Lancet Regional Health-Americas最新文献

{"title":"Sex differences in the association of vascular risk and APOE Genotype with cognitive decline and dementia: evidence from a U.S. longitudinal study","authors":"Longjian Liu ,&nbsp;Jintong Hou ,&nbsp;Saishi Cui ,&nbsp;Xiaopeng Zhao ,&nbsp;Zuolu Liu ,&nbsp;J. Craig Longenecker ,&nbsp;Nathalie S. May ,&nbsp;Jin Jun Luo ,&nbsp;Rose Ann DiMaria-Ghalili ,&nbsp;Howard J. Eisen","doi":"10.1016/j.lana.2025.101346","DOIUrl":"10.1016/j.lana.2025.101346","url":null,"abstract":"<div><h3>Background</h3><div>Sex differences in the association between vascular factors and cognitive outcomes remain unclear. We aimed to investigate the associations of blood pressure metrics (hypertension, systolic blood pressure [SBP), pulse pressure, ankle and brachial pressures, and ankle to brachial pressure index [ABI]) with the risk of cognitive decline and dementia.</div></div><div><h3>Methods</h3><div>We conducted a population-based longitudinal analysis using data from the Atherosclerosis Risk in Communities (ARIC) study (begun in 1987–1989) in the United States. We analyzed a total of 12,268 participants aged 45–64 years who had validated exposure measurements, cognitive function tests (first administrated 1990–1992), and followed up for incidence of dementia through December 2019. Cognitive function was assessed using the Digit Symbol Substitution Test, the Delayed Word Recall Test, and the Word Fluency Test. Dementia cases were identified through a standardized clinical evaluation process, mostly adjudicated by expert reviewers. We performed sex-stratified analyses to examine the associations of blood pressure metrics and APOE ε4 allele with the risk of cognitive decline and dementia.</div></div><div><h3>Findings</h3><div>Over a median follow-up of 26.4 years, 2698 participants developed dementia. Women aged 55–64 had a significantly higher incidence of dementia than men aged 55–64 (14.8 vs. 11.8 per 1000 person-years; p &lt; <em>0.0001</em>). After adjusting for key covariates, SBP, pulse pressure, ankle and brachial pressures were significantly associated with cognitive decline in women (p &lt; 0.05). In men, pulse pressure and ankle pressure showed a significant association. In longitudinal analyses, baseline hypertension and elevated brachial pressure were significantly associated with increased dementia risk in women, whereas in men, elevated brachial pressure and decreased ABI were significantly associated with dementia risk. Individuals with APOE ε4 allele had significantly higher risk of dementia in both sexes. A joint effect of APOE ε4 allele and elevated blood pressure metrics conferred a greater relative excess risk of dementia in women vs. men.</div></div><div><h3>Interpretation</h3><div>These findings highlight notable sex differences in the association between vascular factors and cognitive decline and dementia risk. Women appear more vulnerable to both genetic and vascular risk factors, emphasizing the need for sex-specific approaches in research, prevention, and intervention strategies for cognitive impairment.</div></div><div><h3>Funding</h3><div><span>NIH</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101346"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840624","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":"From detecting abnormalities to diagnosing cancer: how can lay anal examinations be refined?","authors":"Ming Wang,&nbsp;Yanru Cao,&nbsp;Qing Zhu","doi":"10.1016/j.lana.2026.101380","DOIUrl":"10.1016/j.lana.2026.101380","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101380"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077822","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":"Effect of eggs on Maya child development and growth: the Saqmolo’ Project randomized clinical trial","authors":"Gabriela Montenegro-Bethancourt ,&nbsp;Gabriela V. Proaño ,&nbsp;Elizabeth Yakes Jimenez ,&nbsp;Taylor C. Wallace ,&nbsp;Alison Steiber ,&nbsp;Xingya Ma ,&nbsp;Ming Ji ,&nbsp;Peter Rohloff","doi":"10.1016/j.lana.2025.101339","DOIUrl":"10.1016/j.lana.2025.101339","url":null,"abstract":"<div><h3>Background</h3><div>There is worldwide interest in determining whether frequent egg provision during complementary feeding enhances child development and growth in low-resource settings. We evaluated effects of adding one whole egg per day to local standard nutrition care on infant outcomes.</div></div><div><h3>Methods</h3><div>The Saqmolo’ Project individually randomized, partially blinded, comparative effectiveness clinical trial was conducted in rural Guatemala from 2021 to 2023. Maya infants aged 6–9 months were randomized to standard nutrition care alone (growth monitoring, complementary and responsive feeding education, deworming medication, multiple micronutrient powders, and referrals for medical care) versus standard care plus one whole egg per day for 6 months. Mixed linear or logistic regression models were used to estimate between-group differences in primary (global development score) and secondary (growth, anemia status, and diet quality) outcomes.</div></div><div><h3>Findings</h3><div>This trial included 1200 Maya infants (51.3% male). After adjustment for baseline values and participant characteristics, there was no significant between-group difference in global development score (β −0.08 points [95% CI −0.22 to 0.06]). There were also no significant between-group differences for most secondary outcomes. Intervention participants did have significantly higher odds of stunting (odds ratio [OR] 1.42 [95% CI 1.10–1.82]; p = 0.007) and of meeting minimum dietary diversity (OR 1.41 [95% CI 1.20–1.65]; p &lt; 0.001) and minimum adequate diet (OR 1.44 [95% CI 1.26–1.64]; p &lt; 0.001) benchmarks than standard care participants.</div></div><div><h3>Interpretation</h3><div>Provision of one whole egg per day in addition to standard care improved diet quality but did not benefit development, growth, or anemia status among Maya infants.</div></div><div><h3>Funding</h3><div><span>Academy of Nutrition and Dietetics Foundation</span> via an <span>Egg Nutrition Center investigator-initiated research</span> grant.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101339"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790569","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":"Corrigendum to “Impact of strategic public health interventions to reduce tuberculosis incidence in Brazil: a Bayesian structural time-series scenario analysis” - The Lancet Regional Health – Americas 2025; Volume 41: 100963; DOI: 10.1016/j.lana.2024.100963","authors":"Klauss Villalva-Serra ,&nbsp;Beatriz Barreto-Duarte ,&nbsp;Moreno M. Rodrigues ,&nbsp;Artur T.L. Queiroz ,&nbsp;Leonardo Martinez ,&nbsp;Julio Croda ,&nbsp;Valeria C. Rolla ,&nbsp;Afrânio L. Kritski ,&nbsp;Marcelo Cordeiro-Santos ,&nbsp;Timothy R. Sterling ,&nbsp;Mariana Araújo-Pereir ,&nbsp;Bruno B. Andrade","doi":"10.1016/j.lana.2026.101381","DOIUrl":"10.1016/j.lana.2026.101381","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101381"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077820","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":"Authors’ reply to: Todd et al., prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Sarah A. Coggins ,&nbsp;Sagori Mukhopadhyay","doi":"10.1016/j.lana.2025.101369","DOIUrl":"10.1016/j.lana.2025.101369","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101369"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920762","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":"Unique role of the prospective cohort incident-tumor biobank method in etiological research","authors":"Shuji Ogino ,&nbsp;Alpa V. Patel ,&nbsp;Satoko Ugai ,&nbsp;Marios Giannakis ,&nbsp;Tomotaka Ugai","doi":"10.1016/j.lana.2025.101290","DOIUrl":"10.1016/j.lana.2025.101290","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101290"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924386","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":"Health and economic burden of insomnia medications among older Americans: findings from the future elderly model","authors":"Christopher N. Kaufmann ,&nbsp;Adam P. Spira ,&nbsp;Chien-Yu Tseng ,&nbsp;Emerson M. Wickwire","doi":"10.1016/j.lana.2025.101333","DOIUrl":"10.1016/j.lana.2025.101333","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101333"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736321","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":"Suicide-related outcomes in veterans with post-traumatic headache: a retrospective cohort study","authors":"Sarah E. Anthony ,&nbsp;Manali A. Phadke ,&nbsp;Richard B. Lipton ,&nbsp;Daniel G. Rogers ,&nbsp;Lisa A. Brenner ,&nbsp;John P. Ney ,&nbsp;Hamada H. Altalib ,&nbsp;X. Michelle Androulakis ,&nbsp;Amy S. Grinberg ,&nbsp;Melissa Skanderson ,&nbsp;Hung-Mo Lin ,&nbsp;Joel D. Scholten ,&nbsp;Brenda T. Fenton ,&nbsp;Elizabeth K. Seng ,&nbsp;Jason J. Sico","doi":"10.1016/j.lana.2025.101299","DOIUrl":"10.1016/j.lana.2025.101299","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic headache (PTH) is a common sequela of traumatic brain injury (TBI). Although there is a known association between TBI and suicide risk in veterans, the association between PTH and suicide-related outcomes in veterans with TBI is relatively unknown. We aimed to evaluate the association between PTH and suicide-related outcomes in veterans compared to matched controls diagnosed with TBI but no history of headaches.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted with Veterans Health Administration and Department of Defense electronic health record data from fiscal years 2008 through 2020. Veterans with PTH were matched to a control group who had TBI and no headache disorders. Relative risk was estimated using propensity score-weighted log-binomial models that evaluated differences in suicidal ideation, suicide attempts, and suicide death.</div></div><div><h3>Findings</h3><div>Of the 95,224 veterans included in the total sample, 85,730 were male (90.0%) and 9,949 were female (10.0%). The average age of the sample was 45.9 years (SD = 16.6). 73,500 (77.2%) were White, Non-Hispanic, 17,256 (18.1%) were Black, Non-Hispanic, and 4,468 (4.7%) were classified as other or mixed race. Of the 47,612 veterans diagnosed with PTH, 4,618 (9.7%) reported suicidal ideation or suicide attempts compared to 3,162 (6.6%) in the control group. Veterans with PTH had increased risk of suicidal ideation (RR, 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83) compared to matched controls. Using inverse probability weighting to adjust for confounding, these results remained significant. When adjusting for potential confounders, as well as prior suicidal ideation or suicide attempts, there was no significant difference in risk of suicide death in veterans with PTH (RR, 0.83; 95% CI, 0.67–1.02) compared to those with TBI without headache.</div></div><div><h3>Interpretation</h3><div>Veterans with PTH have an increased risk of suicidal ideation and suicide attempts compared to veterans with TBI and without headache. There was no difference in suicide mortality between the two groups. Clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities that contribute to increased risk.</div></div><div><h3>Funding</h3><div>This study was supported by the United States <span>Department of Veterans Affairs</span> special purpose medical service funding (SP80DPE.1-0160).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101299"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526893","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":"Maternal RSV vaccination to protect infants in Brazil: a model-based cost-effectiveness analysis for incorporation into the National Immunisation Program","authors":"Sophia Aguiar Monteiro Borges ,&nbsp;Erick Ohanesian Polli ,&nbsp;Ana Carolina Nonato ,&nbsp;Natacha Cerchiari ,&nbsp;Stéphane Verguet ,&nbsp;Ana Marli Christovam Sartori ,&nbsp;Patrícia Coelho de Soárez","doi":"10.1016/j.lana.2025.101356","DOIUrl":"10.1016/j.lana.2025.101356","url":null,"abstract":"<div><h3>Background</h3><div>In Brazil, respiratory syncytial virus (RSV) is the primary cause of lower respiratory tract infections (LRTI) in children under two years of age. Maternal immunization with the bivalent RSV prefusion F protein vaccine (RSVpreF) has demonstrated high efficacy in protecting infants during their first 6 months of life against RSV-LRTI. We assessed the cost-effectiveness of implementing maternal RSV immunization in Brazil.</div></div><div><h3>Methods</h3><div>We utilised a decision tree model, following a birth cohort during their first year of life. The model compared two strategies: maternal vaccination and no vaccination, from both healthcare system and societal perspectives. Secondary data from Brazilian Health Information Systems, administrative databases and international literature were used. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per disability-adjusted life year (DALY) averted, in 2023 USD. We applied a cost-effectiveness threshold of 8000 USD (40,000 BRL) per DALY based on Brazilian guidelines.</div></div><div><h3>Findings</h3><div>Introduction of RSV vaccination for pregnant women at 50% coverage would prevent around 37,000 RSV cases annually, including 9400 hospitalizations and 28,000 outpatient visits. The program would avert 80 deaths and 1660 DALYs, with an incremental cost of $49,200,000 USD from the healthcare system perspective (ICER $29,700 per DALY averted) and $48,800,000 USD from the societal perspective (ICER $29,200 per DALY averted). These ICERs exceed the acceptable cost-effectiveness Brazilian threshold. To be considered cost-effective, the vaccine dose price would need to be around $12. In sensitivity analyses, vaccine price and efficacy were the most influential parameters, as testing their uncertainty ranges resulted in the largest changes (i.e., the widest range) in the ICER. In the probabilistic sensitivity analysis, the probability that the maternal RSV immunization program is cost-effective at the Brazilian threshold of $8000 per DALY averted was 0% from the healthcare system perspective and 6% from the societal perspective.</div></div><div><h3>Interpretation</h3><div>Our findings indicate maternal RSV immunization could substantially reduce disease burden but would require significant price reduction to meet Brazil's cost-effectiveness threshold.</div></div><div><h3>Funding</h3><div><span>São Paulo Research Foundation</span> (FAPESP), <span>Pan American Health Organization</span> (PAHO) and <span>Brazilian National Council for Scientific and Technological Development</span> (CNPq).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101356"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839177","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":"COVID-19 vaccine trust and uptake: the role of media, interpersonal and institutional trust in a large population-based survey","authors":"Lara E. Coelho ,&nbsp;Guilherme T. Goedert ,&nbsp;Juliano Genari ,&nbsp;Paula M. Luz ,&nbsp;Luiz Max Carvalho ,&nbsp;Cleber V.B.D. Santos ,&nbsp;Daniel Csillag ,&nbsp;Tulio Konečný ,&nbsp;Lucia Campos Pellanda ,&nbsp;Claudio J. Struchiner ,&nbsp;Mariângela Freitas da Silveira ,&nbsp;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":"2026-01-01","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}