Lancet Regional Health-Americas最新文献

{"title":"Baseline variables associated with subsequent HIV seroconversion among gay, bisexual and other men who have sex with men and transgender women: a prospective, multicenter PrEP demonstration study (ImPrEP)","authors":"Carlos F. Caceres ,&nbsp;Heather Pines ,&nbsp;Kelika A. Konda ,&nbsp;Annick Borquez ,&nbsp;Ronaldo Moreira ,&nbsp;Iuri Leite ,&nbsp;Pedro Amparo ,&nbsp;Marcelo Cunha ,&nbsp;Thiago S. Torres ,&nbsp;Juan V. Guanira ,&nbsp;Jean-Pierre Jirón ,&nbsp;Brenda Hoagland ,&nbsp;Heleen Vermandere ,&nbsp;Marcos Benedetti ,&nbsp;Hamid Vega ,&nbsp;Carlos M. Benites ,&nbsp;Cristina Pimenta ,&nbsp;Beatriz Grinztejn ,&nbsp;Valdiléa Veloso ,&nbsp;Karen Campos","doi":"10.1016/j.lana.2025.101098","DOIUrl":"10.1016/j.lana.2025.101098","url":null,"abstract":"<div><h3>Background</h3><div>Ongoing implementation of HIV pre-exposure prophylaxis (PrEP) in Latin America should consider lessons learned from implementation projects such as ImPrEP (Brazil/Mexico/Peru, 2018–2021). In this analysis we assessed the effect of variables ascertained in early appointments on HIV seroconversion among ImPrEP participants.</div></div><div><h3>Methods</h3><div>ImPrEP enrolled HIV-negative men who have sex with men and transgender women (MSM/TGW) aged 18+ years reporting recent condomless anal sex, anal sex with HIV-positive partners, transactional sex, or sexually transmitted infections (STI). Participants received a 30-day PrEP supply; at the 30-day visit and quarterly thereafter they completed behavioural assessments, underwent HIV testing, and received 3-month PrEP supplies if HIV-negative. PrEP adherence was measured using the medication possession ratio (MPR) at the 30-day visit. We used Cox's proportional hazards regression to examine the effect of our sociodemographic, behavioural, STI, and early PrEP care engagement variables of interest on time to HIV seroconversion.</div></div><div><h3>Findings</h3><div>Compared to participants in Brazil, the hazard ratio for HIV seroconversion was higher among those in Peru (HR = 7.91, 95% CI: 4.74–13.20). Compared to participants aged ≥35 years, the HR for HIV seroconversion was higher for those aged 18–24 (aHR = 4.84, 95% CI: 2.55–9.17 and 25–34 (aHR = 2.43, 95% CI: 1.21–4.91). HIV seroconversion was also associated with transgender identity (aHR = 2.28, 95% CI: 1.12–4.66), transactional sex (aHR = 1.88, 95% CI: 1.18–2.99), receptive condomless anal sex (aHR = 2.42, 95% CI: 1.42–4.12), STI diagnosis (aHR = 1.93, 95% CI: 1.25–2.99), and a MPR &lt; 0.6 (aHR = 2.64, 95% CI: 1.52–4.60).</div></div><div><h3>Interpretation</h3><div>While moderate-high, HIV incidence among ImPrEP participants represented a considerable reduction from figures observed among MSM/TGW not using PrEP/PEP. Interventions to improve PrEP adherence are needed among new Latin American PrEP users, especially if baseline factors associated with seroconversion are present. Long-acting injectable PrEP can also become useful for this population.</div></div><div><h3>Funding</h3><div>This study was funded by <span>UNITAID</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101098"},"PeriodicalIF":7.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868838","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":"Adherence to treatment for tuberculosis infection in children using a comprehensive care strategy: a prospective cohort study with a historical control group","authors":"Iader Rodríguez-Márquez ,&nbsp;Dione Benjumea-Bedoya ,&nbsp;Andrea Victoria Restrepo-Gouzy ,&nbsp;Claudia Patricia Beltrán-Arroyave ,&nbsp;Diana Marín ,&nbsp;Fernando Nicolás Montes-Zuluaga ,&nbsp;Juan Carlos Alzate-Ángel ,&nbsp;Lina Marcela Cadavid-Álvarez ,&nbsp;Lizeth Andrea Paniagua-Saldarriaga ,&nbsp;Teresa Realpe ,&nbsp;Yesenia Perea-Torres ,&nbsp;Lisandra María Arango-García ,&nbsp;Natalia Pérez-Doncel ,&nbsp;María Patricia Arbeláez-Montoya ,&nbsp;Jaime Robledo","doi":"10.1016/j.lana.2025.101094","DOIUrl":"10.1016/j.lana.2025.101094","url":null,"abstract":"<div><h3>Background</h3><div>Low adherence to treatment for tuberculosis infection (TBI) in children threatens tuberculosis (TB) control goals. This research focuses on children with close contact to TB and TBI. This study evaluated adherence to treatment of TBI using a comprehensive care strategy (CCS) for close-contact children with pulmonary TB compared with standard of care (SOC).</div></div><div><h3>Methods</h3><div>A prospective cohort study with a historical control group was conducted on children under five, who were close contacts of patients with bacteriologically confirmed pulmonary TB in three Colombian cities (study registration number: <span><span>NCT04331262</span><svg><path></path></svg></span>). The CCS comprised clinical evaluations, rifampicin for four months, multidisciplinary care, and logistical support, while the SOC followed program regulations with isoniazid for nine months. The primary outcome was the proportion of children completing 100% treatment during follow-up, and the secondary outcome was treatment-related adverse events (AEs).</div></div><div><h3>Findings</h3><div>213 children in the SOC group and 86 children in the CCS group were analyzed. The treatment adherence in the SOC group was 40·8% (95% CI 34%; 48%), while in the CCS group it was 76·7% (95% CI 66%; 85%). Children exposed to CCS had 87% higher probability of adherence to TBI treatment compared to SOC (RR 1·87; 95% CI 1·52; 2·31). The incidence of AEs was lower in the CCS group (n = 3) than in those receiving SOC (n = 24).</div></div><div><h3>Interpretation</h3><div>The CCS increases adherence to treatment for TBI in children safely compared to SOC. Future cost-effectiveness studies will help implement this strategy in programmatic settings.</div></div><div><h3>Funding</h3><div><span>Colombian Ministry of Science, Technology and Innovation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101094"},"PeriodicalIF":7.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854754","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":"Actions against the double burden of malnutrition in Peru: a community-informed system dynamics model","authors":"Paraskevi Seferidi ,&nbsp;Laura Guzman-Abello ,&nbsp;Ellis Ballard ,&nbsp;Hilary M. Creed-Kanashiro ,&nbsp;Luis Huicho ,&nbsp;J Jaime Miranda ,&nbsp;Christopher Millett ,&nbsp;Antonio Bernabe-Ortiz","doi":"10.1016/j.lana.2025.101102","DOIUrl":"10.1016/j.lana.2025.101102","url":null,"abstract":"<div><h3>Background</h3><div>Peru's progress in reducing stunting has stagnated since 2018, while the country is facing increasing levels of overnutrition, leading to a double burden of malnutrition. However, this shift in nutrition burden is not reflected in Peru's nutrition policy agenda. This study aims to identify leverage points for actions against population-level double burden of malnutrition in Peru.</div></div><div><h3>Methods</h3><div>We developed a system dynamics model that simulates changes in overweight and stunting over time in Peru through changes in food system drivers. The model was conceptually informed by policymakers, practitioners and community members in Peru and used quantitative and qualitative data from secondary sources and published literature.</div></div><div><h3>Findings</h3><div>The model indicated that several overnutrition policies, including policies targeting food availability and affordability, may decelerate but not halt the increase of overweight in the country, mainly due to industry resistance. However, in the long term, the reallocation of resources towards overnutrition policies may inadvertently hinder progress towards stunting targets. Transforming nutrition policy governance, from siloed overnutrition and undernutrition policies towards a common policy framework against the double burden of malnutrition was the only modelled scenario that halted the rise in overnutrition, while keeping Peru on course to reach its stunting goals.</div></div><div><h3>Interpretation</h3><div>Transition away from policy landscapes that focus on single nutrition outcomes towards synergistic actions that target malnutrition in all forms is a long-term solution towards achieving global nutrition goals. Such policy transitions are especially important in low and middle-income countries like Peru, which are affected by the double burden of malnutrition.</div></div><div><h3>Funding</h3><div>This study was supported by a research grant from the <span>Biotechnology and Biological Sciences Research Council</span> (BBSRC) (grant reference: BB/T009004/1).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101102"},"PeriodicalIF":7.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854696","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":"Implications of adverse and benevolent childhood experiences on the physical and mental health of Mexican adults: a population-based study","authors":"Daniela León Rojas ,&nbsp;Fabiola Castorena Torres ,&nbsp;Nissa Yaing Torres-Soto ,&nbsp;Irene Martín-Estal ,&nbsp;Veronica Mundo Rosas ,&nbsp;Brenda Martinez Tapia ,&nbsp;Julieta Rodríguez-de-Ita","doi":"10.1016/j.lana.2025.101092","DOIUrl":"10.1016/j.lana.2025.101092","url":null,"abstract":"<div><h3>Background</h3><div>Adverse childhood experiences (ACEs) are linked to negative physical and mental health outcomes. Limited information on their influence exists in Latin America and middle-income countries like Mexico. This study aimed to determine the prevalence and impact of ACEs and benevolent childhood experiences (BCEs) on Mexican population health.</div></div><div><h3>Methods</h3><div>From September to November 2023, this cross-sectional study recruited a nationally representative sample of adults aged 18–65, randomly selected from urban and rural areas. Sociodemographic data, ACEs, BCEs, physical and mental health history, and clinical assessments for depression, anxiety, post-traumatic stress disorder, and eating disorders were collected.</div></div><div><h3>Findings</h3><div>Of 1448 participants recruited, 1115 (77%) were women, 1278 (88·2%) reported at least one ACE, while 328 (22·6%) had four or more. Physical (840; 58·6%) and emotional neglect (518; 35·7%) were the most frequent. Four or more ACEs increased the odds of obesity (OR 1·8, 95% CI 1·2–2·8), hypertension (OR 1·6, 95% CI 1·1–2·2), depression (OR 4·7, 95% CI 3·6–6·1) and anxiety (OR 4·1, 95% CI 3·2–5·3) among others. Common BCEs included having at least one supportive caregiver (1298; 89·6%) and feeling comfortable with oneself (1272; 87·8%). BCEs decreased the odds of physical and mental health diagnoses.</div></div><div><h3>Interpretation</h3><div>ACEs are highly prevalent and significantly impact the health of Mexican population. BCEs protect against these effects. Considering ACEs in public policies can help establish interventions to prevent adversity and promote positive childhood experiences.</div></div><div><h3>Funding</h3><div><span>Fundación FEMSA</span>, Centro de Primera Infancia from <span>Tecnológico de Monterrey and Fundación FEMSA</span> and <span>Tecnologico de Monterrey Challenge-Based Research Funding Program</span> 2022.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101092"},"PeriodicalIF":7.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850867","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":"Understanding the broader impacts of non-fatal firearm violence trauma in the United States: a scoping review","authors":"Deanna M. Giraldi ,&nbsp;Susan Swingler ,&nbsp;David S. Kirk ,&nbsp;Sara F. Jacoby ,&nbsp;G.J. Melendez-Torres ,&nbsp;Elinore J. Kaufman ,&nbsp;David K. Humphreys","doi":"10.1016/j.lana.2025.101091","DOIUrl":"10.1016/j.lana.2025.101091","url":null,"abstract":"<div><div>Exposure to firearm violence produces ripples of impact that extend far beyond the physical wounds of direct survivors. This scoping review aimed to describe the breadth of the last 25 years of literature on short-term, long-term, and cumulative impacts of firearm violence in the United States across physical, psychological, social, and economic domains. We searched PubMed, Embase, Scopus, PsycINFO, CINAHL, ProQuest Social Science Premium (ASSIA, NCJRS, and ERIC) and Web of Science until March 2024. Among 3172 articles, 87 met inclusion criteria. Our findings suggest that research most often explores short-term and psychological impacts on direct survivor-witnesses. The review highlights notable gaps, particularly regarding long-term and cumulative impacts among both the immediate social networks of survivor-witnesses and their wider communities. Further research is necessary for the effective development of trauma-informed interventions and the provision of economic resources aimed at supporting a growing population of survivors and communities affected by violence.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101091"},"PeriodicalIF":7.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848002","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":"Prediction of mammographic breast density based on clinical breast ultrasound images using deep learning: a retrospective analysis","authors":"Arianna Bunnell ,&nbsp;Dustin Valdez ,&nbsp;Thomas K. Wolfgruber ,&nbsp;Brandon Quon ,&nbsp;Kailee Hung ,&nbsp;Brenda Y. Hernandez ,&nbsp;Todd B. Seto ,&nbsp;Jeffrey Killeen ,&nbsp;Marshall Miyoshi ,&nbsp;Peter Sadowski ,&nbsp;John A. Shepherd","doi":"10.1016/j.lana.2025.101096","DOIUrl":"10.1016/j.lana.2025.101096","url":null,"abstract":"<div><h3>Background</h3><div>Breast density, as derived from mammographic images and defined by the Breast Imaging Reporting &amp; Data System (BI-RADS), is one of the strongest risk factors for breast cancer. Breast ultrasound is an alternative breast cancer screening modality, particularly useful in low-resource, rural contexts. To date, breast ultrasound has not been used to inform risk models that need breast density. The purpose of this study is to explore the use of artificial intelligence (AI) to predict BI-RADS breast density category from clinical breast ultrasound imaging.</div></div><div><h3>Methods</h3><div>We compared deep learning methods for predicting breast density directly from breast ultrasound imaging, as well as machine learning models from breast ultrasound image gray-level histograms alone. The use of AI-derived breast ultrasound breast density as a breast cancer risk factor was compared to clinical BI-RADS breast density. Retrospective (2009–2022) breast ultrasound data were split by individual into 70/20/10% groups for training, validation, and held-out testing for reporting results.</div></div><div><h3>Findings</h3><div>405,120 clinical breast ultrasound images from 14,066 women (mean age 53 years, range 18–99 years) with clinical breast ultrasound exams were retrospectively selected for inclusion from three institutions: 10,393 training (302,574 images), 2593 validation (69,842), and 1074 testing (28,616). The AI model achieves AUROC 0.854 in breast density classification and statistically significantly outperforms all image statistic-based methods. In an existing clinical 5-year breast cancer risk model, breast ultrasound AI and clinical breast density predict 5-year breast cancer risk with 0.606 and 0.599 AUROC (DeLong’s test p-value: 0.67), respectively.</div></div><div><h3>Interpretation</h3><div>BI-RADS breast density can be estimated from breast ultrasound imaging with high accuracy. The AI model provided superior estimates to other machine learning approaches. Furthermore, we demonstrate that age-adjusted, AI-derived breast ultrasound breast density provides similar predictive power to mammographic breast density in our population. Estimated breast density from ultrasound may be useful in performing breast cancer risk assessment in areas where mammography may not be available.</div></div><div><h3>Funding</h3><div><span>National Cancer Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101096"},"PeriodicalIF":7.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848005","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":"Prescription opioid use and substance use disorder in US women (2006–2022): a retrospective cohort study","authors":"Andrew J. Schoenfeld ,&nbsp;Kaitlyn E. Holly ,&nbsp;Matthew R. Bryan ,&nbsp;Malina O. Hatton ,&nbsp;Matthew Wien ,&nbsp;Tracey P. Koehlmoos","doi":"10.1016/j.lana.2025.101108","DOIUrl":"10.1016/j.lana.2025.101108","url":null,"abstract":"<div><h3>Background</h3><div>Research has shown that multiple deployments may have adverse effects on active-duty servicewomen and women civilian dependents of active-duty servicemembers. There is concern that the associated stress could induce sustained prescription opioid use and substance use disorder (SUD). We sought to evaluate the incidence of sustained opioid use and SUD among servicewomen and women civilian dependents during 2006–2013, a period of increased operational intensity, compared to similar individuals in 2014–2022.</div></div><div><h3>Methods</h3><div>We employed Military Health System claims data to identify servicewomen and dependents who were diagnosed with SUD or demonstrated sustained prescription opioid use (i.e., six months of uninterrupted use). The incidence of sustained opioid use (primary outcome) and SUD associated (secondary outcome) with 2006–2013 was compared to 2014–2022 among servicewomen and dependents. Multivariable log binomial regression was used to adjust for confounding. Ethnicity was not available in our dataset.</div></div><div><h3>Findings</h3><div>4,876,209 individuals were included. The average age (standard deviation [SD]) of the cohorts under study were 26.6 (SD 8.2) for active duty 2006–2013, 26.0 (SD 8.0) for active duty 2014–2022, 35.3 (SD 13.1) for dependents 2006–2013 and 33.6 (SD 12.1) for dependents 2014–2022. Compared to civilian dependents in 2014–2022, servicewomen from 2006 to 2013 demonstrated an increased risk of sustained prescription opioid use (RR 1.49, 95% CI 1.46–1.53). In 2014–2022, servicewomen had a lower risk compared to dependents (RR 0.47, 95% CI 0.45–0.49), while dependents in 2006–2013 were also at higher risk (RR 1.58, 95% CI 1.56–1.60). Servicewomen in 2006–2013 were at significantly greater risk of developing SUD (RR 1.07, 95% CI 1.06–1.08). During 2014–2022, servicewomen displayed a lower risk when compared to dependents (RR 0.80, 95% CI 0.79–0.81). Dependents in 2006–2013 showed a higher risk (RR 1.24, 95% CI 1.24–1.25).</div></div><div><h3>Interpretation</h3><div>We found significant increases in the risks of sustained opioid use and SUD among servicewomen and civilian dependents during a period of increased operational intensity (2006–2013). We believe these findings reflect the deleterious effects of emotional stress, insufficient support structures, and military sexual trauma.</div></div><div><h3>Funding</h3><div><span>U.S. Department of Defense, Defense Health Agency</span> (#HU00012320021).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101108"},"PeriodicalIF":7.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848006","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":"Immunologic changes in the peripheral blood transcriptome of individuals with early-stage chronic Chagas cardiomyopathy: a cross-sectional study","authors":"Carolina Duque ,&nbsp;Jaime So ,&nbsp;Yagahira E. Castro-Sesquen ,&nbsp;Kelly DeToy ,&nbsp;Sneider A. Gutierrez Guarnizo ,&nbsp;Fatemeh Jahanbakhsh ,&nbsp;Edith Malaga Machaca ,&nbsp;Monica Miranda-Schaeubinger ,&nbsp;Indira Chakravarti ,&nbsp;Virginia Cooper ,&nbsp;Mary E. Schmidt ,&nbsp;Luigi Adamo ,&nbsp;Rachel Marcus ,&nbsp;Kawsar R. Talaat ,&nbsp;Robert H. Gilman ,&nbsp;Monica R. Mugnier ,&nbsp;the Chagas Working Group","doi":"10.1016/j.lana.2025.101090","DOIUrl":"10.1016/j.lana.2025.101090","url":null,"abstract":"<div><h3>Background</h3><div>Chagas disease, caused by the protozoan parasite <em>Trypanosoma cruzi,</em> is a neglected disease that affects approximately 6 million individuals worldwide. Of those infected, 20–30% will go on to develop chronic Chagas cardiomyopathy (CCC), and many ultimately to advanced heart failure. The mechanisms by which this progression occurs are poorly understood. In this exploratory study, we sought to provide insight into the physiologic changes associated with the development of early CCC.</div></div><div><h3>Methods</h3><div>We used RNA sequencing to analyse the gene expression changes in the peripheral blood of six patients with Chagas disease with early structural heart disease, four patients with Chagas disease without any signs or symptoms of disease, thirteen patients without Chagas disease with early structural heart disease, and ten patients without Chagas disease or signs of heart disease. Pathway analyses and immune cell deconvolution were employed to further elucidate the biological processes underlying early CCC development.</div></div><div><h3>Findings</h3><div>Our analysis suggests that early CCC is associated with a downregulation of various peripheral immune response genes, including changes suggestive of reduced antigen presentation and T cell activation. Notably, these genes and processes appear to be distinct from those of non-Chagas cardiomyopathies.</div></div><div><h3>Interpretation</h3><div>This work highlights the potential importance of the immune response in early CCC, providing insight into the early pathogenesis of this disease and how it may differ from other cardiomyopathies. The changes we have identified may serve as biomarkers of early CCC and could inform future longitudinal cohort studies of markers of disease progression and strategies for the treatment of CCC in its early stages.</div></div><div><h3>Funding</h3><div><span>NIH</span>, <span>FONDECYT</span>, <span>IDSA</span>, <span>NSF</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101090"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843821","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":"Opioid and stimulant co-prescribing does not equate to a co-epidemic","authors":"Kevin Young Xu ,&nbsp;Richard A. Grucza ,&nbsp;Vitor Soares Tardelli ,&nbsp;Patrick D. Quinn ,&nbsp;Jeffrey F. Scherrer","doi":"10.1016/j.lana.2025.101093","DOIUrl":"10.1016/j.lana.2025.101093","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101093"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838400","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":"Cardiovascular diseases mortality in Brazilian municipalities: estimates from the Global Burden of Disease study, 2000–2018","authors":"Luisa Campos Caldeira Brant ,&nbsp;Juliana Bottoni Souza ,&nbsp;Bruno Ramos Nascimento ,&nbsp;Beatriz Polachini Assunes Gonçalves ,&nbsp;Ana Luiza Assumpção Ciminelli ,&nbsp;Antonio Luiz Pinho Ribeiro ,&nbsp;Deborah Carvalho Malta","doi":"10.1016/j.lana.2025.101106","DOIUrl":"10.1016/j.lana.2025.101106","url":null,"abstract":"<div><h3>Background</h3><div>Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study.</div></div><div><h3>Methods</h3><div>In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000–2002, 2009–2011, 2016–2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in &lt;30,000, 30,000–300,000, and &gt;300,000 inhabitants per region. The % changes in ASMR from 2000–2002 to 2016–2018 were calculated.</div></div><div><h3>Findings</h3><div>In 2000–2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016–2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from −3% in small Northern municipalities to −43% in large Southern municipalities.</div></div><div><h3>Interpretation</h3><div>The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority.</div></div><div><h3>Funding</h3><div><span>Brazilian Ministry of Health</span> [grant 148/2018] and <span>Pan American Health Organization</span> [Letter of Agreement SCON2021-00288].</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101106"},"PeriodicalIF":7.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843069","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}