Pub Date : 2026-01-01Epub Date: 2025-11-29DOI: 10.1016/j.lana.2025.101310
Aurélie Montagne , Cécile Rousseau , Ana Gómez-Carrillo
School-based initiatives are increasingly promoted as solutions to the youth mental health crisis, with Social Emotional Learning (SEL) among the most widely adopted frameworks worldwide. While designed to foster healthy socio-emotional development, evidence for SEL’s long-term mental health benefits remains mixed. Concerns are also growing that universal, non-targeted SEL programs may inadvertently pathologize normal developmental experiences, reinforce self-monitoring, or generate cultural mismatches that undermine resilience. In this personal view, we examine key challenges associated with universal (i.e., non-targeted and intended for all students regardless of baseline risk) school-based programs modeled on SEL. While acknowledging their potential to promote youth well-being, we argue that prescriptive approaches to emotions and sociality can foster confusion among families, resistance among youth, and unintended distress. We highlight risks stemming from conceptual ambiguities and variability in implementation. Rather than abandoning universal programs, we call for rigorous evaluation, cultural adaptation, and integration within broader ecosocial-strategies to foster authentic, context-sensitive resilience in youth.
{"title":"The fine line between the cure and the illness: the risks of prescriptive emotionality and sociality for youth mental health","authors":"Aurélie Montagne , Cécile Rousseau , Ana Gómez-Carrillo","doi":"10.1016/j.lana.2025.101310","DOIUrl":"10.1016/j.lana.2025.101310","url":null,"abstract":"<div><div>School-based initiatives are increasingly promoted as solutions to the youth mental health crisis, with Social Emotional Learning (SEL) among the most widely adopted frameworks worldwide. While designed to foster healthy socio-emotional development, evidence for SEL’s long-term mental health benefits remains mixed. Concerns are also growing that universal, non-targeted SEL programs may inadvertently pathologize normal developmental experiences, reinforce self-monitoring, or generate cultural mismatches that undermine resilience. In this personal view, we examine key challenges associated with universal (i.e., non-targeted and intended for all students regardless of baseline risk) school-based programs modeled on SEL. While acknowledging their potential to promote youth well-being, we argue that prescriptive approaches to emotions and sociality can foster confusion among families, resistance among youth, and unintended distress. We highlight risks stemming from conceptual ambiguities and variability in implementation. Rather than abandoning universal programs, we call for rigorous evaluation, cultural adaptation, and integration within broader ecosocial-strategies to foster authentic, context-sensitive resilience in youth.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101310"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623695","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 : 2026-01-01Epub 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":"2026-01-01","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 : 2026-01-01Epub Date: 2025-11-07DOI: 10.1016/j.lana.2025.101297
Jesús Endara-Mina , Damary S. Jaramillo-Aguilar , Katherine Simbaña-Rivera
{"title":"Oil spill in Esmeraldas: a public health emergency in the context of environmental racism","authors":"Jesús Endara-Mina , Damary S. Jaramillo-Aguilar , Katherine Simbaña-Rivera","doi":"10.1016/j.lana.2025.101297","DOIUrl":"10.1016/j.lana.2025.101297","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101297"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468229","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 : 2026-01-01Epub Date: 2025-12-03DOI: 10.1016/j.lana.2025.101320
Li Niu , Luyao Tan , Angela Diaz , Yunyu Xiao , Yan Li , Yijie Wang
Background
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.
Methods
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.
Findings
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.
Interpretation
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.
Funding
This study was supported by the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the National Institute of Mental Health, and the American Foundation for Suicide Prevention.
{"title":"Neighborhood disadvantage and adolescent sleep health: a longitudinal population-based study","authors":"Li Niu , Luyao Tan , Angela Diaz , Yunyu Xiao , Yan Li , 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-11-15DOI: 10.1016/j.lana.2025.101298
Andrea L. Wirtz , Elizabeth Humes , Tonia C. Poteat , Keri N. Althoff , Kenneth H. Mayer , Erin E. Cooney , Meg Stevenson , Ceza Pontes , Asa E. Radix , Andrew J. Wawrzyniak , Sari L. Reisner
Background
Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States.
Methods
From March 2018–August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24–48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18–24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals.
Findings
Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0–132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7–95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03–1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04–1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01–1·02), psychological distress (aRR:1·08, 95% CI:1·00–1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01–1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence.
Interpretation
GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts.
{"title":"Age-disparate experiences and incidence of gender-based violence victimization of transgender women: findings from a cohort study in eastern and southern United States","authors":"Andrea L. Wirtz , Elizabeth Humes , Tonia C. Poteat , Keri N. Althoff , Kenneth H. Mayer , Erin E. Cooney , Meg Stevenson , Ceza Pontes , Asa E. Radix , Andrew J. Wawrzyniak , Sari L. Reisner","doi":"10.1016/j.lana.2025.101298","DOIUrl":"10.1016/j.lana.2025.101298","url":null,"abstract":"<div><h3>Background</h3><div>Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States.</div></div><div><h3>Methods</h3><div>From March 2018–August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24–48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18–24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals.</div></div><div><h3>Findings</h3><div>Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0–132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7–95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03–1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04–1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01–1·02), psychological distress (aRR:1·08, 95% CI:1·00–1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01–1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence.</div></div><div><h3>Interpretation</h3><div>GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts.</div></div><div><h3>Funding</h3><div>NIH.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101298"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576956","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 : 2026-01-01Epub Date: 2025-11-14DOI: 10.1016/j.lana.2025.101301
Merike Blofield , Andrea L. Wirtz , Magaly Pedraza , Rafael Olarte , Doris Parada
Background
Syphilis incidence is increasing globally; however, cost and time are significant barriers to treatment completion rates among vulnerable populations, including displaced populations and host communities. To inform public health strategies, we aimed to test whether conditional cash transfers (CCT) increased completion of syphilis treatment among a community sample in a border city of Colombia.
Methods
We embedded a quasi-experimental trial of a CCT intervention in a community sexual health program serving participants aged 14 years and older in low-income settlements around Cúcuta, Colombia in 2023. The program included workshops and syphilis screening. Individuals with laboratory-confirmed syphilis were eligible for inclusion in the trial. Both control and CCT arms provided syphilis diagnostics, counseling and free treatment. CCT consisted of cash payments of USD$12.69 for completion of each of two follow-up treatments. We used generalized linear models to estimate the effect of CCT on treatment completion, defined as three doses of penicillin.
Findings
Of 1751 workshop participants, 114 had laboratory-confirmed syphilis and were enrolled in the trial. Participants were 56% female (64/114) and 44% male (50/114), with 6 participants (5.3%) identifying as transgender, regardless of sex at birth. Participants included 47% Venezuelan migrants staying in Cúcuta (53/114), 26% Colombian returnees (30/114), and 19% Colombians from the host community (22/114). Data on ethnicity was not collected. Median age was 34.5 years (IQR: 25.0–46.0). More than three-quarters (78%, 39/50) of CCT participants completed the three-dose treatment regimen compared to 45% (29/64) of control participants, a risk difference of 33% (p < 0.001). In adjusted models, CCT-assigned participants had a 36% higher treatment completion rate compared to control-assigned participants (adjusted risk difference: aRD: 0.36, 95% CI: 0.19–0.53).
{"title":"Conditional cash transfer interventions to support syphilis treatment in vulnerable populations: a quasi-experimental study among displaced and host communities in a border city of Colombia","authors":"Merike Blofield , Andrea L. Wirtz , Magaly Pedraza , Rafael Olarte , Doris Parada","doi":"10.1016/j.lana.2025.101301","DOIUrl":"10.1016/j.lana.2025.101301","url":null,"abstract":"<div><h3>Background</h3><div>Syphilis incidence is increasing globally; however, cost and time are significant barriers to treatment completion rates among vulnerable populations, including displaced populations and host communities. To inform public health strategies, we aimed to test whether conditional cash transfers (CCT) increased completion of syphilis treatment among a community sample in a border city of Colombia.</div></div><div><h3>Methods</h3><div>We embedded a quasi-experimental trial of a CCT intervention in a community sexual health program serving participants aged 14 years and older in low-income settlements around Cúcuta, Colombia in 2023. The program included workshops and syphilis screening. Individuals with laboratory-confirmed syphilis were eligible for inclusion in the trial. Both control and CCT arms provided syphilis diagnostics, counseling and free treatment. CCT consisted of cash payments of USD$12.69 for completion of each of two follow-up treatments. We used generalized linear models to estimate the effect of CCT on treatment completion, defined as three doses of penicillin.</div></div><div><h3>Findings</h3><div>Of 1751 workshop participants, 114 had laboratory-confirmed syphilis and were enrolled in the trial. Participants were 56% female (64/114) and 44% male (50/114), with 6 participants (5.3%) identifying as transgender, regardless of sex at birth. Participants included 47% Venezuelan migrants staying in Cúcuta (53/114), 26% Colombian returnees (30/114), and 19% Colombians from the host community (22/114). Data on ethnicity was not collected. Median age was 34.5 years (IQR: 25.0–46.0). More than three-quarters (78%, 39/50) of CCT participants completed the three-dose treatment regimen compared to 45% (29/64) of control participants, a risk difference of 33% (p < 0.001). In adjusted models, CCT-assigned participants had a 36% higher treatment completion rate compared to control-assigned participants (adjusted risk difference: aRD: 0.36, 95% CI: 0.19–0.53).</div></div><div><h3>Interpretation</h3><div>Conditional cash transfers might enhance syphilis treatment adherence among populations facing socioeconomic challenges.</div></div><div><h3>Funding</h3><div><span>German Development Cooperation Agency</span>, <span>Deutsche Gesellschaft für Internationale Zusammenarbeit</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101301"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526894","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 : 2026-01-01Epub Date: 2025-11-28DOI: 10.1016/j.lana.2025.101319
Atif Kamal
{"title":"Methodological considerations in the assessment of mortality risk among law enforcement officers","authors":"Atif Kamal","doi":"10.1016/j.lana.2025.101319","DOIUrl":"10.1016/j.lana.2025.101319","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101319"},"PeriodicalIF":7.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623696","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 : 2026-01-01Epub 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":"2026-01-01","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 : 2026-01-01Epub 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。
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