Lancet Regional Health-Americas最新文献

{"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}

{"title":"The 2025 Lancet Countdown Latin America report: moving from promises to equitable climate action for a prosperous future","authors":"Stella M. Hartinger ,&nbsp;Yasna Palmeiro-Silva ,&nbsp;Camila Llerena-Cayo ,&nbsp;Rayana Santos Araujo Palharini ,&nbsp;Christian García-Witulski ,&nbsp;Maria Fernanda Salas ,&nbsp;Nicolas Valdés-Ortega ,&nbsp;Avriel Diaz ,&nbsp;Luis E. Escobar ,&nbsp;Carolina Gil Posse ,&nbsp;Juliana Helo Sarmiento ,&nbsp;Andres G. Lescano ,&nbsp;Oscar Melo ,&nbsp;Mónica Pinilla-Roncancio ,&nbsp;David Rojas-Rueda ,&nbsp;Tatiana Souza de Camargo ,&nbsp;Bruno Takahashi ,&nbsp;Luciana Blanco-Villafuerte ,&nbsp;Nicolas Borchers-Arriagada ,&nbsp;Marcia Chame ,&nbsp;Marina Romanello","doi":"10.1016/j.lana.2025.101276","DOIUrl":"10.1016/j.lana.2025.101276","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101276"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736854","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":"Urbanicity, parental social deprivation, and risk of early psychosis in Chile: a national cohort study","authors":"Franco Mascayano ,&nbsp;Javiera Burgos ,&nbsp;Viviana Hernandez ,&nbsp;Rodrigo Casanueva ,&nbsp;Xinyu Yang ,&nbsp;Zeyu Li ,&nbsp;Param Sampat ,&nbsp;Maria Teresa Muñoz-Quezada ,&nbsp;Sebastian Rojas-Navarro ,&nbsp;Katrina Rodriguez ,&nbsp;Jeanette Stingone ,&nbsp;Lawrence Yang ,&nbsp;Ezra Susser","doi":"10.1016/j.lana.2025.101282","DOIUrl":"10.1016/j.lana.2025.101282","url":null,"abstract":"<div><h3>Background</h3><div>In Northern Europe, several studies have indicated that people born and raised in urban areas have an increased risk of psychosis. Emerging research in the Global South has produced more heterogeneous and inconsistent findings, suggesting that the impact of urban environments on psychosis risk may depend on social context and broader environmental factors at multiple levels.</div></div><div><h3>Methods</h3><div>We constructed a cohort of 5,137,561 individuals born in Chile (1992–2012) using the national first episode psychosis (FEP) and Birth and Death registries. We identified 14,410 individuals with nonaffective FEP (ICD-10 F20–F29) recorded between 2005 and 2022. Urbanicity at birth (urban vs rural) was our main exposure. We estimated incidence rate ratios (IRRs) via Poisson regression, adjusting for year of birth and region to account for birth-cohort effects. We also examined whether parental education and employment—two indicators of social deprivation—modified this association.</div></div><div><h3>Findings</h3><div>Over ∼92 million person-years, the crude incidence rate was 15.67 per 100,000 person-years (95% CI: 15.42, 15.93). No overall association between urbanicity at birth and non-affective FEP was found after accounting for social factors (adjusted IRR = 0.96, 95% CI: 0.91, 1.01). However, parental low education appeared to modify the association between urbanicity and psychosis on both multiplicative and additive scales, with an additive interaction (RERI = 0.33, 95% CI: 0.18, 0.47), supporting a model where urbanicity increases psychosis risk primarily in the presence of social deprivation.</div></div><div><h3>Interpretation</h3><div>Urban birth alone was not associated with higher FEP incidence in Chile, but an elevated risk was seen among families with lower educational attainment in urban areas. This suggests a causal interplay between urbanicity and social deprivation, underscoring the importance of multilevel frameworks for understanding psychosis risk, especially in rapidly urbanizing societies.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101282"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681390","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":"Socioeconomic disparities and dog rabies: a retrospective analysis of high-spatial-resolution surveillance data from a Latin American city","authors":"Sherrie Xie ,&nbsp;Julianna Shinnick ,&nbsp;Elvis W. Diaz ,&nbsp;Edith Zegarra ,&nbsp;Ynes Monroy ,&nbsp;Sergio E. Recuenco ,&nbsp;Ricardo Castillo-Neyra","doi":"10.1016/j.lana.2025.101285","DOIUrl":"10.1016/j.lana.2025.101285","url":null,"abstract":"<div><h3>Background</h3><div>Dog-mediated human rabies is intuitively linked to poverty, but few studies have formally investigated the relationship between local socioeconomic disadvantage and dog rabies incidence.</div></div><div><h3>Methods</h3><div>We leveraged a unique, high-spatial-resolution surveillance database from the rabies-endemic city of Arequipa, Peru to probe the relationship between neighbourhood socioeconomic status (SES) and dog rabies risk in 2015–2022. Rabies cases and samples were assigned to the SES level of their block or locality of origin, respectively. We tested the hypothesis that lower SES is associated with increased case positivity and used a spatial statistical model to understand how sample positivity varied spatially.</div></div><div><h3>Findings</h3><div>Rabies cases were concentrated in socioeconomically disadvantaged blocks (<em>p</em> &lt; 0.001), and sample positivity had a significant and positive association with neighbourhood disadvantage (<em>p</em> &lt; 0.05 for all periods), suggesting that surveillance effort was low relative to case incidence in disadvantaged areas. Stratifying samples by those collected via active vs. passive surveillance revealed that active surveillance reduced disparities in surveillance effort and sample positivity. Spatial analysis identified a sample positivity hotspot in a socioeconomically disadvantaged region with low access to health facilities.</div></div><div><h3>Interpretation</h3><div>Dog-mediated rabies is known to impact the poorest regions globally. We found similar patterns mirrored on a much smaller spatial scale–within a single city's limits. A balanced approach combining spatially-targeted (“active”) and community-based (“passive”) surveillance can help reduce rabies disparities. Mass dog vaccination and surveillance programs could target disadvantaged neighbourhoods to allocate resources to the most impacted areas and more effectively control dog rabies epidemics.</div></div><div><h3>Funding</h3><div>US <span>National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101285"},"PeriodicalIF":7.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736855","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 fine line between the cure and the illness: the risks of prescriptive emotionality and sociality for youth mental health","authors":"Aurélie Montagne ,&nbsp;Cécile Rousseau ,&nbsp;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":"2025-11-29","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}