Lancet Regional Health-Americas最新文献

{"title":"Enhancing the response to avian influenza in the US and globally","authors":"Maggie L. Bartlett ,&nbsp;Peter Palese ,&nbsp;Meghan F. Davis ,&nbsp;Sten H. Vermund ,&nbsp;Christian Bréchot ,&nbsp;Jared D. Evans ,&nbsp;Lauren M. Sauer ,&nbsp;Albert Osterhaus ,&nbsp;Andrew Pekosz ,&nbsp;Martha Nelson ,&nbsp;Elyse Stachler ,&nbsp;Florian Krammer ,&nbsp;Gage Moreno ,&nbsp;Gene Olinger ,&nbsp;Marion Koopmans","doi":"10.1016/j.lana.2025.101100","DOIUrl":"10.1016/j.lana.2025.101100","url":null,"abstract":"<div><div>The recent emergence of highly pathogenic H5N1 avian influenza virus infections in dairy cows and humans in the U.S. has raised alarms regarding the potential for a pandemic. Over 995 dairy cow herds and at least 70 humans have been affected, including cases of severe disease and the first reported H5N1-related death in the U.S. Sporadic human infections with no known contact with infected animals highlight the possibility of viral adaptation for efficient human-to-human transmission. Concurrently, the virus continues to circulate in wild birds, backyard flocks, and hunted migratory species, further amplifying the risk to humans and domestic animals. This article provides an overview of the current outbreak status, emphasizes the importance of robust surveillance systems to detect emerging strains with pandemic potential, and highlights risks to the U.S. dairy and poultry industries. Recommendations for risk mitigation include enhanced biosecurity measures, improved surveillance, decentralized testing, and targeted public health messaging. The Global Virus Network calls for urgent, proactive measures to prevent widespread outbreaks, leveraging lessons learned from prior pandemics. These measures include targeted vaccination, improved communication strategies to combat vaccine hesitancy, and the incorporation of social sciences to address barriers to public health interventions.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101100"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270257","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":"On the brink: H5N1 and the risk to human health","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101150","DOIUrl":"10.1016/j.lana.2025.101150","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101150"},"PeriodicalIF":7.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270256","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":"Automated classification of oral potentially malignant disorders and oral squamous cell carcinoma using a convolutional neural network framework: a cross-sectional study","authors":"Cristina Saldivia-Siracusa ,&nbsp;Eduardo Santos Carlos de Souza ,&nbsp;Arnaldo Vitor Barros da Silva ,&nbsp;Anna Luíza Damaceno Araújo ,&nbsp;Caíque Mariano Pedroso ,&nbsp;Tarcília Aparecida da Silva ,&nbsp;Maria Sissa Pereira Sant'Ana ,&nbsp;Felipe Paiva Fonseca ,&nbsp;Hélder Antônio Rebelo Pontes ,&nbsp;Marcos G. Quiles ,&nbsp;Marcio Ajudarte Lopes ,&nbsp;Pablo Agustin Vargas ,&nbsp;Syed Ali Khurram ,&nbsp;Alexander T. Pearson ,&nbsp;Mark W. Lingen ,&nbsp;Luiz Paulo Kowalski ,&nbsp;Keith D. Hunter ,&nbsp;André Carlos Ponce de Leon Ferreira de Carvalho ,&nbsp;Alan Roger Santos-Silva","doi":"10.1016/j.lana.2025.101138","DOIUrl":"10.1016/j.lana.2025.101138","url":null,"abstract":"<div><h3>Background</h3><div>Artificial Intelligence (AI) models hold promise as useful tools in healthcare practice. We aimed to develop and assess AI models for automatic classification of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) clinical images through a Deep Learning (DL) approach, and to explore explainability using Gradient-weighted Class Activation Mapping (Grad-CAM).</div></div><div><h3>Methods</h3><div>This study assessed a dataset of 778 clinical images of OPMD and OSCC, divided into training, model optimization, and internal testing subsets with an 8:1:1 proportion. Transfer learning strategies were applied to pre-train 8 convolutional neural networks (CNN). Performance was evaluated by mean accuracy, precision, recall, specificity, F1-score and area under the receiver operating characteristic (AUROC) values. Grad-CAM qualitative appraisal was performed to assess explainability.</div></div><div><h3>Findings</h3><div>ConvNeXt and MobileNet CNNs showed the best performance. Transfer learning strategies enhanced performance for both algorithms, and the greatest model achieved mean accuracy, precision, recall, F1-score and AUROC of 0.799, 0.837, 0.756, 0.794 and 0.863 during internal testing, respectively. MobileNet displayed the lowest computational cost. Grad-CAM analysis demonstrated discrepancies between the best-performing model and the highest explainability model.</div></div><div><h3>Interpretation</h3><div>ConvNeXt and MobileNet DL models accurately distinguished OSCC from OPMD in clinical photographs taken with different types of image-capture devices. Grad-CAM proved to be an outstanding tool to improve performance interpretation. Obtained results suggest that the adoption of DL models in healthcare could aid in diagnostic assistance and decision-making during clinical practice.</div></div><div><h3>Funding</h3><div>This work was supported by <span>FAPESP</span> (2022/13069-8, 2022/07276-0, 2021/14585-7 and 2024/20694-1), <span>CAPES</span>, <span>CNPq</span> (307604/2023-3) and <span>FAPEMIG</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101138"},"PeriodicalIF":7.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167426","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":"Prenatal Chagas disease screening in Latin America: the current policy landscape and potential utility of an expanded maternal-familial Trypanosoma cruzi testing framework","authors":"Mary K. Lynn ,&nbsp;Marvin Stanley Rodríguez Aquino ,&nbsp;Carlos Alberto Buendía Rivas ,&nbsp;Amaury Morales Landrove ,&nbsp;Alexandra Manoella Portillo de Juarez ,&nbsp;Roberto Aguila Cerón ,&nbsp;Diana García López ,&nbsp;Melissa S. Nolan","doi":"10.1016/j.lana.2025.101139","DOIUrl":"10.1016/j.lana.2025.101139","url":null,"abstract":"<div><div>In 2018, revised World Health Organization guidance moved toward eliminating congenital Chagas disease (<em>Trypanosoma cruzi</em>)—a traditionally vector-borne parasitic disease that can chronically infect persons and be vertically transmitted from untreated mothers to their fetuses during pregnancy. Several endemic countries have since adopted risk-based or universal prenatal screening policies with high variation among strategies, implementation, coverage, and reporting. This article describes a collaborative investigation between researchers and the Salvadoran Ministry of Health, where expanded infant and family follow-up testing was executed after mothers tested <em>T. cruzi</em> positive during parturition. In this pilot study, we found 16% (n = 5/32) of familial members tested positive for previously undiagnosed infection. This manuscript highlights lessons learned from a familial follow-up testing initiative, provides rationale in support of expanding the maternal-familial <em>T. cruzi</em> screening framework in endemic countries, and describes updates on international progress towards implementation of prenatal screening as indicated by updated World Health Organization guidance.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101139"},"PeriodicalIF":7.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139721","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":"Ethnic disparities in the association between maternal socioeconomic status and childhood anemia in Peru: a nationwide multiyear cross-sectional study","authors":"Ali Al-kassab-Córdova ,&nbsp;Claudio Intimayta-Escalante ,&nbsp;Pamela Robles-Valcarcel ,&nbsp;Diego Urrunaga-Pastor ,&nbsp;Baltica Cabieses","doi":"10.1016/j.lana.2025.101117","DOIUrl":"10.1016/j.lana.2025.101117","url":null,"abstract":"<div><h3>Background</h3><div>Maternal socioeconomic status (SES) is closely linked to children's health outcomes. However, the marginalization-related diminished returns theory suggests that increases in SES yield smaller health gains for marginalized populations—such as Afro-Peruvian and Indigenous groups—compared to majority groups like Mestizos, largely due to systemic barriers and social disadvantage. Therefore, the current study aimed to explore ethnic disparities in the association between maternal SES on childhood anemia in Peru.</div></div><div><h3>Methods</h3><div>Using data from the 2017 to 2023 Peruvian Demographic and Health Survey, we conducted a cross-sectional study including children aged 6–59 months with their respective mothers. Ethnicity was grouped into Mestizo, Afro-Peruvian, and Indigenous (Quechua, Aimara, and native of the Amazon). Three proxies of SES were used: wealth index, level of education, and years of education. After stratifying by ethnicity, we estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using generalized linear models with <em>Poisson</em> family. Interaction was assessed on multiplicative and additive scales.</div></div><div><h3>Findings</h3><div>Among 234,364 Peruvian mothers, 45.7% (n = 107,118) identified as Mestizo, 12.6% (n = 29,557) as Afro-Peruvian, and 41.7% (n = 97,689) as Indigenous. The overall prevalence of anemia in children was 32.2%. The association between a very rich wealth index and lower prevalence of anemia was weaker among Indigenous (PR = 0.63, 95% CI: 0.56–0.72) compared to Mestizo individuals (PR = 0.46, 95% CI: 0.42–0.50). Similarly, the association between higher maternal education and lower anemia prevalence was less pronounced for Afro-Peruvian (PR = 0.70, 95% CI: 0.62–0.79) and Indigenous groups (PR = 0.81, 95% CI: 0.77–0.86) than for Mestizos (PR = 0.63, 95%CI: 0.59–0.67). A similar pattern was noted with maternal years of education (Mestizos [PR = 0.95, 95% CI: 0.94–0.96], Afro-Peruvian [PR = 0.97, 95% CI: 0.96–0.98], and Indigenous [PR = 0.98, 95% CI: 0.98–0.99]). Interaction analysis confirmed significantly weaker associations for Afro-Peruvian and Indigenous individuals compared to Mestizos.</div></div><div><h3>Interpretation</h3><div>Maternal SES is associated with lower prevalence of childhood anemia, with stronger associations observed among Mestizo populations compared to Afro-Peruvian and Indigenous groups. This pattern aligns with the marginalization-related diminished returns theory. Maximizing SES alone does not preclude ethnic disparities but rather, may even widen them, highlighting the need for equity-focused interventions that address underlying structural and systemic barriers.</div></div><div><h3>Funding</h3><div>Self-funded.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101117"},"PeriodicalIF":7.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115185","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":"Considering possible drivers of the recent decrease in drug overdose deaths in Canada","authors":"Benedikt Fischer ,&nbsp;Wayne Hall ,&nbsp;Didier Jutras-Aswad ,&nbsp;Bernard Le Foll","doi":"10.1016/j.lana.2025.101141","DOIUrl":"10.1016/j.lana.2025.101141","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101141"},"PeriodicalIF":7.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115357","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":"Including louse-borne Bartonella quintana as a nationally notifiable disease: a step towards health equity","authors":"Carl Boodman ,&nbsp;David L. Heymann ,&nbsp;Heather Coatsworth","doi":"10.1016/j.lana.2025.101137","DOIUrl":"10.1016/j.lana.2025.101137","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101137"},"PeriodicalIF":7.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115358","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":"Early-life mortality rates in Brazil and progress toward meeting related sustainable development goals: a nationwide population study","authors":"Aline de Siqueira Alves Lopes ,&nbsp;Emmanuelle Lira Cariry ,&nbsp;Débora Fontes Leite ,&nbsp;Lucas Barbosa de Santana ,&nbsp;José Rodrigo Santos Silva ,&nbsp;Victor Santana Santos ,&nbsp;Ricardo Queiroz Gurgel","doi":"10.1016/j.lana.2025.101133","DOIUrl":"10.1016/j.lana.2025.101133","url":null,"abstract":"<div><h3>Background</h3><div>Early-life mortality rates have significantly declined since 2000, and sustaining this progress could save over 11 million children's lives worldwide. Achieving uniform reductions in early-life mortality remains a critical public health challenge in Brazil. This study analyzed disaggregated trends in early-life mortality across Brazilian regions and assessed each region's progress toward meeting the Sustainable Development Goals (SDGs) and national targets for Brazil.</div></div><div><h3>Methods</h3><div>This is a population-based analytical and ecological study. We analyzed data from official government information systems for Brazilian regions and states over five consecutive five-year periods between 1998 and 2022. The SDG targets considered were: an under-five mortality rate (U5MR) of 25 per 1000 live births, a neonatal mortality rate (NMR) of 12.0 per 1000 live births, and an infant mortality rate (IMR) of 15.7 per 1000 live births. Brazil's adjusted national targets were: U5MR of 8.3, NMR of 5.3, and IMR of 7.7 per 1000 live births, respectively. We calculated the absolute annual change (AAC) in mortality rates for each five-year interval to assess trends and infer the likelihood of meeting the 2030 targets.</div></div><div><h3>Findings</h3><div>Between 1998 and 2022, U5MR in Brazil declined by 54%, from 32.5 to 15.1 deaths per 1000 live births. The national average met the SDG targets for all age strata, but no state achieved the stricter IPEA targets. From 2018 to 2022, under-five and infant mortality rates showed annual increases (AAC = +0.22 and + 0.10, respectively), while neonatal mortality remained stable (AAC = −0.02). Regional disparities persisted. In 2022, Santa Catarina (South region) had the lowest U5MR (11.5 deaths per 1000 live births), while Roraima (North region) had the highest (24.6 deaths per 1000 live births). Although most states are projected to meet the SDG targets for U5MR by 2030, none are on track to meet the IPEA goals.</div></div><div><h3>Interpretation</h3><div>Despite national progress in meeting SDG targets for early-life mortality, recent increases in under-five and infant deaths and enduring regional inequalities threaten future gains. Sustained improvements will require focused, region-specific strategies to address the social and health determinants driving these disparities.</div></div><div><h3>Funding</h3><div>This research received no specific grant from any funding agency.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101133"},"PeriodicalIF":7.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107688","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 an urban cable car intervention on quality of life: an observational, quasi-experimental study in Bogotá, Colombia (TrUST)","authors":"Laura Baldovino-Chiquillo ,&nbsp;Olga L. Sarmiento ,&nbsp;Donny S. Pasos ,&nbsp;Leonardo Palencia-Pérez ,&nbsp;Gary O'Donovan ,&nbsp;Victor Cantillo-Garcia ,&nbsp;Lina Martínez ,&nbsp;Julian Arellana ,&nbsp;Luis A. Guzman","doi":"10.1016/j.lana.2025.101126","DOIUrl":"10.1016/j.lana.2025.101126","url":null,"abstract":"<div><h3>Background</h3><div>There is little evidence about the relationships between transport interventions and quality of life in low-income settlements in Global South cities. The aim was to assess the effects of the TransMiCable cable car intervention on quality of life in males and females in a low-income settlement in Bogotá, Colombia.</div></div><div><h3>Methods</h3><div>The Urban Transformations and Health (TrUST) natural experiment was conducted between 2018 and 2020 in intervention and control neighbourhoods. Overall quality of life, general health, and specific domains of quality of life were assessed in adults before and after the implementation of the TransMiCable using the World Health Organization's quality of life brief questionnaire. Adjusted multilevel linear regression models were used to estimate the effects on outcomes.</div></div><div><h3>Findings</h3><div>Before the inauguration of TransMiCable, 2052 participants (1289 [62.8%] females and 763 [37.2%] males; mean age 43.5 years [SD 17.7]) completed the questionnaire. Analyses included 825 participants in the intervention group (80% of the baseline sample) and 854 participants in the control group (84% of the baseline sample) who completed the follow-up. Among females in the intervention area, there was an increase in quality of life (adjusted β for the time-by-group interaction, intervention <em>vs.</em> control: 5.81 points [95% CI: 2.47, 9.14]), and general health (adjusted β for the time-by-group interaction: 5.49 points [2.07, 8.92). Among males, quality of life and general health changes were not different in the intervention and control groups.</div></div><div><h3>Interpretation</h3><div>Transport interventions, such as TransMiCable, could have meaningful impacts on the quality of life of women in low-income areas, promoting the achievement of sustainable development goals and improving well-being. A community-based, multisectoral approach is essential to designing integrated mobility policies that reflect the diverse needs of urban communities in the Global South.</div></div><div><h3>Funding</h3><div><span>Wellcome Trust</span> (as part of the Urban Health in Latin America project); <span>Bogotá Urban Planning Department</span>; <span>Ministry of Science, Technology, and Innovation of Colombia</span>; <span>Universidad de Los Andes</span>; <span>Fundación Santa Fe de Bogotá</span>; and <span>Universidad del Norte</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101126"},"PeriodicalIF":7.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084224","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":"Racial/ethnic disparities in pediatric community-acquired pneumonia: addressing the overlooked role of airway morphology","authors":"Alexander N. Ishmatov,&nbsp;Larisa N. Gorina","doi":"10.1016/j.lana.2025.101125","DOIUrl":"10.1016/j.lana.2025.101125","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101125"},"PeriodicalIF":7.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069642","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}