Lancet Regional Health-Americas最新文献

{"title":"Immunogenicity and reactogenicity of fractional vs. full booster doses of COVID-19 vaccines: a non-inferiority, randomised, double-blind, phase IV clinical trial in Brazil","authors":"Marco Antonio Moreira Puga ,&nbsp;Roberto Dias de Oliveira ,&nbsp;Patricia Vieira da Silva ,&nbsp;Vivek Charu ,&nbsp;Haley Hedlin ,&nbsp;Di Lu ,&nbsp;Amy Zhang ,&nbsp;Blake Shaw ,&nbsp;Joelle Ivy Rosser ,&nbsp;Jessica Couvillion Seidman ,&nbsp;Alice Scott Carter ,&nbsp;Farah Naz Qamar ,&nbsp;Stephen P. Luby ,&nbsp;Denise O. Garrett ,&nbsp;Julio Croda","doi":"10.1016/j.lana.2025.101031","DOIUrl":"10.1016/j.lana.2025.101031","url":null,"abstract":"<div><h3>Background</h3><div>Fractional doses of vaccine to protect against COVID-19 offer the potential to expand vaccine availability, reduce side effects, and enhance vaccination campaign efficiency. This study aimed to assess the immune response and safety of fractional doses of SARS-CoV-2 booster vaccines compared to full doses in immunocompetent adults aged 18–60 who had previously received a full series of Sinovac, AZD1222 (AstraZeneca), or BNT162b2 (Pfizer/BioNTech).</div></div><div><h3>Methods</h3><div>This trial was structured as a parallel-group, double-blind, randomised Phase IV non-inferiority study, carried out in Campo Grande, Midwest, Brazil. After obtaining consent, eligible participants were randomised to one of 5–6 study arms, depending on their priming vaccine. Participants were followed for 21–60 days after vaccination through in-person visits and remote contact for blood collection and safety evaluation. Anti-spike binding IgG antibodies were measured by ELISA. The primary outcome was the difference in seroresponse rates between the full and fractional doses, with a non-inferiority threshold of 10%.</div></div><div><h3>Findings</h3><div>A total of 1451 participants were randomised and administered booster vaccines between 5 July and 3 October, 2022. A half dose of BNT162b2 met the non-inferiority threshold, compared to a full dose in the Sinovac and AZD1222 primed groups. Sinovac induced an inferior response compared to AZD1222 and BNT162b2 full or fractional dose boosters in participants primed with Sinovac. Fractional booster doses of BNT162b2 consistently resulted in higher seroresponse rates (ranging from 35.4% to 78.3%) compared to fractional boosters of AZD1222 (ranging from 10.0% to 44.7%) or a full dose of Sinovac (4.2%). Both full and fractional dose vaccines were generally well tolerated. Local and systemic adverse events occurred across all treatment arms in line with expectations, with nine serious adverse events reported, none of which were determined to be related to study vaccination.</div></div><div><h3>Interpretation</h3><div>Our data show that the immunogenicity of booster vaccines depends on the initial vaccine, baseline antibody levels, and the booster vaccine used. Fractional doses of BNT162b2 and AZD1222 were non-inferior to a full Sinovac booster in individuals primed with Sinovac. However, fractional doses of BNT162b2 were not non-inferior in BNT162b2-primed individuals, and AZD1222 fractional doses were only non-inferior in the AZD1222 priming arm. We advise against Sinovac as a booster. Fractional doses of BNT162b2 or AZD1222 remain practical alternatives for Sinovac-primed populations in resource-limited settings.</div></div><div><h3>Funding</h3><div><span>Coalition for Epidemic Preparedness Innovations</span> (CEPI)/<span>Sabin Vaccine Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101031"},"PeriodicalIF":7.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464452","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":"A global call for family-centered ICU care","authors":"Bradley A. Firchow","doi":"10.1016/j.lana.2025.101036","DOIUrl":"10.1016/j.lana.2025.101036","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101036"},"PeriodicalIF":7.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454059","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":"Performance of the World Health Organization (WHO) severe acute respiratory infection (SARI) case definitions in hospitalized children and youth: cross-sectional study","authors":"Peter J. Gill ,&nbsp;Caitlyn L. Kaziev ,&nbsp;Haifa Mtaweh ,&nbsp;Tuana Kant ,&nbsp;Claire Seaton ,&nbsp;Daniel S. Farrar ,&nbsp;Hayley Wagman ,&nbsp;Mei Han ,&nbsp;Rohini R. Datta ,&nbsp;Sanjay Mahant ,&nbsp;Gabrielle Freire ,&nbsp;Aaron Campigotto ,&nbsp;Jeffrey N. Bone ,&nbsp;Manish Sadarangani ,&nbsp;Francine Buchanan ,&nbsp;Shaun K. Morris","doi":"10.1016/j.lana.2025.101034","DOIUrl":"10.1016/j.lana.2025.101034","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory tract infections with viral pathogens are frequently identified using the World Health Organization (WHO) case definition of severe acute respiratory infection (SARI), defined as fever of ≥38°Celsius, cough, onset within 10 days, and hospitalization. While there is extensive research in adults, less is known about the WHO SARI case definition performance in children and youth. We aimed to determine the performance of the WHO SARI and modified case definitions in identifying viral respiratory tract infections in hospitalized children and youth.</div></div><div><h3>Methods</h3><div>Retrospective observational cross-sectional study of hospitalized children (0–18 years) with an acute respiratory infection and who received a respiratory viral test at two large Canadian children’s hospitals from July 2022 to June 2023. The WHO SARI and modified SARI case definitions were evaluated overall, by virus and age, with reporting of sensitivity and specificity.</div></div><div><h3>Findings</h3><div>There were 2333 hospital admissions, with a median age of 2.4 years (IQR 0.8–5.0). 78% (n = 1828) had one or more viruses identified, most commonly respiratory syncytial virus (30%, n = 709). The WHO SARI definition had a sensitivity of 58% and specificity of 49% for identifying infections with a microbiologically confirmed virus. For Influenza only, the sensitivity was 71% and specificity 44%. The lowest sensitivity was among young children &lt;3 months (28%) and 3 to &lt;6 months (45%). Modified SARI definitions had similarly poor performance, with trade-offs of sensitivity and specificity.</div></div><div><h3>Interpretation</h3><div>The widely implemented WHO SARI case definition has sub-optimal performance among children and youth hospitalized with acute respiratory infections. Public health surveillance based on these case definitions may inadequately detect and monitor known and emerging infections, highlighting the need to develop an accurate and reliable SARI case definition for children and youth globally.</div></div><div><h3>Funding</h3><div><span>Public Health Agency of Canada</span>, <span>SickKids Foundation</span>, <span>BC Children’s Hospital</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101034"},"PeriodicalIF":7.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464453","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":"Assessing the impact of revising MenACWY vaccination schedule for adolescents in the United States: a modelling study","authors":"Affan Shoukat ,&nbsp;Chad R. Wells ,&nbsp;Thomas Shin ,&nbsp;Lilia Potter-Schwartz ,&nbsp;Alison P. Galvani ,&nbsp;Seyed M. Moghadas","doi":"10.1016/j.lana.2025.101033","DOIUrl":"10.1016/j.lana.2025.101033","url":null,"abstract":"<div><h3>Background</h3><div>The current recommendation for MenACWY vaccination against invasive meningococcal disease (IMD) in the United States (US) includes two doses: the first dose at ages 11–12 and a booster dose at age 16. The Advisory Committee on Immunization Practices has proposed options for revising this schedule by either eliminating the first dose or adjusting the timing of the first dose to age 15 and the booster to ages 17–18. The impact of these alternative schedules on IMD incidence remains undetermined.</div></div><div><h3>Methods</h3><div>We developed an age-stratified, agent-based Monte-Carlo simulation model of meningococcal transmission dynamics, parameterised with US age demographics, to assess the impact of the proposed changes to the MenACWY vaccination schedules. Excluding serogroup A, absent in the US for decades, the model included serogroups C, W, and Y for asymptomatic infection (carriage) and vaccine effectiveness against IMD. We calibrated serogroup-specific transmission and IMD development probabilities by fitting the model to reported IMD cases from 1997 to 2004, before vaccine introduction. The calibrated model then simulated the current vaccination schedule (CVS) starting in 2005 and alternative schedules from January 1, 2025 to December 31, 2035, comparing outcomes over the same period.</div></div><div><h3>Findings</h3><div>Switching from the CVS to a single-dose program at age 16 with 61% vaccine uptake (as reported for the booster in 2022) would result in 1062 (95% Uncertainty Range [UR]: 724–1419) additional IMD cases during the 11-year study period. With a case fatality rate of 14.5%, this change could cause an estimated 154 (95% UR: 105–206) additional deaths. Even if vaccine uptake increased to 90% at age 16, the program would still result in 934 (95% UR: 640–1242) additional cases and 135 (95% UR: 93–180) more deaths compared to the CVS. The second alternative schedule (i.e. first dose at age 15, booster at ages 17–18) also increased IMD cases, notably shifting a substantial burden to adolescents aged 11–15 years.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that the current MenACWY vaccination program remains more effective than the proposed alternatives, even with increased vaccine uptake during late adolescence. Improving the uptake rate of the booster at age 16 while maintaining the 11–12-year dose within the existing program would reduce the IMD burden among high-risk adolescents and young adults.</div></div><div><h3>Funding</h3><div>This study was in part supported by Sanofi. Seyed M. Moghadas acknowledges support from the <span>Natural Sciences and Engineering Research Council</span> of Canada Discovery Grant and Alliance Grant (ALLRP 576914-22). Alison P. Galvani acknowledges support from The <span>Notsew Orm Sands Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101033"},"PeriodicalIF":7.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436756","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":"Corrigendum to long-term prescription opioid use following surgery in the US (2017–2022): a population-based study Lancet Reg Health Am. 2024 Dec 4;40:100948","authors":"Andrew J. Schoenfeld ,&nbsp;Zara Cooper ,&nbsp;Amanda Banaag ,&nbsp;Jonathan Gong ,&nbsp;Matthew R. Bryan ,&nbsp;Chirstian Coles ,&nbsp;Tracey P. Koehlmoos","doi":"10.1016/j.lana.2025.101043","DOIUrl":"10.1016/j.lana.2025.101043","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101043"},"PeriodicalIF":7.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428251","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":"The recent trend of twin epidemic in the United States: a 10-year longitudinal cohort study of co-prescriptions of opioids and stimulants","authors":"Seungyeon Lee ,&nbsp;Wenyu Song ,&nbsp;David W. Bates ,&nbsp;Richard D. Urman ,&nbsp;Ping Zhang","doi":"10.1016/j.lana.2025.101030","DOIUrl":"10.1016/j.lana.2025.101030","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the use of central nervous system stimulant medications has increased among the population already using opioids, referred to as a “twin epidemic.” There is an increasing concern about its harmful outcomes in large populations. However, very few studies examined the co-prescription pattern of these two drug categories over a long period, and there is currently no clear restriction on stimulant prescriptions among patients under opioid treatment in the United States. The objectives of our study were to identify opioid prescription dosage time-dependent patterns and patient subgroups representing distinct trajectories on a national level in the recent 10 years, and to further investigate longitudinal associations between stimulant and opioid prescriptions and the impact of stimulant prescriptions on opioid dosage patterns.</div></div><div><h3>Methods</h3><div>We obtained patient records from MarketScan, one of the largest clinical databases of health insurance in the United States. 10 years (2012–2021) of prescription records and related patient profiles, who received at least two independent opioid prescriptions, were utilized for developing a group-based opioid dose trajectory model.</div></div><div><h3>Findings</h3><div>From an initial cohort including 22 million patients with 96 million opioid prescriptions, we developed a study cohort of 2,895,960 patients with a mean age of 43.9 years (standard deviation [SD] 13.0), of whom 1,244,077 (43%) were male. Significant geographical variations in opioid prescription frequency and dosage among four U.S. regions were observed. The trajectory model identified five distinct opioid dose groups. Stimulant prescription before the initial opioid prescription was positively associated with escalating opioid doses (odds ratio [OR]: 7.58; 95% confidence intervals [CI] 6.14–9.35, opioid dose increasing group compared to the decreasing group). Stimulant co-prescriptions were also associated with increasing opioid doses (OR: 1.73; 95% CI 1.40–2.14) and were identified in patients with a higher prevalence of opioid use disorder.</div></div><div><h3>Interpretation</h3><div>During the recent 10 years, stimulant prescription is positively associated with escalating opioid prescription activities in U.S. healthcare systems, suggesting co-prescriptions of these two types of drugs are an important contributing factor for a national-level twin epidemic. Healthcare leaders and policymakers should pay more attention to this issue and its potential harms.</div></div><div><h3>Funding</h3><div><span>National Institute of General Medical Sciences</span>, <span>National Institute on Drug Abuse</span>, and <span>National Science Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 101030"},"PeriodicalIF":7.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429389","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":"The hidden crisis of incarcerated individuals during wildfires","authors":"Katherine LeMasters ,&nbsp;Lawrence A. Haber","doi":"10.1016/j.lana.2025.101032","DOIUrl":"10.1016/j.lana.2025.101032","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101032"},"PeriodicalIF":7.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422679","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":"Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021","authors":"Ramón Martinez ,&nbsp;Paula Muñoz-Venturelli ,&nbsp;Pedro Ordunez ,&nbsp;Felipe Fregni ,&nbsp;Carlos Abanto ,&nbsp;Matias Alet ,&nbsp;Tony Fabián Alvarez ,&nbsp;Pablo Amaya ,&nbsp;Sebastian Ameriso ,&nbsp;Antonio Arauz ,&nbsp;Miguel A. Barboza ,&nbsp;Hernán Bayona ,&nbsp;Antonio Bernabé-Ortiz ,&nbsp;Juan Calleja ,&nbsp;Vanessa Cano-Nigenda ,&nbsp;Leonardo Augusto Carbonera ,&nbsp;Rodrigo M. Carrillo-Larco ,&nbsp;Angel Corredor ,&nbsp;Ana Cláudia de Souza ,&nbsp;Claudio Jimenez ,&nbsp;Pablo M. Lavados","doi":"10.1016/j.lana.2025.101017","DOIUrl":"10.1016/j.lana.2025.101017","url":null,"abstract":"<div><h3>Background</h3><div>Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends.</div></div><div><h3>Findings</h3><div>In 2021, there were 1.1 million (95% uncertainty interval: 1.0–1.2) new cases, 12.9 million (12.3–13.7) prevalent cases, 0.5 million (0.5–0.6) deaths, and 11.4 million (10.6–12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends.</div></div><div><h3>Interpretation</h3><div>Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015–2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend.</div></div><div><h3>Funding</h3><div>There was no funding source for this study.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101017"},"PeriodicalIF":7.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422632","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":"Cost-effectiveness of screening, decolonisation and isolation strategies for carbapenem-resistant Enterobacterales and methicillin-resistant Staphylococcus aureus infections in hospitals: a sex-stratified mathematical modelling study","authors":"Kasim Allel ,&nbsp;Patricia Garcia ,&nbsp;Anne Peters ,&nbsp;Jose Munita ,&nbsp;Eduardo A. Undurraga ,&nbsp;Laith Yakob","doi":"10.1016/j.lana.2025.101019","DOIUrl":"10.1016/j.lana.2025.101019","url":null,"abstract":"<div><h3>Background</h3><div>Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and carbapenem-resistant Enterobacterales (CRE) impose the greatest burden among critical bacterial pathogens. Evidence for sex differences among antibiotic resistant bacterial infections is increasing but a focus on policy implications is needed. We assessed impact of CRE/MRSA on excess length of hospital stay, intensive care unit admission, and mortality by sex from a retrospective cohort study (n = 873) of patients in three Chilean hospitals, 2018–2021.</div></div><div><h3>Methods</h3><div>We used inverse-probability weighting combined with descriptive, logistic, and competing-risks analyses. We developed a sex-stratified deterministic compartmental model to analyse hospital transmission dynamics and the cost-effectiveness of nine interventions. We compared interventions based on the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained and estimated net benefits.</div></div><div><h3>Findings</h3><div>The adjusted odds of women acquiring CRE and MRSA were 0.44 (0.28–0.70; p = 0.0013) and 0.73 (95% CI = 0.48–1.01; p = 0.050), respectively. Competing-risk models indicated higher mortality rates among women, compared to men. Mathematical model projections showed that pre-emptive isolation across all newly admitted high-risk men was the most cost-effective intervention (ICER = $1366/QALY and $1083/QALY for CRE and MRSA, respectively). Chromogenic agar coupled with MRSA decolonisation was the second most cost-effective intervention ($2099/QALY), followed by screening plus isolation or pre-emptive isolation strategies (ICER ranged between $2411/QALY and $4216/QALY across CRE and MRSA models). Probabilistic sensitivity analysis showed that strategies were ICER &lt; willingness-to-pay in 80% of simulations, except for testing plus digestive decolonisation for CRE. At a 20% national hospital coverage at least $12.2 million could be saved.</div></div><div><h3>Interpretation</h3><div>Our model suggests that targeted infection control strategies would effectively address rising CRE and MRSA infections. Maximising health-economic gains may be achieved by focusing on control measures for men as primary drivers for transmission, thereby reducing the disproportionate disease burden borne by women.</div></div><div><h3>Funding</h3><div>Agencia Nacional de Investigación y Desarrollo <span>ANID</span>, Chile.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101019"},"PeriodicalIF":7.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422677","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":"Investigating the spatial association between supervised consumption services and homicide rates in Toronto, Canada, 2010–2023: an ecological analysis","authors":"Dan Werb ,&nbsp;Hae Seung Sung ,&nbsp;Yingbo Na ,&nbsp;Indhu Rammohan ,&nbsp;Jolene Eeuwes ,&nbsp;Ashley Smoke ,&nbsp;Akwasi Owusu-Bempah ,&nbsp;Thomas Kerr ,&nbsp;Mohammad Karamouzian","doi":"10.1016/j.lana.2025.101022","DOIUrl":"10.1016/j.lana.2025.101022","url":null,"abstract":"<div><h3>Background</h3><div>Supervised consumption services (SCS) are effective at preventing overdose mortality. However, their effect on public safety remains contested. We investigated homicide rates in areas near SCS in Toronto.</div></div><div><h3>Methods</h3><div>We classified coroner-reported fatal shootings and stabbings (January 1st, 2010 to September 30th 2023) by geographic zone: within 500 m (‘near’), between 500 m and 3 km (‘far’), and beyond 3 km of an SCS (‘out’). We then used Poisson regression to calculate the rate ratio (RR) across zones 18, 36, 48, and 60 months pre vs. post SCS implementation. Finally, we compared spatial homicide incidence prior to and after the date of the implementation of each SCS using interrupted time series (ITS).</div></div><div><h3>Findings</h3><div>Overall, 956 homicides occurred, and 590 (62%) were fatal shootings and stabbings. There was no meaningful change in the rate of fatal shootings and stabbings within 3 kms of SCS (near and far zones) after their implementation. However, between 48 and 60 months pos-implementation, we detected an increase in out zones. In an ITS analysis, we observed a reduction in the monthly incidence in near zones and an increase in out zones.</div></div><div><h3>Interpretation</h3><div>SCS implementation was not associated with increased homicide rates; instead, we observed a reduction in monthly incidence near SCS. These results may inform drug market activity responses that optimize community health and safety.</div></div><div><h3>Funding</h3><div><span>Canadian Institutes of Health Research</span>, the <span>New Frontiers in Research Fund</span>, <span>St. Michael’s Hospital Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"43 ","pages":"Article 101022"},"PeriodicalIF":7.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422680","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}