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The US Food and Drug Administration’s Regulation of Mifepristone

This qualitative analysis uses information from US Food and Drug Administration (FDA) documents obtained through a Freedom of Information Act request to characterize the FDA’s decision-making with respect to the regulation of mifepristone, especially the agency’s rationale for establishing, maintaining, or modifying key components of its regulatory approach over time.

[Articles] Identifying undiagnosed HIV infected individuals in a community-based door to door testing initiative in outbreak affected areas of Larkana and surrounding districts, Pakistan

More than five years since the nosocomial HIV outbreak in Ratodero, undiagnosed HIV infections persist in the community. The undiagnosed HIV infection is common among children in Ratodero, and among both adults and children in surrounding areas. Self-reported HIV risk exposures point to reuse of needles and syringes as the predominant mode of transmission. The situation warrants urgent need to address unsafe injection practices and safety in healthcare facilities.

[Articles] Household SARS-CoV-2 transmission during Omicron wave in Chiang Mai, Thailand: a prospective observational study

Despite widespread vaccination, household transmission of SARS-CoV-2 remained common. Prior immunity in contacts and lower viral load in index cases reduced risk. These findings underscore the central role of households in ongoing spread and highlight the value of booster vaccination and genomic surveillance to clarify transmission pathways and inform prevention policies.

[Personal View] Expanding the neurological spectrum of HTLV-1 beyond HAM/TSP: a contemporary perspective

Human T-lymphotropic virus type 1 (HTLV-1) has long been linked mainly to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, four decades of research show that the virus causes a much broader range of neurological conditions. In Latin America and the Caribbean—regions with high prevalence but limited awareness, diagnostic capacity, and treatment—its burden is especially severe. Misdiagnosis or neglect often delays care, leading to increased disability and emotional distress.

[Viewpoint] Ethical challenges and opportunities for integrating predictive analytics in community-based overdose prevention

As predictive analytics become more widely integrated into local public health responses to the United States overdose epidemic, community-based substance use service providers have begun to adopt machine learning-based predictive tools to guide the allocation and delivery of overdose prevention services. While these tools hold promise for anticipating community overdose risk and enhancing the efficiency of overdose prevention resource distribution, outreach, and education efforts, their use in community settings raises substantial ethical and practical challenges.

[Correspondence] Inclusion of incarcerated individuals in wildfire exposure registries

One year after wildfires tore through Los Angeles in January 2025, public health experts continue to examine the effects of this major wildland–urban interface (WUI) event on surrounding medically vulnerable communities.1 These are communities characterized by disproportionate exposure to poor air quality, elevated burdens of chronic illness, limited access to medical care, and a constrained ability to evacuate. Such vulnerabilities are heightened within jails and prisons, and yet the carceral population has been largely excluded from scrutiny despite their WUI fire exposure in the region.

[Comment] An undeniable public health urgency, but an incomplete response: centering racial and ethnic equity in Canada's “Strategic approaches to reducing the substance use-related burden of disease”

The recent article published in The Lancet Regional Health—Americas by Fischer and colleagues1 provides an important and useful appraisal of the burden of disease attributable to substance use in Canada, rightly emphasizing the urgency of effective public action. The authors pointed out three essential points. First, the scale and acceleration of the overdose crisis clearly demonstrate an imperative to act. Since 2016, tens of thousands of deaths from opioid toxicity have constituted a sustained public health crisis, with a strong predominance of fentanyl and other synthetic opioids in the illicit drug supply in Canada.

[Comment] Impact and scope of Mexican clinical practice guideline for adult overweight and obesity on weight stigma

The new clinical practice guideline (CPG) for managing overweight and obesity in adults is the first obesity guideline in Mexico to be developed using a methodologically rigorous approach and through collaboration with patients and healthcare professionals (HCPs) to ensure the recommendations are evidence-based, practical, and patient-centered.1 With 74.5% of Mexican adults living with overweight or obesity,2 this national CPG was urgently needed to direct the attention of policymakers and healthcare providers, and to support the development of evidence-based interventions within the Mexican health systems.

[Comment] Brazil's health tax at a crossroads: safeguarding the constitutional victory against ultra-processed foods

Brazil faces a watershed moment for its public health policy. In 2023, the country achieved a constitutional milestone by instituting a Selective Tax to discourage the consumption of products detrimental to health and the environment.1 As Latin America's largest nation, with over 212 million inhabitants, Brazil's health policies exert considerable influence both regionally and globally. Yet this historic advance faces a constant risk of erosion from legislative manoeuvres driven by corporate interests, a conflict that epitomises the global tension between evidence-informed policymaking and the aggressive commercial determinants of health.

[Comment] Beyond encampments: an evidence-based path to solving Canada's homelessness crisis

Homeless encampments have become a permanent fixture of the Canadian landscape, from large urban centers to small towns and remote communities. This reality reflects a national crisis with an estimated 67,000 people experiencing homelessness on any given night, with regional rates as high as 27 per 10,000 people in Central Canada.1 The COVID-19 pandemic dramatically expanded homeless encampments, as people experiencing unsheltered homelessness surged by 107%, contributing to a 79% increase in overall homelessness on a given night.

[Comment] Uncovering the biases: why the claimed mask–excess mortality link fails to hold

The relationship between mask usage and excess mortality during the COVID-19 pandemic remains a subject of ongoing debate. A recent article by Tausk and Spira, “Does mask usage correlate with excess mortality? Findings from 24 European countries,”1 reported a positive correlation between mask use and excess mortality in 2020 and 2021. This finding attracted considerable attention, particularly in Brazil, where the authors are based. The study's ecological design, which is susceptible to bias when assessing individual-level exposures (such as mask use) compared to aggregate exposures (such as citywide pollution), has prompted widespread discussion on social media platforms.

[Review] Quantitative measures of subjective wellbeing for adolescents: a scoping review and synthesis of comparable data

Efforts to promote adolescent wellbeing are of increasing global interest. Although the ability to measure wellbeing is essential for identifying disparities between and within populations, and for tracking progress in improving wellbeing, the best way to measure this elusive concept in adolescents is unclear. We undertook a scoping review of quantitative measures of subjective wellbeing to identify those used in population studies of adolescents (aged 10–24 years), and mapped the identified measures against an adolescent wellbeing framework developed by the UN H6+ Technical Working Group on Adolescent Health and Well-Being.

[Review] Muscle dysmorphia in adolescents and young adults

Body image concerns among adolescent boys and young men are increasingly recognised as societal ideals shift towards a lean, muscular physique. In severe cases, these pressures can lead to muscle dysmorphia, a specifier of body dysmorphic disorder marked by preoccupation with being too small or insufficiently muscular. Adolescents and young adults are developmentally vulnerable and might be at higher risk for a variety of eating-related and body image-related concerns, including muscle dysmorphia.

[Articles] Impact of high-dose vitamin D and calcium carbonate supplementation on bone density in adolescents living with HIV: a randomised, placebo-controlled trial

There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D3 and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitamin D insufficiency, which could increase peak bone mass.

[Corrections] Correction to Lancet Child Adolesc Health 2025; 9: 837–47

Sampri A, Shi W, Bolton T, et al. Vascular and inflammatory diseases after COVID-19 infection and vaccination in children and young people in England: a retrospective, population-based cohort study using linked electronic health records. Lancet Child Adolesc Health 2025; 9: 837–47—In this Article, the final sentence of the fifth paragraph in the Results section should read “Crude incidence rates for all outcomes, with the exception of thrombocytopenia or inflammatory conditions, were generally higher for those who were vaccinated than unvaccinated (appendix p 14).”; in table 2, the data for stroke outcome in the analytic cohort to evaluate COVID-19 vaccinations should be “630/12 968 667/5·10 (4·71–5·49)”; and the appendix has been corrected.