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The rise and fall of carfentanil in Toronto's unregulated drug supply 卡芬太尼在多伦多不受管制的毒品供应中的兴衰
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-11 DOI: 10.1016/j.lana.2025.101152
Mohammad Karamouzian
{"title":"The rise and fall of carfentanil in Toronto's unregulated drug supply","authors":"Mohammad Karamouzian","doi":"10.1016/j.lana.2025.101152","DOIUrl":"10.1016/j.lana.2025.101152","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101152"},"PeriodicalIF":7.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262705","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
Lenacapavir: a potential game changer for HIV prevention in the Americas, if the game is played equitably Lenacapavir:如果游戏公平进行,它可能改变美洲艾滋病预防的游戏规则
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-10 DOI: 10.1016/j.lana.2025.101146
Valeria D. Cantos , Brenda Crabtree Ramírez , Colleen F. Kelley , Carlos del Rio , Beatriz Grinsztejn
{"title":"Lenacapavir: a potential game changer for HIV prevention in the Americas, if the game is played equitably","authors":"Valeria D. Cantos ,&nbsp;Brenda Crabtree Ramírez ,&nbsp;Colleen F. Kelley ,&nbsp;Carlos del Rio ,&nbsp;Beatriz Grinsztejn","doi":"10.1016/j.lana.2025.101146","DOIUrl":"10.1016/j.lana.2025.101146","url":null,"abstract":"<div><div>Lenacapavir, a first in class long-acting capsid inhibitor has near 100% efficacy in preventing HIV. As such, it has the potential to curb the rising HIV incidence in Latin America, a region with stark intra- and inter-country PrEP uptake disparities. In this viewpoint, we summarize the current efforts to scale up lenacapavir access globally and the necessary steps to include Latin America in these endeavours.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101146"},"PeriodicalIF":7.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242929","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
The concentration of tuberculosis within Paraguay’s Indigenous population, 2018–2022: a retrospective population-based study 2018-2022年巴拉圭土著人口中结核病的集中:一项基于人口的回顾性研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-10 DOI: 10.1016/j.lana.2025.101140
Angélica Medina , Jacob Sussman , Natalia Sosa , Melissa Valdez , Jason R. Andrews , Julio Croda , Gladys Estigarribia Sanabria , Guillermo Sequera , Sarita Aguirre , Katharine S. Walter
{"title":"The concentration of tuberculosis within Paraguay’s Indigenous population, 2018–2022: a retrospective population-based study","authors":"Angélica Medina ,&nbsp;Jacob Sussman ,&nbsp;Natalia Sosa ,&nbsp;Melissa Valdez ,&nbsp;Jason R. Andrews ,&nbsp;Julio Croda ,&nbsp;Gladys Estigarribia Sanabria ,&nbsp;Guillermo Sequera ,&nbsp;Sarita Aguirre ,&nbsp;Katharine S. Walter","doi":"10.1016/j.lana.2025.101140","DOIUrl":"10.1016/j.lana.2025.101140","url":null,"abstract":"<div><h3>Background</h3><div>While over the past decade global incidence rates of tuberculosis (TB) have decreased, in Paraguay incidence has risen. A new reporting system implemented in 2018 has not previously been used to characterise trends in TB and identify areas to prioritise for the expansion of access to TB diagnostics and treatment programmes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of all TB cases notified to the Paraguay National Program for Tuberculosis Control (NPTC) from 2018 to 2022. We quantified trends in case notifications spatially and in specific populations identified as vulnerable by the NPTC and measured trends in access to GeneXpert testing.</div></div><div><h3>Findings</h3><div>Of the 13,725 TB cases notified in Paraguay from 2018 to 2022, 2337 (17%) occurred among incarcerated individuals and 1743 (12.7%) occurred among self-identified Indigenous individuals. In 2022, the relative risk of TB was 87 and 6.39 (95% CI: 6.08–6.72) among persons deprived of liberty and Indigenous populations, compared to those who are not persons deprived of liberty and non-Indigenous populations respectively. We found significant heterogeneity in TB incidence across Paraguay’s 17 departments. While 45% of TB cases among the Indigenous population occurred in the Chaco Region, in western Paraguay, notification among the Indigenous population was highest (1127.4 per 100,000) in the Capital, including the metropolitan area.</div></div><div><h3>Interpretation</h3><div>TB cases are concentrated among Paraguay’s incarcerated and Indigenous populations, both of which have extremely high relative risk of TB. Our findings highlight the urgency of expanding access to TB diagnosis, treatment, and prevention across the country and specifically, to the populations at heightened risk of TB.</div></div><div><h3>Funding</h3><div><span><span>K01AI173385</span></span> (<span>NIH</span>, <span>NIAID</span>), <span>University of Utah</span> UROP.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101140"},"PeriodicalIF":7.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242928","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
Bridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’ 弥合恰加斯病管理方面的差距:在巴西初级卫生保健系统内使用实施科学方法的混合方法研究——“Implementa-Chagas/SaMi-Trop项目”
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-07 DOI: 10.1016/j.lana.2025.101136
Carlos Henrique Valente Moreira , Laura Azevedo , Ariela Mota Ferreira , Ana Carolina Gonçalves Oliveira , Andréia Brito de Souza , Desirée Sant’Ana Haikal , Cláudia Di Lorenzo Oliveira , Clareci Silva Cardoso , Matthew Spinelli , Ana Luiza Bierrenbach , Nayara Dornela Quintino , Nayara Ragi Baldoni , Renata Fiuza Damasceno , Malu Ribeiro Drumond , Thallyta Maria Vieira , Dardiane Santos Cruz , Sâmara Fernandes Leite , Ana Clara de Jesus Santos , Léa Campos de Oliveira Silva , Renata Buccheri , Ester Cerdeira Sabino
{"title":"Bridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’","authors":"Carlos Henrique Valente Moreira ,&nbsp;Laura Azevedo ,&nbsp;Ariela Mota Ferreira ,&nbsp;Ana Carolina Gonçalves Oliveira ,&nbsp;Andréia Brito de Souza ,&nbsp;Desirée Sant’Ana Haikal ,&nbsp;Cláudia Di Lorenzo Oliveira ,&nbsp;Clareci Silva Cardoso ,&nbsp;Matthew Spinelli ,&nbsp;Ana Luiza Bierrenbach ,&nbsp;Nayara Dornela Quintino ,&nbsp;Nayara Ragi Baldoni ,&nbsp;Renata Fiuza Damasceno ,&nbsp;Malu Ribeiro Drumond ,&nbsp;Thallyta Maria Vieira ,&nbsp;Dardiane Santos Cruz ,&nbsp;Sâmara Fernandes Leite ,&nbsp;Ana Clara de Jesus Santos ,&nbsp;Léa Campos de Oliveira Silva ,&nbsp;Renata Buccheri ,&nbsp;Ester Cerdeira Sabino","doi":"10.1016/j.lana.2025.101136","DOIUrl":"10.1016/j.lana.2025.101136","url":null,"abstract":"<div><h3>Background</h3><div>Chagas Disease (ChD), a prevalent Neglected Tropical Disease in Latin America, affects millions and poses significant challenges in Brazil's primary healthcare system. Despite the availability of diagnostic tools and effective drugs, screening and treatment rates remain alarmingly low. This study aims to identify barriers and facilitators in ChD management, focusing on integrating services into routine healthcare operations.</div></div><div><h3>Methods</h3><div>An exploratory sequential mixed-methods approach was used, combining focus groups with primary care physicians, in-depth interviews, and quantitative surveys with healthcare professionals. The Theoretical Domains Framework (TDF) and the Capability Opportunity Motivation-Behaviour (COM-B) model guided the analysis of decision-making processes in ChD management. Intervention strategies were developed using the Behaviour Change Wheel (BCW) framework, emphasizing educational programmes, hands-on training, and infrastructural improvements.</div></div><div><h3>Findings</h3><div>The study identified key barriers, including limited awareness of ChD among healthcare professionals, reliance on symptomatic diagnosis, environmental constraints, and inadequate public and professional engagement with ChD. We proposed tailored interventions to enhance primary healthcare personnel competencies through education, training, and infrastructure adjustments.</div></div><div><h3>Interpretation</h3><div>The study advocates for a paradigm shift in ChD management towards early intervention and comprehensive care. It highlights the importance of a team-based strategy aligned with the WHO's Neglected Tropical Diseases roadmap, particularly in remote areas. This approach addresses healthcare workers' challenges, fostering a more proactive and informed ChD management strategy.</div></div><div><h3>Funding</h3><div>The <span>NIH</span> supported the study under the Sami-Trop cohort study (Grant n. U01AI168383).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101136"},"PeriodicalIF":7.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229900","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
Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based study 美国老年人计量吸入器的使用和可及性及可持续替代品:一项基于人群的研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-05 DOI: 10.1016/j.lana.2025.101142
Ashwaghosha Parthasarathi , Isao Iwata , Catherine Chen , Amy R. Li , Novella Lye , Poonam Gandhi , Melanie Rua , Reynold A. Panettieri Jr. , Jared Radbel , Mahesh Padukudru Anand , Mary Bridgeman , Soko Setoguchi
{"title":"Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based study","authors":"Ashwaghosha Parthasarathi ,&nbsp;Isao Iwata ,&nbsp;Catherine Chen ,&nbsp;Amy R. Li ,&nbsp;Novella Lye ,&nbsp;Poonam Gandhi ,&nbsp;Melanie Rua ,&nbsp;Reynold A. Panettieri Jr. ,&nbsp;Jared Radbel ,&nbsp;Mahesh Padukudru Anand ,&nbsp;Mary Bridgeman ,&nbsp;Soko Setoguchi","doi":"10.1016/j.lana.2025.101142","DOIUrl":"10.1016/j.lana.2025.101142","url":null,"abstract":"<div><h3>Background</h3><div>Attaining the Paris Agreement goal of limiting global temperature rise to below 1.5–2 °C requires the healthcare sector to achieve net-zero emissions by 2050. This necessitates adopting diverse strategies, including replacing carbon-intensive metered-dose inhalers (MDIs) with more environmentally sustainable dry powder inhalers (DPIs) and soft mist inhalers (SMIs). While several European countries have successfully made this transition, patterns of MDI use and barriers to adopting sustainable alternatives in the United States remain poorly understood. Thus, we assessed inhaler utilization, costs, and insurance coverage among U.S. older adults.</div></div><div><h3>Methods</h3><div>Using 100% fee-for-service Medicare data with pharmacy benefit (2008–2022), we described utilization trends and costs by device types and drug classes, including inhaled corticosteroids [ICS] and short-/long-acting beta-agonists [S/LABA]. Using the COVERAGE Search database, we extracted formulary data from Part D plans in 10 large US states and described insurance coverage, formulary tier placement (categorizing drugs by costs), prior authorization (requiring insurer approval for coverage), and step therapy (requiring initial trial of lower-cost drugs).</div></div><div><h3>Findings</h3><div>Of 160,845,280 inhalers dispensed to 10,494,068 older adults (mean age 74 ± 7 years; 38% male; 85% White), 51% were MDIs. Of these MDIs, 88% were SABA and ICS. Median deductible-phase out-of-pocket costs were $3–9 for SABA MDIs vs. $42–49 for DPIs/SMIs and $3–4 for ICS MDIs vs. $3–116 for DPIs/SMIs. Only 18% and 50% of 2530 Part D plans covered SABA and ICS DPIs, respectively. Among the covering plans, &gt;70% placed DPIs for SABA or ICS in higher-cost tiers, with 32–58% requiring prior authorization or step therapy.</div></div><div><h3>Interpretation</h3><div>MDIs, primarily as SABA or ICS, accounted for over half of inhalers dispensed to US older adults. Most insurance plans excluded sustainable alternatives for SABA/ICS. When covered, additional approval steps and/or higher patient costs were posed. Multi-level efforts are needed to ensure affordable access to sustainable alternatives, as demonstrated in European countries.</div></div><div><h3>Funding</h3><div>Funding for this study was provided by the <span>National Institutes of Health</span> and the <span>National Institute on Aging</span> (1R01AG060232-01A1).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101142"},"PeriodicalIF":7.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221878","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
Derivation and validation of a point-based forecasting tool for SARS-CoV-2 critical care occupancy: a population-based modeling study 基于点的SARS-CoV-2重症监护入住预测工具的推导和验证:基于人群的建模研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-05 DOI: 10.1016/j.lana.2025.101143
Alicia A. Grima, Clara Eunyoung Lee, Ashleigh R. Tuite, Natalie J. Wilson, Alison E. Simmons, David N. Fisman
{"title":"Derivation and validation of a point-based forecasting tool for SARS-CoV-2 critical care occupancy: a population-based modeling study","authors":"Alicia A. Grima,&nbsp;Clara Eunyoung Lee,&nbsp;Ashleigh R. Tuite,&nbsp;Natalie J. Wilson,&nbsp;Alison E. Simmons,&nbsp;David N. Fisman","doi":"10.1016/j.lana.2025.101143","DOIUrl":"10.1016/j.lana.2025.101143","url":null,"abstract":"<div><h3>Background</h3><div>The requirement for critical care in even a modest fraction of SARS-CoV-2-infected individuals made critical care resources a key societal chokepoint during the COVID-19 pandemic. We previously developed a simple regression-based point score to forecast critical care occupancy in Ontario, Canada, using case numbers, mean age of cases, and testing volume. In this study, we aimed to validate and update this forecasting model to account for evolving population immunity, including the effects of widespread vaccination.</div></div><div><h3>Methods</h3><div>We obtained complete provincial SARS-CoV-2 case, testing, and vaccination data from March 2020 to September 2022, subdividing the pandemic into six waves. Our initial model was fitted using data from the first two waves; an updated model included wave 3, which was dominated by N501Y+ variants. We validated the models by comparing projections to waves not used for fitting. Predictive validity was assessed using Spearman's rho. Counterfactual scenarios without vaccination were modeled to estimate vaccine-attributable reductions in critical care admissions.</div></div><div><h3>Findings</h3><div>The initial model (waves 1–2) was well calibrated (rho = 0.85) but had modest predictive validity (rho = 0.46). Predictive validity improved with models fitted to waves 1–3, both without (rho = 0.60) and with vaccination (rho = 0.68); model fit improved significantly with vaccination (p = 0.013). Averted admissions attributable to vaccination were estimated at 144% (22,017 expected vs. 9020 observed).</div></div><div><h3>Interpretation</h3><div>Simple regression-based forecasting tools remain valuable for predicting SARS-CoV-2 critical care occupancy. However, models developed early in the pandemic should be recalibrated to account for evolving immunity, including widespread vaccination.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span> (OV4-170360); <span>R. Howard Webster Foundation</span> (via the University of Toronto Institute for Pandemics).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101143"},"PeriodicalIF":7.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221993","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
Patient journey and disease burden characterization of the population with phenylketonuria (PKU) in Brazil: a retrospective analysis through data reported in the public health system administrative database (DATASUS) 巴西苯丙酮尿症(PKU)人群的患者旅程和疾病负担特征:通过公共卫生系统管理数据库(DATASUS)报告的数据进行回顾性分析
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-04 DOI: 10.1016/j.lana.2025.101134
Paula R. Vargas , Monique Poubel , Bárbara Martins , Paloma Velez , Daniel Vilela , Debora Mesojedovas , Tatiana Sá Pacheco Carneiro Magalhães , Karly S. Louie , André Pessoa
{"title":"Patient journey and disease burden characterization of the population with phenylketonuria (PKU) in Brazil: a retrospective analysis through data reported in the public health system administrative database (DATASUS)","authors":"Paula R. Vargas ,&nbsp;Monique Poubel ,&nbsp;Bárbara Martins ,&nbsp;Paloma Velez ,&nbsp;Daniel Vilela ,&nbsp;Debora Mesojedovas ,&nbsp;Tatiana Sá Pacheco Carneiro Magalhães ,&nbsp;Karly S. Louie ,&nbsp;André Pessoa","doi":"10.1016/j.lana.2025.101134","DOIUrl":"10.1016/j.lana.2025.101134","url":null,"abstract":"<div><h3>Background</h3><div>In 2001, Brazil implemented a national newborn screening (NBS) for various conditions, including phenylketonuria (PKU). Data is lacking on the effectiveness of the NBS program in diagnosing PKU at birth and initiating treatment with a Phe-free amino acid-based formula within 30 days of diagnosis. This study evaluated the effectiveness of the NBS program and characterized the PKU population.</div></div><div><h3>Methods</h3><div>An observational, repeated cross-sectional population-based study was conducted using anonymized data from the Department of Informatics of the Unified Health System (DATASUS) in Brazil from 2008 to 2021. Only patients with confirmed diagnoses were included.</div></div><div><h3>Findings</h3><div>NBS coverage of live births within 30 days of birth was &gt;80% for all years, while annual incidence of PKU ranged from 4 to 8 per 100,000 live births. Median time to screening diagnosis from birth was approximately 18 days (all years). DATASUS had 7615 patients with a record of PKU. The median age of the first record in DATASUS was 6.1 years, predominantly from the southeast region (53%). Also, 44% of the PKU population had a record of receiving Phe-free formula for treatment. Metabolic and related disorders were most prevalent in those &lt;18 years of age (28.1%), while mental and behavioral disorders were most prevalent in those ≥18 years of age (100%).</div></div><div><h3>Interpretation</h3><div>Further investigations are necessary to enhance the effectiveness of NBS coverage, reduce the time from diagnosis to treatment initiation, improve Phe-free formula distribution, and improve DATASUS data quality.</div></div><div><h3>Funding</h3><div>The current study was funded by <span>BioMarin Pharmaceutical</span>, Novato, CA.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101134"},"PeriodicalIF":7.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203506","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
Hidden figures underlying quality measures: revealing hidden racial inequalities in end-of-life cancer care delivery: a cohort study 隐藏的数字背后的质量措施:揭示隐藏的种族不平等在临终癌症护理交付:一项队列研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-03 DOI: 10.1016/j.lana.2025.101135
Inas S. Khayal , John J. Shin , Gabriel A. Brooks , Amber E. Barnato , Ellesse-Roselee Akré , Terri Lewinson , Amro M. Farid , A. James O'Malley
{"title":"Hidden figures underlying quality measures: revealing hidden racial inequalities in end-of-life cancer care delivery: a cohort study","authors":"Inas S. Khayal ,&nbsp;John J. Shin ,&nbsp;Gabriel A. Brooks ,&nbsp;Amber E. Barnato ,&nbsp;Ellesse-Roselee Akré ,&nbsp;Terri Lewinson ,&nbsp;Amro M. Farid ,&nbsp;A. James O'Malley","doi":"10.1016/j.lana.2025.101135","DOIUrl":"10.1016/j.lana.2025.101135","url":null,"abstract":"<div><h3>Background</h3><div>Calls for healthcare systems to reduce disparities in cancer care access and outcomes draw on comparisons of existing measures across race and ethnicity subgroups. This approach may hide inequities driven by systematic bias in the timing of care delivery. The goals of this study were to: (1) identify differences in the timing of care delivery between racial groups, and (2) determine whether these differences could be identified from quality measures.</div></div><div><h3>Methods</h3><div>Retrospective decedent follow-back study of hospitals treating Medicare fee-for-service beneficiaries with advanced cancer aged 65–99 who died April–December 2016. Among hospitals serving at least 11 decedents of color (including Black or African-American, Asian/Pacific Islander, Hispanic, American Indian/Alaska Native, and Other) and 11 White decedents, we calculated hospital-level differences between White decedents and decedents of color for 1) any use of palliative care and hospice (Measures) and 2) daily counts of palliative care and hospice use for each day in the 6 months before death (Signatures).</div></div><div><h3>Findings</h3><div>The cohort included 30,319 decedents across 217 hospitals, of whom 7,852 (25.9%) were people of color (POC). The median of the hospital-specific aggregate measure difference was −5.35% (IQR = 12.83) for palliative care, indicating more POC received any palliative care, and 3.66% (IQR = 12.45) for hospice care, indicating more White people (WP) received any hospice care. We identified 5 high-level cluster-group descriptions of inequality from signatures. Inequality information from signatures matched those from measures in only 46.5% and 39.2% of hospitals for palliative and hospice care, respectively.</div></div><div><h3>Interpretation</h3><div>Signatures incorporating timing of care delivery using longitudinal data revealed patterns of racial-ethnic inequalities in end-of-life cancer care otherwise missed by traditional aggregate quality measures.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>American Cancer Society Award</span> (RSG-22-128-01-HOPS).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101135"},"PeriodicalIF":7.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203505","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
In-person and media gun violence exposure in the United States: prevalence and disparities in a nationally representative, cross-sectional sample of adults 美国的面对面和媒体枪支暴力暴露:在全国代表性的成年人横断面样本中的流行和差异
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-01 DOI: 10.1016/j.lana.2025.101101
Daniel C. Semenza , Kimberly C. Burke , Devon Ziminski , Brielle Savage , Michael D. Anestis , Richard Stansfield
{"title":"In-person and media gun violence exposure in the United States: prevalence and disparities in a nationally representative, cross-sectional sample of adults","authors":"Daniel C. Semenza ,&nbsp;Kimberly C. Burke ,&nbsp;Devon Ziminski ,&nbsp;Brielle Savage ,&nbsp;Michael D. Anestis ,&nbsp;Richard Stansfield","doi":"10.1016/j.lana.2025.101101","DOIUrl":"10.1016/j.lana.2025.101101","url":null,"abstract":"<div><h3>Background</h3><div>Knowledge remains limited about how people experience different types of exposure to gun violence. We analyzed the prevalence of in-person and media gun violence exposure (GVE) in a nationally representative sample of US adults.</div></div><div><h3>Methods</h3><div>Data were collected from 8009 US adults in May 2024, using design weights for representativeness. We measured in-person GVE, including direct (e.g., being shot) and indirect (e.g., hearing gunshots) exposures, along with frequency of exposure via traditional and social media. Exposures were analyzed by racial/ethnic group and household income. Multivariable associations were estimated using weighted multilevel mixed-effects regression models.</div></div><div><h3>Findings</h3><div>Significant racial/ethnic disparities in GVE were observed. Black Americans reported higher prevalence of all individual exposures (e.g., 38.5% of Black Americans [N = 337] know a family member or friend who has been shot vs. 25.53% of Hispanic Americans [N = 265] and 15.78% of White Americans [N = 849]), except firearm suicide. Black adults had higher media GVE, and neighborhood socioeconomic disadvantage was consistently linked to greater in-person exposure. Racial/ethnic disparities remained in multivariable models, including cumulative in-person exposure (Black beta [β] = 0.29, 95% CI: 0.17–0.41, p &lt; 0.0001; Hispanic β = 0.13, 95% CI: 0.03–0.24, p = 0.018) and high media exposure (Black odds ratio [OR] = 1.57, 95% CI: 1.20–2.05, p = 0.001).</div></div><div><h3>Interpretation</h3><div>Nearly two-thirds of US adults have experienced in-person gun violence. Marked racial/ethnic disparities for both in-person and media GVE call for comprehensive strategies to reduce gun violence.</div></div><div><h3>Funding</h3><div>Authors are affiliated with the <span>New Jersey Gun Violence Research Center</span>, funded by the <span>NJ Office of the Secretary of Higher Education</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101101"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270570","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
Cyberbullying, mental health, and substance use experimentation among early adolescents: a prospective cohort study 青少年早期网络欺凌、心理健康和物质使用实验:一项前瞻性队列研究
IF 7
Lancet Regional Health-Americas Pub Date : 2025-06-01 DOI: 10.1016/j.lana.2025.101002
Jason M. Nagata , Joan Shim , Priyadharshini Balasubramanian , Alicia W. Leong , Zacariah Smith-Russack , Iris Y. Shao , Abubakr A.A. Al-Shoaibi , Christiane K. Helmer , Kyle T. Ganson , Alexander Testa , Orsolya Kiss , Jinbo He , Allison K. Groves , Sarah Baird , Fiona C. Baker
{"title":"Cyberbullying, mental health, and substance use experimentation among early adolescents: a prospective cohort study","authors":"Jason M. Nagata ,&nbsp;Joan Shim ,&nbsp;Priyadharshini Balasubramanian ,&nbsp;Alicia W. Leong ,&nbsp;Zacariah Smith-Russack ,&nbsp;Iris Y. Shao ,&nbsp;Abubakr A.A. Al-Shoaibi ,&nbsp;Christiane K. Helmer ,&nbsp;Kyle T. Ganson ,&nbsp;Alexander Testa ,&nbsp;Orsolya Kiss ,&nbsp;Jinbo He ,&nbsp;Allison K. Groves ,&nbsp;Sarah Baird ,&nbsp;Fiona C. Baker","doi":"10.1016/j.lana.2025.101002","DOIUrl":"10.1016/j.lana.2025.101002","url":null,"abstract":"<div><h3>Background</h3><div>Although cyberbullying has been linked with adverse health outcomes, most prior studies have been cross-sectional, and there are limited large-scale, prospective analyses examining cyberbullying and mental health and substance use outcomes in early adolescents. Therefore, the aim of this study was to determine prospective associations between cyberbullying, mental health, and substance use experimentation one year later in a US national cohort of early adolescents (11–12 years old).</div></div><div><h3>Methods</h3><div>We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2, N = 9799). Linear and logistic regression analyses were used to determine associations between cyberbullying victimization (exposure variable, Year 2) and mental health (depressive, anxiety, attention, somatic, oppositional defiant, conduct problems, and suicidal behaviours), and substance (alcohol, nicotine, cannabis) use experimentation outcomes (Year 3), adjusting for sociodemographic variables and mental health outcomes, suicidal behaviours, or reported substance use experimentation at Year 2.</div></div><div><h3>Findings</h3><div>The total analysed sample comprised 9799 who were 48.4% female and racially/ethnically diverse (45.1% non-White). 8.7% reported lifetime cyberbullying victimization. Cyberbullying victimization was prospectively associated with higher depressive (β = 0.61, 95% CI 0.02–1.19), somatic (β = 1.00, 95% CI 0.42–1.57), and attention problems (β = 0.52, 95% CI 0.03–1.00), as well as suicidal behaviors (adjusted odds ratio [AOR] 2.62, 95% CI 1.73–3.98) one year later. Cyberbullying victimization was prospectively associated with higher odds of alcohol (AOR 1.98, 95% CI 1.53–2.57), nicotine (AOR 3.37, 95% 2.16–5.26), and cannabis (AOR 4.65, 95% 2.46–8.77) experimentation one year later. While cyberbullying victimization was associated with anxiety, oppositional defiant, and conduct problems in the unadjusted model, this was no longer significant after adjusting for covariates.</div></div><div><h3>Interpretation</h3><div>Given associations with poor mental health and substance use in early adolescents, it is important to develop interventions to prevent and reduce cyberbullying. Pediatricians, parents, and educators can provide mental health support for early adolescent victims of cyberbullying.</div></div><div><h3>Funding</h3><div>This research was supported by the <span>Bill and Melinda Gates Foundation</span> (INV-048897). J.M.N. was funded by the <span>National Institutes of Health</span> (K08HL159350 and R01MH135492) and the <span>Doris Duke Charitable Foundation</span> (<span><span>2022056</span></span>).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101002"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270571","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
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