Lancet Regional Health-Americas最新文献

{"title":"The prevalence of cannabis use pre-versus post-cannabis legalization in Canada by mental health status: findings from national repeat cross-sectional surveys","authors":"Samantha Rundle ,&nbsp;Maryam Iraniparast ,&nbsp;David Hammond","doi":"10.1016/j.lana.2026.101373","DOIUrl":"10.1016/j.lana.2026.101373","url":null,"abstract":"<div><h3>Background</h3><div>The bidirectional relationship between cannabis use and mental health is complex. With the liberalization of cannabis laws in many countries, it is increasingly important to understand the impacts of cannabis legalization on individuals with mental health conditions. This study aimed to examine changes in cannabis use by mental health status pre-versus 5-years post-legalization of recreational cannabis in Canada.</div></div><div><h3>Methods</h3><div>Data were from the International Cannabis Policy Study's national repeat cross-sectional surveys, conducted annually in Canada between 2018 and 2023, one year before and five years after the legalization of cannabis. The current analysis includes 92,843 Canadians aged 16–65 years. Adjusted logistic regression models examined changes in daily and past 12-month cannabis use pre-versus post-legalization among individuals experiencing each of the five mental health problems in the last year: anxiety, bipolar, depression, post-traumatic stress disorder (PTSD), and schizophrenia.</div></div><div><h3>Findings</h3><div>Past 12-month cannabis consumption increased from pre-legalization versus the year immediately following legalization (2019) among those with anxiety (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.15, 1.53, <em>p</em> &lt; 0.0001), depression (AOR = 1.47, 95% CI = 1.26, 1.73, <em>p</em> &lt; 0.0001), and those reporting ‘no experience’ of a mental health problem in the past year (AOR = 1.52, 95% CI = 1.37, 1.68, <em>p</em> &lt; 0.0001). Past 12-month cannabis use remained significantly higher in 2023 versus pre-legalization for anxiety and depression. Daily cannabis use increased from 2018 to 2019 only among those not reporting any experience of a mental health problem in the past year (AOR = 1.34, 95% CI = 1.10, 1.62, <em>p</em> &lt; 0.0001). No other pre-post legalization differences were observed among individuals who experienced bipolar, PTSD, or schizophrenia.</div></div><div><h3>Interpretation</h3><div>Few changes in cannabis use were observed pre-versus post-cannabis legalization among Canadians who reported experiencing a mental health problem, whereas daily and past 12-month use increased among Canadians not reporting a mental health problem.</div></div><div><h3>Funding</h3><div>Funding for the ICPS study was provided by a <span>Canadian Institutes of Health Research Project Grant and Project Bridge Grant</span> (PJT-153342).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101373"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037678","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":"‘Strategic approaches to reducing the substance use-related burden of disease in Canada’ — authors' reply","authors":"Benedikt Fischer ,&nbsp;Wayne Hall ,&nbsp;Bernard Le Foll ,&nbsp;Patricia Conrod","doi":"10.1016/j.lana.2026.101376","DOIUrl":"10.1016/j.lana.2026.101376","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101376"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078147","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":"Twenty years of efforts to reduce stunting in Ecuador: how to accelerate progress and confront the challenges?","authors":"Jairo Rivera ,&nbsp;Estefani Jarrín ,&nbsp;Ximena Garzon-Villalba ,&nbsp;José Ruales","doi":"10.1016/j.lana.2026.101386","DOIUrl":"10.1016/j.lana.2026.101386","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101386"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188632","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":"Physical restraint use in a United States intensive care unit—a retrospective cross sectional, single center cohort study from 2008 to 2022","authors":"Maximin Lange ,&nbsp;Leo A. Celi ,&nbsp;Ben Carter ,&nbsp;Jesse D. Raffa ,&nbsp;Sharon C. O'Donoghue ,&nbsp;Marzyeh Ghassemi ,&nbsp;Tom J. Pollard","doi":"10.1016/j.lana.2026.101374","DOIUrl":"10.1016/j.lana.2026.101374","url":null,"abstract":"<div><h3>Background</h3><div>Physical restraints are widely used in intensive care units (ICUs) despite uncertain clinical benefit and risks. We aimed to characterise patterns of restraint use, demographic and clinical predictors, and temporal trends before and after introduction of federal restraint-related reporting requirements.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of 51,838 adults admitted to ICUs at Beth Israel Deaconess Medical Center, Boston, MA, USA, between 2008 and 2022, using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record repository. Primary outcome was the proportion of ICU days with documented physical restraint use. Associations between restraint use and demographic and clinical factors were estimated using a binomial generalised linear model with a logit link. Propensity score matching compared Black and White patients under varying adjustment specifications.</div></div><div><h3>Findings</h3><div>Among 51,838 patients (mean age 63.8 years; 57% male), 21,091 (40.7%) experienced restraint. Use increased from 36.9% in 2008–10 to 44.0% in 2020–22 (p &lt; 0.0001). Asian (aOR 0.84, 95% CI 0.79–0.89) and Hispanic/Latino patients (aOR 0.87, 95% CI 0.83–0.92) had lower odds of restraint than White patients. Propensity score matching between Black and White patients revealed ethnic patterns were highly sensitive to model specification: excluding demographic characteristics revealed significant disparities, which were attenuated when psychiatric diagnoses were also excluded. Matched White patients were not representative of all White ICU patients but rather a subset resembling Black patients on observed characteristics.</div></div><div><h3>Interpretation</h3><div>Restraint practices appear to vary with patient acuity, institutional factors, and communication barriers. The sensitivity of ethnic disparities to psychiatric diagnosis adjustment suggests these diagnoses may function as mediators rather than confounders, potentially reflecting systematic differences in clinical assessment along the causal pathway between ethnicity and restraint decisions. The non-representativeness of matched cohorts underscores that disparities depend on which patient subgroups are compared. Prospective multisite studies with standardized assessment protocols are needed to validate findings, disentangle true clinical variation from systematic bias and provide a more comprehensive understanding of restraint practices across US ICU settings.</div></div><div><h3>Funding</h3><div>No study-specific funding was received.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101374"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978367","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":"Exercise dose, measurement reliability, and mechanistic inference in fibromyalgia trials: a critical appraisal","authors":"André Pontes-Silva","doi":"10.1016/j.lana.2026.101384","DOIUrl":"10.1016/j.lana.2026.101384","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101384"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188631","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":"Impact and scope of Mexican clinical practice guideline for adult overweight and obesity on weight stigma","authors":"Emma Chávez-Manzanera ,&nbsp;Verónica Vázquez-Velázquez","doi":"10.1016/j.lana.2025.101366","DOIUrl":"10.1016/j.lana.2025.101366","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101366"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927694","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":"An undeniable public health urgency, but an incomplete response: centering racial and ethnic equity in Canada's “Strategic approaches to reducing the substance use-related burden of disease”","authors":"Jude Mary Cénat ,&nbsp;Idrissa Beogo ,&nbsp;Monnica Williams ,&nbsp;Smita Pakhale","doi":"10.1016/j.lana.2025.101370","DOIUrl":"10.1016/j.lana.2025.101370","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101370"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927696","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":"Expanding the neurological spectrum of HTLV-1 beyond HAM/TSP: a contemporary perspective","authors":"Abelardo Q.C. Araujo ,&nbsp;Marcus Tulius T. Silva","doi":"10.1016/j.lana.2025.101347","DOIUrl":"10.1016/j.lana.2025.101347","url":null,"abstract":"<div><div>Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress. This Personal View highlights the expanding neurological spectrum of HTLV-1, which includes rare but well-documented encephalopathy, cognitive decline, peripheral neuropathy, inflammatory myopathy, cerebellar dysfunction, autonomic disorders, motor neuron disease-like syndromes, and seizures. These can happen independently or alongside HAM/TSP. The proposed concept of an “HTLV-1 neurological complex” better represents this multifaceted involvement. Recognising this diversity is essential for accurate diagnosis and better outcomes, particularly in endemic settings. A paradigm shift is needed—one that broadens the clinical focus beyond myelopathy to encompass the full neurological spectrum, thereby improving global care and management.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101347"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885799","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":"Inclusion of incarcerated individuals in wildfire exposure registries","authors":"Lawrence A. Haber ,&nbsp;Katherine LeMasters ,&nbsp;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}