Lancet Regional Health-Americas最新文献

{"title":"Cost-effectiveness of screening, decolonisation and isolation strategies for carbapenem-resistant Enterobacterales and methicillin-resistant Staphylococcus aureus infections in hospitals: a sex-stratified mathematical modelling study","authors":"Kasim Allel ,&nbsp;Patricia Garcia ,&nbsp;Anne Peters ,&nbsp;Jose Munita ,&nbsp;Eduardo A. Undurraga ,&nbsp;Laith Yakob","doi":"10.1016/j.lana.2025.101019","DOIUrl":"10.1016/j.lana.2025.101019","url":null,"abstract":"<div><h3>Background</h3><div>Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and carbapenem-resistant Enterobacterales (CRE) impose the greatest burden among critical bacterial pathogens. Evidence for sex differences among antibiotic resistant bacterial infections is increasing but a focus on policy implications is needed. We assessed impact of CRE/MRSA on excess length of hospital stay, intensive care unit admission, and mortality by sex from a retrospective cohort study (n = 873) of patients in three Chilean hospitals, 2018–2021.</div></div><div><h3>Methods</h3><div>We used inverse-probability weighting combined with descriptive, logistic, and competing-risks analyses. We developed a sex-stratified deterministic compartmental model to analyse hospital transmission dynamics and the cost-effectiveness of nine interventions. We compared interventions based on the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained and estimated net benefits.</div></div><div><h3>Findings</h3><div>The adjusted odds of women acquiring CRE and MRSA were 0.44 (0.28–0.70; p = 0.0013) and 0.73 (95% CI = 0.48–1.01; p = 0.050), respectively. Competing-risk models indicated higher mortality rates among women, compared to men. Mathematical model projections showed that pre-emptive isolation across all newly admitted high-risk men was the most cost-effective intervention (ICER = $1366/QALY and $1083/QALY for CRE and MRSA, respectively). Chromogenic agar coupled with MRSA decolonisation was the second most cost-effective intervention ($2099/QALY), followed by screening plus isolation or pre-emptive isolation strategies (ICER ranged between $2411/QALY and $4216/QALY across CRE and MRSA models). Probabilistic sensitivity analysis showed that strategies were ICER &lt; willingness-to-pay in 80% of simulations, except for testing plus digestive decolonisation for CRE. At a 20% national hospital coverage at least $12.2 million could be saved.</div></div><div><h3>Interpretation</h3><div>Our model suggests that targeted infection control strategies would effectively address rising CRE and MRSA infections. Maximising health-economic gains may be achieved by focusing on control measures for men as primary drivers for transmission, thereby reducing the disproportionate disease burden borne by women.</div></div><div><h3>Funding</h3><div>Agencia Nacional de Investigación y Desarrollo <span>ANID</span>, Chile.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101019"},"PeriodicalIF":7.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422677","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":"Investigating the spatial association between supervised consumption services and homicide rates in Toronto, Canada, 2010–2023: an ecological analysis","authors":"Dan Werb ,&nbsp;Hae Seung Sung ,&nbsp;Yingbo Na ,&nbsp;Indhu Rammohan ,&nbsp;Jolene Eeuwes ,&nbsp;Ashley Smoke ,&nbsp;Akwasi Owusu-Bempah ,&nbsp;Thomas Kerr ,&nbsp;Mohammad Karamouzian","doi":"10.1016/j.lana.2025.101022","DOIUrl":"10.1016/j.lana.2025.101022","url":null,"abstract":"<div><h3>Background</h3><div>Supervised consumption services (SCS) are effective at preventing overdose mortality. However, their effect on public safety remains contested. We investigated homicide rates in areas near SCS in Toronto.</div></div><div><h3>Methods</h3><div>We classified coroner-reported fatal shootings and stabbings (January 1st, 2010 to September 30th 2023) by geographic zone: within 500 m (‘near’), between 500 m and 3 km (‘far’), and beyond 3 km of an SCS (‘out’). We then used Poisson regression to calculate the rate ratio (RR) across zones 18, 36, 48, and 60 months pre vs. post SCS implementation. Finally, we compared spatial homicide incidence prior to and after the date of the implementation of each SCS using interrupted time series (ITS).</div></div><div><h3>Findings</h3><div>Overall, 956 homicides occurred, and 590 (62%) were fatal shootings and stabbings. There was no meaningful change in the rate of fatal shootings and stabbings within 3 kms of SCS (near and far zones) after their implementation. However, between 48 and 60 months pos-implementation, we detected an increase in out zones. In an ITS analysis, we observed a reduction in the monthly incidence in near zones and an increase in out zones.</div></div><div><h3>Interpretation</h3><div>SCS implementation was not associated with increased homicide rates; instead, we observed a reduction in monthly incidence near SCS. These results may inform drug market activity responses that optimize community health and safety.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span>, the <span>New Frontiers in Research Fund</span>, <span>St. Michael’s Hospital Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101022"},"PeriodicalIF":7.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422680","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":"Differences in Long COVID severity by duration of illness, symptom evolution, and vaccination: a longitudinal cohort study from the INSPIRE group","authors":"Michael Gottlieb ,&nbsp;Huihui Yu ,&nbsp;Ji Chen ,&nbsp;Erica S. Spatz ,&nbsp;Nicole L. Gentile ,&nbsp;Rachel E. Geyer ,&nbsp;Michelle Santangelo ,&nbsp;Caitlin Malicki ,&nbsp;Kristyn Gatling ,&nbsp;Sharon Saydah ,&nbsp;Kelli N. O'Laughlin ,&nbsp;Kari A. Stephens ,&nbsp;Joann G. Elmore ,&nbsp;Lauren E. Wisk ,&nbsp;Michelle L'Hommedieu ,&nbsp;Robert M. Rodriguez ,&nbsp;Juan Carlos C. Montoy ,&nbsp;Ralph C. Wang ,&nbsp;Kristin L. Rising ,&nbsp;Efrat Kean ,&nbsp;Robert A. Weinstein","doi":"10.1016/j.lana.2025.101026","DOIUrl":"10.1016/j.lana.2025.101026","url":null,"abstract":"<div><h3>Background</h3><div>Although short-term outcomes of Long COVID have been described, longer-term physical and mental health outcomes of Long COVID are less well-established. This study sought to assess differences in long-term physical and mental health outcomes extending up to three years among those with current, resolved, and no Long COVID, as well as duration of Long COVID and vaccination status.</div></div><div><h3>Methods</h3><div>This was a prospective, multisite, study of participants with SARS-CoV-2 infection from 12/7/2020-8/29/2022, with data collected through 4/2/2024. Surveys included validated tools for physical and mental health. Data were analyzed by Long COVID status (never-had, resolved, current), Long COVID duration and vaccination status.</div></div><div><h3>Findings</h3><div>Of 3663 participants, 2604 (71.1%) never had Long COVID, 994 (27.1%) reported current Long COVID, and 65 (1.8%) reported resolved Long COVID. Compared to never having Long COVID, current Long COVID had lower/worse scores for Patient-Reported Outcomes Measurement Information System (PROMIS) version 29 Physical (7.8; 95% confidence interval [CI] 7.3–8.3) and Mental Health (9.4; 95% CI 8.8–10.1) and higher likelihood of moderate-to-high stress (adjusted odds ratio [aOR]: 2.0; 95% CI 1.6–2.4), moderate-to-high loneliness (aOR: 1.6; 95% CI 1.4–2.0), moderate-to-severe fatigue (aOR: 3.0; 95% CI 2.5–3.7), insufficient activity (aOR for Speedy Nutrition and Physical Activity Assessment ≤4: 0.6; 95% CI 0.5–0.7; aOR for Exercise Vital Sign ≤150 min/week: 0.7, 95% CI 0.6–1.0), and worse dyspnea (aOR: 5.0; 95% CI 4.3–5.8). Resolved Long COVID had lower scores for PROMIS Physical by 2.0 (95% CI 0.2–3.8) and Mental Health by 2.3 (95% CI 0.2–4.4) than the never-had-Long COVID cohort. Number of COVID-19 vaccinations was associated with better outcomes across all measures.</div></div><div><h3>Interpretation</h3><div>Among participants followed up to 3 years after initial infection, those with current Long COVID had worse physical and mental health outcomes. The majority of those with Long COVID did not resolve, with less than 2% having resolved Long COVID. The resolved Long COVID cohort had moderately worse physical and mental health compared with those never-having-Long COVID. COVID-19 vaccination was associated with better outcomes.</div></div><div><h3>Funding</h3><div><span>Centers for Disease Control and Prevention</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101026"},"PeriodicalIF":7.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403503","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 burden of limited resources in Latin America on healthcare quality and management","authors":"João Paulo Telles ,&nbsp;Felipe Tuon ,&nbsp;Alexandre Cunha ,&nbsp;Jaime Luis Lopes Rocha","doi":"10.1016/j.lana.2025.101014","DOIUrl":"10.1016/j.lana.2025.101014","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101014"},"PeriodicalIF":7.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422678","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":"Prevalence and moderators of depression symptoms among black individuals in Western Countries: a systematic review and meta-analysis among 1.3 million people in 421 studies","authors":"Jude Mary Cénat ,&nbsp;Seyed Mohammad Mahdi Moshirian Farahi ,&nbsp;Léa Gakima ,&nbsp;Joana Mukunzi ,&nbsp;Wina Paul Darius ,&nbsp;David Guangyu Diao ,&nbsp;Farid Mansoub Bekarkhanechi ,&nbsp;Anaïse Dalcé ,&nbsp;Binty-Kamila Bangoura ,&nbsp;Jihane Mkhatri ,&nbsp;Max Collom ,&nbsp;Sarah Belachew ,&nbsp;Kathy Josiah ,&nbsp;Nicole Weisemberg ,&nbsp;Patrick R. Labelle ,&nbsp;Rose Darly Dalexis","doi":"10.1016/j.lana.2025.101027","DOIUrl":"10.1016/j.lana.2025.101027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Black people living in Western countries face a range of structural challenges and disparities (e.g. difficult socio-economic conditions, historical and intergenerational trauma, police brutality, racism) that adversely affect their mental health. This study assesses depression prevalence among Black individuals in minority contexts, examining sociodemographic factors, study type, evaluation period, publication year, and measures; and differences in depression rates between Black individuals and other racial groups (Asian, Indigenous, Latinx, White).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;To identify studies, a comprehensive search strategy was developed and executed on September 30, 2022 across six databases (Allied and Complementary Medicine Database, APA PsycInfo, CINAHL. Cochrane CENTRAL, Embase, MEDLINE). The meta-analysis protocol was registered with PROSPERO (CRD42020155634). A random-effects meta-analysis estimated depression prevalence among Black individuals. Meta-regression tested differences by racial background, gender, sample type, evaluation method, age group, and publication year, reporting Odd ratios (ORs) with Confidence intervals (CIs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;From 21,215 citations, 421 studies were included with a sample of 1,305,366 Black individuals (411 studies were conducted in North America, 9 in Europe, and one in both Europe and North America). Pooled prevalence was 20.2% (95% CI: 18.7%–21.7%) among Black individuals, 13.4% (95% CI: 10.2–16.9) among Asians, 21.0% (95% CI: 18.7–23.5) among Latinx, and 17.8% (95% CI: 16.3–19.2) among Whites. It was significantly lower among White (OR = 0.98, &lt;em&gt;p&lt;/em&gt; = 0.04, 95% CI: 0.95, 1.00) and Asian people (OR = 0.94, &lt;em&gt;p&lt;/em&gt; = 0.004, 95% CI: 0.90, 0.98) compared to Black individuals. Pooled prevalence was 26.6% for the past week (95% CI: 24.6%–28.6%), 22.1% (95% CI: 19.2–23.1) for the past two weeks, 21.6% (95% CI: 11.6–33.5) for the past month, 9.1% (95% CI: 7.7%–10.7%) for the past year, and 16.6 (95% CI: 12.9–20.8) for lifetime. Depression prevalence was higher among Black women (24.3%; 95% CI: 21.3–27.4) and in North America (20.3%; 95% CI: 18.8–21.9). Depression prevalence was higher in 2000–2009 (23.5%; 95% CI: 20.9–26.2), decreased in 2010–2019 (17.7%; 95% CI: 15.6–19.9) and increased since 2020 (20.6%; 95% CI: 17.5–23.8).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;As depression constitutes a burden among Black individuals in the West, it is urgent to mobilize public health agencies, research funding agencies and clinicians to develop and implement antiracist and culturally adapted prevention and intervention programs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Public Health Agency of Canada&lt;/span&gt;, (grant number &lt;span&gt;&lt;span&gt;1920-HQ-000053&lt;/span&gt;&lt;/span&gt;), the &lt;span&gt;Social Sciences and Humanities Research Council&lt;/span&gt; (SSHRC) and &lt;span&gt;Canadian Institutes of Health Research&lt;/span&gt; (CIHR) (grant number &lt;span&gt;&lt;span&gt;469050&lt;/span&gt;&lt;/","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101027"},"PeriodicalIF":7.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403504","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":"Hospitalizations for all-cause pediatric acute respiratory diseases in Alberta, Canada, before, during, and after the COVID-19 pandemic: a population-level retrospective cohort study from 2010 to 2024","authors":"Christine D. Lukac ,&nbsp;Brett Simms ,&nbsp;Grace P.S. Kwong ,&nbsp;Jessalyn K. Holodinsky ,&nbsp;David W. Johnson ,&nbsp;James D. Kellner","doi":"10.1016/j.lana.2025.101024","DOIUrl":"10.1016/j.lana.2025.101024","url":null,"abstract":"<div><h3>Background</h3><div>This population-level retrospective cohort study measured seasonal patterns of pediatric hospitalizations, pediatric intensive care unit (PICU) admissions, and average age of children diagnosed with acute respiratory diseases (ARD) during pre-pandemic, COVID-19 pandemic, and late/post-pandemic periods.</div></div><div><h3>Methods</h3><div>From September 2010 through August 2024, all hospitalizations for ARD among children &lt;18 years old were identified from the provincial Discharge Abstract Database, in Alberta, Canada. Seasonal autoregressive integrated moving average (SARIMA) models were developed based on pre-pandemic trends and predicted expected weekly outcomes with 95% confidence intervals (95% CI) from March 2020 onward. Observed and expected outcomes with 95% CI were compared to measure impacts during peak seasons.</div></div><div><h3>Findings</h3><div>There were 52,839 ARD hospitalizations: 16,003 (30.29%) bronchiolitis, 7958 (15.06%) influenza-like illness, 14,366 (27.19%) pneumonia, 2989 (5.66%) croup, 10,266 (19.43%) asthma exacerbation, and 1257 (2.38%) COVID-19. Further, 4433 (8.39%) hospitalizations included a PICU admission. During the pre-pandemic period, hospitalizations for ARD had a biennial pattern, where the peak incidence was highest every other winter season. During the pandemic and late/post-pandemic periods, the average weekly incidence of hospitalization for ARD/100,000 children decreased 91.25% during winter 2020–2021 (1.03 observed vs. 11.81 [95% CI 7.30, 16.33] expected), increased 47.98% during winter 2022–2023 (18.06 observed vs. 12.20 [95% CI 7.06, 17.34] expected), and returned near pre-pandemic incidence during winter 2023–2024 (12.87 observed vs. 11.87 [95% CI 6.08, 17.67] expected) compared with incidence predicted by the SARIMA model. During winter 2022–2023 when hospitalizations surged, there was no significant change in the average weekly incidence of PICU admissions for ARD/100,000 children (2.07 observed vs. 1.26 [95% CI 0.26, 2.27] expected), nor percent PICU admissions (10.21% observed vs. 10.11% [95% CI 5.50, 14.73] expected), nor in average age (31.95 months observed vs. 34.20 months [95% CI 25.89, 42.52] expected).</div></div><div><h3>Interpretation</h3><div>Hospitalizations for pediatric ARD decreased dramatically during winter 2020–2021, surged during winter 2022–2023, and returned near pre-pandemic incidence during winter 2023–2024. There was no lasting change in PICU admissions nor average age. Ongoing surveillance will describe the evolving seasonal pattern of ARD during the post-pandemic period.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101024"},"PeriodicalIF":7.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395645","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":"Quality of care in Colombian women with early-onset breast cancer in two time periods: findings from a nationwide administrative registry cohort","authors":"Ana Maria Valbuena-Garcia ,&nbsp;Silvia Juliana Trujillo-Cáceres ,&nbsp;Juliana Alexandra Hernández Vargas ,&nbsp;Sandra Diaz ,&nbsp;Lizbeth Acuña ,&nbsp;Sandra Perdomo ,&nbsp;Marion Piñeros","doi":"10.1016/j.lana.2025.101018","DOIUrl":"10.1016/j.lana.2025.101018","url":null,"abstract":"<div><h3>Background</h3><div>Early-onset breast cancer (EOBC) refers to breast cancer diagnosed in women aged 18–45 years, being in many cases associated with hereditary breast cancer syndromes, diagnosed at more advanced stages and worse prognosis. In this paper, we sought to describe the main characteristics of EOBC and quality of care within the framework of the national health system in Colombia.</div></div><div><h3>Methods</h3><div>Cross-sectional study. We used a national administrative cancer registry, including women diagnosed with EOBC between 2017 and 2022. Demographic and clinical characteristics, as well as quality healthcare indicators, were compared (numbers and percentages) over two periods (2017–2019, 2020–2022), stratified by health insurance scheme.</div></div><div><h3>Findings</h3><div>7621 women with incident EOBC were included, constituting 19.4% (7621/39,238) of all breast cancers reported in the study period. The mean age was 39.2 (SD 5.2). Most of the cases (23% [1753/7621]) were diagnosed at stage IIA. Systemic therapy was the most frequent first treatment. When comparing both periods, the main areas of improvement were related to breast-conserving surgery for early stages (from 60.3% [459/761] to 68.3% [699/1024]), access to palliative care for metastatic cancer (from 29.5% [59/199] to 54.9% [101/184]), and reduction of waiting times. The time from collecting biopsy samples to receiving results showed the biggest improvement between periods (from a mean of 24.5 to 5.0 days). However, delays in initiating treatment persist, with an average of over two months.</div></div><div><h3>Interpretation</h3><div>While the quality of breast cancer care in women with EOBC has improved in recent years in Colombia, mainly due to better access to specific technologies and treatments, there are important challenges regarding early detection and health services delays that require corrective measures.</div></div><div><h3>Funding</h3><div>Work at the IARC/WHO was supported by regular budget funding.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101018"},"PeriodicalIF":7.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394408","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":"Machine learning to predict dementia for American Indian and Alaska native peoples: a retrospective cohort study","authors":"Kayleen Ports ,&nbsp;Jiahui Dai ,&nbsp;Kyle Conniff ,&nbsp;Maria M. Corrada ,&nbsp;Spero M. Manson ,&nbsp;Joan O’Connell ,&nbsp;Luohua Jiang","doi":"10.1016/j.lana.2025.101013","DOIUrl":"10.1016/j.lana.2025.101013","url":null,"abstract":"<div><h3>Background</h3><div>Dementia is an increasing concern among American Indian and Alaska Native (AI/AN) communities, yet machine learning models utilizing electronic health record (EHR) data have not been developed or validated for this population. This study aimed to develop a two-year dementia risk prediction model for AI/AN individuals actively using Indian Health Service (IHS) and Tribal health services.</div></div><div><h3>Methods</h3><div>Seven years of data were obtained from the IHS National Data Warehouse and related EHR databases and divided into a five-year baseline period (FY2007–2011) and a two-year dementia prediction period (FY2012–2013). Four algorithms were assessed: logistic regression, Least Absolute Shrinkage and Selection Operator (LASSO), random forest, and eXtreme Gradient Boosting (XGBoost). Dementia Risk Score (DRS)-based and extended models were developed for each algorithm, with performance evaluated by the area under the receiver operating characteristic curve (AUC).</div></div><div><h3>Findings</h3><div>The study cohort included 17,398 AI/AN adults aged ≥ 65 years who were dementia-free at baseline, of whom 59.8% were female. Over the two-year follow-up, 611 individuals (3.5%) were diagnosed with incident dementia. Extended models for logistic regression, LASSO, and XGBoost performed comparably: AUCs (95% CI) of 0.83 (0.79, 0.86), 0.83 (0.79, 0.86), and 0.82 (0.79, 0.86). These top-performing models shared 12 of the 15 highest-ranked predictors, with novel predictors including service utilization.</div></div><div><h3>Interpretation</h3><div>Machine learning algorithms utilizing EHR data can effectively predict two-year dementia risk among AI/AN older adults. These models could aid IHS and Tribal health clinicians in identifying high-risk individuals, facilitating timely interventions and improved care coordination.</div></div><div><h3>Funding</h3><div><span>NIH</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101013"},"PeriodicalIF":7.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402900","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":"Impact of conditional cash transfer programs on health outcomes in Argentina: a retrospective, observational analysis based on MICS 2019/2020","authors":"Zlatko Nikoloski ,&nbsp;Maria Elisa Zapata ,&nbsp;Elias Mossialos","doi":"10.1016/j.lana.2025.101011","DOIUrl":"10.1016/j.lana.2025.101011","url":null,"abstract":"<div><h3>Background</h3><div>Conditional cash transfers (CCTs) are widely used to combat intergenerational poverty and to invest in human capital. Argentina introduced its own CCT program AUH (<em>Asignación Universal por Hijo</em>) in 2009. The aim of this research was to assess the relationship between the AUH program and key indicators: healthcare use, nutritional indicators (among children under five years), and high school enrollment.</div></div><div><h3>Methods</h3><div>We utilized data from the Multiple Indicators Cluster Survey (MICS) conducted in Argentina between late 2019 and early 2020. Specifically, we employed different matching techniques to estimate the relationship between AUH and healthcare utilization and high school enrolment. Additionally, we assessed the program's importance in improving nutrition outcomes among children under five years.</div></div><div><h3>Findings</h3><div>Our analysis reveals that the AUH program has not significantly increased healthcare utilization among affiliated children. When accounting for program heterogeneity, the impact of the program was found to be consistent across boys and girls, and across children of different ages, although we found evidence of increased healthcare utilization among adolescents. In addition, there was no statistically significant evidence for a link between program affiliation and reduction in stunting and wasting among children under five years. Furthermore, the program has led to increased high school enrolment among boys, consistent with established findings.</div></div><div><h3>Interpretation</h3><div>The AUH program demonstrates a limited impact, particularly on health and nutrition outcome indicators. Efforts should be made to improve the program by focusing on cash transfer conditionality and amount, as well as strengthening healthcare infrastructure.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101011"},"PeriodicalIF":7.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394409","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":"Directly observed treatment for tuberculosis care and social support: essential lifeline or outdated burden?","authors":"Beatriz Barreto-Duarte ,&nbsp;Klauss Villalva-Serra ,&nbsp;Julio Croda ,&nbsp;Ricardo A. Arcêncio ,&nbsp;Ethel L.N. Maciel ,&nbsp;Bruno B. Andrade","doi":"10.1016/j.lana.2025.101015","DOIUrl":"10.1016/j.lana.2025.101015","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101015"},"PeriodicalIF":7.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394500","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}