Pub Date : 2026-02-01Epub Date: 2025-12-02DOI: 10.1016/j.lana.2025.101322
Jesús Ramírez Bermúdez , Sheila Castro-Suarez , Luciana D'Alessio , Jorge Holguín Lew , Louise Makarem Oliveira , Mônica Sanches Yassuda , Hernando Santamaría-García , Andrea Slachevsky , William Tamayo Agudelo , Julio Torales , Norha Vera San Juan , Vaughan Bell
From the impact of armed conflict and political violence to the neuropsychiatric consequences of neglected tropical diseases, Latin America has a unique profile of region-specific risk factors that mean it is not always well-served by neuropsychiatric practice developed in high-income regions. Here, we review the region-specific neuropsychiatric characteristics of traumatic brain injury, stroke, epilepsy, dementia, functional neurological disorder, infectious diseases, environmental health risks, and substance use. Additionally, we identify structural challenges for neuropsychiatric health and suggest pathways to develop a specifically Latin American neuropsychiatry as a cross-disciplinary, multi-professional field based on practical steps to strengthen research capacity, training, clinical practice, and care delivery. Latin America should be a priority for neuropsychiatry, and we argue for a Latin American neuropsychiatry that has much to offer the region and much to contribute worldwide.
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Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.lana.2025.101336
Latam Collaborative Colorectal Surgery Consortium
<div><h3>Background</h3><div>Urgent abdominal operations represent a large proportion of surgical care and are associated with substantial morbidity and mortality. Evidence is scarce from low- and middle-income countries (LMICs), including Latin America (LA). The lack of regionally representative outcomes data hinders quality-improvement efforts and understanding of modifiable risk factors that could be targeted to improve urgent care.</div></div><div><h3>Methods</h3><div>We present results from a prospective, multicenter observational cohort study of urgent abdominal surgery conducted in 14 countries across Latin America between February and December 2024. Eligible participants were consecutive adults (≥18 years) undergoing urgent gastrointestinal operations at each site during a 6-week inclusion window. The primary outcome was 30-day mortality. Secondary outcomes were reoperation, readmission, time to discharge, and prolonged intensive care unit (ICU) stay (defined as >72 h). Bayesian time-to-event models and Bayesian logistic regression were used to estimate associations between the outcomes and pre-specified covariates (age, sex, obesity, center volume, Charlson Comorbidity Index, SOFA score, surgical approach, operative time, prior abdominal surgery, intraoperative complications).</div></div><div><h3>Findings</h3><div>A total of 1015 patients were included from 89 hospitals (mean age 58.3 years; 50.4% female and 49.6% male). The most common indications for surgery were intestinal obstruction (46.8%), perforation (23.4%), and abdominal abscess (9.6%). Overall 30-day mortality was 12.6% (128/1015) and one in three of these deaths occurred within 24 h of the index operation. Prolonged ICU stay occurred in 27.9% of patients, reoperation was required in 18.4% and readmission in 4.9%. Across all models, we consistently found an association between Charlson Comorbidity Index >3, SOFA score >3, and open surgical approach with higher odds or hazard of adverse postoperative outcomes, including death. Patients with SOFA >3 had substantially increased odds of prolonged ICU stay and higher hazard of reoperation and death. In contrast, open surgery was associated with longer hospitalization and more reoperations, as well as higher mortality.</div></div><div><h3>Interpretation</h3><div>This large multi-country cohort provides the first region-wide estimates of outcomes after urgent abdominal surgery in Latin America. Mortality remains high, with almost one-third of all deaths occurring in the first 24 h after surgery. Patients’ comorbidity burden, physiological derangement at presentation, and operative approach are all key determinants of outcome after urgent abdominal surgery. This evidence provides a baseline for quality-improvement efforts and highlights the urgent need for region-specific guidelines and protocols to standardize urgent surgical care across Latin America.</div></div><div><h3>Funding</h3><div>This study received no external f
{"title":"Outcomes of urgent gastrointestinal-related procedures in Latin America (LATAM-URG): a prospective multicentre study","authors":"Latam Collaborative Colorectal Surgery Consortium","doi":"10.1016/j.lana.2025.101336","DOIUrl":"10.1016/j.lana.2025.101336","url":null,"abstract":"<div><h3>Background</h3><div>Urgent abdominal operations represent a large proportion of surgical care and are associated with substantial morbidity and mortality. Evidence is scarce from low- and middle-income countries (LMICs), including Latin America (LA). The lack of regionally representative outcomes data hinders quality-improvement efforts and understanding of modifiable risk factors that could be targeted to improve urgent care.</div></div><div><h3>Methods</h3><div>We present results from a prospective, multicenter observational cohort study of urgent abdominal surgery conducted in 14 countries across Latin America between February and December 2024. Eligible participants were consecutive adults (≥18 years) undergoing urgent gastrointestinal operations at each site during a 6-week inclusion window. The primary outcome was 30-day mortality. Secondary outcomes were reoperation, readmission, time to discharge, and prolonged intensive care unit (ICU) stay (defined as >72 h). Bayesian time-to-event models and Bayesian logistic regression were used to estimate associations between the outcomes and pre-specified covariates (age, sex, obesity, center volume, Charlson Comorbidity Index, SOFA score, surgical approach, operative time, prior abdominal surgery, intraoperative complications).</div></div><div><h3>Findings</h3><div>A total of 1015 patients were included from 89 hospitals (mean age 58.3 years; 50.4% female and 49.6% male). The most common indications for surgery were intestinal obstruction (46.8%), perforation (23.4%), and abdominal abscess (9.6%). Overall 30-day mortality was 12.6% (128/1015) and one in three of these deaths occurred within 24 h of the index operation. Prolonged ICU stay occurred in 27.9% of patients, reoperation was required in 18.4% and readmission in 4.9%. Across all models, we consistently found an association between Charlson Comorbidity Index >3, SOFA score >3, and open surgical approach with higher odds or hazard of adverse postoperative outcomes, including death. Patients with SOFA >3 had substantially increased odds of prolonged ICU stay and higher hazard of reoperation and death. In contrast, open surgery was associated with longer hospitalization and more reoperations, as well as higher mortality.</div></div><div><h3>Interpretation</h3><div>This large multi-country cohort provides the first region-wide estimates of outcomes after urgent abdominal surgery in Latin America. Mortality remains high, with almost one-third of all deaths occurring in the first 24 h after surgery. Patients’ comorbidity burden, physiological derangement at presentation, and operative approach are all key determinants of outcome after urgent abdominal surgery. This evidence provides a baseline for quality-improvement efforts and highlights the urgent need for region-specific guidelines and protocols to standardize urgent surgical care across Latin America.</div></div><div><h3>Funding</h3><div>This study received no external f","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101336"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790568","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 : 2026-02-01Epub Date: 2026-01-02DOI: 10.1016/j.lana.2025.101351
Theodore L. Wagener , Alice Hinton , Theodore M. Brasky , Yoo Jin Cho , Laura A. Beebe , Michael S. Businelle , Matthew J. Carpenter , Jonathan Hart , Katrina A. Vickerman
Background
E-cigarettes have emerged as a potentially more effective and satisfying alternative to nicotine replacement therapy (NRT) for smokers who struggle to quit. Although quitlines are effective platforms for tobacco cessation, they have not incorporated e-cigarettes due to regulatory concerns and limited clinical evidence. We evaluated whether quitline-delivered counseling combined with e-cigarettes was more effective than counseling with NRT among adults who recently failed to quit using standard quitline services.
Methods
We conducted a pragmatic, open-label, parallel-group randomised controlled trial with two U.S. state quitlines between October 2020 and January 2023. Adults [N = 350; 212 (61%) female & 248 (72%) white] who were still smoking after a recent quitline enrollment were randomised (1:1) to receive 8 weeks of either JUUL e-cigarettes or a combination of nicotine patch and lozenge, along with three counseling calls. The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (7-day PPA) at 8 weeks. Analyses used an intent-to-treat approach; secondary outcomes included 12-week abstinence, prolonged abstinence, changes in smoking behavior, dependence, and adverse effects.
Findings
At 8 weeks, 7-day PPA did not differ significantly between e-cigarette and NRT groups [25 (14.3%) of 175 and 17 (9.7%) of 175, respectively; OR 1.56; 95% CI 0.80–3.04; p = 0.19]. Both groups showed similar reductions in cigarette use and dependence. Adherence to counseling and assigned products was high. Adverse events were generally mild; cough and breathing difficulties were more frequently reported in the e-cigarette group and NRT participants reported more dizziness, sleeplessness, and allergies.
Interpretation
Among quitline users with a recent failed quit attempt, e-cigarettes combined with quitline counseling were not more effective than combination NRT in increasing smoking abstinence after 8 weeks’ follow-up.
Funding
U.S. National Institute on Drug Abuse.
对于那些努力戒烟的人来说，de -香烟已经成为尼古丁替代疗法（NRT）潜在的更有效、更令人满意的替代品。虽然戒烟热线是戒烟的有效平台，但由于监管方面的考虑和有限的临床证据，它们并没有纳入电子烟。我们评估了在最近使用标准戒烟热线服务戒烟失败的成年人中，戒烟热线提供的咨询与电子烟结合是否比NRT更有效。方法：我们在2020年10月至2023年1月期间对美国两条州戒烟线进行了一项实用、开放标签、平行组随机对照试验。成人[N = 350；在最近的戒烟热线登记后，仍在吸烟的212名（61%）女性（248名（72%）白人）被随机分成（1:1）组，接受8周的JUUL电子烟或尼古丁贴片和锭剂的组合，同时还有3个咨询电话。主要终点是8周时经生化验证的7天点流行戒烟（7天PPA）。分析采用意向治疗法；次要结局包括12周戒烟、长期戒烟、吸烟行为的改变、依赖和不良反应。结果发现，在8周，7天的PPA在电子烟组和NRT组之间没有显著差异[175人中分别有25人（14.3%）和17人（9.7%）；或1.56;95% ci 0.80-3.04；P = 0.19]。两组人在吸烟和对香烟的依赖方面都有相似的减少。对咨询和指定产品的依从性很高。不良事件一般轻微；电子烟组更频繁地报告咳嗽和呼吸困难，NRT参与者报告更多的头晕、失眠和过敏。解释：在最近戒烟失败的戒烟热线使用者中，经过8周的随访，电子烟联合戒烟热线咨询在增加戒烟方面并不比联合NRT更有效。国家药物滥用研究所。
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Pub Date : 2026-02-01Epub Date: 2025-12-20DOI: 10.1016/j.lana.2025.101340
Mônica Viegas Andrade , Kenya Valeria Micaela de Souza Noronha , Aline de Souza , Nayara Abreu Julião , André Soares Motta-Santos , Paulo Estevão Franco Braga , Henrique Bracarense , André Batista Alves do Santos , Bruno Ramos Nascimento , Ísis Eloah Machado , Francisco Rogerlândio Martins-Melo , Israel Molina , Pablo Perel , Yvonne Geissbühler , Caroline Demacq , Hector Eduardo Castro Jaramillo , Luis Eduardo Echeverría , Mario Bruno Principato , Luisa Fernanda Aguilera Mora , Marisa Liliana Fernandez , Antonio Luiz Pinho Ribeiro
Background
Chagas disease (ChD) remains a public health concern in Latin America. Despite a decline in overall prevalence, the chronic symptomatic forms still impose a substantial epidemiological and economic burden. This study undertakes a comprehensive, population-based cost analysis of chronic Chagas disease (CCD) from a societal perspective in seven endemic Latin American countries for 2010 and 2023.
Methods
A Markov model with one-year cycles and six states was employed. Direct medical and indirect costs, converted to 2024 purchasing power parity US dollars, were estimated using prevalence data from the Global Burden of Disease Study 2023. Based on a previous Brazilian Markov model, parameters were adjusted using healthcare coverage and per capita health expenditure ratios for each country, further validated by national experts.
Findings
In 2010, Brazil (US$252 billion) and Argentina (US$164 billion) had the highest lifetime burdens. As a percentage of annual Gross Domestic Product, Bolivia (0·9%) and Argentina (0·8%) were most affected. CCD accounted for 6% of total health expenditures in both countries. Between 2010 and 2023, most countries experienced a decline in economic burden due to decreased CCD prevalence, despite an increased proportion of patients with cardiac conditions, reflecting population aging and disease progression.
Interpretation
CCD imposes substantial economic burden across Latin American countries. Epidemiological shift to older populations with severe cardiac forms signals increased healthcare demands. Findings inform policymakers for resource allocation and tailored interventions.
Funding
Funding was provided by Novartis Pharma AG as part of a research collaboration with the World Heart Federation (project number CLCZ696D2010R).
{"title":"Economic burden of Chagas disease in Latin American countries: a population-based cost-of-illness analysis from the RAISE study","authors":"Mônica Viegas Andrade , Kenya Valeria Micaela de Souza Noronha , Aline de Souza , Nayara Abreu Julião , André Soares Motta-Santos , Paulo Estevão Franco Braga , Henrique Bracarense , André Batista Alves do Santos , Bruno Ramos Nascimento , Ísis Eloah Machado , Francisco Rogerlândio Martins-Melo , Israel Molina , Pablo Perel , Yvonne Geissbühler , Caroline Demacq , Hector Eduardo Castro Jaramillo , Luis Eduardo Echeverría , Mario Bruno Principato , Luisa Fernanda Aguilera Mora , Marisa Liliana Fernandez , Antonio Luiz Pinho Ribeiro","doi":"10.1016/j.lana.2025.101340","DOIUrl":"10.1016/j.lana.2025.101340","url":null,"abstract":"<div><h3>Background</h3><div>Chagas disease (ChD) remains a public health concern in Latin America. Despite a decline in overall prevalence, the chronic symptomatic forms still impose a substantial epidemiological and economic burden. This study undertakes a comprehensive, population-based cost analysis of chronic Chagas disease (CCD) from a societal perspective in seven endemic Latin American countries for 2010 and 2023.</div></div><div><h3>Methods</h3><div>A Markov model with one-year cycles and six states was employed. Direct medical and indirect costs, converted to 2024 purchasing power parity US dollars, were estimated using prevalence data from the Global Burden of Disease Study 2023. Based on a previous Brazilian Markov model, parameters were adjusted using healthcare coverage and per capita health expenditure ratios for each country, further validated by national experts.</div></div><div><h3>Findings</h3><div>In 2010, Brazil (US$252 billion) and Argentina (US$164 billion) had the highest lifetime burdens. As a percentage of annual Gross Domestic Product, Bolivia (0·9%) and Argentina (0·8%) were most affected. CCD accounted for 6% of total health expenditures in both countries. Between 2010 and 2023, most countries experienced a decline in economic burden due to decreased CCD prevalence, despite an increased proportion of patients with cardiac conditions, reflecting population aging and disease progression.</div></div><div><h3>Interpretation</h3><div>CCD imposes substantial economic burden across Latin American countries. Epidemiological shift to older populations with severe cardiac forms signals increased healthcare demands. Findings inform policymakers for resource allocation and tailored interventions.</div></div><div><h3>Funding</h3><div>Funding was provided by <span>Novartis Pharma AG</span> as part of a research collaboration with the <span>World Heart Federation</span> (project number CLCZ696D2010R).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101340"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790536","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}
Domestic violence has played a key role in linking firearms and homicide amongst female individuals. Combined with the increase of reports of violence against women during the COVID-19 pandemic, a rise in emergency department (ED) visits may be witnessed. Our aim was to estimate the changes in prevalence and risk factors associated with assault and firearm-related emergency department (ED) visits by female patients following the COVID-19 pandemic.
Methods
We performed a retrospective cross-sectional study of female patients presenting to EDs due to assault from the National Emergency Department Sample (NEDS) from 2018 to 2021. Independent variables included age, race, mortality, ED disposition, primary payer, location, mean total ED chargers, quartile ZIP income, and mechanism and intent of injury. The adjusted association between independent variables and ED visits among patients injured by firearms compared to those injured by other assaults was examined.
Findings
The analytic sample represented an estimated 1,575,543 ED weighted records of female assault cases out of a total weighted sample of 537,133,200 observations (0.29%). While year-over-year ED encounters decreased, firearm injuries and the proportion of patients admitted and dying in the hospital increased. Female patients who were injured by firearms had 89 times higher risk of dying in the ED (RR = 88.82; 95% CI 6 = 72.38–97.06) compared to female patients injured by non-firearm injury mechanisms. Racial disparities were prevalent, with Native American women experiencing the greatest risk of being assaulted (RR = 2.81; 95% CI 2.67–2.97). Victims of firearm related assaults had nearly 4.12 times the risk of identifying as Black compared with those assaulted without firearms (95% CI 3.75–4.52). Female patients seeking care for assault had higher risk of being uninsured (95% CI 2.70–2.77).
Interpretation
While year-over-year ED encounters due to assault decreased, lockdowns and restrictions associated with the observed COVID-19 pandemic may not fully reflect changes in abuse rates in this time period. The strong connection between firearm presence and female homicide and continuations of assault and firearm-related ED visits among vulnerable demographic groups highlights the need for effective strategies to reduce violence.
Funding
Unfunded.
家庭暴力在将枪支与女性杀人联系起来方面发挥了关键作用。在2019冠状病毒病大流行期间，暴力侵害妇女行为的报告有所增加，因此急诊就诊人数可能会增加。我们的目的是估计2019冠状病毒病大流行后女性患者攻击和枪支相关急诊科（ED）就诊的患病率和风险因素的变化。方法：我们对2018年至2021年国家急诊科样本（NEDS）中因攻击而就诊的女性患者进行了回顾性横断面研究。独立变量包括年龄、种族、死亡率、急症处置、主要付款人、地点、平均急症总收费人、四分位数ZIP收入、机制和伤害意图。与其他袭击受伤的患者相比，受火器伤害的患者与急诊室就诊之间的调整后的自变量之间的关联进行了检查。分析样本代表了537,133,200个观察的总加权样本（0.29%）中约1,575,543个女性性侵案件的ED加权记录。虽然急诊病例逐年减少，但火器伤害以及住院和死亡的患者比例却有所增加。女性火器伤患者急诊死亡风险是非火器伤女性患者的89倍（RR = 88.82; 95% CI 6 = 72.38 ~ 97.06）。种族差异普遍存在，美洲原住民妇女遭受侵犯的风险最大（RR = 2.81; 95% CI 2.67-2.97）。与没有枪支的受害者相比，枪支相关袭击的受害者被认定为黑人的风险近4.12倍（95% CI 3.75-4.52）。因遭受袭击而寻求治疗的女性患者没有保险的风险更高（95% CI 2.70-2.77）。虽然因袭击而导致的急诊事件逐年减少，但与观察到的COVID-19大流行相关的封锁和限制可能无法完全反映这一时期虐待率的变化。在弱势群体中，枪支的存在与女性杀人、持续的攻击和与枪支有关的急诊科就诊之间存在着密切的联系，这突出表明需要制定有效的战略来减少暴力。
{"title":"US emergency department visits by women due to assault (2018–2021): a retrospective cross-sectional analysis","authors":"Summer Chavez , Irma Ugalde , Michael Ulrich , Omolola Adepoju , Tonghui Xu , Winston Liaw","doi":"10.1016/j.lana.2025.101343","DOIUrl":"10.1016/j.lana.2025.101343","url":null,"abstract":"<div><h3>Background</h3><div>Domestic violence has played a key role in linking firearms and homicide amongst female individuals. Combined with the increase of reports of violence against women during the COVID-19 pandemic, a rise in emergency department (ED) visits may be witnessed. Our aim was to estimate the changes in prevalence and risk factors associated with assault and firearm-related emergency department (ED) visits by female patients following the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We performed a retrospective cross-sectional study of female patients presenting to EDs due to assault from the National Emergency Department Sample (NEDS) from 2018 to 2021. Independent variables included age, race, mortality, ED disposition, primary payer, location, mean total ED chargers, quartile ZIP income, and mechanism and intent of injury. The adjusted association between independent variables and ED visits among patients injured by firearms compared to those injured by other assaults was examined.</div></div><div><h3>Findings</h3><div>The analytic sample represented an estimated 1,575,543 ED weighted records of female assault cases out of a total weighted sample of 537,133,200 observations (0.29%). While year-over-year ED encounters decreased, firearm injuries and the proportion of patients admitted and dying in the hospital increased. Female patients who were injured by firearms had 89 times higher risk of dying in the ED (RR = 88.82; 95% CI 6 = 72.38–97.06) compared to female patients injured by non-firearm injury mechanisms. Racial disparities were prevalent, with Native American women experiencing the greatest risk of being assaulted (RR = 2.81; 95% CI 2.67–2.97). Victims of firearm related assaults had nearly 4.12 times the risk of identifying as Black compared with those assaulted without firearms (95% CI 3.75–4.52). Female patients seeking care for assault had higher risk of being uninsured (95% CI 2.70–2.77).</div></div><div><h3>Interpretation</h3><div>While year-over-year ED encounters due to assault decreased, lockdowns and restrictions associated with the observed COVID-19 pandemic may not fully reflect changes in abuse rates in this time period. The strong connection between firearm presence and female homicide and continuations of assault and firearm-related ED visits among vulnerable demographic groups highlights the need for effective strategies to reduce violence.</div></div><div><h3>Funding</h3><div>Unfunded.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101343"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925434","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 : 2026-02-01Epub Date: 2026-02-05DOI: 10.1016/j.lana.2026.101389
Bingpeng Gao , Junwen Wang
{"title":"Evolving registry staging and competing risks in analyses of First Nations prostate cancer outcomes","authors":"Bingpeng Gao , Junwen Wang","doi":"10.1016/j.lana.2026.101389","DOIUrl":"10.1016/j.lana.2026.101389","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101389"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214174","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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