Lancet Regional Health-Americas最新文献

{"title":"Geographic accessibility to hospital childbirths in Brazil (2010–2011 and 2018–2019): a cross-sectional study","authors":"Priscila Costa Albuquerque ,&nbsp;Lucas Lopes Felipe ,&nbsp;Juliana Freitas Lopes ,&nbsp;Wagner de Souza Tassinari ,&nbsp;Fabio Zicker ,&nbsp;Bruna de Paula Fonseca","doi":"10.1016/j.lana.2024.100976","DOIUrl":"10.1016/j.lana.2024.100976","url":null,"abstract":"<div><h3>Background</h3><div>Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time.</div></div><div><h3>Methods</h3><div>Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010–2011 and 2018–2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated.</div></div><div><h3>Findings</h3><div>A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n = 1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n = 843,501) in 2010–2011 to 27.3% (n = 915,805) in 2018–2019. Distance and travel time rose by 31.1% (54.0 km–70.8 km) and 33.6% (63.1–84.3 min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n = 817,499), and the North had the lowest (16.0%; n = 138,295). Women in the North faced the longest travel distances (97.5–133.4 km) and times (1,012–1,850 min), while those in the Southeast and South experienced the shortest distances (37.2–55.9 km and 41.2–54.8 km, respectively) and times (38–52 min and 41–52 min).</div></div><div><h3>Interpretation</h3><div>The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe.</div></div><div><h3>Funding</h3><div>Fundação Oswaldo Cruz; CNPq; FAPERJ.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100976"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malaria spillover in Indigenous Guyanese communities following a crackdown on illegal gold mining in Brazil","authors":"Pablo M. De Salazar ,&nbsp;Andrea Parra-Salazar ,&nbsp;Reza Niles-Robin ,&nbsp;Olivia Valz ,&nbsp;Kashana James ,&nbsp;Caroline O. Buckee ,&nbsp;Horace Cox","doi":"10.1016/j.lana.2024.100969","DOIUrl":"10.1016/j.lana.2024.100969","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100969"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas","authors":"J.D. Schwalm ,&nbsp;Philip Joseph ,&nbsp;Darryl Leong ,&nbsp;Jose Patricio Lopez-Lopez ,&nbsp;Oyere Onuma ,&nbsp;Palki Bhatt ,&nbsp;Alvaro Avezum ,&nbsp;Marjan Walli-Attaei ,&nbsp;Martin McKee ,&nbsp;Yusuf Salim","doi":"10.1016/j.lana.2024.100964","DOIUrl":"10.1016/j.lana.2024.100964","url":null,"abstract":"<div><div>While, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100964"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease: addressing poverty is key","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101029","DOIUrl":"10.1016/j.lana.2025.101029","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 101029"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political determinants of cancer health","authors":"Edward Christopher Dee ,&nbsp;Maria Jocelyn Kara Magsanoc-Alikpala ,&nbsp;Fabio Ynoe Moraes ,&nbsp;Jonas Willmann ,&nbsp;Frederic Ivan L. Ting ,&nbsp;Erin Jay G. Feliciano","doi":"10.1016/j.lana.2025.101008","DOIUrl":"10.1016/j.lana.2025.101008","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101008"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-COV-2 re-infection and incidence of post-acute sequelae of COVID-19 (PASC) among essential workers in New York: a retrospective cohort study","authors":"Tesleem K. Babalola ,&nbsp;Sean A.P. Clouston ,&nbsp;Zennur Sekendiz ,&nbsp;Devi Chowdhury ,&nbsp;Nicola Soriolo ,&nbsp;Joseph Kawuki ,&nbsp;Jaymie Meliker ,&nbsp;Melissa Carr ,&nbsp;Bruno R. Valenti ,&nbsp;Ashley Fontana ,&nbsp;Onix A. Melendez ,&nbsp;Olga Morozova ,&nbsp;Benjamin J. Luft","doi":"10.1016/j.lana.2024.100984","DOIUrl":"10.1016/j.lana.2024.100984","url":null,"abstract":"<div><h3>Background</h3><div>After surviving Coronavirus Disease 2019 (COVID-19), some people develop symptoms known as post-acute sequelae of COVID-19 (PASC). PASC is an emerging phenomenon yet to be fully understood, and identifying risk factors has been challenging. This study investigated the association between the number of COVID-19 episodes and the incidence of PASC among essential workers.</div></div><div><h3>Methods</h3><div>We analyzed data from 2511 essential workers, mainly first responders, with confirmed polymerase chain reaction, antibody, or antigen-positive test results for SARS-CoV-2 infection from March 2020 to February 2024. Data were collected through in-person questionnaires and surveys sent via text and email, internal medical records, follow-up calls, and external medical records. Participants who reported continuation or the development of new symptoms three months after the initial SARS-CoV-2 infection, with symptoms lasting for at least two months, were categorized as having PASC, while those without any COVID-19 or whose symptoms resolved were classified as non-PASC. PASC was common in this cohort so we used a Poisson regression model to compute multivariable-adjusted Relative Risk (RR) for the association between risk of PASC and SARS-CoV-2 re-infection, severity, and vaccination status at first infection.</div></div><div><h3>Findings</h3><div>A total of 475 (prevalence = 18.9%, [95% confidence interval] = [17.4–20.5]) PASC patients were identified. The mean (standard deviation (SD)) age of participants who experienced PASC (54.8 (7.2) years) was similar to those who did not (54.2 (7.4) years). There were 403 (16.1% [14.6–17.5]) participants who experienced multiple instances of COVID-19. After adjusting for relevant demographic, lifestyle, and clinical variables, we found a significant association between the risk of experiencing PASC and multiple SARS-COV-2 infections (RR = 1.41 [1.14–1.74]), severe COVID-19 (RR = 3.17 [2.41–4.16]), and being unvaccinated at first infection (RR = 3.29 [2.46–4.41]).</div></div><div><h3>Interpretation</h3><div>Although the pathogenetic mechanism for PASC remains unclear, identifying risk factors such as lack of vaccination or re-infection can assist in better understanding and managing the condition.</div></div><div><h3>Funding</h3><div><span>National Institute on Aging</span> (NIH/NIA R01 AG049953) and <span>Centers for Disease Control and Prevention</span> (CDC/NIOSH U01 OH011864) and (CDC/NIOSH U01 OH012275).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100984"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in stage at diagnosis of head and neck tumours in Brazil: a comprehensive analysis of hospital-based cancer registries","authors":"Flávia Nascimento de Carvalho ,&nbsp;Marianna de Camargo Cancela ,&nbsp;Luciano Mesentier da Costa ,&nbsp;Luís Felipe Leite Martins ,&nbsp;Fernando Luiz Dias ,&nbsp;Dyego Leandro Bezerra de Souza ,&nbsp;Luis Felipe Ribeiro Pinto","doi":"10.1016/j.lana.2024.100986","DOIUrl":"10.1016/j.lana.2024.100986","url":null,"abstract":"<div><h3>Background</h3><div>The advanced stage of cancer is a determining factor in poor prognosis. Head and neck squamous cell carcinomas (HNSCC) are highly incident in Brazil, but similarly to many Low and Middle-Income Countries, data is limited regarding the proportion of tumours diagnosed at advanced clinical stages and the main factors associated with it. Therefore, this study aimed to identify the factors associated with advanced stage of HNSCC in Brazil.</div></div><div><h3>Methods</h3><div>Cross-sectional study based on secondary data collected from Hospital-based Cancer Registries (HBCR) between 2000 and 2017. Descriptive data analysis and Poisson regression with robust variance were performed to determine prevalence ratios (PRs).</div></div><div><h3>Findings</h3><div>Among 145,365 HNSCC cases, 78.2% (90,267/115,371) were diagnosed at stages III or IV. The highest percentage of advanced-stage tumours were hypopharyngeal [91.3% (10,186/11,159)], followed by oropharyngeal [86.6% (28,578/32,991)], oral cavity [75.1% (27,121/36,120)], and laryngeal cancer [69.5% (24,382/35,101)]. We observed annual increase trends of 0.29% and 0.38% for oral cavity and oropharyngeal late-stage tumours, respectively. Patients younger than 50 years old, with a low education level, presenting a primary tumour located in the hypopharynx or oropharynx, and alcohol and tobacco consumers were positively associated with advanced stage. Furthermore, we observed a dose–response effect of a statistically significant reduction in the prevalence of cases diagnosed in advanced stages as the patients' age group or education level increased.</div></div><div><h3>Interpretation</h3><div>Diagnosis of HNSCC at advanced clinical stages in Brazil was associated with age, primary tumour site, and socioeconomic factors that must be mitigated, allowing more universal and equitable access and diagnosis at earlier stages.</div></div><div><h3>Funding</h3><div>No funding.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100986"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of physical activity fragmentation with all-cause mortality in Hispanics: a prospective cohort study","authors":"Mauro F.F. Mediano ,&nbsp;Yejin Mok ,&nbsp;Shoshana H. Ballew ,&nbsp;Franklyn Gonzalez II ,&nbsp;Daniela Sotres-Alvarez ,&nbsp;Yasmin Mossavar-Rahmani ,&nbsp;Robert Kaplan ,&nbsp;Jordan A. Carlson ,&nbsp;Sarah K. Alver ,&nbsp;Martha Daviglus ,&nbsp;Olga Garcia-Bedoya ,&nbsp;Kelly R. Evenson ,&nbsp;Jennifer A. Schrack ,&nbsp;Kunihiro Matsushita","doi":"10.1016/j.lana.2025.100996","DOIUrl":"10.1016/j.lana.2025.100996","url":null,"abstract":"<div><h3>Background</h3><div>Physical activity fragmentation represents the frequency of transitioning from an active to sedentary state. The prognostic information of physical activity fragmentation is unclear in Hispanics/Latinos. This study examined the association of PA fragmentation with all-cause mortality in Hispanic/Latino adults.</div></div><div><h3>Methods</h3><div>We investigated 11,992 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (18–74 yr; 52.2% women), from four United States urban communities (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California), that wore an accelerometer for one week. Physical activity fragmentation was calculated using the active-to-sedentary transition probability (ASTP) as the reciprocal of the average active bout duration. Daily total log-transformed activity count (TLAC) was used as a measure of total physical activity. The residual of ASTP regressed on TLAC (TLAC-adjusted ASTP) was explored to investigate the association of ASTP independent of total physical activity. Deaths were identified from annual follow-up interviews, obituary searches, or matches to the National Death Index through December 31, 2021. Cox regression models were fitted according to physical activity fragmentation.</div></div><div><h3>Findings</h3><div>There were 745 deaths (6.2%) over a mean follow-up of 11.2 (SD 2.2) years. The highest compared to the lowest tertile of ASTP showed a HR of 1.45 (95% CI 1.10–1.92) of all-cause mortality after accounting for confounders. The mortality risk also increased for each 0.10-unit increase of ASTP, as a continuous variable, by 22% (HR 1.22; 95% CI 1.07–1.39). The results were similar considering TLAC-adjusted ASTP.</div></div><div><h3>Interpretation</h3><div>Among Hispanic/Latino adults, more fragmented physical activity was associated with elevated all-cause mortality, independent of total physical activity volume.</div></div><div><h3>Funding</h3><div>HCHS/SOL was supported by the <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100996"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dapagliflozin for the treatment of heart failure with reduced ejection fraction in Brazil: a cost-effectiveness analysis","authors":"Marcio Coutinho Xavier Naves ,&nbsp;Angelica Amorim Amato ,&nbsp;Ivan Ricardo Zimmermann ,&nbsp;Henry Maia Peixoto","doi":"10.1016/j.lana.2024.100968","DOIUrl":"10.1016/j.lana.2024.100968","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure, a complex clinical syndrome with high morbidity and mortality, has become a significant burden on public health. Recently, a new class of antidiabetic agents–the sodium-glucose cotransporter 2 (SGLT2) inhibitors–was associated with a significant reduction on mortality and hospitalization in HF with reduced ejection fraction (HFrEF) when added to standard pharmacological treatment. Considering the lack of data on its cost-effectiveness, the present study aims to estimate the incremental cost-effectiveness ratio of add-on dapagliflozin treatment for HFrEF from the Brazilian public healthcare system perspective.</div></div><div><h3>Methods</h3><div>We built a Markov model to estimate the clinical outcomes and costs of 1,000 hypothetical subjects with established HFrEF in a lifetime horizon. The model inputs were based on the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial and local data. The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses, as well as scenario analyses, were performed.</div></div><div><h3>Findings</h3><div>The addition of dapagliflozin to standard care treatment in 1,000 HFrEF patients yielded an expected value of 366.99 additional QALYs at an incremental cost of US$ 1,517,878.49, resulting in an ICER of US$ 4,136.08 per QALY gained, being a cost-effective strategy considering the Brazilian official cost-effectiveness threshold (US$ 8,000/QALY). In probabilistic sensitivity analyses, 96.60% of the simulations were also cost-effective. In the scenario analyses, results were similar for individuals with and without diabetes.</div></div><div><h3>Interpretation</h3><div>Dapagliflozin is likely to be cost-effective when added to standard HFrEF therapy in Brazil.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Institute of Science and Technology</span> for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde—IATS).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100968"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing venous thromboembolism prevention in community oncology: a call for continued action","authors":"Xinyue Yang,&nbsp;Zhiqiang Zhang","doi":"10.1016/j.lana.2024.100978","DOIUrl":"10.1016/j.lana.2024.100978","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100978"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}