Lancet Regional Health-Americas最新文献

{"title":"Could rituximab revolutionize multiple sclerosis treatment in Brazil? The missed opportunity for fewer relapses and lower costs","authors":"Guilherme Diogo Silva,&nbsp;Leonardo Zumerkorn Pipek,&nbsp;Mateus Boaventura de Oliveira,&nbsp;Samira Luisa Apóstolos-Pereira,&nbsp;Tarso Adoni,&nbsp;Angelina Maria Martins Lino,&nbsp;Dagoberto Callegaro,&nbsp;Luiz Henrique Martins Castro","doi":"10.1016/j.lana.2025.101171","DOIUrl":"10.1016/j.lana.2025.101171","url":null,"abstract":"<div><div>Multiple sclerosis (MS) is a leading cause of neurological disability in young adults, affecting an estimated 2.8 million people worldwide. Early treatment with high-efficacy therapies is associated with better long-term outcomes, yet access to these therapies remains limited in many countries, including Brazil. Rituximab, a B-cell depleting agent, has emerged as a highly effective, safe, and cost-saving treatment for MS. A randomized trial and observational studies demonstrate that rituximab is superior in reducing relapse rates compared to commonly used first-line therapies. Rituximab also has a well-established safety profile and is associated with lower overall treatment costs. Although rituximab remains off-label for MS, it is supported by expert societies, endorsed by patient organizations, and has been added to the World Health Organization’s list of essential medicines. We strongly recommend rituximab as an early treatment option for MS in Brazil, where its adoption could improve outcomes, reduce health inequities and lower healthcare system costs.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101171"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518647","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":"No safe line: the human cost of dismantling LGBTQ+ youth support services","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101191","DOIUrl":"10.1016/j.lana.2025.101191","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101191"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595943","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":"Reflections on the American Psychiatric Association 2025 Annual Meeting","authors":"Orison O. Woolcott","doi":"10.1016/j.lana.2025.101164","DOIUrl":"10.1016/j.lana.2025.101164","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101164"},"PeriodicalIF":7.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510636","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":"Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005–2022: a repeated cross-sectional study","authors":"Deborah S. Hasin ,&nbsp;Carol Malte ,&nbsp;Melanie M. Wall ,&nbsp;Daniel Alschuler ,&nbsp;Tracy L. Simpson ,&nbsp;Mark Olfson ,&nbsp;Ofir Livne ,&nbsp;Zachary L. Mannes ,&nbsp;David S. Fink ,&nbsp;Katherine M. Keyes ,&nbsp;Magdalena Cerdá ,&nbsp;Charles C. Maynard ,&nbsp;Salomeh Keyhani ,&nbsp;Silvia S. Martins ,&nbsp;Scott Sherman ,&nbsp;Andrew J. Saxon","doi":"10.1016/j.lana.2025.101155","DOIUrl":"10.1016/j.lana.2025.101155","url":null,"abstract":"<div><h3>Background</h3><div>We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did not have common psychiatric disorders.</div></div><div><h3>Methods</h3><div>Electronic medical record data (2005–2022) were analyzed on patients aged 18–75 with ≥1 VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given year (sample sizes ranging from 3,234,382 in 2005 to 4,436,883 in 2022). Patients were predominantly male (&gt;80%) and non-Hispanic White (&gt;60%). Utilizing all 18 years of data, CUD prevalence increases attributable to MCL or RCL enactment were estimated among patients with affective, anxiety, psychotic-spectrum disorders, and Any Psychiatric Disorder (APD) using staggered difference-in-difference (DiD) models and 99% Confidence Intervals (CIs), testing differences between patient groups with and without psychiatric disorders via non-overlap in the 99% CIs of their DiD estimates.</div></div><div><h3>Findings</h3><div>Among APD-negative patients, CUD prevalence was &lt;1.0% in all years, while among APD-positive patients, CUD prevalence increased from 3.26% in 2005 to 5.68% in 2022 in no-CL states, from 3.51% to 6.35% in MCL-only states, and from 3.41% to 6.35% in MCL/RCL states. Among the APD group, DiD estimates of MCL-only and MCL/RCL effects were modest-sized, but the lower bound of the 99% CI for the DiD estimate for MCL-only and MCL/RCL effects was larger than the upper bound of the 99% CI among the no-APD group, indicating significantly stronger MCL-only and MCL/RCL effects among patients with APD. Results were similar for MCL-only and MCL/RCL effects among disorder-specific groups (depression, post-traumatic stress disorder [PTSD], anxiety or bipolar disorders) and for MCL/RCL effects among patients with psychotic-spectrum disorders.</div></div><div><h3>Interpretation</h3><div>Cannabis legalization contributed to greater CUD prevalence increases among patients with psychiatric disorders. However, modest-sized DiD estimates suggested operation of other factors, e.g., commercialization, changing attitudes, expectancies. As cannabis legalization widens, recognizing and treating CUD in patients with psychiatric disorders becomes increasingly important.</div></div><div><h3>Funding</h3><div>This study was supported by <span>National Institute on Drug Abuse</span> grant <span><span>R01DA048860</span></span>, the <span>New York State Psychiatric Institute</span>, and the <span>VA Centers of Excellence in Substance Addiction Treatment and Education</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101155"},"PeriodicalIF":7.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502142","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":"Addressing ethnicity in pediatrics must be combined with addressing poverty and access to care: the experience of the French West Indies and French Guiana","authors":"Arthur Felix ,&nbsp;Narcisse Elenga ,&nbsp;Lindsay Osei","doi":"10.1016/j.lana.2025.101169","DOIUrl":"10.1016/j.lana.2025.101169","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101169"},"PeriodicalIF":7.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489494","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 2024 South America ablaze: health impacts and policy imperatives for protecting population health in an era of wildfires","authors":"Yasna Palmeiro-Silva ,&nbsp;Camila Llerena-Cayo ,&nbsp;Luciana Blanco-Villafuerte ,&nbsp;David Rojas-Rueda ,&nbsp;Nicolas Borchers Arriagada ,&nbsp;Zoila Vela-Clavo ,&nbsp;Tatiana de Camargo ,&nbsp;Matilde Rusticucci ,&nbsp;Armando Valdes-Velasquez ,&nbsp;Stella M. Hartinger","doi":"10.1016/j.lana.2025.101160","DOIUrl":"10.1016/j.lana.2025.101160","url":null,"abstract":"<div><div>The 2024 wildfires in South America, particularly in the Amazon and Pantanal, were not only a disaster for ecosystems, but also for public health and people's health and wellbeing. These record-breaking fires were likely driven by overlapping triggers: climate change-related heat and droughts and human-driven land-use change. We documented that rapidly evolving wildfires together with limited preparedness and slow responses from emergency and health agencies resulted in severe health impacts, including several fatalities and thousands people displaced, injured, and/or with cardiorespiratory symptoms. These, however, partially represent the situation as mental health outcomes were largely unrecorded and other impacts are yet to be seen. In a climate increasingly prone to severe wildfires, comprehensive action is key. Integrated disaster risk reduction strategies, strengthened health systems, and improved risk communication are essential to protect human health from this escalating threat.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101160"},"PeriodicalIF":7.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488937","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":"Effects of missed anti-tuberculosis therapy doses on treatment outcome: a multi-center cohort study","authors":"Isabella B.B. Ferreira ,&nbsp;Rodrigo C. Menezes ,&nbsp;Mariana Araújo-Pereira ,&nbsp;Valeria C. Rolla ,&nbsp;Afrânio L. Kritski ,&nbsp;Marcelo Cordeiro-Santos ,&nbsp;Timothy R. Sterling ,&nbsp;Cody Staats ,&nbsp;Gustavo Amorim ,&nbsp;Anete Trajman ,&nbsp;Bruno B. Andrade","doi":"10.1016/j.lana.2025.101162","DOIUrl":"10.1016/j.lana.2025.101162","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a leading cause of infectious disease mortality globally. Although directly observed therapy (DOT) has been widely implemented to improve adherence, nonadherence continues to compromise treatment success rates, especially in real-world settings. Therefore, this study aims to assess the impact of missed doses on TB treatment outcomes.</div></div><div><h3>Methods</h3><div>Prospective study that followed adults with drug-sensitive TB for two years after TB treatment initiation at five clinical centers of the RePORT-Brazil cohort between June 2015 and June 2019. Participants not in DOT or followed for less than 30 days were excluded. Nonadherence was defined as the percentage of missed doses relative to the prescribed regimen, monitored daily through DOT. The primary composite outcome comprised treatment failure, disease recurrence, drug resistance, death, or loss to follow-up (LTFU) after 30 days of treatment. Associations were assessed with multivariable logistic regression.</div></div><div><h3>Findings</h3><div>Among the 578 participants analyzed, 218 (37·7%) experienced unfavorable outcomes. Overall, 23% of participants missed more than 10% of prescribed doses, and this group had an 81·2% likelihood of experiencing unfavorable outcomes, compared to only 21·6% among those with complete adherence. A significant association was observed between the percentage of missed doses and unfavorable outcomes (adjusted OR: 1·11, 95% CI: 1·07–1·14, p-value &lt; 0·0001).</div></div><div><h3>Interpretation</h3><div>Even minor nonadherence in TB treatment was associated with an increased risk of unfavorable outcomes, highlighting the role of adherence in successful TB care.</div></div><div><h3>Funding</h3><div><span>Fundação Oswaldo Cruz</span>, <span>Fundação José Silveira</span>, <span>Departamento de Ciência e Tecnologia</span>, <span>US National Institute of Allergy and Infectious Diseases</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101162"},"PeriodicalIF":7.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471819","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":"Prevalence of HPV, cytological abnormalities, and impact of the HPV vaccine in Mexico: a Nationwide Study of 596,944 women","authors":"Abraham García-Gil ,&nbsp;Marco Antonio Luna-Ruiz-Esparza ,&nbsp;José Luis Moreno-Camacho ,&nbsp;Diana Yadira Calva-Espinosa ,&nbsp;Ludwing Erick González-Mena ,&nbsp;Luis Fernando Hernández-Lezama ,&nbsp;Pablo Kuri-Morales ,&nbsp;Juan Carlos Balcázar-Rodríguez ,&nbsp;Abraham Campos-Romero ,&nbsp;Jonathan Alcántar-Fernández","doi":"10.1016/j.lana.2025.101156","DOIUrl":"10.1016/j.lana.2025.101156","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer (CC) remains a significant public health challenge worldwide and is the second leading cause of cancer-related death in women in Mexico. Although CC is highly preventable, effective implementation of screening programs to detect women with precancerous lesions is crucial to reduce its burden. This study evaluated HPV infection, its correlation with cytological abnormalities, and the impact of HPV vaccination in 596,944 women from all 32 states of Mexico.</div></div><div><h3>Methods</h3><div>Samples were processed using a fully automated molecular biology laboratory setup (Roche Cobas prime - Cobas 6800), and cytotechnologists assessed cytological outcomes.</div></div><div><h3>Findings</h3><div>The highest prevalence of HPV infection was observed among women under the age of 25, with 23,615 individuals (37.4%) testing positive. This was primarily attributable to infections with the pooled high-risk HPV genotypes included in the assay (HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), which accounted for 22,792 cases (36.1%). In contrast, HPV16 and HPV18 were most prevalent among women aged 25–34 years, with 7251 (5.21%) and 3281 (2.36%) infections, respectively. Low-grade squamous intraepithelial lesion (LSIL) was the most frequently detected cytological abnormality, identified in 15,411 cases (2.6%), and was predominantly associated with the pooled HPV genotypes (73.7%). A two-dose HPV vaccination regimen conferred strong protection against HPV16 (odds ratio [OR] = 0.21) and HPV18 (OR = 0.33), but did not significantly reduce the prevalence of infection with the pooled HPV genotypes (OR = 0.98).</div></div><div><h3>Interpretation</h3><div>The notable carcinogenic potential of the HPV POOL underscores the need for broader vaccine formulations. Adopting a nonavalent vaccine in future campaigns, expanding screening coverage, and reinforcing sexual education for younger women are key measures to help policymakers mitigate the impact of CC in Mexico.</div></div><div><h3>Funding</h3><div>This work was funded by <span>Salud Digna</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101156"},"PeriodicalIF":7.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481364","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":"Healthcare resource utilisation and costs associated with hypertension in children and adolescents: a population-based cohort study","authors":"Junayd Hussain ,&nbsp;Rabeeyah Ahmed ,&nbsp;Cal H. Robinson ,&nbsp;Nivethika Jeyakumar ,&nbsp;Graham Smith ,&nbsp;Tammy M. Brady ,&nbsp;Allison B. Dart ,&nbsp;Janis Dionne ,&nbsp;Sabine Karam ,&nbsp;Ashlene McKay ,&nbsp;Rulan S. Parekh ,&nbsp;Manish D. Sinha ,&nbsp;Andrew M. South ,&nbsp;Carol Vincent ,&nbsp;Rahul Chanchlani","doi":"10.1016/j.lana.2025.101157","DOIUrl":"10.1016/j.lana.2025.101157","url":null,"abstract":"<div><h3>Background</h3><div>The global prevalence of paediatric hypertension has increased, contributing to long-term cardiovascular and kidney morbidity. However, healthcare resource utilisation and costs attributable to paediatric hypertension remain uncertain. This study evaluates healthcare utilisation and costs among hypertensive children compared to controls.</div></div><div><h3>Methods</h3><div>In a population-based retrospective cohort study, we analysed youth (aged 3–18 years) diagnosed with hypertension in Ontario, Canada (1993–2021). Using propensity score matching, 25,605 hypertensive children were compared to 128,025 controls and followed until death, emigration, or 31 March 2022. Healthcare utilisation (hospitalisations, emergency visits, outpatient visits) was assessed via negative binomial regression. Secondary outcomes included healthcare costs and specialist follow-up.</div></div><div><h3>Findings</h3><div>Median age was 15 years [IQR 11–17], 49% were female, and comorbidities were uncommon (4% (6497/153,630) congenital heart disease, 2% (9359/153,630) malignancy, 2% (2892/153,630) diabetes, 1% (2004/153,630) chronic kidney disease). Over a median follow-up of 12.9 [IQR 6.8–19.9] years, hypertensive children had higher hospitalisations (rate ratio [RR] 2.13, 95% CI 2.03–2.22), emergency visits (RR 1.08, 95% CI 1.05–1.11), and outpatient visits (RR 1.33, 95% CI 1.31–1.34). Mean healthcare costs were substantially higher in children with hypertension, especially in the first year ($16,690 vs $2659 per person-year).</div></div><div><h3>Interpretation</h3><div>Healthcare resource utilisation was significantly higher in youth with hypertension. These findings provide a basis for future cost-effectiveness studies on preventing paediatric hypertension and its complications.</div></div><div><h3>Funding</h3><div>This study was funded in part by a 2021/2022 <span>CoRE Builder Team</span> Grant from <span>McMaster University’s</span> Department of Paediatrics and supported by <span>ICES Western</span>, funded by the <span>Ontario Ministry of Health</span> (MOH) and <span>Ministry of Long-Term Care</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101157"},"PeriodicalIF":7.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365893","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":"Electroconvulsive therapy highlights the urgency of addressing medical stigma","authors":"Rebecca E. Barchas","doi":"10.1016/j.lana.2025.101154","DOIUrl":"10.1016/j.lana.2025.101154","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101154"},"PeriodicalIF":7.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364588","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}