Lancet Regional Health-Americas最新文献

{"title":"A thank you to our 2024 reviewers and update on our inclusion and diversity commitments","authors":"","doi":"10.1016/j.lana.2025.101025","DOIUrl":"10.1016/j.lana.2025.101025","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 101025"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403080","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":"Personalized screening strategies for TP53 R337H carriers: a retrospective cohort study of tumor spectrum in Li-Fraumeni syndrome adult carriers","authors":"Pedro A.F. Galante ,&nbsp;Gabriela D.A. Guardia ,&nbsp;Janina Pisani ,&nbsp;Renata L. Sandoval ,&nbsp;Mateus C. Barros-Filho ,&nbsp;Ana Carolina Leite Vieira Costa Gifoni ,&nbsp;Diogo F.C. Patrão ,&nbsp;Patricia Ashton-Prolla ,&nbsp;Vitor Fiorin de Vasconcellos ,&nbsp;Claire Freycon ,&nbsp;Arnold Levine ,&nbsp;Pierre Hainaut ,&nbsp;Maria Isabel Achatz","doi":"10.1016/j.lana.2024.100982","DOIUrl":"10.1016/j.lana.2024.100982","url":null,"abstract":"<div><h3>Background</h3><div>Li-Fraumeni Syndrome (LFS) is a predisposition associated with early onset malignant tumors caused by germline pathogenic variants in the <em>TP53</em> gene. Although rare worldwide, LFS is prevalent in Southern Brazil due to the founder pathogenic variant R337H. Here, we assessed tumor patterns and temporal trends, cancer risk, and sex differences of adult R337H carriers and carriers of other LFS-associated variants.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 708 adults, combining data from two sources: the Brazilian Li-Fraumeni Syndrome Study cohort and the NCI TP53 database. We assessed the clinical characteristics of 303 adults with R337H and compared them with those associated with 405 carriers of other TP53 variants.</div></div><div><h3>Findings</h3><div>R337H carriers, compared to adult carriers of other <em>TP53</em> variants typical of LFS, had a lower cumulative risk of developing cancer (54% vs 78%). Female R337H carriers were at a higher risk than males (65% vs 30%) and had a higher risk of developing a second primary cancer, underscoring a strong sex bias not observed in carriers of other variants. The most common cancers were breast cancer and soft tissue sarcoma in females, and soft tissue sarcoma and prostate cancer in males. Common second malignancies were breast cancer in females and lung cancer in males.</div></div><div><h3>Interpretation</h3><div>This study shows that R337H is associated with a lifetime risk of multiple LFS-spectrum cancers but with incomplete penetrance, particularly in males. Our findings suggest that R337H carriers would benefit from tailored surveillance and risk reduction strategies.</div></div><div><h3>Funding</h3><div><span>São Paulo Research Foundation</span>, <span>Conselho Nacional de Pesquisa</span>, and <span>Hospital Sírio-Libanês</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100982"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079938","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":"Geography and age drive racial and ethnic disparities in hospital mortality for paediatric community-acquired pneumonia in the United States: a retrospective population based cohort study of hospitalized patients","authors":"Cody-Aaron L. Gathers ,&nbsp;Nadir Yehya ,&nbsp;Anireddy Reddy ,&nbsp;Paula M. Magee ,&nbsp;Vanessa C. Denny ,&nbsp;Michelle R. Mayeda ,&nbsp;Amanda O’Halloran ,&nbsp;Sanjiv D. Mehta ,&nbsp;Stephanie Wanamaker ,&nbsp;Jessica C. Fowler ,&nbsp;Garrett Keim","doi":"10.1016/j.lana.2025.101001","DOIUrl":"10.1016/j.lana.2025.101001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Racial disparities in the outcomes of adult community-acquired pneumonia are well described. However, the presence of racial and ethnic disparities in paediatric community-acquired pneumonia and the mechanisms underlying these disparities remain unclear. Motivated by disparities related to age and geography in paediatric sepsis, we evaluated the association between the joint exposure of race/ethnicity, age, and geographic region and mortality for community-acquired pneumonia to provide opportunities for assessment of future interventions that provide equitable healthcare. We hypothesized that geographic region and age would inform the association between race or ethnicity and mortality in community-acquired pneumonia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a retrospective cohort study of children age &lt; 18 years with community-acquired pneumonia hospitalized between 2016 and 2021 in the Public Health Information System (PHIS) database. Models included a priori stratification of age ≤ 1 year and geographic region. Racial and ethnic groups (White, Black, Hispanic/Latino, and Other), four geographic regions (Northeast, South, Midwest, or West), and two age categories (&lt;1 and ≥1 year) were combined to create a joint exposure variable. Multivariable logistic regression, clustered by hospital and adjusting for sex, primary insurance payer, median household income quartile, urban identification, and the presence of a complex chronic condition(s), quantified the relationship between the joint exposure and all-cause mortality for paediatric community-acquired pneumonia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 783,744 patients (median age 4 years [interquartile range 1–9 years], 45.9% female) with CAP, the overall mortality rate was 0.9%. Region and age strongly impacted mortality in all racial and ethnic groups, with higher mortality for Black, Hispanic/Latino, and Other patients &lt;1 year. Among patients &lt;1 year, Black patients in the South (OR 2.35, 95% CI 1.52–3.63, p &lt; 0.001) and West (OR 2.47, 95% CI 1.35–4.49, p = 0.003) and Hispanic/Latino patients in the Northeast (OR 2.36, 95% CI 1.46–3.66, p = 0.031) had the highest mortality, relative to White patients &lt;1 year in the Northeast.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;We found evidence of racial and ethnic disparities in mortality for children diagnosed with community-acquired pneumonia. Joint associations of race, ethnicity, age, and geographic region may partially inform potential mechanisms underlying these disparities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Dr. Gathers’ effort on this study was supported by a &lt;span&gt;National Institutes of Health&lt;/span&gt; (NIH) Training Grant &lt;span&gt;&lt;span&gt;T32HL098054&lt;/span&gt;&lt;/span&gt;. Dr. Yehya is supported by &lt;span&gt;NIH&lt;/span&gt; grant number &lt;span&gt;&lt;span&gt;R01-HL148054&lt;/span&gt;&lt;/span&gt;. Dr. Keim was supported by &lt;span&gt;NIH&lt;/span&gt; Training Grant &lt;span&gt;&lt;span&gt;2T32GM112596&lt;/span&gt;&lt;/span&gt; and &lt;span&gt;&lt;span&gt;L40HL170463&lt;/span&gt;&lt;/","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 101001"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141880","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":"Beyond altitude: reevaluating microvascular adaptations through sexual dimorphism and ethnic diversity","authors":"Yingyu Wang ,&nbsp;Weiqi Liu ,&nbsp;Bing Wang ,&nbsp;Yuan Li ,&nbsp;Mingming Liu","doi":"10.1016/j.lana.2024.100979","DOIUrl":"10.1016/j.lana.2024.100979","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100979"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013102","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":"Trends in depressive symptoms among high school students with and without health-risk behaviors in the United States: A population-based study","authors":"Tanner J. Bommersbach ,&nbsp;Mark Olfson ,&nbsp;Taeho Greg Rhee","doi":"10.1016/j.lana.2025.101000","DOIUrl":"10.1016/j.lana.2025.101000","url":null,"abstract":"<div><h3>Background</h3><div>Despite the recent rise in depressive symptoms among adolescents, trends in at-risk groups remain poorly understood. This study estimated national trends in depressive symptoms among high school students with and without health-risk behaviors.</div></div><div><h3>Methods</h3><div>Data were analyzed from the 2007 to 2021 Youth Risk Behavior Survey (YRBS), a biennial cross-sectional survey of US high school students (n = 119,654). Depressive symptoms were defined as past-year feelings of sadness/hopelessness almost every day for ≥2 weeks impacting usual activities. 24 health-risk behaviors across five categories (violence, substance use, sexual, physical/sedentary, and weight-related) were considered. Multivariable-adjusted logistic regression identified health-risk behaviors independently associated with depressive symptoms. National trends in depressive symptoms among students with and without these health-risk behaviors were estimated. National trends in health-risk behaviors were also estimated among those with depressive symptoms.</div></div><div><h3>Findings</h3><div>Among 119,654 students (mean age, 16.0 [SD = 1.2] years; 50.1% females; and 45.3% non-Hispanic White), depressive symptoms increased from 28.4% (2007) to 42.3% (2021) (biennial average percent change (BAPC), 3.0% [95% confidence interval (CI), 2.6–3.4%]). The largest increases occurred among females (BAPC, 3.3% [2.9–3.8%]) and non-Hispanic White students (BAPC, 3.6% [3.0–4.1%]). Depressive symptoms increased more among students engaging in ≤1 risk category (BAPC = 4.6% [3.6–5.7%]) than students engaging in 4–5 risk categories (BAPC = 2.9% [2.4–3.3%]) (interaction, <em>p</em> = 0.037) and there was a general trend toward decreasing engagement in risk behaviors among students with depressive symptoms. In subgroup analyses, there was a disproportionately large increase in depressive symptoms among students reporting cannabis use, high-risk screen time, shorter sleep hours, and unhealthy weight perception.</div></div><div><h3>Interpretation</h3><div>Depressive symptoms increased faster among high school students without than with multiple behavioral risk factors. A broadening of the depression risk profile underscores the potential value of universal depression screening to identify students who may otherwise go undetected by targeted screening.</div></div><div><h3>Funding</h3><div>The study was not funded.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 101000"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141997","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":"Geographic accessibility to hospital childbirths in Brazil (2010–2011 and 2018–2019): a cross-sectional study","authors":"Priscila Costa Albuquerque ,&nbsp;Lucas Lopes Felipe ,&nbsp;Juliana Freitas Lopes ,&nbsp;Wagner de Souza Tassinari ,&nbsp;Fabio Zicker ,&nbsp;Bruna de Paula Fonseca","doi":"10.1016/j.lana.2024.100976","DOIUrl":"10.1016/j.lana.2024.100976","url":null,"abstract":"<div><h3>Background</h3><div>Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time.</div></div><div><h3>Methods</h3><div>Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010–2011 and 2018–2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated.</div></div><div><h3>Findings</h3><div>A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n = 1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n = 843,501) in 2010–2011 to 27.3% (n = 915,805) in 2018–2019. Distance and travel time rose by 31.1% (54.0 km–70.8 km) and 33.6% (63.1–84.3 min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n = 817,499), and the North had the lowest (16.0%; n = 138,295). Women in the North faced the longest travel distances (97.5–133.4 km) and times (1,012–1,850 min), while those in the Southeast and South experienced the shortest distances (37.2–55.9 km and 41.2–54.8 km, respectively) and times (38–52 min and 41–52 min).</div></div><div><h3>Interpretation</h3><div>The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe.</div></div><div><h3>Funding</h3><div>Fundação Oswaldo Cruz; CNPq; FAPERJ.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100976"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013111","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":"Malaria spillover in Indigenous Guyanese communities following a crackdown on illegal gold mining in Brazil","authors":"Pablo M. De Salazar ,&nbsp;Andrea Parra-Salazar ,&nbsp;Reza Niles-Robin ,&nbsp;Olivia Valz ,&nbsp;Kashana James ,&nbsp;Caroline O. Buckee ,&nbsp;Horace Cox","doi":"10.1016/j.lana.2024.100969","DOIUrl":"10.1016/j.lana.2024.100969","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100969"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013113","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":"Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas","authors":"J.D. Schwalm ,&nbsp;Philip Joseph ,&nbsp;Darryl Leong ,&nbsp;Jose Patricio Lopez-Lopez ,&nbsp;Oyere Onuma ,&nbsp;Palki Bhatt ,&nbsp;Alvaro Avezum ,&nbsp;Marjan Walli-Attaei ,&nbsp;Martin McKee ,&nbsp;Yusuf Salim","doi":"10.1016/j.lana.2024.100964","DOIUrl":"10.1016/j.lana.2024.100964","url":null,"abstract":"<div><div>While, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 100964"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402965","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":"Cardiovascular disease: addressing poverty is key","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101029","DOIUrl":"10.1016/j.lana.2025.101029","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"42 ","pages":"Article 101029"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403079","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":"Political determinants of cancer health","authors":"Edward Christopher Dee ,&nbsp;Maria Jocelyn Kara Magsanoc-Alikpala ,&nbsp;Fabio Ynoe Moraes ,&nbsp;Jonas Willmann ,&nbsp;Frederic Ivan L. Ting ,&nbsp;Erin Jay G. Feliciano","doi":"10.1016/j.lana.2025.101008","DOIUrl":"10.1016/j.lana.2025.101008","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101008"},"PeriodicalIF":7.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125468","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}