Lancet Regional Health-Americas最新文献

{"title":"Neighborhood disadvantage and adolescent sleep health: a longitudinal population-based study","authors":"Li Niu ,&nbsp;Luyao Tan ,&nbsp;Angela Diaz ,&nbsp;Yunyu Xiao ,&nbsp;Yan Li ,&nbsp;Yijie Wang","doi":"10.1016/j.lana.2025.101320","DOIUrl":"10.1016/j.lana.2025.101320","url":null,"abstract":"<div><h3>Background</h3><div>Neighborhood disadvantage may adversely affect adolescent sleep health, yet causal evidence is limited and whether these effects differ by sex and pubertal development remain unclear. This study examined the potential causal effect of neighborhood disadvantage on adolescent sleep duration and variability over a two-year period.</div></div><div><h3>Methods</h3><div>This cohort study analyzed data from 5045 adolescents (mean age 9.96 years at baseline) in the Adolescent Brain Cognitive Development (ABCD) Study, a longitudinal, population-based sample in the United States. Three indicators of neighborhood disadvantage were assessed: Area Deprivation Index (ADI), air pollution, and nighttime noise, each dichotomized at the 80th percentile to indicate high exposure. Sleep outcomes were derived from Fitbit devices worn continuously for 21 days two years after baseline, including sleep duration and night-to-night variability (defined as the standard deviation of sleep duration across nights). Bayesian causal forests were used to estimate average treatment effects (ATEs) and subgroup-specific effects by sex and pubertal status. Analyses adjusted for the propensity to reside in a high-advantage neighborhood, accounting for individual and household factors including income-to-needs ratio, parental education, and race/ethnicity.</div></div><div><h3>Findings</h3><div>Adolescents living in neighborhoods with high ADI (ATE −0.11, 10th percentile: −0.18, 90th percentile: −0.05), high air pollution (ATE −0.08, −0.14 to −0.02), and high nighttime noise (ATE −0.07, −0.13 to −0.01) had shorter sleep duration two years after baseline. High ADI was also associated with greater night-to-night sleep variability (ATE 0.17, 0.10–0.23). Stratified analyses revealed that boys were more susceptible to reduced sleep duration, girls to greater sleep variability, and adolescents with more advanced pubertal status were more affected across both outcomes.</div></div><div><h3>Interpretation</h3><div>Neighborhood disadvantage has lasting adverse effects on adolescent sleep health, with differential vulnerability by sex and pubertal stage. These findings underscore the need for developmentally tailored policies and interventions that address neighborhood environments to promote healthy sleep during adolescence.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Natural Science Foundation of China,</span> the <span>Fundamental Research Funds for the Central Universities</span>, the <span>National Institute of Mental Health</span>, and the <span>American Foundation for Suicide Prevention</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101320"},"PeriodicalIF":7.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid weight gain in first 2 years of life and BMI trajectories from 3 to <10 years: a population-based longitudinal study of 1.7 million Brazilian children","authors":"Carolina Santiago-Vieira ,&nbsp;Leah Li ,&nbsp;Rita de Cássia Ribeiro Silva ,&nbsp;Juliana Freitas de Mello e Silva ,&nbsp;Enny S. Paixão ,&nbsp;Maurício L. Barreto ,&nbsp;Gustavo Velasquez-Melendez","doi":"10.1016/j.lana.2025.101326","DOIUrl":"10.1016/j.lana.2025.101326","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is considered a disease with negative health impacts at all life stages. Changes in growth patterns, such as postnatal rapid weight gain (RWG), can be important predictors of growth trajectories in children. We investigated the association between RWG during the first two years of life and subsequent BMI trajectories from the age 3–to 9 years, and whether the association differed by birth weight group.</div></div><div><h3>Methods</h3><div>We used the data of a population-based cohort from the Cadastro Único (CadÚnico) of the Federal Government, the linkage of the National Live Births System (SINASC) and the National Food and Nutritional Surveillance System (SISVAN). The sample comprised 1.7 million Brazilian children aged from zero to nine years from 2008 to 2017. Mixed-effects models were used to estimate mean age-trajectories for BMI by RWG group.</div></div><div><h3>Findings</h3><div>Children who experienced RWG during the first two years of life had higher mean BMI trajectories from 3 to 9 years, compared to those who did not. The difference was seen across all birth weight groups, and was more evident for the children with high birth weight. At age 9, the BMI difference between RWG and non-RWG children was 1.31 kg/m² (boys) and 1.43 kg/m² (girls) for children with adequate birth weight, 1.27 kg/m² (boys) and 1.35 kg/m² (girls) for low birth weight, and 2.25 kg/m² (boys) and 2.86 kg/m² (girls) for macrosomia.</div></div><div><h3>Interpretation</h3><div>Children who experienced RWG during the first two years of life had higher BMI trajectories than children who did not. The finding highlighted the importance of monitoring child growth, which allows the early identification of potential growth deviations and the implementation of necessary interventions to ensure that children grow healthy and reach their full developmental potential.</div></div><div><h3>Funding</h3><div>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES, CAPES/Print/UFBA; <span>University College London</span> (UCL); <span>National Institute for Health Research</span> (NIHR) <span>Great Ormond Street Hospital Biomedical Research Centre</span>; Fundação de Amparo à Pesquisa do Estado de Minas Gerais—FAPEMIG; <span>National Council for Scientific and Technological Development</span>—CNPq; CNPq/CGFP/DECIT/SECTICS; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde; <span>Wellcome Trust</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101326"},"PeriodicalIF":7.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of large-scale release of Wolbachia mosquitoes on dengue incidence in Campo Grande, Brazil: an ecological study","authors":"Fabiani de Morais Batista ,&nbsp;Paloma M. Carcamo ,&nbsp;Elisabeth Nelson ,&nbsp;Antonio Brandão da Silva Neto ,&nbsp;Daniel Henrique Tsuha ,&nbsp;Veruska Lahdo ,&nbsp;Vagner Ricardo dos Santos ,&nbsp;Gabriel Sylvestre Ribeiro ,&nbsp;Renato da Silva Lopes ,&nbsp;Pilar Amadeu ,&nbsp;Marcos Vinicius Ferreira Mendes Blanco ,&nbsp;Thiago Rodrigues da Costa ,&nbsp;Karlos Diogo de Melo Chalegre ,&nbsp;Thais Irene Souza Riback ,&nbsp;Cátia Cabral da Silva ,&nbsp;Otavio T. Ranzani ,&nbsp;Derek A.T. Cummings ,&nbsp;Jason R. Andrews ,&nbsp;Albert I. Ko ,&nbsp;Matt D.T. Hitchings ,&nbsp;Julio Croda","doi":"10.1016/j.lana.2025.101327","DOIUrl":"10.1016/j.lana.2025.101327","url":null,"abstract":"<div><h3>Background</h3><div>The introduction of the <em>w</em>Mel strain of <em>Wolbachia</em> into <em>Aedes aegypti</em> mosquitoes significantly reduces dengue virus transmission. We evaluated the impact of large-scale releases of <em>Wolbachia</em>-infected <em>Ae. aegypti</em> on dengue incidence in Campo Grande, a large urban city in the Central-West region of Brazil, in the first deployment of <em>Wolbachia</em> as an official dengue-control strategy by the Brazilian federal government.</div></div><div><h3>Methods</h3><div>Mosquitoes infected with <em>w</em>Mel <em>Wolbachia</em> were released in geographically phased deployments throughout Campo Grande from December 2020 through December 2023. An ovitrap surveillance network monitored <em>Wolbachia</em> prevalence in local <em>Ae. aegypti</em> populations during and after releases. Mixed-effects negative binomial regression was used to evaluate neighborhood-level monthly notified dengue incidence (2008–2024) as a function of monthly <em>w</em>Mel exposure status, comparing fully treated (<em>w</em>Mel prevalence stably ≥60%) and partially treated (ongoing releases or <em>w</em>Mel &lt;60%) with untreated periods, accounting for seasonal variation.</div></div><div><h3>Findings</h3><div>More than 100 million <em>Wolbachia</em>-infected mosquitoes were released, achieving a post-intervention mean <em>Wolbachia</em> prevalence of 86.4% (95% CI 84.0–88.9), with 89% of intervention areas reaching stable <em>Wolbachia</em> levels ≥60%. Stable establishment of <em>w</em>Mel at ≥60% prevalence was associated with a 63.2% (95% CI 51.9–71.9) reduction in dengue incidence.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate successful large-scale <em>Wolbachia</em> establishment in <em>Ae. aegypti</em> populations and a substantial epidemiological impact on dengue incidence in an urban Brazilian setting. This study provides robust evidence supporting <em>Wolbachia</em> deployment as an effective, sustainable public health intervention and validates its implementation as a federal government-supported dengue control strategy in Brazil.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>Brazilian Ministry of Health</span> and the <span>Oswaldo Cruz Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101327"},"PeriodicalIF":7.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards a Latin American neuropsychiatry: challenges and opportunities","authors":"Jesús Ramírez Bermúdez ,&nbsp;Sheila Castro-Suarez ,&nbsp;Luciana D'Alessio ,&nbsp;Jorge Holguín Lew ,&nbsp;Louise Makarem Oliveira ,&nbsp;Mônica Sanches Yassuda ,&nbsp;Hernando Santamaría-García ,&nbsp;Andrea Slachevsky ,&nbsp;William Tamayo Agudelo ,&nbsp;Julio Torales ,&nbsp;Norha Vera San Juan ,&nbsp;Vaughan Bell","doi":"10.1016/j.lana.2025.101322","DOIUrl":"10.1016/j.lana.2025.101322","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101322"},"PeriodicalIF":7.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waist-to-height ratio and coronary artery calcium incidence: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)","authors":"Thiago Bosco Mendes ,&nbsp;Giuliano Generoso ,&nbsp;Ronaldo C. Fabiano ,&nbsp;Bruno Halpern ,&nbsp;Carolina Castro Porto Silva Janovsky ,&nbsp;Carlos Manuel Romero ,&nbsp;Raul D. Santos ,&nbsp;Isabela Bensenor ,&nbsp;Paulo Andrade Lotufo ,&nbsp;Marcio Sommer Bittencourt","doi":"10.1016/j.lana.2025.101281","DOIUrl":"10.1016/j.lana.2025.101281","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a cardiovascular risk factor and coronary artery calcium (CAC) is frequently used to assess coronary atherosclerosis burden. The purpose of this study was to evaluate body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) as predictors of CAC incidence.</div></div><div><h3>Methods</h3><div>We analyzed ELSA-Brasil cohort participants with no cardiovascular disease who had an initial CAC score of zero and repeated the test. Multivariate logistic regression analyses were performed to assess BMI, WC, and WHtR as predictors of CAC incidence.</div></div><div><h3>Findings</h3><div>A total of 2721 participants (mean age 48.1 ± 7.56 years, 62.6% females) self-reported as White (57%), Brown/mixed (22.8%), Black (15.4%), Asian (4%) or Native/Indigenous (0.9%) were analyzed. CAC incidence after a mean of 5.24 years was 15.5% (confidence interval [CI] 95%: 14.2–17%). In unadjusted analysis, BMI, WC, and WHtR were positively associated with CAC incidence with an odds ratio (OR) of 1.19 (CI 95%: 1.08–1.31), 1.37 (CI 95% 1.23–1.52) and 1.39 (CI 95%: 1.25–1.54) per standard deviation, respectively. In the fully adjusted model, WHtR was the only independent predictor of CAC incidence, OR: 1.18 (CI 95% 1.03–1.35) per standard deviation. This effect was mainly driven by individuals with BMI &lt;30 kg/m².</div></div><div><h3>Interpretation</h3><div>WHtR was the only independent anthropometric measure predictor of atherosclerosis incidence assessed by coronary artery calcium score. This effect is particularly relevant in individuals with BMI &lt;30 kg/m².</div></div><div><h3>Funding</h3><div><span>National Council for Scientific and Technological Development</span> (CNPq), Brazil.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101281"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycobacterium tuberculosis transmission dynamics within prisons: a population-based genomic study","authors":"Katharine S. Walter ,&nbsp;Everton Ferreira Lemos ,&nbsp;Ana Paula Cavalcante Aires Alves ,&nbsp;Gabriela Felix Chaves Ferreira ,&nbsp;Vanessa Maruyama Martins Coutinho ,&nbsp;Barun Mathema ,&nbsp;Joshua L. Warren ,&nbsp;Caroline Colijn ,&nbsp;Ted Cohen ,&nbsp;Julio Croda ,&nbsp;Jason R. Andrews","doi":"10.1016/j.lana.2025.101262","DOIUrl":"10.1016/j.lana.2025.101262","url":null,"abstract":"<div><h3>Background</h3><div>One barrier to intervening in the global tuberculosis pandemic is that it is unknown whether <em>Mycobacterium tuberculosis</em> transmission largely occurs through repeated close exposures among few contacts or many shorter-term contacts. Identifying sources of transmission is particularly urgent in congregate settings like prisons with high incidence of infection. Our aim was to identify the type of contacts associated with <em>M. tuberculosis</em> transmission risk within prisons.</div></div><div><h3>Methods</h3><div>We conducted genomic surveillance in a prison system in Central West Brazil. We whole genome sequenced <em>M. tuberculosis</em> isolates and collected detailed incarceration histories. We modeled transmission linkages as a function of different types of prison exposures, using genomic clustering as a proxy for transmission and controlling for multiple pairwise comparisons.</div></div><div><h3>Findings</h3><div>We collected detailed incarceration histories for 595 individuals, mean age 31 (ST—standard deviation 8.5) and 99% men, from whom we sequenced 550 high quality <em>M. tuberculosis</em> genomes. In a binomial model, a month-long increase in exposure to an individual with tuberculosis within a prison cell increased the odds of pairwise genomic clustering by 14% (odds ratio—OR: 1.14, 95% CI: 1.09–1.19) and a six-month increase in exposure doubled the odds of genomic clustering (OR: 2.24, 95% CI: 1.73–2.91). Most (83%; 494 of 595) individuals with tuberculosis had at least one potential day-long exposure in a prison cell to another individual with tuberculosis, and frequently many, with a median of 8 (interquartile range—IQR: 4–12) potential unique exposures to individuals in prison cells. Frequent movements by the prison system create a highly connected contact network: individuals with tuberculosis were transferred a median of 8 (IQR: 4–13) times in the 2 years before diagnosis.</div></div><div><h3>Interpretation</h3><div>While documented cell-level exposures can explain a significant proportion of <em>M. tuberculosis</em> transmission, most transmission links occur outside prison cells, either from other contacts in the same prison or from unreported or unsampled exposures. Our results support the urgent expansion of prison-wide mass screenings, tuberculosis preventive therapy, and structural interventions to reduce transmission risk in prisons and other congregate settings.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span> (NIAID: 5K01AI173385, R01AI100358, and R01AI149620).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101262"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening genomic surveillance for neglected tropical diseases in the Americas","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101338","DOIUrl":"10.1016/j.lana.2025.101338","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101338"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refugee healthcare resilience and burdens: a 10-year mixed-methods analysis of system shocks in Canada","authors":"Eric Norrie ,&nbsp;Linda Holdbrook ,&nbsp;Rabina Grewal ,&nbsp;Rachel Talavlikar ,&nbsp;Mohammad Yasir Essar ,&nbsp;Tyler Williamson ,&nbsp;Annalee Coakley ,&nbsp;Kerry McBrien ,&nbsp;Gabriel E. Fabreau","doi":"10.1016/j.lana.2025.101279","DOIUrl":"10.1016/j.lana.2025.101279","url":null,"abstract":"<div><h3>Background</h3><div>System shocks, including policy changes, refugee surges, and pandemics, strain healthcare systems. These shocks compound refugee health vulnerabilities, limiting care but may also trigger adaptive responses that build resilience. Understanding local responses is essential for resilient care models.</div></div><div><h3>Methods</h3><div>This sequential explanatory mixed-methods retrospective study (2011–2020) examined how a refugee health centre in Alberta, Canada, responded to four shocks: Interim Federal Health Program (IFHP) Cuts (2012), Syrian Surge (2015), Yazidi Resettlement (2017), and COVID-19 (2020). We hypothesized that each shock would drive temporary utilization changes, reflected in level (immediate) and slope (monthly rate of change) shifts, with corresponding impacts on patients and providers. Interrupted time series analysis estimated level and slope differences in monthly appointments (total, family physician, specialist, multidisciplinary team). Interviews with health centre leaders were thematically analyzed using an adapted Health System Resilience framework and integrated with quantitative findings to assess resilience and operational burdens.</div></div><div><h3>Findings</h3><div>Between 2011 and 2020, 10,661 refugees from 106 countries attended 107,642 appointments. The mean age was 24.49 years (SD 17.09; range 0–107), and 47.82% (5094) were female. Mean monthly appointments increased from 455 to 2,208, with an adjusted level difference of +1656.06 and slope increase of +95.68 (p &lt; 0.0.01). Family physician and multidisciplinary team appointments rose substantially, while specialist care declined during COVID-19. Mean provider hours increased from 175.8 to 1097.3 (6.2-fold). Qualitative analysis indicated resilience capacities but also burnout, vicarious trauma, and financial strain. Integration revealed the centre developed resilience but experienced operational burden.</div></div><div><h3>Interpretation</h3><div>Over a decade, the centre adapted to successive shocks, transforming into a beacon clinic. It demonstrated resilience through care expansion and innovation, at the cost of operational burden.</div></div><div><h3>Funding</h3><div><span>O'Brien Institute for Public Health</span> and the <span>MSI Foundation</span> of Alberta.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101279"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory syncytial virus prevention in infants and equity in Latin America and the Caribbean: from evidence to action","authors":"María L. Avila-Aguero ,&nbsp;Luiza Helena Falleiros-Arlant ,&nbsp;José Brea ,&nbsp;Carlos Espinal ,&nbsp;Flor Muñoz","doi":"10.1016/j.lana.2025.101316","DOIUrl":"10.1016/j.lana.2025.101316","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101316"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEARTS quality: a policy framework to strengthen hypertension and cardiovascular risk management in primary healthcare—insights from HEARTS in the Americas","authors":"Esteban Londoño ,&nbsp;Reena Gupta ,&nbsp;Patrick Van der Stuyft ,&nbsp;Martin Heine ,&nbsp;Gloria Giraldo ,&nbsp;Grace Marie Ku ,&nbsp;Jeffrey Brettler ,&nbsp;Andrés Rosende ,&nbsp;Vilma Irazola ,&nbsp;Jerry Toelsie ,&nbsp;Carolina Neira ,&nbsp;Teresa Aumala ,&nbsp;Yamilé Valdés ,&nbsp;Eric Zúñiga ,&nbsp;Libardo Rodríguez ,&nbsp;Matías Villatoro ,&nbsp;María Cristina Escobar ,&nbsp;Vivian Pérez ,&nbsp;Alied Bencomo ,&nbsp;Michael Pereira ,&nbsp;Pedro Ordunez","doi":"10.1016/j.lana.2025.101311","DOIUrl":"10.1016/j.lana.2025.101311","url":null,"abstract":"<div><div>HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10,000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening—supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101311"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681412","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}