Lancet Regional Health-Americas最新文献

{"title":"Reassessing Spinola et al.: data, sources, and the case for Brazil's e-cigarette ban","authors":"Andre Luiz Oliveira da Silva , Stanton A. Glantz","doi":"10.1016/j.lana.2026.101387","DOIUrl":"10.1016/j.lana.2026.101387","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"56 ","pages":"Article 101387"},"PeriodicalIF":7.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146135697","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":"Ethical challenges and opportunities for integrating predictive analytics in community-based overdose prevention","authors":"Bennett Allen ,&nbsp;Adelya Urmanche ,&nbsp;Brenda Curtis ,&nbsp;Celia Fisher","doi":"10.1016/j.lana.2025.101345","DOIUrl":"10.1016/j.lana.2025.101345","url":null,"abstract":"<div><div>As predictive analytics become more widely integrated into local public health responses to the United States overdose epidemic, community-based substance use service providers have begun to adopt machine learning-based predictive tools to guide the allocation and delivery of overdose prevention services. While these tools hold promise for anticipating community overdose risk and enhancing the efficiency of overdose prevention resource distribution, outreach, and education efforts, their use in community settings raises substantial ethical and practical challenges. In this Viewpoint, we examine the application of predictive analytics to community-based overdose prevention through a public health ethics lens, drawing on principles of distributive justice, transparency, community participation, and implementation readiness. We outline five key ethical considerations for developers (i.e., institutional responsibility, oversimplification of complex social realities, data and algorithmic bias, community displacement in decision making, and equity trade-offs) and corresponding practical challenges for service providers. We offer five recommendations for developers, public health authorities, and frontline organizations to overcome challenges and ensure responsible, equity-driven implementation. As data-driven approaches to overdose prevention proliferate, ethical and participatory frameworks will be essential to ensure predictive tools strengthen, rather than undermine, community trust and health equity.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101345"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842552","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":"Mammography does not fit all: the screening controversy in Brazil","authors":"José Bines ,&nbsp;Fabiola Kestelman","doi":"10.1016/j.lana.2025.101367","DOIUrl":"10.1016/j.lana.2025.101367","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101367"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927695","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":"Single-dose HPV vaccination in the United States — a multi-modeling analysis","authors":"Emily A. Burger ,&nbsp;Jean-François Laprise ,&nbsp;Jennifer C. Spencer ,&nbsp;Stephen Sy ,&nbsp;Mary Caroline Regan ,&nbsp;Melanie Drolet ,&nbsp;Éléonore Chamberland ,&nbsp;Marc Brisson ,&nbsp;Jane J. Kim","doi":"10.1016/j.lana.2025.101361","DOIUrl":"10.1016/j.lana.2025.101361","url":null,"abstract":"<div><h3>Background</h3><div>Evidence supporting the non-inferior efficacy of single-dose human papillomavirus (HPV) vaccination has prompted reconsideration of existing multi-dose HPV vaccination schedules. We evaluated the long-term health impact of adopting single-dose HPV vaccination in the United States to inform policy deliberations.</div></div><div><h3>Methods</h3><div>We applied two validated individual-based simulation models of HPV transmission and cervical cancer to project the impact of switching from a two-dose to a single-dose HPV vaccination schedule in 2025 in the context of historical HPV vaccination uptake in the United States. Four scenarios were simulated: continuation of two-dose vaccination (or equivalent single-dose efficacy of 98%) and three alternative pessimistic single-dose strategies with lower vaccine efficacy (90%) and/or duration of protection (average of 25 years). Outcomes included age-standardized incidence rates of HPV-16 infection and cervical cancer from years 2005–2099. Additional analyses examined effects under lower vaccination coverage observed in select U.S. regions.</div></div><div><h3>Findings</h3><div>Maintaining two doses or switching to a non-inferior single-dose HPV vaccination schedule was projected to nearly eliminate HPV-16 infections and reduce cervical cancer incidence by over 90% by the end of the century. Scenarios assuming a lower efficacy or waning protection showed increases in cervical cancer incidence of less than 2 percentage points decades after a switch to single-dose vaccination with no impact on the timeframe to cervical cancer elimination.</div></div><div><h3>Interpretation</h3><div>Switching to a single-dose HPV vaccination schedule is projected to maintain reductions in cervical cancer, even under pessimistic efficacy and durability assumptions. Continued monitoring of single-dose HPV vaccine efficacy over time remains critical.</div></div><div><h3>Funding</h3><div>PATH on behalf of the <span>Single-Dose HPV Vaccine Evaluation Consortium</span>; <span>Bill and Melinda Gates Foundation</span> (grant No. <span><span>OPP48979</span></span>), and the <span>US National Institutes of Health</span>/<span>National Cancer Institute</span> (Grant Number <span><span>U01 CA253912</span></span>).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101361"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927697","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":"Uncovering the post-pandemic timing of influenza, RSV, and COVID-19 driving seasonal influenza-like illness in the United States: a retrospective ecological study","authors":"George Dewey ,&nbsp;Austin G. Meyer ,&nbsp;Raul Garrido Garcia ,&nbsp;Mauricio Santillana","doi":"10.1016/j.lana.2025.101359","DOIUrl":"10.1016/j.lana.2025.101359","url":null,"abstract":"<div><h3>Background</h3><div>Influenza and respiratory syncytial virus (RSV) are major contributors to the burden of seasonal influenza-like illnesses (ILI) in the US. The prevention and treatment of ILI varies substantially across age groups and in cost and administration schedule. This study aimed to characterize the timing and ordering of RSV, influenza, and COVID-19 epidemics in the post-pandemic period to inform public health preparedness.</div></div><div><h3>Methods</h3><div>We implemented a series of independent regression models to infer the contribution of each of these diseases to seasonal ILI syndromic indicators. We further implemented anomaly-detection algorithms on data from the US Centers for Disease Control and Prevention National Syndromic Surveillance Program for the 2022–23, 2023–24, and 2024–25 ILI seasons to identify the timing of onsets and peaks of RSV, influenza, and COVID-19.</div></div><div><h3>Findings</h3><div>A total of 148 state-ILI seasons were analyzed. In 114 out of 148 (77.0%) of analyzed seasons, volume of RSV emergency department (ED) visits peaked before influenza ED visits. The median time difference between peaks of RSV and peaks of influenza was +3.0 weeks (95% percentile range: −7.0, +7.0 weeks; interquartile range: 5.0 weeks). The timing of RSV and influenza onsets were found to occur more synchronously in the 2023–2024 and 2024–2025 ILI seasons. The timing of COVID-19 outbreaks did not show a consistent seasonal pattern across the study period.</div></div><div><h3>Interpretation</h3><div>RSV epidemics frequently reach peak volume before influenza epidemics across the US. Healthcare professionals and public health authorities should anticipate increases in RSV cases and hospitalizations at the start of the annual ILI season and establish infrastructure and planning to handle incoming surges of both RSV and influenza appropriately.</div></div><div><h3>Funding</h3><div>CDC <span>Center for Forecasting and Outbreak Analytics</span>; <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101359"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885800","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":"Uncovering the biases: why the claimed mask–excess mortality link fails to hold","authors":"Thiago Cerqueira-Silva ,&nbsp;Felipe Argolo ,&nbsp;Gabriel Gonçalves da Costa ,&nbsp;Felipe Nogueira Barbara ,&nbsp;Pedro Hallal ,&nbsp;Bruno Gualano","doi":"10.1016/j.lana.2025.101360","DOIUrl":"10.1016/j.lana.2025.101360","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101360"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885804","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 comparison between catheter ablation of ventricular tachycardia in Chagas disease versus ischemic and dilated cardiomyopathy — a retrospective cohort study","authors":"Rodrigo Melo Kulchetscki,&nbsp;Luan Vieira Rodrigues,&nbsp;Cristiano Faria Pisani,&nbsp;Muhieddine Omar Chokr,&nbsp;Carina Abigail Hardy,&nbsp;Sissy Lara de Melo,&nbsp;Maurício Ibrahim Scanavacca","doi":"10.1016/j.lana.2026.101394","DOIUrl":"10.1016/j.lana.2026.101394","url":null,"abstract":"<div><h3>Background</h3><div>Chagas cardiomyopathy (ChC) is associated with a high burden of ventricular arrhythmias (VA), but long-term outcomes of catheter ablation (CA) in this population remain poorly characterized, especially when compared to other cardiomyopathies.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective cohort of consecutive patients with structural heart disease undergoing catheter ablation for sustained monomorphic VT (2011–2020) at a tertiary hospital in Brazil, grouped as ChC (n = 164), ischemic cardiomyopathy (ICM; n = 76) or idiopathic dilated cardiomyopathy (DCM; n = 48). The primary endpoint was a composite of all-cause death, heart transplantation, or VT recurrence; time-to-event outcomes were assessed with Kaplan–Meier and multivariable Cox models, and VT recurrence was additionally evaluated using Fine–Gray competing-risk analyses.</div></div><div><h3>Findings</h3><div>We analysed 378 VT ablation procedures in 288 patients (mean age 61 ± 10 years; 208 [72%] male, 80 [28%] female; mean LVEF 35 ± 11%). Compared with ICM and idiopathic DCM, ChC more often required epicardial access (78% versus 15% in ICM and 31% in DCM; p &lt; 0.001) and had lower acute non-inducibility (46% versus 62% in ICM; p &lt; 0.001). Over a median follow-up of 29.0 months (IQR 3.3–69.1), for the last procedure the composite endpoint (death, heart transplant, or VT recurrence) occurred in 71.9% of ChC, 48.6% of ICM, and 58.3% of DCM (overall p = 0.068; pairwise ChC versus ICM p = 0.028). In adjusted Cox models, ChC was associated with higher risk of the composite endpoint (HR 1.73, 95% CI 1.16–2.59; p = 0.008) and higher all-cause mortality (HR 2.41, 1.00–5.78; p = 0.049), but not for VT recurrence, which did not differ by etiology in Kaplan–Meier or competing-risk analyses (Fine–Gray: last procedure p = 0.824; first procedure p = 0.305). Overall mortality was higher in ChC than non-ChC (36.0% versus 21.7%; p = 0.034), driven largely by non-cardiovascular death (p = 0.047) rather than cardiovascular death (p = 0.134). For the composite endpoint, higher LVEF was protective (per 1% increase: HR 0.97, 0.95–0.99; p = 0.017), while major intraprocedural complications conferred the greatest risk (HR 13.70, 3.27–57.39; p &lt; 0.001).</div></div><div><h3>Interpretation</h3><div>Chagas cardiomyopathy was associated with worse adjusted long-term outcomes after VT ablation—driven primarily by higher mortality. Across models, higher LVEF was protective, while markers of clinical instability and major intraprocedural complications identified patients at highest risk. These findings underscore the need for meticulous procedural strategy—particularly when epicardial access is anticipated—and comprehensive post-procedural heart failure and comorbidity management in ChC.</div></div><div><h3>Funding</h3><div>No funding was necessary for this study.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101394"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396900","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":"Long-term effects of cooking with liquefied petroleum gas or biomass on linear growth trajectories from birth to the pre-school years in Puno, Peru: a prospective cohort study","authors":"Laura Nicolaou ,&nbsp;Carolyn J. Reuland ,&nbsp;Mingling Yang ,&nbsp;Kendra N. Williams ,&nbsp;Stella M. Hartinger ,&nbsp;Marilú Chiang ,&nbsp;William Checkley","doi":"10.1016/j.lana.2026.101382","DOIUrl":"10.1016/j.lana.2026.101382","url":null,"abstract":"<div><h3>Background</h3><div>Household air pollution (HAP) is a major global health risk. Observational studies link HAP exposure to impaired child growth, but randomized controlled trial (RCT) evidence is inconsistent.</div></div><div><h3>Methods</h3><div>We followed children born during an RCT of an 18-month liquefied petroleum gas (LPG) intervention among 800 pregnant women in Puno, Peru. We measured personal exposures to fine particulate matter (PM_2.5) and carbon monoxide (CO) three times during pregnancy and three times during infancy. We measured length quarterly between birth and 12 months and height once between age 2–4 years. We assessed the effect of the LPG intervention on growth trajectories and evaluated exposure-response associations between height-for-age z-score (HAZ) and PM_2.5 or CO exposures.</div></div><div><h3>Findings</h3><div>We revisited 683 children (mean age 34.0 ± 6.6 months, 49.3% male, 52.3% intervention). Mean HAZ at age 2–4 years was −0.92 ± 0.83 SDs in intervention children and −1.00 ± 0.80 SDs in controls (p = 0.33). In intention-to-treat analysis, the HAZ difference between groups was 0.08 SDs (95% CI −0.04 to 0.21) favoring the intervention. Neither prenatal nor postnatal PM_2.5 or CO exposures were associated with HAZ. A 10 μg/m³ difference in prenatal and postnatal PM_2.5 corresponded to a HAZ difference of −0.003 SDs (−0.011 to 0.005) and −0.001 SDs (−0.005 to 0.007), respectively. A 1 ppm difference in prenatal or postnatal CO corresponded to −0.009 SDs (−0.025 to 0.008) and 0.000 (−0.011 to 0.012), respectively.</div></div><div><h3>Interpretation</h3><div>Children of mothers randomized to LPG were not taller than controls. Personal PM_2.5 or CO exposures did not influence child growth.</div></div><div><h3>Funding</h3><div><span>US National Institutes of Health</span>; <span>Bill &amp; Melinda Gates Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101382"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078714","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":"Oral health in the Americas: progress, gaps, and the path to universal coverage","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2026.101458","DOIUrl":"10.1016/j.lana.2026.101458","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101458"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147449019","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":"Brazil's health tax at a crossroads: safeguarding the constitutional victory against ultra-processed foods","authors":"Felipe Silva Neves ,&nbsp;Larissa Loures Mendes ,&nbsp;Eduardo Augusto Fernandes Nilson ,&nbsp;Inês Rugani Ribeiro de Castro ,&nbsp;Rafael Moreira Claro ,&nbsp;Daniela Silva Canella ,&nbsp;Ísis Eloah Machado ,&nbsp;Ariene Silva do Carmo ,&nbsp;Mariana Carvalho de Menezes ,&nbsp;Deborah Carvalho Malta","doi":"10.1016/j.lana.2025.101363","DOIUrl":"10.1016/j.lana.2025.101363","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101363"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885801","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}