Lancet Regional Health-Americas最新文献

{"title":"Accelerating the elimination of cervical cancer: cross-sectional examination of cancer prevention and control in Latin America and the Caribbean","authors":"Sara Benitez Majano ,&nbsp;Nathalia Katz ,&nbsp;Soledad Urrutia ,&nbsp;Roberta Caixeta ,&nbsp;Carlos Torres ,&nbsp;Carolina Chavez Cortes ,&nbsp;Maribel Almonte ,&nbsp;Melissa Lopez Varon ,&nbsp;Reina Guerrero ,&nbsp;Kathleen Schmeler ,&nbsp;Erin Kobetz ,&nbsp;Corinne Ferrari ,&nbsp;Carlos Espinal ,&nbsp;Francisco Becerra-Posada ,&nbsp;Karla Alfaro ,&nbsp;Daniel Salas ,&nbsp;Anselm Hennis ,&nbsp;Silvana Luciani ,&nbsp;Mauricio Maza","doi":"10.1016/j.lana.2026.101398","DOIUrl":"10.1016/j.lana.2026.101398","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer is a public health problem in Latin America and the Caribbean (LAC). The Cervical Cancer Elimination strategy sets three targets (90% HPV vaccination, 70% screening, 90% treatment) for countries to be in the path towards elimination. This study provides an overview of the current status of cervical cancer control in LAC, highlighting opportunities and challenges for cervical cancer elimination.</div></div><div><h3>Methods</h3><div>We conducted a descriptive analysis of the cervical cancer control status in LAC, using an online questionnaire completed by delegates from health authorities of 35 countries/territories.</div></div><div><h3>Findings</h3><div>We found marked advances in the development of national plans and cervical cancer elimination strategies, particularly in Latin America. Caribbean countries and territories face barriers in program organization and human resource provision. While HPV vaccination is systematically monitored, surveillance systems for screening and treatment are limited, reducing the ability to track program performance and progress. Transition to HPV testing is ongoing, but ensuring adequate funding and management of screen-positive females remain challenging. Gaps in histopathology and treatment —especially radiotherapy— are most pronounced in the Caribbean.</div></div><div><h3>Interpretation</h3><div>Regional collaboration, resource mobilization, and investment in information systems and workforce capacity are essential to achieve equitable access to cervical cancer prevention and care. This analysis provides a baseline to guide future studies to support LAC countries in achieving the 90-70-90 targets.</div></div><div><h3>Funding</h3><div>Work funded by the <span>Spanish Agency for International Development Cooperation</span> (AECID) and <span>Gavi</span>, the Vaccine Alliance.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101398"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448884","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 critical role of affective content in the analgesic effect of virtual reality: a cross-sectional within-subject study","authors":"Nandini Raghuraman ,&nbsp;Roni Shafir ,&nbsp;GianCarlo Colloca ,&nbsp;Craig Kier ,&nbsp;Barbara Brawn ,&nbsp;Amitabh Varshney ,&nbsp;Sarah Murthi ,&nbsp;Yang Wang ,&nbsp;Luana Colloca","doi":"10.1016/j.lana.2026.101385","DOIUrl":"10.1016/j.lana.2026.101385","url":null,"abstract":"<div><h3>Background</h3><div>The dual challenges of the opioid crisis and the global burden of chronic pain underscore the need for safe, non-pharmacological alternatives. Virtual reality (VR) is a promising digital therapeutic for pain, yet its mechanisms remain unclear. This study aimed to disentangle the roles of immersion and emotional engagement in VR-induced analgesia in individuals with temporomandibular disorders (TMD).</div></div><div><h3>Methods</h3><div>In a counterbalanced within-subject design, 62 adults with TMD (21 males, 41 females; mean age 34.7 years [19–55]; 57 (91.9%) non-Hispanic or Latino, 30 (48.4%) White) were exposed to seven conditions: three immersive VR environments (ocean, opera, pink noise), matched non-immersive (2D) versions, and a 2-back working memory task. Heat pain tolerance was assessed using thermal stimulation. Participants rated pain intensity, pain unpleasantness, mood, anxiety, and enjoyment. Skin conductance response (SCR) indexed autonomic arousal. Multilevel mediation models tested the underlying psychological mechanisms.</div></div><div><h3>Findings</h3><div>VR Ocean significantly increased heat pain tolerance (Cohen's d = 1.60), reduced pain intensity and unpleasantness, improved mood, and reduced situational anxiety relative to all other conditions (all p &lt; 0.05). It was also rated as the most enjoyable experience (p &lt; 0.01). Mediation analyses indicated mood (ab = −5.15) and enjoyment (ab = −6.12) significantly mediated VR Ocean's effect on pain intensity, whereas anxiety did not. No mediators explained changes in pain tolerance. SCR did not differ between VR and 2D conditions.</div></div><div><h3>Interpretation</h3><div>VR-based analgesia relies not only on immersion but also on affectively rewarding contents. Digital therapeutics that enhance positive mood and enjoyment may be especially effective for chronic pain management.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Institutes of Health</span> and the University of Maryland.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101385"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291328","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 prevalence of cannabis use pre-versus post-cannabis legalization in Canada by mental health status: findings from national repeat cross-sectional surveys","authors":"Samantha Rundle ,&nbsp;Maryam Iraniparast ,&nbsp;David Hammond","doi":"10.1016/j.lana.2026.101373","DOIUrl":"10.1016/j.lana.2026.101373","url":null,"abstract":"<div><h3>Background</h3><div>The bidirectional relationship between cannabis use and mental health is complex. With the liberalization of cannabis laws in many countries, it is increasingly important to understand the impacts of cannabis legalization on individuals with mental health conditions. This study aimed to examine changes in cannabis use by mental health status pre-versus 5-years post-legalization of recreational cannabis in Canada.</div></div><div><h3>Methods</h3><div>Data were from the International Cannabis Policy Study's national repeat cross-sectional surveys, conducted annually in Canada between 2018 and 2023, one year before and five years after the legalization of cannabis. The current analysis includes 92,843 Canadians aged 16–65 years. Adjusted logistic regression models examined changes in daily and past 12-month cannabis use pre-versus post-legalization among individuals experiencing each of the five mental health problems in the last year: anxiety, bipolar, depression, post-traumatic stress disorder (PTSD), and schizophrenia.</div></div><div><h3>Findings</h3><div>Past 12-month cannabis consumption increased from pre-legalization versus the year immediately following legalization (2019) among those with anxiety (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.15, 1.53, <em>p</em> &lt; 0.0001), depression (AOR = 1.47, 95% CI = 1.26, 1.73, <em>p</em> &lt; 0.0001), and those reporting ‘no experience’ of a mental health problem in the past year (AOR = 1.52, 95% CI = 1.37, 1.68, <em>p</em> &lt; 0.0001). Past 12-month cannabis use remained significantly higher in 2023 versus pre-legalization for anxiety and depression. Daily cannabis use increased from 2018 to 2019 only among those not reporting any experience of a mental health problem in the past year (AOR = 1.34, 95% CI = 1.10, 1.62, <em>p</em> &lt; 0.0001). No other pre-post legalization differences were observed among individuals who experienced bipolar, PTSD, or schizophrenia.</div></div><div><h3>Interpretation</h3><div>Few changes in cannabis use were observed pre-versus post-cannabis legalization among Canadians who reported experiencing a mental health problem, whereas daily and past 12-month use increased among Canadians not reporting a mental health problem.</div></div><div><h3>Funding</h3><div>Funding for the ICPS study was provided by a <span>Canadian Institutes of Health Research Project Grant and Project Bridge Grant</span> (PJT-153342).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101373"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037678","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":"‘Strategic approaches to reducing the substance use-related burden of disease in Canada’ — authors' reply","authors":"Benedikt Fischer ,&nbsp;Wayne Hall ,&nbsp;Bernard Le Foll ,&nbsp;Patricia Conrod","doi":"10.1016/j.lana.2026.101376","DOIUrl":"10.1016/j.lana.2026.101376","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101376"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078147","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":"Twenty years of efforts to reduce stunting in Ecuador: how to accelerate progress and confront the challenges?","authors":"Jairo Rivera ,&nbsp;Estefani Jarrín ,&nbsp;Ximena Garzon-Villalba ,&nbsp;José Ruales","doi":"10.1016/j.lana.2026.101386","DOIUrl":"10.1016/j.lana.2026.101386","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101386"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188632","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":"Physical restraint use in a United States intensive care unit—a retrospective cross sectional, single center cohort study from 2008 to 2022","authors":"Maximin Lange ,&nbsp;Leo A. Celi ,&nbsp;Ben Carter ,&nbsp;Jesse D. Raffa ,&nbsp;Sharon C. O'Donoghue ,&nbsp;Marzyeh Ghassemi ,&nbsp;Tom J. Pollard","doi":"10.1016/j.lana.2026.101374","DOIUrl":"10.1016/j.lana.2026.101374","url":null,"abstract":"<div><h3>Background</h3><div>Physical restraints are widely used in intensive care units (ICUs) despite uncertain clinical benefit and risks. We aimed to characterise patterns of restraint use, demographic and clinical predictors, and temporal trends before and after introduction of federal restraint-related reporting requirements.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of 51,838 adults admitted to ICUs at Beth Israel Deaconess Medical Center, Boston, MA, USA, between 2008 and 2022, using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record repository. Primary outcome was the proportion of ICU days with documented physical restraint use. Associations between restraint use and demographic and clinical factors were estimated using a binomial generalised linear model with a logit link. Propensity score matching compared Black and White patients under varying adjustment specifications.</div></div><div><h3>Findings</h3><div>Among 51,838 patients (mean age 63.8 years; 57% male), 21,091 (40.7%) experienced restraint. Use increased from 36.9% in 2008–10 to 44.0% in 2020–22 (p &lt; 0.0001). Asian (aOR 0.84, 95% CI 0.79–0.89) and Hispanic/Latino patients (aOR 0.87, 95% CI 0.83–0.92) had lower odds of restraint than White patients. Propensity score matching between Black and White patients revealed ethnic patterns were highly sensitive to model specification: excluding demographic characteristics revealed significant disparities, which were attenuated when psychiatric diagnoses were also excluded. Matched White patients were not representative of all White ICU patients but rather a subset resembling Black patients on observed characteristics.</div></div><div><h3>Interpretation</h3><div>Restraint practices appear to vary with patient acuity, institutional factors, and communication barriers. The sensitivity of ethnic disparities to psychiatric diagnosis adjustment suggests these diagnoses may function as mediators rather than confounders, potentially reflecting systematic differences in clinical assessment along the causal pathway between ethnicity and restraint decisions. The non-representativeness of matched cohorts underscores that disparities depend on which patient subgroups are compared. Prospective multisite studies with standardized assessment protocols are needed to validate findings, disentangle true clinical variation from systematic bias and provide a more comprehensive understanding of restraint practices across US ICU settings.</div></div><div><h3>Funding</h3><div>No study-specific funding was received.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101374"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978367","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":"Impact and scope of Mexican clinical practice guideline for adult overweight and obesity on weight stigma","authors":"Emma Chávez-Manzanera ,&nbsp;Verónica Vázquez-Velázquez","doi":"10.1016/j.lana.2025.101366","DOIUrl":"10.1016/j.lana.2025.101366","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101366"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927694","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":"Exercise dose, measurement reliability, and mechanistic inference in fibromyalgia trials: a critical appraisal","authors":"André Pontes-Silva","doi":"10.1016/j.lana.2026.101384","DOIUrl":"10.1016/j.lana.2026.101384","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101384"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188631","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":"An undeniable public health urgency, but an incomplete response: centering racial and ethnic equity in Canada's “Strategic approaches to reducing the substance use-related burden of disease”","authors":"Jude Mary Cénat ,&nbsp;Idrissa Beogo ,&nbsp;Monnica Williams ,&nbsp;Smita Pakhale","doi":"10.1016/j.lana.2025.101370","DOIUrl":"10.1016/j.lana.2025.101370","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101370"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927696","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":"Expanding the neurological spectrum of HTLV-1 beyond HAM/TSP: a contemporary perspective","authors":"Abelardo Q.C. Araujo ,&nbsp;Marcus Tulius T. Silva","doi":"10.1016/j.lana.2025.101347","DOIUrl":"10.1016/j.lana.2025.101347","url":null,"abstract":"<div><div>Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress. This Personal View highlights the expanding neurological spectrum of HTLV-1, which includes rare but well-documented encephalopathy, cognitive decline, peripheral neuropathy, inflammatory myopathy, cerebellar dysfunction, autonomic disorders, motor neuron disease-like syndromes, and seizures. These can happen independently or alongside HAM/TSP. The proposed concept of an “HTLV-1 neurological complex” better represents this multifaceted involvement. Recognising this diversity is essential for accurate diagnosis and better outcomes, particularly in endemic settings. A paradigm shift is needed—one that broadens the clinical focus beyond myelopathy to encompass the full neurological spectrum, thereby improving global care and management.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101347"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885799","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}