Lancet Regional Health-Americas最新文献

{"title":"Intensity-modulated proton therapy vs intensity-modulated radiotherapy in nasopharyngeal carcinoma: a case–control study","authors":"Caineng Cao ,&nbsp;Teeradon Treechairusame ,&nbsp;Amir H. Safavi ,&nbsp;Yingzhi Wu ,&nbsp;Zhigang Zhang ,&nbsp;Achraf Shamseddine ,&nbsp;Yao Yu ,&nbsp;Nadeem Riaz ,&nbsp;Daphna Y. Gelblum ,&nbsp;Sean M. McBride ,&nbsp;Alan L. Ho ,&nbsp;Winston Wong ,&nbsp;Lara A. Dunn ,&nbsp;Loren Scott Michel ,&nbsp;Eric J. Sherman ,&nbsp;Nancy Y. Lee","doi":"10.1016/j.lana.2025.101352","DOIUrl":"10.1016/j.lana.2025.101352","url":null,"abstract":"<div><h3>Background</h3><div>Intensity-modulated proton therapy (IMPT) is associated with fewer acute toxicities compared with intensity-modulated radiotherapy (IMRT) in definitive treatment of nonmetastatic nasopharyngeal carcinoma (NPC). Longer term efficacy and safety data are warranted to appraise the comparative benefit of IMPT for this population. The aim of this study was to evaluate the long-term toxicity and survival outcomes of NPC treated with IMPT vs IMRT at a tertiary academic cancer center during 2016–2022.</div></div><div><h3>Methods</h3><div>Sixty-seven (42.1%) cases treated by IMPT, and 92 (57.9%) controls treated by IMRT were included.</div></div><div><h3>Findings</h3><div>The median follow-up time was 55.4 months (interquartile range [IQR], 32.1–73.8 months). The incidence of any grade 2+ acute toxicity was lower with IMPT than IMRT (86.6% vs 97.8%, p = 0.009). Based on the logistic regression analysis, radiotherapy modality (IMRT vs IMPT) was significantly associated with developing any grade 2+ acute toxicity (odds ratio, 0.177; 95% confidence interval 0.035–0.886; p = 0.035). The incidence of grade 2+ late toxicity was not significantly different (p &gt; 0.05) following IMPT (40.3%) and IMRT (52.7%). There were no statistically significant differences following IMRT and IMPT in 5-year cumulative incidence of local or regional failures [16.4% (9.1–25.6) vs 14.1% (6.5–24.7)], progression free survival and overall survival.</div></div><div><h3>Interpretation</h3><div>Although there were no statistically significant differences in incidence of late toxicities or oncologic outcomes, IMPT was associated with lower incidence of acute toxicity in comparison with IMRT.</div></div><div><h3>Funding</h3><div>This research was funded in part through the <span>National Institutes of Health</span>/<span>National Cancer Institute Cancer Center</span> Support Grant <span><span>P30 CA008748</span></span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101352"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884385","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":"Retail pharmacy clinics in Mexico: a commentary","authors":"M. Arantxa Colchero ,&nbsp;Tonatiuh Barrientos-Gutiérrez ,&nbsp;Mauricio Hernández-Ávila","doi":"10.1016/j.lana.2025.101341","DOIUrl":"10.1016/j.lana.2025.101341","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101341"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840104","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":"Towards a Latin American neuropsychiatry: challenges and opportunities","authors":"Jesús Ramírez Bermúdez ,&nbsp;Sheila Castro-Suarez ,&nbsp;Luciana D'Alessio ,&nbsp;Jorge Holguín Lew ,&nbsp;Louise Makarem Oliveira ,&nbsp;Mônica Sanches Yassuda ,&nbsp;Hernando Santamaría-García ,&nbsp;Andrea Slachevsky ,&nbsp;William Tamayo Agudelo ,&nbsp;Julio Torales ,&nbsp;Norha Vera San Juan ,&nbsp;Vaughan Bell","doi":"10.1016/j.lana.2025.101322","DOIUrl":"10.1016/j.lana.2025.101322","url":null,"abstract":"<div><div>From the impact of armed conflict and political violence to the neuropsychiatric consequences of neglected tropical diseases, Latin America has a unique profile of region-specific risk factors that mean it is not always well-served by neuropsychiatric practice developed in high-income regions. Here, we review the region-specific neuropsychiatric characteristics of traumatic brain injury, stroke, epilepsy, dementia, functional neurological disorder, infectious diseases, environmental health risks, and substance use. Additionally, we identify structural challenges for neuropsychiatric health and suggest pathways to develop a specifically Latin American neuropsychiatry as a cross-disciplinary, multi-professional field based on practical steps to strengthen research capacity, training, clinical practice, and care delivery. Latin America should be a priority for neuropsychiatry, and we argue for a Latin American neuropsychiatry that has much to offer the region and much to contribute worldwide.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101322"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645847","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":"Evidence speaks beyond conceptual frameworks","authors":"Mariana Álvarez-Aceves ,&nbsp;Lina Sofía Palacio-Mejía ,&nbsp;Mauricio Hernández-Ávila ,&nbsp;Edgar Leonel González-González ,&nbsp;Carlos Arturo Castro-Del Ángel ,&nbsp;Leslie Guzmán-Sandoval ,&nbsp;Juan Eugenio Hernández-Ávila","doi":"10.1016/j.lana.2025.101358","DOIUrl":"10.1016/j.lana.2025.101358","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101358"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884481","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":"Residency growth in Mexico: expansion and alignment challenges","authors":"Mauricio Gonzalez-Urquijo","doi":"10.1016/j.lana.2025.101337","DOIUrl":"10.1016/j.lana.2025.101337","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101337"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737868","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":"Outcomes of urgent gastrointestinal-related procedures in Latin America (LATAM-URG): a prospective multicentre study","authors":"Latam Collaborative Colorectal Surgery Consortium","doi":"10.1016/j.lana.2025.101336","DOIUrl":"10.1016/j.lana.2025.101336","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Urgent abdominal operations represent a large proportion of surgical care and are associated with substantial morbidity and mortality. Evidence is scarce from low- and middle-income countries (LMICs), including Latin America (LA). The lack of regionally representative outcomes data hinders quality-improvement efforts and understanding of modifiable risk factors that could be targeted to improve urgent care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We present results from a prospective, multicenter observational cohort study of urgent abdominal surgery conducted in 14 countries across Latin America between February and December 2024. Eligible participants were consecutive adults (≥18 years) undergoing urgent gastrointestinal operations at each site during a 6-week inclusion window. The primary outcome was 30-day mortality. Secondary outcomes were reoperation, readmission, time to discharge, and prolonged intensive care unit (ICU) stay (defined as &gt;72 h). Bayesian time-to-event models and Bayesian logistic regression were used to estimate associations between the outcomes and pre-specified covariates (age, sex, obesity, center volume, Charlson Comorbidity Index, SOFA score, surgical approach, operative time, prior abdominal surgery, intraoperative complications).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 1015 patients were included from 89 hospitals (mean age 58.3 years; 50.4% female and 49.6% male). The most common indications for surgery were intestinal obstruction (46.8%), perforation (23.4%), and abdominal abscess (9.6%). Overall 30-day mortality was 12.6% (128/1015) and one in three of these deaths occurred within 24 h of the index operation. Prolonged ICU stay occurred in 27.9% of patients, reoperation was required in 18.4% and readmission in 4.9%. Across all models, we consistently found an association between Charlson Comorbidity Index &gt;3, SOFA score &gt;3, and open surgical approach with higher odds or hazard of adverse postoperative outcomes, including death. Patients with SOFA &gt;3 had substantially increased odds of prolonged ICU stay and higher hazard of reoperation and death. In contrast, open surgery was associated with longer hospitalization and more reoperations, as well as higher mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This large multi-country cohort provides the first region-wide estimates of outcomes after urgent abdominal surgery in Latin America. Mortality remains high, with almost one-third of all deaths occurring in the first 24 h after surgery. Patients’ comorbidity burden, physiological derangement at presentation, and operative approach are all key determinants of outcome after urgent abdominal surgery. This evidence provides a baseline for quality-improvement efforts and highlights the urgent need for region-specific guidelines and protocols to standardize urgent surgical care across Latin America.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study received no external f","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101336"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790568","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":"Beyond numbers: the missing conceptual foundation in evaluating Mexico's health system performance","authors":"Héctor Arreola-Ornelas ,&nbsp;David Contreras-Loya ,&nbsp;Edson Serván-Mori ,&nbsp;Michael Touchton ,&nbsp;Octavio Gómez-Dantés","doi":"10.1016/j.lana.2025.101357","DOIUrl":"10.1016/j.lana.2025.101357","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101357"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884387","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":"E-cigarettes versus combination nicotine replacement therapy following a recent failed quit attempt: a pragmatic randomized trial through state tobacco quitlines","authors":"Theodore L. Wagener ,&nbsp;Alice Hinton ,&nbsp;Theodore M. Brasky ,&nbsp;Yoo Jin Cho ,&nbsp;Laura A. Beebe ,&nbsp;Michael S. Businelle ,&nbsp;Matthew J. Carpenter ,&nbsp;Jonathan Hart ,&nbsp;Katrina A. Vickerman","doi":"10.1016/j.lana.2025.101351","DOIUrl":"10.1016/j.lana.2025.101351","url":null,"abstract":"<div><h3>Background</h3><div>E-cigarettes have emerged as a potentially more effective and satisfying alternative to nicotine replacement therapy (NRT) for smokers who struggle to quit. Although quitlines are effective platforms for tobacco cessation, they have not incorporated e-cigarettes due to regulatory concerns and limited clinical evidence. We evaluated whether quitline-delivered counseling combined with e-cigarettes was more effective than counseling with NRT among adults who recently failed to quit using standard quitline services.</div></div><div><h3>Methods</h3><div>We conducted a pragmatic, open-label, parallel-group randomised controlled trial with two U.S. state quitlines between October 2020 and January 2023. Adults [N = 350; 212 (61%) female &amp; 248 (72%) white] who were still smoking after a recent quitline enrollment were randomised (1:1) to receive 8 weeks of either JUUL e-cigarettes or a combination of nicotine patch and lozenge, along with three counseling calls. The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (7-day PPA) at 8 weeks. Analyses used an intent-to-treat approach; secondary outcomes included 12-week abstinence, prolonged abstinence, changes in smoking behavior, dependence, and adverse effects.</div></div><div><h3>Findings</h3><div>At 8 weeks, 7-day PPA did not differ significantly between e-cigarette and NRT groups [25 (14.3%) of 175 and 17 (9.7%) of 175, respectively; OR 1.56; 95% CI 0.80–3.04; p = 0.19]. Both groups showed similar reductions in cigarette use and dependence. Adherence to counseling and assigned products was high. Adverse events were generally mild; cough and breathing difficulties were more frequently reported in the e-cigarette group and NRT participants reported more dizziness, sleeplessness, and allergies.</div></div><div><h3>Interpretation</h3><div>Among quitline users with a recent failed quit attempt, e-cigarettes combined with quitline counseling were not more effective than combination NRT in increasing smoking abstinence after 8 weeks’ follow-up.</div></div><div><h3>Funding</h3><div>U.S. <span>National Institute on Drug Abuse</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101351"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884386","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":"Economic burden of Chagas disease in Latin American countries: a population-based cost-of-illness analysis from the RAISE study","authors":"Mônica Viegas Andrade ,&nbsp;Kenya Valeria Micaela de Souza Noronha ,&nbsp;Aline de Souza ,&nbsp;Nayara Abreu Julião ,&nbsp;André Soares Motta-Santos ,&nbsp;Paulo Estevão Franco Braga ,&nbsp;Henrique Bracarense ,&nbsp;André Batista Alves do Santos ,&nbsp;Bruno Ramos Nascimento ,&nbsp;Ísis Eloah Machado ,&nbsp;Francisco Rogerlândio Martins-Melo ,&nbsp;Israel Molina ,&nbsp;Pablo Perel ,&nbsp;Yvonne Geissbühler ,&nbsp;Caroline Demacq ,&nbsp;Hector Eduardo Castro Jaramillo ,&nbsp;Luis Eduardo Echeverría ,&nbsp;Mario Bruno Principato ,&nbsp;Luisa Fernanda Aguilera Mora ,&nbsp;Marisa Liliana Fernandez ,&nbsp;Antonio Luiz Pinho Ribeiro","doi":"10.1016/j.lana.2025.101340","DOIUrl":"10.1016/j.lana.2025.101340","url":null,"abstract":"<div><h3>Background</h3><div>Chagas disease (ChD) remains a public health concern in Latin America. Despite a decline in overall prevalence, the chronic symptomatic forms still impose a substantial epidemiological and economic burden. This study undertakes a comprehensive, population-based cost analysis of chronic Chagas disease (CCD) from a societal perspective in seven endemic Latin American countries for 2010 and 2023.</div></div><div><h3>Methods</h3><div>A Markov model with one-year cycles and six states was employed. Direct medical and indirect costs, converted to 2024 purchasing power parity US dollars, were estimated using prevalence data from the Global Burden of Disease Study 2023. Based on a previous Brazilian Markov model, parameters were adjusted using healthcare coverage and per capita health expenditure ratios for each country, further validated by national experts.</div></div><div><h3>Findings</h3><div>In 2010, Brazil (US$252 billion) and Argentina (US$164 billion) had the highest lifetime burdens. As a percentage of annual Gross Domestic Product, Bolivia (0·9%) and Argentina (0·8%) were most affected. CCD accounted for 6% of total health expenditures in both countries. Between 2010 and 2023, most countries experienced a decline in economic burden due to decreased CCD prevalence, despite an increased proportion of patients with cardiac conditions, reflecting population aging and disease progression.</div></div><div><h3>Interpretation</h3><div>CCD imposes substantial economic burden across Latin American countries. Epidemiological shift to older populations with severe cardiac forms signals increased healthcare demands. Findings inform policymakers for resource allocation and tailored interventions.</div></div><div><h3>Funding</h3><div>Funding was provided by <span>Novartis Pharma AG</span> as part of a research collaboration with the <span>World Heart Federation</span> (project number CLCZ696D2010R).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101340"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790536","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":"Evolving registry staging and competing risks in analyses of First Nations prostate cancer outcomes","authors":"Bingpeng Gao ,&nbsp;Junwen Wang","doi":"10.1016/j.lana.2026.101389","DOIUrl":"10.1016/j.lana.2026.101389","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101389"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214174","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}