Pub Date : 2025-12-11DOI: 10.1016/j.lana.2025.101323
Priscila de Morais Sato , Fernanda Lopes , Sonora English , Silvana Oliveira da Silva , James Berson Lalane , Thilagawathi Abi Deivanayagam , Rute Ramos da Silva Costa , Elizângela Baré , Indira Ramos Gomes , Delan Devakumar
We conducted a scoping review to examine how racism affects the health of minoritized populations in Brazil. A comprehensive search was carried out, and identified articles underwent independent double screening. The 145 included studies consistently highlighted structural health inequities, with White advantage functioning as a protective factor. Institutional racism restricts healthcare access and availability, exacerbating minoritized populations’ vulnerability to violence and disease through discrimination and substandard care. Spatial segregation further exposes minoritized populations to harmful environmental conditions and limited infrastructure, while traditional and migrant communities experience marginalization, social isolation, increased disease exposure, and poorer livelihoods. Interpersonal racism negatively impacts mental and physical health across the lifespan, with gender and socioeconomic conditions intersecting and shaping these experiences. The study provides critical insights for practice, policy, and research by demonstrating how racism at multiple levels shapes health inequities in Brazil and by emphasizing the need for human rights-centred, redistributive interventions that promote justice, equity, and inclusive care for minoritized populations.
Funding: This publication was funded by Edital 02/2025—PRPPG/UFBA (Scientific Publications Support Program) and by the CNPq Productivity in Research Scholarship (process number 306359/2024-3).
{"title":"Mapping the expressions and impacts of racism on health in Brazil: a scoping review","authors":"Priscila de Morais Sato , Fernanda Lopes , Sonora English , Silvana Oliveira da Silva , James Berson Lalane , Thilagawathi Abi Deivanayagam , Rute Ramos da Silva Costa , Elizângela Baré , Indira Ramos Gomes , Delan Devakumar","doi":"10.1016/j.lana.2025.101323","DOIUrl":"10.1016/j.lana.2025.101323","url":null,"abstract":"<div><div>We conducted a scoping review to examine how racism affects the health of minoritized populations in Brazil. A comprehensive search was carried out, and identified articles underwent independent double screening. The 145 included studies consistently highlighted structural health inequities, with White advantage functioning as a protective factor. Institutional racism restricts healthcare access and availability, exacerbating minoritized populations’ vulnerability to violence and disease through discrimination and substandard care. Spatial segregation further exposes minoritized populations to harmful environmental conditions and limited infrastructure, while traditional and migrant communities experience marginalization, social isolation, increased disease exposure, and poorer livelihoods. Interpersonal racism negatively impacts mental and physical health across the lifespan, with gender and socioeconomic conditions intersecting and shaping these experiences. The study provides critical insights for practice, policy, and research by demonstrating how racism at multiple levels shapes health inequities in Brazil and by emphasizing the need for human rights-centred, redistributive interventions that promote justice, equity, and inclusive care for minoritized populations.</div><div>Funding: This publication was funded by Edital 02/2025—PRPPG/UFBA (<span>Scientific Publications Support Program</span>) and by the <span>CNPq Productivity in Research Scholarship</span> (process number 306359/2024-3).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101323"},"PeriodicalIF":7.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737867","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}
Pub Date : 2025-12-11DOI: 10.1016/j.lana.2025.101334
Marco Antonio Catussi Paschoalotto , Eduardo Alves Lazzari , Rudi Rocha , Adriano Massuda , Marcia C. Castro
Health system resilience (HSR) is essential to sustaining equitable essential functions under acute and chronic stressors in decentralized systems. We developed and validated a Brazil-tailored HSR framework that distinguishes steady-state performance from resilience-specific capacities and assigns responsibilities across federal, state, regional, and municipal levels. Using a three-phase qualitative deductive–inductive approach with 48 international and national experts, we identified nine dimensions, 18 subdimensions, and 65 indicators that prioritise governance coherence, surge workforce strategies, emergency regulation, real-time monitoring, and access to critical technologies. The framework clarifies boundaries between general health system performance and adaptive, absorptive, and transformative functions, and specifies how managers can apply it in practice through structured scoping, mapping, scoring, prioritisation, planning, and monitoring steps. Although designed for Brazil's Unified Health System (SUS), the development logic generalises to other decentralised contexts with appropriate re-allocation of responsibilities and calibration to national financing rules. This policy-facing tool supports actionable resilience strengthening in complex, multi-level systems.
{"title":"Building a health system resilience framework: national, state, regional, and local perspectives","authors":"Marco Antonio Catussi Paschoalotto , Eduardo Alves Lazzari , Rudi Rocha , Adriano Massuda , Marcia C. Castro","doi":"10.1016/j.lana.2025.101334","DOIUrl":"10.1016/j.lana.2025.101334","url":null,"abstract":"<div><div>Health system resilience (HSR) is essential to sustaining equitable essential functions under acute and chronic stressors in decentralized systems. We developed and validated a Brazil-tailored HSR framework that distinguishes steady-state performance from resilience-specific capacities and assigns responsibilities across federal, state, regional, and municipal levels. Using a three-phase qualitative deductive–inductive approach with 48 international and national experts, we identified nine dimensions, 18 subdimensions, and 65 indicators that prioritise governance coherence, surge workforce strategies, emergency regulation, real-time monitoring, and access to critical technologies. The framework clarifies boundaries between general health system performance and adaptive, absorptive, and transformative functions, and specifies how managers can apply it in practice through structured scoping, mapping, scoring, prioritisation, planning, and monitoring steps. Although designed for Brazil's Unified Health System (SUS), the development logic generalises to other decentralised contexts with appropriate re-allocation of responsibilities and calibration to national financing rules. This policy-facing tool supports actionable resilience strengthening in complex, multi-level systems.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101334"},"PeriodicalIF":7.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737800","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}
Pub Date : 2025-12-08DOI: 10.1016/j.lana.2025.101324
Lara E. Coelho , Guilherme T. Goedert , Juliano Genari , Paula M. Luz , Luiz Max Carvalho , Cleber V.B.D. Santos , Daniel Csillag , Tulio Konečný , Lucia Campos Pellanda , Claudio J. Struchiner , Mariângela Freitas da Silveira , Pedro C. Hallal
Background
Vaccine uptake is critical to controlling COVID-19 and other infectious diseases, and trust in vaccines is a key determinant of vaccine coverage. This study aims to examine how individual characteristics and primary information sources during the pandemic influenced COVID-19 vaccine trust and uptake.
Methods
We performed a secondary analysis of the EPICOVID 2.0 survey, a Brazilian nationwide study (March–April 2024) that used multistage probabilistic sampling. Participants aged 18 or older from the EPICOVID 2.0 study were included in the analyses. Machine learning algorithms were employed to predict COVID-19 vaccine trust and uptake, measuring the influence of each covariate on the predicted probabilities.
Findings
Among 29,281 participants (63.9% women; median age 51 years), 60% reported trusting the COVID-19 vaccine and 72% had received ≥3 doses. Uptake strongly correlated with trust: 67% of unvaccinated or unsure participants distrusted the vaccine, while trust increased with the number of doses—62.6% (3 doses), 73.8% (4 doses), and 89.8% (≥5 doses). Gen Z adults (18–30 years) were less likely to trust the vaccine (negative influence of −0.07). Positive predictors of trust included higher education and trust in television or nurses as information sources (positive influences of 0.05, 0.09 and 0.07, respectively).
Interpretation
Trust and uptake of the COVID-19 vaccine were moderate, 60% and 72%, respectively. Gen Z adults reported greater distrust and lower uptake, while higher education was associated with increased trust. These findings highlight the need for tailored communication and health literacy interventions to improve vaccine uptake.
{"title":"COVID-19 vaccine trust and uptake: the role of media, interpersonal and institutional trust in a large population-based survey","authors":"Lara E. Coelho , Guilherme T. Goedert , Juliano Genari , Paula M. Luz , Luiz Max Carvalho , Cleber V.B.D. Santos , Daniel Csillag , Tulio Konečný , Lucia Campos Pellanda , Claudio J. Struchiner , Mariângela Freitas da Silveira , Pedro C. Hallal","doi":"10.1016/j.lana.2025.101324","DOIUrl":"10.1016/j.lana.2025.101324","url":null,"abstract":"<div><h3>Background</h3><div>Vaccine uptake is critical to controlling COVID-19 and other infectious diseases, and trust in vaccines is a key determinant of vaccine coverage. This study aims to examine how individual characteristics and primary information sources during the pandemic influenced COVID-19 vaccine trust and uptake.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of the EPICOVID 2.0 survey, a Brazilian nationwide study (March–April 2024) that used multistage probabilistic sampling. Participants aged 18 or older from the EPICOVID 2.0 study were included in the analyses. Machine learning algorithms were employed to predict COVID-19 vaccine trust and uptake, measuring the influence of each covariate on the predicted probabilities.</div></div><div><h3>Findings</h3><div>Among 29,281 participants (63.9% women; median age 51 years), 60% reported trusting the COVID-19 vaccine and 72% had received ≥3 doses. Uptake strongly correlated with trust: 67% of unvaccinated or unsure participants distrusted the vaccine, while trust increased with the number of doses—62.6% (3 doses), 73.8% (4 doses), and 89.8% (≥5 doses). Gen Z adults (18–30 years) were less likely to trust the vaccine (negative influence of −0.07). Positive predictors of trust included higher education and trust in television or nurses as information sources (positive influences of 0.05, 0.09 and 0.07, respectively).</div></div><div><h3>Interpretation</h3><div>Trust and uptake of the COVID-19 vaccine were moderate, 60% and 72%, respectively. Gen Z adults reported greater distrust and lower uptake, while higher education was associated with increased trust. These findings highlight the need for tailored communication and health literacy interventions to improve vaccine uptake.</div></div><div><h3>Funding</h3><div><span>Brazilian Ministry of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101324"},"PeriodicalIF":7.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736322","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}
Pub Date : 2025-12-06DOI: 10.1016/j.lana.2025.101325
Sarah McKetta , Kodiak R.S. Soled , Payal Chakraborty , Colleen A. Reynolds , Bethany G. Everett , Daphna Stroumsa , Sebastien Haneuse , S. Bryn Austin , Jorge E. Chavarro , A. Heather Eliassen , Aimee K. Huang , Brittany M. Charlton
Background
The study aim was to quantify differences in risk for Cesarean birth vary by sexual orientation.
Methods
We pooled data from singleton, live births in the Nurses’ Health Studies 2 and 3, and the Growing Up Today Study (N = 102,298 pregnancies). We used generalized estimating equations to fit logistic models for risks of primary Cesarean birth comparing sexual minority (SM) to completely heterosexual participants, controlling for year and age. SM participants were further stratified into heterosexual with prior same-sex experience (i.e., identifying as heterosexual, but with same-sex attractions, behaviors, or prior SM identity), mostly heterosexual, bisexual, and lesbian/gay subgroups. We examined heterogeneity by parity, labor induction, and racialized identity.
Findings
SM participants had higher risks of primary Cesarean birth than their completely heterosexual peers (adjusted odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.01–1.12), with increases most pronounced among pregnancies to heterosexual participants with prior same-sex experience (OR = 1.12, 95% CI 1.04–1.20). Labor induction was associated with a higher magnitude disparity (OR for induced labor = 1.21, 95% CI 1.09–1.35; OR for spontaneous labor = 0.91, 95% CI 0.83–1.01; p-value for interaction = 0.09). Racialized identity or parity did not moderate sexual orientation-related disparities in primary Cesarean birth.
Interpretation
SM people have increased risks for primary Cesarean birth, but these vary across sexual orientation subgroups. We found increased risks for a rarely studied subgroup of sexual minority people, those who identify as heterosexual but have prior same-sex experience. These disparities are most pronounced when labor is induced. All participants were assumed to be women based on surveys querying sex and birth histories, but we were limited in generalizability due to not knowing their gender identities.
Funding
National Institutes of Health (United States).
研究的目的是量化性取向不同的剖宫产风险的差异。方法：我们汇集了来自护士健康研究2和3中的单胎、活产和成长研究（N = 102,298例妊娠）的数据。我们使用广义估计方程来拟合逻辑模型，比较性少数（SM）和完全异性恋参与者的初次剖宫产风险，控制年龄和年龄。SM参与者被进一步划分为有过同性经历的异性恋者（即，自认为是异性恋者，但有同性吸引力、行为或先前的SM身份），主要是异性恋、双性恋和女同性恋/男同性恋亚组。我们通过平等、劳动诱导和种族化身份来检验异质性。研究发现，ssm参与者的初次剖宫产风险高于完全异性恋的同龄人（校正优势比[OR] = 1.07, 95%可信区间[CI] 1.01-1.12），在有过同性经历的异性恋参与者中，这一风险增加最为明显（OR = 1.12, 95% CI 1.04-1.20）。引产与较大的幅度差异相关（引产的OR = 1.21, 95% CI 1.09-1.35；自然分娩的OR = 0.91, 95% CI 0.83-1.01；相互作用的p值= 0.09）。种族化的身份或胎次并不能缓和初次剖宫产中与性取向相关的差异。人们初次剖宫产的风险增加，但这在不同的性取向亚群中有所不同。我们发现，很少研究的性少数人群，即那些认为自己是异性恋但之前有过同性经历的人，风险增加。这些差异在引产时最为明显。根据对性别和出生史的调查，我们假设所有参与者都是女性，但由于不知道他们的性别身份，我们的概括性受到限制。国家卫生研究院（美国）。
{"title":"Disparities in primary Cesarean birth by sexual orientation: a population-based analysis across three longitudinal cohorts","authors":"Sarah McKetta , Kodiak R.S. Soled , Payal Chakraborty , Colleen A. Reynolds , Bethany G. Everett , Daphna Stroumsa , Sebastien Haneuse , S. Bryn Austin , Jorge E. Chavarro , A. Heather Eliassen , Aimee K. Huang , Brittany M. Charlton","doi":"10.1016/j.lana.2025.101325","DOIUrl":"10.1016/j.lana.2025.101325","url":null,"abstract":"<div><h3>Background</h3><div>The study aim was to quantify differences in risk for Cesarean birth vary by sexual orientation.</div></div><div><h3>Methods</h3><div>We pooled data from singleton, live births in the Nurses’ Health Studies 2 and 3, and the Growing Up Today Study (N = 102,298 pregnancies). We used generalized estimating equations to fit logistic models for risks of primary Cesarean birth comparing sexual minority (SM) to completely heterosexual participants, controlling for year and age. SM participants were further stratified into heterosexual with prior same-sex experience (i.e., identifying as heterosexual, but with same-sex attractions, behaviors, or prior SM identity), mostly heterosexual, bisexual, and lesbian/gay subgroups. We examined heterogeneity by parity, labor induction, and racialized identity.</div></div><div><h3>Findings</h3><div>SM participants had higher risks of primary Cesarean birth than their completely heterosexual peers (adjusted odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.01–1.12), with increases most pronounced among pregnancies to heterosexual participants with prior same-sex experience (OR = 1.12, 95% CI 1.04–1.20). Labor induction was associated with a higher magnitude disparity (OR for induced labor = 1.21, 95% CI 1.09–1.35; OR for spontaneous labor = 0.91, 95% CI 0.83–1.01; p-value for interaction = 0.09). Racialized identity or parity did not moderate sexual orientation-related disparities in primary Cesarean birth.</div></div><div><h3>Interpretation</h3><div>SM people have increased risks for primary Cesarean birth, but these vary across sexual orientation subgroups. We found increased risks for a rarely studied subgroup of sexual minority people, those who identify as heterosexual but have prior same-sex experience. These disparities are most pronounced when labor is induced. All participants were assumed to be women based on surveys querying sex and birth histories, but we were limited in generalizability due to not knowing their gender identities.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span> (United States).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101325"},"PeriodicalIF":7.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683869","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}
Pub Date : 2025-12-06DOI: 10.1016/j.lana.2025.101321
Juan Javier López Rivera , Natalia Hernández-Bocanegra , Katherine Aguirre-Guataqui , María Paula Rodríguez Calderón , Laura Camila Rios Pinto , Ronald Cardenas-Prieto , Adriana Piza-Buitrago , Paula Rueda-Gaitán , Julian Lamilla , Mario Isaza-Ruget
Background
Considerable fraction of global cancer cases stem from hereditary cancer predisposition syndromes (HCSs). The identification of genetic variants linked to HCSs is crucial for prompt treatment of both patients and their families. This study aimed to assess the diagnostic performance of multigene panels in detecting variants linked to hereditary cancer predisposition in a cohort of 8165 individuals from Colombia.
Methods
We analyzed 8165 individuals in Colombia (2018–2024), with and without personal or family cancer history, using NGS hereditary cancer panels. Variant interpretation (P, LP, VUS) was performed with SOPHiA DDM and Varsome Clinical, following ACMG guidelines and ClinGen Hereditary Cancer Group criteria.
Findings
61.8% (n = 5049) of patients were referred from Bogotá and 38.10% (n = 3116) from other cities in Colombia. It was not possible to distinguish between ethnic groups. The age range of patients was 0–97 (mean = 55 years; SD = 12.1), 86% (n = 7024) were female and 14% (n = 1142) male. 409 P/LP variants were identified in high-penetrance genes such as BRCA1/2, in 946 individuals, resulting in an overall diagnostic yield of 9.82%. Among the most important findings were increased diagnostic yields in ovarian and colorectal cancer, as well as in unaffected individuals with a family history of cancer. Finally, 38 novel variants and recurrent alterations in 27 HCS-related genes reinforce the need to prioritize these biomarkers in diagnostic evaluations.
Interpretation
This study provides insights into the performance of genetic panels for detecting HCS-associated variants in the largest Latin American cohort evaluated to date. These findings demonstrate that robust panel-based testing strategies enable the systematic detection of clinically relevant signs that would not be captured through phenotype-driven approaches alone. BRCA1 and BRCA2 were the most frequently altered high-penetrance genes, with higher diagnostic yields in breast, ovarian, and colorectal cancers, as well as in unaffected individuals with a family history.
{"title":"Genomic landscape of hereditary cancer syndromes in the largest cohort in Colombia: a retrospective study","authors":"Juan Javier López Rivera , Natalia Hernández-Bocanegra , Katherine Aguirre-Guataqui , María Paula Rodríguez Calderón , Laura Camila Rios Pinto , Ronald Cardenas-Prieto , Adriana Piza-Buitrago , Paula Rueda-Gaitán , Julian Lamilla , Mario Isaza-Ruget","doi":"10.1016/j.lana.2025.101321","DOIUrl":"10.1016/j.lana.2025.101321","url":null,"abstract":"<div><h3>Background</h3><div>Considerable fraction of global cancer cases stem from hereditary cancer predisposition syndromes (HCSs). The identification of genetic variants linked to HCSs is crucial for prompt treatment of both patients and their families. This study aimed to assess the diagnostic performance of multigene panels in detecting variants linked to hereditary cancer predisposition in a cohort of 8165 individuals from Colombia.</div></div><div><h3>Methods</h3><div>We analyzed 8165 individuals in Colombia (2018–2024), with and without personal or family cancer history, using NGS hereditary cancer panels. Variant interpretation (P, LP, VUS) was performed with SOPHiA DDM and Varsome Clinical, following ACMG guidelines and ClinGen Hereditary Cancer Group criteria.</div></div><div><h3>Findings</h3><div>61.8% (n = 5049) of patients were referred from Bogotá and 38.10% (n = 3116) from other cities in Colombia. It was not possible to distinguish between ethnic groups. The age range of patients was 0–97 (mean = 55 years; SD = 12.1), 86% (n = 7024) were female and 14% (n = 1142) male. 409 P/LP variants were identified in high-penetrance genes such as <em>BRCA1/2</em>, in 946 individuals, resulting in an overall diagnostic yield of 9.82%. Among the most important findings were increased diagnostic yields in ovarian and colorectal cancer, as well as in unaffected individuals with a family history of cancer. Finally, 38 novel variants and recurrent alterations in 27 HCS-related genes reinforce the need to prioritize these biomarkers in diagnostic evaluations.</div></div><div><h3>Interpretation</h3><div>This study provides insights into the performance of genetic panels for detecting HCS-associated variants in the largest Latin American cohort evaluated to date. These findings demonstrate that robust panel-based testing strategies enable the systematic detection of clinically relevant signs that would not be captured through phenotype-driven approaches alone. <em>BRCA1</em> and <em>BRCA2</em> were the most frequently altered high-penetrance genes, with higher diagnostic yields in breast, ovarian, and colorectal cancers, as well as in unaffected individuals with a family history.</div></div><div><h3>Funding</h3><div><span>Fundación Universitaria Sanitas</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101321"},"PeriodicalIF":7.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681430","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}
Pub Date : 2025-12-06DOI: 10.1016/j.lana.2025.101330
Peter T. Tanksley , J.C. Barnes , J. Pete Blair , M. Hunter Martaindale
{"title":"Clarifying methods and interpretations in law enforcement mortality surveillance: response to Kamal","authors":"Peter T. Tanksley , J.C. Barnes , J. Pete Blair , M. Hunter Martaindale","doi":"10.1016/j.lana.2025.101330","DOIUrl":"10.1016/j.lana.2025.101330","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101330"},"PeriodicalIF":7.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681433","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}
Pub Date : 2025-12-06DOI: 10.1016/j.lana.2025.101317
Alan G. Nyitray , Timothy L. McAuliffe , Jenna Nitkowski , Cameron Liebert , Michael D. Swartz , Ashish A. Deshmukh , Jared Kerman , Ellen Almirol , John A. Schneider , J. Michael Wilkerson , Lu-Yu Hwang , Derek Smith , Duo Yu , Aniruddha Hazra , Elizabeth Y. Chiao , Prevent Anal Cancer Palpation Study Team
Background
While anal cancer screening is now recommended in several countries for high-incidence populations, barriers impede screening uptake. It is well known that patient recognition of symptoms increases cancer screening uptake, and we previously demonstrated that patients can detect small masses at the perianus and in the anal canal. In this current analysis, we aimed to longitudinally assess the effect of repetition and practice on patient self-recognition of small masses.
Methods
Individuals and couples of sexual minority men and transgender women were taught to conduct an anal self-examination or anal companion examination (ASE/ACE) at visit 1 and then randomized to a practice or control condition. Six months later, at visit 2, the effect of practice and repetition of the ASE/ACE on detection of abnormalities was assessed by comparing the lay exam results to those of a clinician. Concordance, κ, and area under the receiver operating characteristic curves (AUC) was used to quantify the comparison.
Findings
Concordance between lay exam and clinician exam increased from visit 1 (73%, 524/714) to visit 2 (95%, 535/561) (κ = 0.87, 95% CI 0.82–0.92). Overall AUC at visit 2 was 0.93 (95% CI 0.90–0.96). Although there was no difference in concordance between the practice (95%, 267/281) and control arms (96%, 268/280) (p = 0.69), concordance increased with ASE/ACE repetition (ptrend < 0.001) and was 98% (354/363) for individuals performing the ASE/ACE ≥2 times between visits. For individuals with incident abnormalities at visit 2, concordance was 100% (27/27). Results did not differ by age or HIV status. False positive and false negative results by the ASE/ACE were 2% (10/561) and 3% (16/561), respectively.
Interpretation
Because lay individuals can detect anal abnormalities, clinicians conducting an anal examination may suggest that the patient's own lay exams may detect early invasive anal cancer.
Funding
National Cancer Institute.
虽然目前在一些国家推荐对高发病率人群进行肛门癌筛查，但有一些障碍阻碍了筛查的实施。众所周知，患者对症状的认识增加了癌症筛查的吸收，我们以前证明患者可以在肛门周围和肛管中发现小肿块。在当前的分析中，我们旨在纵向评估重复和练习对小肿块患者自我认知的影响。方法性少数男性和跨性别女性的个体和夫妇在第一次就诊时进行肛门自我检查或肛门伴检（ASE/ACE），然后随机分为实践组和对照组。6个月后，在第2次就诊时，通过比较门诊检查结果和临床医生的检查结果来评估练习和重复ASE/ACE对异常检测的影响。采用一致性、κ和受试者工作特征曲线下面积（AUC）来量化比较。从第1次就诊（73%,524/714）到第2次就诊（95%,535/561），门诊检查与临床检查的一致性增加（κ = 0.87, 95% CI 0.82 ~ 0.92）。第2次就诊时的总AUC为0.93 （95% CI 0.90-0.96）。虽然实践组（95%,267/281）和对照组（96%,268/280）之间的一致性没有差异（p = 0.69），但随着ASE/ACE的重复，一致性增加（p趋势<； 0.001），对于两次访问之间进行ASE/ACE≥2次的个体，一致性为98%（354/363）。对于在第2次访问时出现意外异常的个体，一致性为100%（27/27）。结果没有因年龄或HIV感染状况而不同。ASE/ACE假阳性和假阴性结果分别为2%（10/561）和3%（16/561）。由于外行人可以发现肛门异常，进行肛门检查的临床医生可能会建议患者自己的外行人检查可以发现早期浸润性肛门癌。资助国家癌症研究所。
{"title":"The longitudinal effect of repetition and practice on the accuracy of lay anal examinations for detecting perianal and anal canal abnormalities: a prospective study","authors":"Alan G. Nyitray , Timothy L. McAuliffe , Jenna Nitkowski , Cameron Liebert , Michael D. Swartz , Ashish A. Deshmukh , Jared Kerman , Ellen Almirol , John A. Schneider , J. Michael Wilkerson , Lu-Yu Hwang , Derek Smith , Duo Yu , Aniruddha Hazra , Elizabeth Y. Chiao , Prevent Anal Cancer Palpation Study Team","doi":"10.1016/j.lana.2025.101317","DOIUrl":"10.1016/j.lana.2025.101317","url":null,"abstract":"<div><h3>Background</h3><div>While anal cancer screening is now recommended in several countries for high-incidence populations, barriers impede screening uptake. It is well known that patient recognition of symptoms increases cancer screening uptake, and we previously demonstrated that patients can detect small masses at the perianus and in the anal canal. In this current analysis, we aimed to longitudinally assess the effect of repetition and practice on patient self-recognition of small masses.</div></div><div><h3>Methods</h3><div>Individuals and couples of sexual minority men and transgender women were taught to conduct an anal self-examination or anal companion examination (ASE/ACE) at visit 1 and then randomized to a practice or control condition. Six months later, at visit 2, the effect of practice and repetition of the ASE/ACE on detection of abnormalities was assessed by comparing the lay exam results to those of a clinician. Concordance, <em>κ,</em> and area under the receiver operating characteristic curves (AUC) was used to quantify the comparison.</div></div><div><h3>Findings</h3><div>Concordance between lay exam and clinician exam increased from visit 1 (73%, 524/714) to visit 2 (95%, 535/561) (<em>κ</em> = 0.87, 95% CI 0.82–0.92). Overall AUC at visit 2 was 0.93 (95% CI 0.90–0.96). Although there was no difference in concordance between the practice (95%, 267/281) and control arms (96%, 268/280) (p = 0.69), concordance increased with ASE/ACE repetition (p<sub>trend</sub> < 0.001) and was 98% (354/363) for individuals performing the ASE/ACE ≥2 times between visits. For individuals with incident abnormalities at visit 2, concordance was 100% (27/27). Results did not differ by age or HIV status. False positive and false negative results by the ASE/ACE were 2% (10/561) and 3% (16/561), respectively.</div></div><div><h3>Interpretation</h3><div>Because lay individuals can detect anal abnormalities, clinicians conducting an anal examination may suggest that the patient's own lay exams may detect early invasive anal cancer.</div></div><div><h3>Funding</h3><div><span>National Cancer Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101317"},"PeriodicalIF":7.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690637","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}
Pub Date : 2025-12-06DOI: 10.1016/j.lana.2025.101307
Michael Touchton , Héctor Arreola-Ornelas , Klaudia A. Arizmendi-Barrera , Valentina Vargas Enciso , Felicia Marie Knaul
Background
Value-Based Healthcare (VBHC) represents a paradigm shift from the traditional fee-for-service model to a fee-for-value model, aiming to optimize patient outcomes relative to cost. This study assesses the transition to VBHC in three Latin American countries: Argentina, Brazil, and Mexico. By identifying barriers and opportunities to unlock value in these health systems, it provides recommendations for advancing VBHC across the region.
Methods
Multiple methods were used integrating targeted literature reviews, key informant interviews, and qualitative indicators scoring based on the Harvard High-Value Health System (HVHS) Model. Data were collected from academic and national health databases, government reports, and international health organizations. Thematic analysis was conducted to synthesize findings from the literature and interviews, while qualitative indicators were assessed using the HVHS Model.
Findings
Brazil and Mexico have made progress in adopting VBHC principles, particularly in digital health and integrated care models. Brazil's Health Value Score (HVS) pilot and the Adequate Childbirth Project are key initiatives demonstrating the potential for improving patient outcomes and resource allocation. Mexico's Telemedicine Program has improved access to specialized care in remote areas. However, both countries face challenges such as fragmented healthcare systems, procurement practices that undermine value, and limited data interoperability. For example, Brazil's health Ministry has yet to establish a national or regional policy on VBHC. Argentina has shown progress in digital data systems and analytics, driven by the National Strategy of Digital Health 2018–2024, but faces significant challenges in healthcare financing, outcome measurement, and performance benchmarking.
Interpretation
Advancing VBHC in Latin America requires comprehensive policy reforms, infrastructure investment, and collaboration among patients as well as the public, private, and non-profit sectors. Key recommendations include implementing standardized cost and outcome measurement frameworks, investing in health information technology, reforming procurement regulations to prioritize value, and providing training and support for healthcare providers. Addressing these challenges will enable the region to implement VBHC effectively, fostering more efficient, equitable, and sustainable, technologically flexible healthcare systems.
Funding
We acknowledge support from the U.S. Chamber of Commerce and the Global Innovation Hub.
{"title":"Drivers and barriers for the implementation of value-based healthcare in Latin America: a cross-country qualitative policy analysis","authors":"Michael Touchton , Héctor Arreola-Ornelas , Klaudia A. Arizmendi-Barrera , Valentina Vargas Enciso , Felicia Marie Knaul","doi":"10.1016/j.lana.2025.101307","DOIUrl":"10.1016/j.lana.2025.101307","url":null,"abstract":"<div><h3>Background</h3><div>Value-Based Healthcare (VBHC) represents a paradigm shift from the traditional fee-for-service model to a fee-for-value model, aiming to optimize patient outcomes relative to cost. This study assesses the transition to VBHC in three Latin American countries: Argentina, Brazil, and Mexico. By identifying barriers and opportunities to unlock value in these health systems, it provides recommendations for advancing VBHC across the region.</div></div><div><h3>Methods</h3><div>Multiple methods were used integrating targeted literature reviews, key informant interviews, and qualitative indicators scoring based on the Harvard High-Value Health System (HVHS) Model. Data were collected from academic and national health databases, government reports, and international health organizations. Thematic analysis was conducted to synthesize findings from the literature and interviews, while qualitative indicators were assessed using the HVHS Model.</div></div><div><h3>Findings</h3><div>Brazil and Mexico have made progress in adopting VBHC principles, particularly in digital health and integrated care models. Brazil's Health Value Score (HVS) pilot and the Adequate Childbirth Project are key initiatives demonstrating the potential for improving patient outcomes and resource allocation. Mexico's Telemedicine Program has improved access to specialized care in remote areas. However, both countries face challenges such as fragmented healthcare systems, procurement practices that undermine value, and limited data interoperability. For example, Brazil's health Ministry has yet to establish a national or regional policy on VBHC. Argentina has shown progress in digital data systems and analytics, driven by the National Strategy of Digital Health 2018–2024, but faces significant challenges in healthcare financing, outcome measurement, and performance benchmarking.</div></div><div><h3>Interpretation</h3><div>Advancing VBHC in Latin America requires comprehensive policy reforms, infrastructure investment, and collaboration among patients as well as the public, private, and non-profit sectors. Key recommendations include implementing standardized cost and outcome measurement frameworks, investing in health information technology, reforming procurement regulations to prioritize value, and providing training and support for healthcare providers. Addressing these challenges will enable the region to implement VBHC effectively, fostering more efficient, equitable, and sustainable, technologically flexible healthcare systems.</div></div><div><h3>Funding</h3><div>We acknowledge support from the U.S. Chamber of Commerce and the Global Innovation Hub.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101307"},"PeriodicalIF":7.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681414","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}
Pub Date : 2025-12-05DOI: 10.1016/j.lana.2025.101329
André Salem Szklo , Vera da Costa e Silva
{"title":"Brazil's successful regulation of E-cigarettes: a valuable learning opportunity for other countries","authors":"André Salem Szklo , Vera da Costa e Silva","doi":"10.1016/j.lana.2025.101329","DOIUrl":"10.1016/j.lana.2025.101329","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101329"},"PeriodicalIF":7.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681434","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}
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