance of the immune response in early CCC, providing insight into the early pathogenesis of this disease and how it may differ from other cardiomyopathies. The changes we have identified may serve as biomarkers of early CCC and could inform future longitudinal cohort studies of markers of disease progression and strategies for the treatment of CCC in its early stages.</div></div><div><h3>Funding</h3><div><span>NIH</span>, <span>FONDECYT</span>, <span>IDSA</span>, <span>NSF</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101090"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843821","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}
引用次数: 0
Opioid and stimulant co-prescribing does not equate to a co-epidemic 阿片类药物和兴奋剂的共同处方并不等同于共同流行病
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-17 DOI: 10.1016/j.lana.2025.101093
Kevin Young Xu , Richard A. Grucza , Vitor Soares Tardelli , Patrick D. Quinn , Jeffrey F. Scherrer
{"title":"Opioid and stimulant co-prescribing does not equate to a co-epidemic","authors":"Kevin Young Xu ,&nbsp;Richard A. Grucza ,&nbsp;Vitor Soares Tardelli ,&nbsp;Patrick D. Quinn ,&nbsp;Jeffrey F. Scherrer","doi":"10.1016/j.lana.2025.101093","DOIUrl":"10.1016/j.lana.2025.101093","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101093"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838400","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}
引用次数: 0
Cardiovascular diseases mortality in Brazilian municipalities: estimates from the Global Burden of Disease study, 2000–2018 巴西城市心血管疾病死亡率:2000-2018年全球疾病负担研究估计数
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-17 DOI: 10.1016/j.lana.2025.101106
Luisa Campos Caldeira Brant , Juliana Bottoni Souza , Bruno Ramos Nascimento , Beatriz Polachini Assunes Gonçalves , Ana Luiza Assumpção Ciminelli , Antonio Luiz Pinho Ribeiro , Deborah Carvalho Malta
{"title":"Cardiovascular diseases mortality in Brazilian municipalities: estimates from the Global Burden of Disease study, 2000–2018","authors":"Luisa Campos Caldeira Brant ,&nbsp;Juliana Bottoni Souza ,&nbsp;Bruno Ramos Nascimento ,&nbsp;Beatriz Polachini Assunes Gonçalves ,&nbsp;Ana Luiza Assumpção Ciminelli ,&nbsp;Antonio Luiz Pinho Ribeiro ,&nbsp;Deborah Carvalho Malta","doi":"10.1016/j.lana.2025.101106","DOIUrl":"10.1016/j.lana.2025.101106","url":null,"abstract":"<div><h3>Background</h3><div>Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study.</div></div><div><h3>Methods</h3><div>In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000–2002, 2009–2011, 2016–2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in &lt;30,000, 30,000–300,000, and &gt;300,000 inhabitants per region. The % changes in ASMR from 2000–2002 to 2016–2018 were calculated.</div></div><div><h3>Findings</h3><div>In 2000–2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016–2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from −3% in small Northern municipalities to −43% in large Southern municipalities.</div></div><div><h3>Interpretation</h3><div>The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority.</div></div><div><h3>Funding</h3><div><span>Brazilian Ministry of Health</span> [grant 148/2018] and <span>Pan American Health Organization</span> [Letter of Agreement SCON2021-00288].</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101106"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843069","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}
引用次数: 0
Expanding healthcare capacity in Canada: the potential of internationally trained physicians 扩大加拿大的保健能力:受过国际培训的医生的潜力
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-16 DOI: 10.1016/j.lana.2025.101095
Luis Francisco Leiva Tobelem , Fabio Ynoe de Moraes , Filipe Nadir Caparica Santos
{"title":"Expanding healthcare capacity in Canada: the potential of internationally trained physicians","authors":"Luis Francisco Leiva Tobelem ,&nbsp;Fabio Ynoe de Moraes ,&nbsp;Filipe Nadir Caparica Santos","doi":"10.1016/j.lana.2025.101095","DOIUrl":"10.1016/j.lana.2025.101095","url":null,"abstract":"<div><div>Canada's healthcare system is facing a severe shortage of doctors, leaving millions of Canadians struggling to access essential primary and specialist care. Despite substantial investment in healthcare, Canada still falls behind other OECD countries in having enough physicians to meet patient needs. This crisis, fueled by inadequate workforce planning, an aging population, and increasing physician burnout, has forced more patients to rely on emergency departments for basic care, driving up costs and reducing quality of service. Internationally trained physicians (ITPs) represent a significant yet underutilized resource. However, they encounter numerous barriers, including restrictive licensing practices, insufficient residency spots, and accreditation systems that occasionally value training length more than clinical performance or demonstrated competency. To address these urgent challenges, Canada should expand on competency-based accreditation methods, build on existing Practice Ready Assessment programs, create more residency placements for ITPs, and reduce bureaucratic hurdles. Taking immediate steps toward these reforms will improve healthcare access, patient outcomes, and ensure long-term sustainability of healthcare across Canada.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101095"},"PeriodicalIF":7.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833413","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}
引用次数: 0
Interpreting trends of opioid and stimulant co-prescribing in the United States: the need for attention to evidence-based prescribing practice in the context of co-occurring mental and or substance use disorders 解释美国阿片类药物和兴奋剂联合处方的趋势:在同时发生的精神和/或物质使用障碍的背景下,需要关注循证处方实践
IF 7
Lancet Regional Health-Americas Pub Date : 2025-04-16 DOI: 10.1016/j.lana.2025.101097
Heather Palis , Chloé G. Xavier , Roshni Desai , Sara Davidson , Scott MacDonald
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