The Lancet Regional Health - Americas

PurposeThe COVID-19 pandemic coincided with worsening U.S. drug overdose mortality and widening racial and ethnic disparities. We estimated race/ethnicity-specific excess overdose deaths at the state level during 2020-2023 and examined how these burdens scale with population size. MethodsWe analyzed annual overdose deaths from 2014-2023 for five racial/ethnic groups in 47 states and the District of Columbia. Pre-pandemic trends (2014-2019) were fit using a generalized growth model, and deaths e...

BackgroundPediatric long COVID is associated with substantial symptom burden, yet evidence-based pharmacologic treatments remain limited. Low-dose naltrexone (LDN) has been proposed as a potential symptomatic therapy, but data in pediatric populations is lacking. MethodsWe conducted a retrospective analysis of pediatric and young adult patients ([≤]25 years) with a clinical diagnosis of long COVID who were prescribed LDN between July 2020 and July 2025 at three multidisciplinary pediatric lo...

BackgroundShort-term neurobiological effects of opioids are well characterized, yet the long-term consequences of substance exposure on malignancy risk remain poorly understood. Ethical constraints limit prospective analysis of opioid exposure and primary malignant brain tumor (PMBT) risk in human patients, making large-scale electronic health record (EHR) analyses essential. This study evaluates the 10-year incidence of PMBTs among adults with opioid-abuse disorder related diagnoses exposed to ...

OBJECTIVEOpioid misuse exacts a tremendous toll on society. Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious treatment for opioid misuse. Yet, the cost-effectiveness of this intervention remains unknown. METHODSCost-effectiveness and cost-benefit analyses of a randomized clinical trial with enrollment of 250 adults with chronic pain prescribed long-term opioid therapy who were misusing opioids. Participants were randomized to MORE (training in mindfulness, reappraisal, and sav...

BackgroundSerotype 3 (S3) has remained a major cause of invasive pneumococcal disease (IPD) despite its inclusion in 13-valent pneumococcal conjugate vaccine (PCV). In October 2023, a 15-valent PCV (PCV15) including S3 was introduced into the Catalan universal childhood immunization program. MethodsWe conducted a retrospective pre-post surveillance study to compare pediatric IPD incidence in Catalonia during a pre-PCV15 period (October 1, 2022-September 30, 2023) and two post-PCV15 periods (Oct...

ObjectiveGiven the potential severity and economic burden of falls, we compared the short-term risk of falls following initiation of sustained-release (SR) tapentadol versus controlled-release (CR) oxycodone in real-world clinical practice. DesignActive comparator, new user retrospective cohort study using routinely collected health data from 2014 to 2020. SettingNew South Wales, Australia. ParticipantsPeople aged [≥]18 years initiating publicly subsidised tapentadol (SR) or oxycodone (CR)...

BackgroundThe coexistence of cancer and hypertension presents complex clinical challenges, yet limited research has characterized this population using nationally representative data. Understanding demographic patterns, social determinants of health, and environmental health perceptions in this group is essential for developing targeted interventions. MethodsWe analyzed data from the Health Information National Trends Survey (HINTS) 6, focusing on 507 respondents with both cancer and hypertensi...

AimsTo characterize decreases in overdose mortality in the United States between 2023 and 2024 by substance involvement, geography, race/ethnicity, demographic, and other key dimensions. DesignPopulation-based study of national death records. SettingUnited States. Participants/casesAll individuals who died from drug overdose between January 1999 and December 2024. MeasurementsAnnual or monthly (annualized) overdose deaths per 100,000 population. Year and month of occurrence of overdose death...

PurposeWhile genomic testing is integral to pediatric inborn errors of immunity (IEI) care, few studies have examined strategies to support its optimal delivery. This study aimed to characterize a pediatric IEI cohort and assess the impact of implementing a mainstream model-of-care (MoC). Materials/MethodsComprehensive chart audit was conducted for patients ([≤]18y) who received IEI genomic testing in Queensland, Australia, from 2017-2025. Descriptive analyses captured demographic and clinic...

Purpose: Tumor genomic testing (TGT) is standard-of-care for most patients with advanced/metastatic cancer. Despite established guidelines, patient education prior to TGT is frequently omitted. The purpose of this study was to evaluate the impact and durability of a concise 3-4 minute video for patient education prior to TGT in community versus academic sites and across cancer types. Patients and Methods: Patients undergoing standard-of-care TGT were enrolled at a tertiary academic institution ...

The two largest US measles outbreaks in over two decades (2025 Gaines County, Texas: 414 cases, contained; 2025-2026 Spartanburg County, South Carolina: 923+ cases, ongoing) occurred in counties with similar sub-threshold K-12 MMR coverage (85.1% vs 88.8%), yet their trajectories diverged dramatically. Using kernel density estimation with a common bandwidth and bootstrap uncertainty quantification, we compared sub-county vaccination data at the district level for Texas (3 districts, 3,560 studen...

BackgroundPost-traumatic stress symptoms (PTSS) are prevalent among children with cancer and their families. Although family-based interventions such as the Surviving Cancer Competently Intervention Program (SCCIP) are effective, their reliance on mental health specialists limits scalability, highlighting the need for nurse-led approaches. Methods and analysisThis multicenter randomized controlled trial will enroll 110 families of children with cancer to evaluate the efficacy of a nurse-led ada...

ObjectivesTo investigate the factors associated with the deterioration of post-COVID-19 condition (PCC) symptoms in patients who received a dose of SARS-CoV-2 vaccine [≥] 90 days after their infection. MethodMulticenter cohort study conducted in 33 emergency departments across Canada, including 476 patients who developed PCC according to the World Health Organization definition. Data were collected via telephone questionnaires. Statistical analyses, including logistic regression models, were...

Between 2010 and 2021, fentanyl and stimulants co-involved deaths increased from 0.6% to 32.3% of all overdose deaths in the U.S. The Centers for Disease Control and Prevention monitors overdose deaths, but reports are delayed by about 4 -6 months. Therefore, advanced methods are needed for optimized trend monitoring and preparing the healthcare system. We developed and compared traditional and machine learning (ML)-based time series prediction models for forecasting opioid and stimulant-involve...

Burnout is common among genetic counselors (GCs). Clinician burnout has been found to adversely affect individual well-being, patient care, and likelihood of staying in a role. Both individual and systems solutions are needed to address clinician burnout. Mindfulness meditation (MM) is one individual-level solution that has shown promise for reducing burnout in other clinicians but has not been studied in GCs. We conducted a decentralized, parallel, three-arm randomized controlled trial comparin...

BackgroundLinked administrative data covering whole populations are fundamental resources for longitudinal studies of children with rare conditions (cases) and unaffected peers (comparators). Data minimisation regulations sometimes limit the number of comparators per case (sampled comparators, SC), with unknown impact on study findings. MethodsUsing Monte Carlo draws, we simulated 100 000 children with and without an exemplar condition, congenital hypothyroidism (CHT), with covariates (sex and ...

BackgroundUnderstanding tuberculosis (TB) transmission dynamics is necessary to interrupt disease spread. We developed a model to estimate adjusted odds ratios (ORs) for factors associated with genetic relatedness, as proxy for transmission. MethodsWe build upon an existing iterative model that modifies genetically linked tuberculosis case data to better represent true transmission links. We incorporate bootstrapped logistic regression to calculate adjusted ORs with confidence intervals that ac...

BackgroundRespiratory viruses are major contributors to population mortality, but cause-of-death coding undercounts their impact. Ecological regression models linking viral circulation to mortality fluctuations can address this limitation. AimTo estimate the population attributable fraction (PAF) of mortality associated with influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 in Ontario, Canada (1993-2024). MethodsWe analysed monthly all-cause mortality data with laboratory su...

PurposeTo describe the rationale, methods, and baseline sample descriptives of the Adolescent and Young Adult Tracking Engagement and Management Skills (AYA TEAMS) cohort. The AYA TEAMS study is a longitudinal observational cohort study that aims to identify determinants and patterns of self-management and engagement in cancer-related long-term follow-up (LTFU) care and validate a novel transition readiness assessment among adolescent and young adult (AYA) survivors of childhood cancer. Partici...

Measles resurgence in high-income countries that previously achieved elimination reveals a critical surveillance failure: current systems rely on county-level aggregates that obscure fine-scale clustering where outbreaks originate. We assembled the nationwide multiscale vaccination database spanning 45 US states (2013-2025), encompassing over 50,000 schools, 13,000 districts, and 3,000 counties. We developed a gravity-based transmission framework and demonstrate that school-level effective repro...