EClinicalMedicine最新文献

{"title":"Spatial variation, pooled prevalence, and factors associated with perinatal mortality in Sub-Saharan Africa, evidence from demographic and health surveys 2015-2023: a geospatial regression approach.","authors":"Belayneh Jejaw Abate, Alemakef Wagnew Melesse, Helen Brhan, Muluken Chanie Agimas","doi":"10.1016/j.eclinm.2025.103137","DOIUrl":"10.1016/j.eclinm.2025.103137","url":null,"abstract":"<p><strong>Background: </strong>Sub-Saharan Africa (SSA) bears the greatest burden of perinatal mortality in the world, and the magnitude of the problem varied based on geographical location. A detailed understanding of spatial variation is important to improve the targeting of interventions, to identify the most affected community, and for designing evidence-based health policies. Hence, this study aimed to assess pooled prevalence, spatial variation, and factors contributing to perinatal mortality in SSA.</p><p><strong>Methods: </strong>A cross-sectional study using Demographic and Health Survey datasets (2015-2023) of 25 SSA countries with a total of 201,566 weighted samples was used for this study. The global spatial autocorrelation was explored using global Moran's-I, and the spatial variation of perinatal mortality was examined using hot spot analysis (Local Getis-Ord Gi∗ statistic). Spatial regression analyses (ordinary least squares, spatial error model, spatial lag model, geographically weighted regression, and multiscale geographically weighted regression) were conducted. Models were assessed using corrected Akaike information criteria and adjusted R². A p-value threshold of 0.05 was set to identify statistically significant spatial predictors, and the corresponding local coefficients were illustrated on a map.</p><p><strong>Findings: </strong>The pooled prevalence of perinatal mortality in SSA was 46.63 per 1000 total births (95% CI: 42.48, 51.17), and its spatial distribution was found to be clustered (Global Moran's I = 0.18, p < 0.01). Significant hotspot areas were located in Nigeria, Madagascar, Rwanda, Malawi, Burundi, Gambia, Uganda, Côte d'Ivoire, Angola, Ethiopia, Burkina Faso, and Senegal, while significant cold spots were located in Kenya, Gabon, South Africa, Ghana, Mali, and Mauritania. The multi-scale geographic weighted regression model explained 85% of the spatial variation of perinatal mortality in SSA. No antenatal care visit, birth interval less than 15 months, women undergoing cesarean section delivery, unemployed women, and households without children were significant spatial predictors of perinatal mortality in SSA.</p><p><strong>Interpretation: </strong>Perinatal mortality in SSA was high and varied across regions. We identified five predictors for perinatal mortality that might be a priority for policymakers. Enhancing antenatal care and family planning services and empowering women through employment opportunities is crucial to decreasing perinatal mortality in the region.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103137"},"PeriodicalIF":9.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways through which water, sanitation, hygiene, and nutrition interventions reduce antibiotic use in young children: a mediation analysis of a cohort nested within a cluster-randomized trial.","authors":"Anna T Nguyen, Gabby Barratt Heitmann, Andrew Mertens, Sania Ashraf, Md Ziaur Rahman, Shahjahan Ali, Mahbub Rahman, Benjamin F Arnold, Jessica A Grembi, Audrie Lin, Ayse Ercumen, Jade Benjamin-Chung","doi":"10.1016/j.eclinm.2025.103147","DOIUrl":"10.1016/j.eclinm.2025.103147","url":null,"abstract":"<p><strong>Background: </strong>Low-cost, household-level water, sanitation, and hygiene (WASH) and nutrition interventions can reduce pediatric antibiotic use, but the mechanism through which interventions reduce antibiotic use has not been investigated.</p><p><strong>Methods: </strong>We conducted a causal mediation analysis using data collected between September 2013 and October 2015 from a cohort nested within the WASH Benefits Bangladesh cluster-randomized trial (NCT01590095). Among a subsample of children within the WASH, nutrition, nutrition + WASH, and control arms (N = 1409 children; 267 clusters), we recorded caregiver-reported antibiotic use at ages 14 and 28 months and collected stool at age 14 months. Our primary outcome was any caregiver-reported antibiotic use by index children within the past 30 or 90 days measured at age 14 and 28 months. Mediators included caregiver-reported child diarrhea, acute respiratory infection (ARI), and fever; and enteric pathogen carriage in stool measured by qPCR. Both intervention-mediator and mediator-outcome models were controlled for mediator-outcome confounders.</p><p><strong>Findings: </strong>The receipt of any WASH or nutrition intervention reduced caregiver-reported antibiotic use through all pathways in the past month by 5.5 percentage points (95% CI 1.2, 9.9), from 49.5% (95% CI 45.9%, 53.0%) in the control group to 45.0% (95% CI 42.7%, 47.2%) in the pooled intervention group. When separating this effect into different pathways, we found that interventions reduced antibiotic use by 0.6 percentage points (95% CI 0.1, 1.3) through reduced diarrhea, 0.7 percentage points (95% CI 0.1, 1.5) through reduced ARI with fever, and 1.5 percentage points (95% CI 0.4, 3.0) through reduced prevalence of enteric viruses. Interventions reduced antibiotic use through any of these measured mediators by 2.1 percentage points (95% CI -0.3, 4.5).</p><p><strong>Interpretation: </strong>WASH and nutrition interventions reduced pediatric antibiotic use through the prevention of enteric and respiratory infections in a rural, low-income population. Given that many of these infections are caused by viruses or parasites, WASH and nutrition interventions may help reduce inappropriate antibiotic use in similar settings.</p><p><strong>Funding: </strong>Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103147"},"PeriodicalIF":9.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, disparities, and trends in intimate partner violence against women living in urban slums in 34 low-income and middle-income countries: a multi-country cross-sectional study.","authors":"Shaoru Chen, Ning Ma, Yuhao Kong, Zekun Chen, John Lapah Niyi, Peter Karoli, Hajirani M Msuya, Melkamu Aderajew Zemene, Md Nuruzzaman Khan, Million Phiri, Akanni Ibukun Akinyemi, Rockli Kim, Feng Cheng, Yi Song, Chunling Lu, S V Subramanian, Pascal Geldsetzer, Yue Qiu, Zhihui Li","doi":"10.1016/j.eclinm.2025.103140","DOIUrl":"10.1016/j.eclinm.2025.103140","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is a significant public health issue, closely tied to social and neighborhood environments. The impoverished, overcrowded, and stressful conditions in urban slums may heighten IPV risk, yet evidence remains limited. This study aims to assess the prevalence, disparities, and trends of IPV in urban slums across low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>This cross-sectional study used nationally representative Demographic and Health Surveys data from 2006 to 2023, focusing on countries with available domestic violence data for women aged 15-49. The outcomes measured include past-year exposure to any IPV (primary outcome) and physical IPV, sexual IPV, and psychological IPV (secondary outcomes). We examined both absolute and relative disparities between urban slums, non-slum urban, and rural areas using differences and ratios. Additionally, we used Fairlie decomposition analysis based on a multivariable logistic regression model to examine the contributions of IPV risk factors (i.e., poor partner relationships, gender inequality, and poverty) to the disparities. For countries with multiple surveys, we conducted trend analysis by assessing annual changes in IPV prevalence in urban slums and the disparities.</p><p><strong>Findings: </strong>Among 283,658 women from 34 LMICs, 14,111 (5.0%) lived in urban slums. IPV prevalence in urban slums was notably high, with 18 of the studied countries above 30% for any IPV. Women in urban slums experienced higher IPV rates than those in non-slum urban and rural areas. For example, the prevalence of any IPV in urban slums was 31.4% (95% confidence interval [CI]: 30.7-32.2), which was 5.9 percentage points (95% CI: 5.1-6.7, P < 0.0001) higher than that in non-slum urban areas and 1.2 percentage points (95% CI: 0.4-2.0, P = 0.0022) higher than that in rural areas. Controlling behavior by husbands explained the largest proportion of disparities in all IPV types between urban slums and other areas. For example, 27.2% (95% CI: 25.1-29.3) of the any IPV disparities between urban slums and non-slum urban areas could be explained by this factor. In ten countries with multiple surveys, trend analysis showed rising any IPV prevalence in urban slums of four countries-Sierra Leone, Tanzania, Mali, and Nigeria-with Sierra Leone having the most significant increase (4.6 percentage points, 95% CI: 2.5-6.6, P < 0.0001).</p><p><strong>Interpretation: </strong>Our findings suggest that IPV is more prevalent in urban slums than other areas, underscoring the need for targeted public health strategies, such as addressing harmful partner's behaviors.</p><p><strong>Funding: </strong>This research was supported by China National Natural Science Foundation and the Research Fund, Vanke School of Public Health, Tsinghua University.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103140"},"PeriodicalIF":9.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure change and hypertension incidence among Ghanaians living in rural Ghana, urban Ghana and The Netherlands: a prospective cohort study.","authors":"Eva L van der Linden, Marieke Hoevenaar-Blom, Erik Beune, Samuel Nkansah Darko, Sampson Twumasi Ankrah, Karlijn A C Meeks, Felix Chilunga, Charles Hayfron-Benjamin, Peter Henneman, Bert-Jan van den Born, Ellis Owusu Dabo, Charles Agyemang","doi":"10.1016/j.eclinm.2025.103141","DOIUrl":"10.1016/j.eclinm.2025.103141","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal data on blood pressure changes in sub-Saharan African populations are limited despite a high hypertension burden. This study analysed systolic blood pressure (SBP) change and hypertension incidence among people from Ghana living in rural Ghana, urban Ghana, people from Ghana living in The Netherlands and a Dutch European population living in Amsterdam, The Netherlands.</p><p><strong>Methods: </strong>The population-based Research on Obesity and Diabetes among African Migrants Prospective (RODAM-Pros) cohort study included adults aged ≥18 years at baseline (2012-2015) and follow-up (2019-2021) to study cardiovascular risk factors. At both timepoints, blood pressure (BP) was measured using a semiautomated device. Hypertension was defined as having a SBP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg or the use of antihypertensive medication. We compared age-standardised SBP change and hypertension incidence between the geographical locations via linear and Poisson regression analyses, with adjustment for age, follow-up time, education, baseline BP, body mass index, renal function, and diabetes mellitus. The study protocol was approved by the respective ethics committees in Ghana and The Netherlands.</p><p><strong>Findings: </strong>Data from 632 people living in rural Ghana, 602 in urban Ghana, 861 Ghanaian, and 2038 Dutch people living in Amsterdam, were analysed (58.3% women, mean age at baseline 46.5 years, follow-up time 6·5 years). SBP increased most in women in rural Ghana (+9.5 mmHg, 95% confidence interval 7·3-11·7 mmHg), compared to +5·7 mmHg (3·6-7·7 mmHg) in urban Ghana, +2·2 mmHg (0·7-3·7 mmHg) in Ghanaian women in Amsterdam and -0·4 mmHg (-1·2 to 0·4 mmHg) in Dutch women. In men, SBP increased +5·5 mmHg (2·6-8·4 mmHg) in rural Ghana, +6·1 mmHg (2·8-9·5 mmHg) in urban Ghana, +2·1 mmHg (0·4-3·8 mmHg) in Ghanaian men in Amsterdam, and +0·3 mmHg (-0·5 to 1·1 mmHg) in Dutch men. Hypertension incidence ranged from 20·7% (95% confidence interval 14·3-29·2%) in men in rural Ghana to 34·2% (23·3-49·1%) in urban Ghana, vs. 27·9% (19·8-38·5%) in Ghanaian men in Amsterdam and 14·5% (11·8-17·6%) in Dutch men. Among women, incidence was 29·0% (23·1-35·9%) in rural Ghana, 27·6% (21·4-35·3%) in urban Ghana, 34·4% (26·0-45·4%) in Ghanaian women in Amsterdam, and 7·2% (5·6-9·2%) in Dutch women. Hypertension incidence rate ratios did not differ across populations, regardless of adjustment for covariates.</p><p><strong>Interpretation: </strong>SBP and hypertension increases were more pronounced in rural and urban Ghana than among migrants from Ghana in The Netherlands, suggesting that urbanisation of cardiovascular risk profile now extends to rural sub-Saharan Africa.</p><p><strong>Funding: </strong>European Research Council (grant number 772244).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103141"},"PeriodicalIF":9.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of machine learning models with blood-based digital biomarkers for Alzheimer's disease diagnosis: a multicohort diagnostic study.","authors":"Bin Jiao, Ziyu Ouyang, Xuewen Xiao, Cong Zhang, Tianyan Xu, Qijie Yang, Yuan Zhu, Yiliang Liu, Xixi Liu, Yafang Zhou, Xinxin Liao, Shilin Luo, Beisha Tang, Zhigang Li, Lu Shen","doi":"10.1016/j.eclinm.2025.103142","DOIUrl":"10.1016/j.eclinm.2025.103142","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) involves complex alterations in biological pathways, making comprehensive blood biomarkers crucial for accurate and earlier diagnosis. However, the cost-effectiveness and operational complexity of method using blood-based biomarkers significantly limit its availability in clinical practice.</p><p><strong>Methods: </strong>We developed low-cost, convenient machine learning-based with digital biomarkers (MLDB) using plasma spectra data to detect AD or mild cognitive impairment (MCI) from healthy controls (HCs) and discriminate AD from different types of neurodegenerative diseases. Retrospective data were gathered for 1324 individuals, including 293 with amyloid beta positive AD, 151 with mild cognitive impairment (MCI), 106 with Lewy body dementia (DLB), 106 with frontotemporal dementia (FTD), 135 with progressive supranuclear palsy (PSP) and 533 healthy controls (HCs) between July 2017 and August 2023.</p><p><strong>Findings: </strong>Random forest classifier and feature selection procedures were used to select digital biomarkers. MLDB achieved area under the curves (AUCs) of 0.92 (AD vs. HC, Sensitivity 88.2%, specificity 84.1%), 0.89 (MCI vs. HC, Sensitivity 88.8%, specificity 86.4%), 0.83 (AD vs. DLB, Sensitivity 77.2%, specificity 74.6%), 0.80 (AD vs. FTD, sensitivity 74.2%, specificity 72.4%), and 0.93 (AD vs. PSP, sensitivity 76.1%, specificity 75.7%). Digital biomarkers distinguishing AD from HC were negatively correlated with plasma p-tau217 (<i>r</i> = -0.22, <i>p</i> < 0.05) and glial fibrillary acidic protein (GFAP) (<i>r</i> = -0.09, <i>p</i> < 0.05).</p><p><strong>Interpretation: </strong>The ATR-FTIR (Attenuated Total Reflectance-Fourier Transform Infrared) plasma spectra features can identify AD-related pathological changes. These spectral features serve as digital biomarkers, providing valuable support in the early screening and diagnosis of AD.</p><p><strong>Funding: </strong>The National Natural Science Foundation of China, STI2030-Major Projects, National Key R&D Program of China, Outstanding Youth Fund of Hunan Provincial Natural Science Foundation, Hunan Health Commission Grant, Science and Technology Major Project of Hunan Province, Hunan Innovative Province Construction Project, Grant of National Clinical Research Center for Geriatric Disorders, Xiangya Hospital and Postdoctoral Fellowship Program of CPSF.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103142"},"PeriodicalIF":9.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor in response to a letter by Fuchs and Santosham regarding; assessing safety and efficacy of a novel glucose-free amino acid oral rehydration solution for watery diarrhea management in children: a randomized, controlled, phase III trial.","authors":"Pradip Bardhan, Neil Fawkes, Adam B Smith, Olivier Fontaine","doi":"10.1016/j.eclinm.2025.103111","DOIUrl":"10.1016/j.eclinm.2025.103111","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103111"},"PeriodicalIF":9.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of non-Hodgkin lymphoma with point-of-care manufactured CAR T cells: a dual institution, phase 1 trial.","authors":"Armin Ghobadi, Paolo F Caimi, Jane S Reese, Krishna Goparaju, Martina di Trani, Julie Ritchey, Zachary Jackson, Benjamin Tomlinson, Jennifer M Schiavone, Sarah Kleinsorge-Block, Kayla Zamborsky, Linda Eissenberg, Dina Schneider, Kirsten M Boughan, Emily C Zabor, Leland Metheny, Molly Gallogly, Winfried Kruger, Michael Kadan, Andrew Worden A S, Ashish Sharma, Brenda W Cooper, Folashade Otegbeye, Rafick P Sekaly, David N Wald, Carmelo Carlo-Stella, John DiPersio, Rimas Orentas, Boro Dropulic, Marcos de Lima","doi":"10.1016/j.eclinm.2025.103138","DOIUrl":"10.1016/j.eclinm.2025.103138","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Point-of-care manufacture of chimeric antigen receptor (CAR)-T cells can significantly reduce the time from apheresis to infusion. We conducted a dual-institution phase I trial aimed evaluating the safety and feasibility of this manufacturing model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;CASE 2417 was a phase I clinical trial. Adults with relapsed or refractory CD19 positive non-Hodgkin lymphoma (R/R NHL) treated with ≥2 prior systemic therapies were eligible. MB-CART-19 is an anti-CD19 CAR T-cell product manufactured using the CliniMACS Prodigy device with 4-1BB and CD3ζ costimulatory domains. Lymphodepletion included fludarabine 25 mg/m&lt;sup&gt;2&lt;/sup&gt; for 3 days and cyclophosphamide 60 mg/kg for 1 day. Prophylactic tocilizumab was allowed. Three dose levels (0.5, 1.0 and 2.0 × 10&lt;sup&gt;6&lt;/sup&gt; cells/kg) were tested using a 3 + 3 dose-escalation schema. The primary outcome of this study was to determine the safety as defined by the dose limiting toxicities of MB-CART-19 in patients with relapsed and refractory NHL, co-primary outcome was determining the phase 2 dose of MB-CART-19. Secondary outcomes include defining the toxicity profile and to evaluate the initial efficacy of MB-CART-19 against relapsed or refractory NHL. This study was registered in ClinicalTrials.govNCT03434769.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Thirty-one patients were enrolled between July 2018 and January 2021. Twenty-four (77%) had aggressive lymphoma, 7 (24%) had indolent lymphoma (follicular lymphoma and marginal zone lymphoma). The median number of previous therapies was 5 (range 2-13, interquartile range [IQR] 3-5). All enrolled patients received MB-CART-19. Median apheresis to infusion time was 13 days (range 9-20, IQR 9-13). One dose limiting toxicity (DLT) was observed in dose escalation (fatal cytokine release syndrome [CRS]), whereas one patient died in dose expansion secondary to hemophagocytic syndrome. Both deaths were considered treatment-related. Twenty (65%) patients had CRS, three (10%) grade ≥3. Ten patients (32%) experienced immune effector cell neurotoxicity syndrome (ICANS), four (13%) grade ≥3. Neutropenia (n = 28, 90%), thrombocytopenia (n = 15, 48%) and anaemia (n = 13, 42%) were the most frequent grade ≥3 adverse events. Twenty-five out of 29 (86%, 95% confidence interval [CI]: 68-96%) response-evaluable patients had disease response and 22 (76%, 95% CI: 56-90%) had complete response; the overall and complete response rates for response-evaluable aggressive lymphoma patients (n = 22) were 82% (n = 18, 95% CI: 60-95%) and 73% (n = 16, 95% CI: 50-89%). Median follow up was 24.5 (IQR 17-32) months, median progression free survival (PFS) was 26 months (95% CI: 19-not reached [NR]) and median PFS was not reached (95% CI: 25 months-NR). Two-year estimates of PFS and overall survival (OS) were 63% (95% CI: 47-83%) and 68% (95% CI: 52-88%), respectively. Median PFS was 26 months (95% CI: 7-NR) for aggressive lymphoma patients with 2-year ","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103138"},"PeriodicalIF":9.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do the effects of interventions aimed at the prevention of childhood obesity reduce inequities? A re-analysis of randomized trial data from two Cochrane reviews.","authors":"Jennifer C Palmer, Annabel L Davies, Francesca Spiga, Berit L Heitmann, Russell Jago, Carolyn D Summerbell, Julian P T Higgins","doi":"10.1016/j.eclinm.2025.103130","DOIUrl":"10.1016/j.eclinm.2025.103130","url":null,"abstract":"<p><strong>Background: </strong>Public health attempts to prevent obesity in children and young people should aim to minimize health inequalities. Two Cochrane reviews examining interventions aiming to prevent childhood obesity found that interventions promoting (only) physical activity have a small beneficial effect on BMI for people aged 5-18 years, as do interventions promoting physical activity alongside healthy eating for 5-11 year olds. We examined whether the effectiveness of the interventions included in these reviews differed according to eight factors associated with inequity: place, race/ethnicity, occupation, gender/sex, religion, education, socio-economic status, and social capital (the PROGRESS framework).</p><p><strong>Methods: </strong>We collected data on change in BMI (standardized or unstandardized), subgrouped by baseline measures of PROGRESS factors, for intervention and control groups, from trial authors. We calculated the intervention effect per subgroup (mean difference), then contrasted these to estimate interactions between intervention and the baseline factors. We combined interaction estimates for each factor across trials using meta-analyses.</p><p><strong>Findings: </strong>We collected subgrouped data from 81 trials that took place between 2001 and 2020, involving 84,713 participants. We found no substantial differences in effectiveness of interventions for PROGRESS subgroups in most scenarios. However, in the younger age group (5-11 years), the effect of interventions on standardized BMI appeared to be higher in boys (average difference in mean differences 0.03; 95% CI 0.01 to 0.06; 45 studies, n = 44,740), which was consistent in direction with the BMI effect (average difference in mean differences 0.06 kg/m2; 95% CI -0.02 to 0.13; 31 studies, n = 27,083).</p><p><strong>Interpretation: </strong>Our findings suggest that those responsible for public health can promote these beneficial interventions without major concerns about increasing inequalities but should be mindful that these interventions may work better in boys aged 5-11 years than girls. More data are needed, so we encourage future trialists to perform subgroup analyses on PROGRESS factors.</p><p><strong>Funding: </strong>National Institute for Health and Care Research (NIHR).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103130"},"PeriodicalIF":9.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global estimates of rotavirus vaccine efficacy and effectiveness: a rapid review and meta-regression analysis.","authors":"Ottavia Prunas, Ernest O Asare, Elizabeth Sajewski, Yueqi Li, Zeaan Pithawala, Daniel M Weinberger, Joshua L Warren, George E Armah, Nigel A Cunliffe, Miren Iturriza-Gómara, Benjamin A Lopman, Virginia E Pitzer","doi":"10.1016/j.eclinm.2025.103122","DOIUrl":"10.1016/j.eclinm.2025.103122","url":null,"abstract":"<p><strong>Background: </strong>Rotavirus is the leading cause of diarrhoea worldwide, particularly affecting young children. While national rotavirus immunization programs have reduced rotavirus morbidity and mortality, vaccine performance varies considerably between high-income and low-income settings.</p><p><strong>Methods: </strong>We updated a previous systematic review of studies reporting rotavirus vaccine efficacy and vaccine effectiveness against severe rotavirus-associated gastroenteritis (RVGE) by performing a rapid review from July 1, 2020 through October 16, 2024. We included randomized controlled trials reporting vaccine efficacy against severe RVGE and case-control and cohort studies reporting vaccine effectiveness against hospitalization with RVGE in children <5 years old for current internationally licensed vaccines. We developed a meta-regression model for vaccine efficacy and effectiveness using widely available country-specific predictors of rotavirus vaccine performance and simultaneously estimated the relationship between vaccine efficacy and effectiveness. We used the model to predict vaccine efficacy and effectiveness for all countries and assessed its predictive accuracy using a modified leave-one-country-out validation approach.</p><p><strong>Findings: </strong>Predicted vaccine efficacy ranged from 69.6% to 94.3% across countries in the Americas, European, and Western Pacific Regions, with a decreased efficacy ranging from 18.6% to 85.3% in the African, South-East Asian, and Eastern Mediterranean regions. Estimates of vaccine effectiveness were generally lower than vaccine efficacy when efficacy was greater than 60%, but effectiveness was predicted to be higher when vaccine efficacy was low. A strong correlation (<i>r</i> = 0.63) was found between the observed and predicted vaccine efficacy and effectiveness, with 98.2% of observed efficacy and effectiveness estimates falling within the 95% prediction intervals.</p><p><strong>Interpretation: </strong>Our approach enhances the understanding of global variation in rotavirus vaccine performance and can be used to inform predictions of the potential impact of rotavirus vaccines for countries that have yet to introduce them. Higher-quality data on predictor variables and broader regional representation in vaccine trials are required for more robust vaccine performance estimates.</p><p><strong>Funding: </strong>National Institutes of Health/National Institute of Allergy and Infectious Diseases (R01AI112970) and the Bill & Melinda Gates Foundation (INV-17940).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103122"},"PeriodicalIF":9.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on \"Changes in memory and cognition during the SARS-CoV-2 human challenge study\".","authors":"Raffaella Ravinetto, François Hirsch, Yves Donazzolo, Lorenzo Montrasio, François Bompart","doi":"10.1016/j.eclinm.2025.103144","DOIUrl":"10.1016/j.eclinm.2025.103144","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"81 ","pages":"103144"},"PeriodicalIF":9.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}