Lancet Regional Health-Americas最新文献

{"title":"Inclusion of incarcerated individuals in wildfire exposure registries","authors":"Lawrence A. Haber , Katherine LeMasters , Justin Berk","doi":"10.1016/j.lana.2025.101354","DOIUrl":"10.1016/j.lana.2025.101354","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101354"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885803","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":"Associations between state-level abortion restrictions and postpartum depression symptoms from a United States nationwide cohort","authors":"Maetal E. Haas-Kogan ,&nbsp;Andrea Pelletier ,&nbsp;Amanda Koire ,&nbsp;Primavera A. Spagnolo ,&nbsp;Deborah Bartz","doi":"10.1016/j.lana.2026.101410","DOIUrl":"10.1016/j.lana.2026.101410","url":null,"abstract":"<div><h3>Background</h3><div>U.S. maternal mortality rates have more than doubled over the last two decades, with maternal mental health conditions being significant contributors. Concurrently, the adoption of U.S. state-level restrictions on abortion access have also increased. We aimed to examine the association between the number of state-level abortion restrictions and postpartum depression symptoms in a U.S. nationwide cohort.</div></div><div><h3>Methods</h3><div>This retrospective cohort study compared state-level abortion restriction policy data from the Guttmacher Institute from each preceding year (2016–2021) to rates of postpartum depression symptoms collected from the nationally representative Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2017–2022) dataset. PRAMS participants were randomly selected from 41 participating states’ birth registries, representing 30·4% of U.S. live births. The primary outcome was postpartum depression symptoms, assessed using validated screening questions. Secondary outcomes included demographic and clinical predictors of postpartum depression. Variables found to be significant on bivariate analysis were included in the logistic multivariable model. People with lived experience were involved in the design, analysis, and interpretation of this study.</div></div><div><h3>Findings</h3><div>The sample included 201,770 respondents, weighted to represent 5·65 million individuals. The mean age was 29·7 years, with 72·6% identifying as White and 57·9% having private insurance. Higher numbers of state-level abortion restrictions were associated with increased odds of postpartum depression symptoms (OR = 1·02, 95% CI [1·01, 1·03], p = 0·001), particularly among those relying on public insurance (OR = 1·02, 95% CI [1·01–1·04], p = 0·002). This association was particularly pronounced among racial and ethnic minorities, individuals with a history of depression, and those with lower levels of education or income who gave birth in high-restriction states.</div></div><div><h3>Interpretation</h3><div>The adoption of more abortion restrictions is linked to higher prevalence of postpartum depression symptoms, especially for those with public insurance. These findings show that restricted abortion has detrimental effects on perinatal mental health, highlighting the need for policy reforms.</div></div><div><h3>Funding</h3><div>No funding was provided for this study, funding from Brigham and Women's Hospital, <span>Mary Horrigan Connors Center for Women's Health Research</span> was provided for journal editorial processing fees.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101410"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327404","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":"Advancing real-world evidence in Brazil: regulatory gaps and global lessons","authors":"Nélio Cézar de Aquino ,&nbsp;Cadiele Oliana Reichert ,&nbsp;Luis Alberto de Padua Covas Lage ,&nbsp;Hebert Fabricio Culler ,&nbsp;Felipe Santa Rosa Roitberg ,&nbsp;Vanderson Rocha ,&nbsp;Flávia Neves Rocha Alves ,&nbsp;Juliana Pereira","doi":"10.1016/j.lana.2025.101344","DOIUrl":"10.1016/j.lana.2025.101344","url":null,"abstract":"<div><div>Regulatory agencies are increasingly incorporating real-world data (RWD) and real-world evidence (RWE) into decision-making frameworks to complement randomized clinical trials. While some regions, such as the U.S. and EU, have developed structured approaches for RWE use, Brazil's regulatory environment remains comparatively limited. This study examines the status of RWE regulatory integration in Brazil through an analysis of normative documents, institutional publications, and selected case studies, using a comparative policy perspective. Although advances have been made in data standardization and the publication of technical guidelines, such as ANVISA's Guidance No. 64/2023, the practical use of RWE in regulatory processes is still nascent. Key challenges include fragmented data infrastructure, and limited intersectoral coordination. Addressing these gaps will require improved interoperability across health information systems, convergence of methodological standards, and sustained collaboration among regulatory authorities, academia, and data holders to enable consistent and scientifically robust use of RWE in the Brazilian context and, potentially, in other low- and middle-income countries.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101344"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792268","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 Latin American Diabetes Association 2025 congress","authors":"Orison O. Woolcott","doi":"10.1016/j.lana.2026.101378","DOIUrl":"10.1016/j.lana.2026.101378","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101378"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077821","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":"Disparities in primary Cesarean birth by sexual orientation: a population-based analysis across three longitudinal cohorts","authors":"Sarah McKetta ,&nbsp;Kodiak R.S. Soled ,&nbsp;Payal Chakraborty ,&nbsp;Colleen A. Reynolds ,&nbsp;Bethany G. Everett ,&nbsp;Daphna Stroumsa ,&nbsp;Sebastien Haneuse ,&nbsp;S. Bryn Austin ,&nbsp;Jorge E. Chavarro ,&nbsp;A. Heather Eliassen ,&nbsp;Aimee K. Huang ,&nbsp;Brittany M. Charlton","doi":"10.1016/j.lana.2025.101325","DOIUrl":"10.1016/j.lana.2025.101325","url":null,"abstract":"<div><h3>Background</h3><div>The study aim was to quantify differences in risk for Cesarean birth vary by sexual orientation.</div></div><div><h3>Methods</h3><div>We pooled data from singleton, live births in the Nurses’ Health Studies 2 and 3, and the Growing Up Today Study (N = 102,298 pregnancies). We used generalized estimating equations to fit logistic models for risks of primary Cesarean birth comparing sexual minority (SM) to completely heterosexual participants, controlling for year and age. SM participants were further stratified into heterosexual with prior same-sex experience (i.e., identifying as heterosexual, but with same-sex attractions, behaviors, or prior SM identity), mostly heterosexual, bisexual, and lesbian/gay subgroups. We examined heterogeneity by parity, labor induction, and racialized identity.</div></div><div><h3>Findings</h3><div>SM participants had higher risks of primary Cesarean birth than their completely heterosexual peers (adjusted odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.01–1.12), with increases most pronounced among pregnancies to heterosexual participants with prior same-sex experience (OR = 1.12, 95% CI 1.04–1.20). Labor induction was associated with a higher magnitude disparity (OR for induced labor = 1.21, 95% CI 1.09–1.35; OR for spontaneous labor = 0.91, 95% CI 0.83–1.01; p-value for interaction = 0.09). Racialized identity or parity did not moderate sexual orientation-related disparities in primary Cesarean birth.</div></div><div><h3>Interpretation</h3><div>SM people have increased risks for primary Cesarean birth, but these vary across sexual orientation subgroups. We found increased risks for a rarely studied subgroup of sexual minority people, those who identify as heterosexual but have prior same-sex experience. These disparities are most pronounced when labor is induced. All participants were assumed to be women based on surveys querying sex and birth histories, but we were limited in generalizability due to not knowing their gender identities.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span> (United States).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101325"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683869","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":"Advancing maternal and child health and nutrition in Ecuador: a call for research","authors":"Taissa Vila,&nbsp;Orison O. Woolcott","doi":"10.1016/j.lana.2026.101377","DOIUrl":"10.1016/j.lana.2026.101377","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101377"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976914","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":"Disparities in prostate cancer outcomes between First Nations and Non-First Nations men in Canada—Cohort study","authors":"Patrick Albers ,&nbsp;Khalid Amin ,&nbsp;Stacey Broomfield ,&nbsp;Janis Geary ,&nbsp;Joy Pader ,&nbsp;Angeline Letendre ,&nbsp;Wayne Clark ,&nbsp;Amy Colquhoun ,&nbsp;Lea Bill ,&nbsp;Adam Kinnaird","doi":"10.1016/j.lana.2025.101331","DOIUrl":"10.1016/j.lana.2025.101331","url":null,"abstract":"<div><h3>Background</h3><div>First Nations men in Canada, one of the three distinct Indigenous groups along with Inuit and Métis, have been reported to present with more aggressive prostate cancers than non-First Nations men. However, the long-term impact on prostate cancer-specific survival remains unclear. This study examines disparities in prostate cancer outcomes between First Nations and non-First Nations men in Alberta.</div></div><div><h3>Methods</h3><div>Data from the Alberta Cancer Registry (1995–2022) were analyzed for all men aged 18 and above diagnosed with prostate cancer. First Nations status was determined using the Alberta Health Care Insurance Plan registry. The primary outcome was age-standardized prostate cancer mortality; secondary outcomes included age at death and prostate cancer-specific survival. Statistical analyses included t-tests, Chi-squared tests, Kaplan–Meier survival curves, log-rank tests, and Cox proportional hazards models. Data on socioeconomic deprivation were not available, and analyses could not be adjusted for this potential confounder.</div></div><div><h3>Findings</h3><div>The dataset comprised 1,323,333 person-years for First Nations men and 37,820,148 for non-First Nations men. First Nations men were diagnosed younger (65.8 vs. 67.8 years, p &lt; 0.0001) and died earlier (74.4 vs. 78.9 years, p &lt; 0.0001) across both rural and urban settings. Age-adjusted prostate cancer mortality was higher (41.5 vs. 30.1 per 100,000, p &lt; 0.0001), and Stage IV disease was more common (17.8% vs. 12.2%, p &lt; 0.0001). Prostate cancer-specific survival was worse (HR 1.67, 95% CI 1.43–1.96, p &lt; 0.0001). After adjusting for age, stage, location, and number of malignancies, overall survival was similar (HR 1.06, 95% CI 0.57–1.89, p = 0.84).</div></div><div><h3>Interpretation</h3><div>First Nations men in Alberta are diagnosed with prostate cancer at a younger age and later stage, leading to higher overall mortality. After adjustment, disease-specific survival is similar to non-First Nations men. These findings indicate disparities may arise from delayed diagnosis, underscoring the need for culturally safe, community-informed initiatives promoting earlier presentation and detection.</div></div><div><h3>Funding</h3><div><span>Movember</span>, <span>Alberta Cancer Foundation</span>, <span>Bird Dogs</span>, <span>University Hospital Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101331"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272037","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":"Waist-to-height ratio and cardiovascular risk: moving beyond BMI in aging populations","authors":"Juan C. Pineda,&nbsp;Diana M. Montano,&nbsp;Liesed N. Urbano","doi":"10.1016/j.lana.2025.101349","DOIUrl":"10.1016/j.lana.2025.101349","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101349"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840105","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 and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Isobel M.F. Todd ,&nbsp;David P. Burgner ,&nbsp;Maria C. Magnus ,&nbsp;Lars Henning Pedersen ,&nbsp;Jessica E. Miller","doi":"10.1016/j.lana.2025.101368","DOIUrl":"10.1016/j.lana.2025.101368","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101368"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925433","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 utilisation across five years among adolescents following metabolic-bariatric surgery; a prospective observational study","authors":"Andrew J. Beamish ,&nbsp;Todd Jenkins ,&nbsp;Justin R. Ryder ,&nbsp;Anita Courcoulas ,&nbsp;Robert M. Dorman ,&nbsp;Marc Michalsky ,&nbsp;Carrol Harmon ,&nbsp;Michael Helmrath ,&nbsp;Thomas H. Inge","doi":"10.1016/j.lana.2025.101332","DOIUrl":"10.1016/j.lana.2025.101332","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic and bariatric surgery (MBS) is an effective treatment for adolescent severe obesity. Little is known about subsequent healthcare utilisation for individuals who have undergone MBS as adolescents, both related and unrelated to the surgical intervention. This study aimed to document healthcare utilisation events across 5 years after MBS, comparing procedure types and evaluating factors associated with these events.</div></div><div><h3>Methods</h3><div>The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study prospectively enrolled 228 adolescents prior to MBS (Roux-en-Y gastric bypass or vertical sleeve gastrectomy) across 5 US children's hospitals. Healthcare utilisation event data collection was standardised, and rigorously collected; events were categorised by system and classified as related or unrelated to the MBS intervention. Factors influencing/predicting the likelihood of healthcare utilisation events were evaluated using negative binomial regression modelling.</div></div><div><h3>Findings</h3><div>Mean baseline age and body mass index (BMI) of participants at surgery were 17 ± 1·6 years and 53 kg/m², respectively. Related healthcare utilisation events numbered 141 in 81 participants (67·3 per 500 person-years, 95% CI 53·4–84·9). A total of 224 unrelated healthcare utilisation events unrelated occurred in 112 individuals (107·4 per 500 person-years, 95% CI 94·2–122·5). Over 5 years, participants with a complication within 30 days of surgery had significantly higher rates of subsequent healthcare utilisation events. No difference in rates by surgical procedures was observed for related events or events with hospital admission. However, among participants without baseline type 2 diabetes, vertical sleeve gastrectomy was associated with higher rates of unrelated events compared to Roux-en-Y gastric bypass. Fifty-two percent of events involved admission to hospital, with no difference by procedure, but higher admission rates were observed with higher BMI and hypertension at baseline.</div></div><div><h3>Interpretation</h3><div>Healthcare utilisation events were common after bariatric surgery and early post-operative surgical complications predicted later healthcare utilisation events. Healthcare utilisation events were more common after sleeve gastrectomy than RYGB in patients without type 2 diabetes at baseline. Findings will better inform surgical candidates of real-world expectations after surgery, and allow providers to consider closer monitoring of those with a 30-day healthcare utilisation event.</div></div><div><h3>Funding</h3><div><span>National Institutes for Health</span> (NIH) research support was provided through the following grants: NIH UM1DK072493 and NIH UM1DK095710. The contents of this manuscript are the authors’ sole responsibility and do not necessarily represent official NIH views.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101332"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840623","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}