EClinicalMedicine最新文献

{"title":"Global burden of dengue on healthcare systems: a meta-analysis of healthcare resource utilisation.","authors":"Namita Kaushik, Subhashini Subramanian, Kinfemichael Gedif, Thej Kumar Nallagangula, Shivaprasad Singuru, Shaishav Panchal, Isabelle Meyer-Andrieux, Jean-Bernard Gruenberger, Angela McBride, Sophie Yacoub, Andreas Tietz","doi":"10.1016/j.eclinm.2026.104217","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104217","url":null,"abstract":"<p><strong>Background: </strong>Dengue poses an increasing health challenge, yet contemporary global healthcare resource utilisation (HCRU) data remain limited.</p><p><strong>Methods: </strong>A systematic literature review (SLR) and meta-analysis of studies published 2013-2026 was conducted to estimate hospitalisation rate (HR) and length of stay (LOS) for dengue. Pooled proportions and means were analysed with 95% confidence intervals (CIs) under fixed- and random-effects models globally and by region. Meta-regression models estimated potential sources of heterogeneity. Additionally, sensitivity (excluding sample sizes <100, >50,000, and >50,000 and <100) and subgroup analyses were conducted for disease severity, patient characteristics, and region (PROSPERO# CRD42023480948).</p><p><strong>Findings: </strong>Of 341 studies included in the SLR, studies reporting HR (121) and LOS (204) were prioritised for analysis. Global HR among patients with dengue, irrespective of severity, was 36.7% (95% CI 29.0-44.4), under the random-effects model. HR was higher for severe versus non-severe dengue (79.4% [55.9-92.2] versus 26.6% [19.3-35.4]), with versus without warning signs (36.9% [23.3-52.9] versus 17.7% [10.2-28.9]), and in Asia versus Latin America (35.1% [18.0-57.2] versus 29.3% [18.4-43.2]). Global mean LOS among hospitalised patients with dengue, irrespective of severity, was 4.9 days (95% CI 4.6-5.2) under the random-effects model. Severe dengue had longer LOS versus non-severe dengue (6.5 [5.4-7.7] versus 4.6 [4.3-4.9] days), especially for patients with versus without comorbidities (6.1 [5.1-7.2] versus 5.1 [4.3-5.9] days), and in Asia versus Latin America (5.1 [4.8-5.5] versus 4.1 [3.4-4.7] days). Meta-regression showed disease severity was the single significant factor (p < 0.0001) associated with high HR and longer LOS (I² ≥ 99.8%) among the factors analysed.</p><p><strong>Interpretation: </strong>Due to high heterogeneity between studies and interregional differences, pooled estimates should be interpreted with caution. These findings indicate the considerable burden of dengue driven by HCRU, offering valuable insights for health system preparedness, clinical trial design, and policy planning.</p><p><strong>Funding: </strong>Novartis Pharma AG.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104217"},"PeriodicalIF":12.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179089","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":"Association of dengue severity with the serotype of infection: a systematic review and meta-analysis.","authors":"Hadrian Jules Ang, Clare McCormack, Christl A Donnelly, Ilaria Dorigatti","doi":"10.1016/j.eclinm.2026.104218","DOIUrl":"10.1016/j.eclinm.2026.104218","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dengue is a mosquito-borne infection caused by one of four dengue virus serotypes (DENV1-4) that circulates endemically across the tropics and subtropics. To date, there is contrasting evidence on the relationship between the serotype of infection and disease severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review (PROSPERO, CRD42023443101) and meta-analysis to examine the association between the serotype of symptomatic infections with severe disease while accounting for both prior exposure status and geographic region, with severity defined by (i) the 1997 World Health Organization (WHO) guidelines, (ii) the 2009 WHO guidelines or (iii) hospitalisation. We searched the Global Health, Embase Classic + Embase, and Medline databases using Ovid for studies published up to 20 January 2025 and extracted case counts with matched serotype and severity information. We fitted generalised linear mixed models to estimate the proportions of severe cases, running independent analyses per severity definition, and stratifying by prior exposure-serotype combinations (e.g. primary DENV2) and geographic region (Asia versus Americas). Heterogeneity was assessed using the &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;τ&lt;/mi&gt;&lt;/mrow&gt; &lt;/math&gt; and &lt;math&gt; &lt;mrow&gt;&lt;msup&gt;&lt;mi&gt;I&lt;/mi&gt; &lt;mn&gt;2&lt;/mn&gt;&lt;/msup&gt; &lt;/mrow&gt; &lt;/math&gt; metrics and risk of bias was assessed by adapting an established tool for risk of bias in prevalence studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Our search yielded 4621 unique records, with 71 studies included for the meta-analysis. We found that, on average, DENV3 in Asia resulted in the highest proportion of DHF/DSS (21·00% [95% CrI: 13·02-30·44%]) and hospitalised (22·00% [95% CrI: 0·88-75·31%]) cases among symptomatic primary infections, while also causing the highest proportion of DHF/DSS among secondary infections (37·61% [95% CrI: 24·19-52·32%]). However, conditional on the same prior exposure status (primary/secondary infections), we found no statistically significant differences between serotypes across the three severity definitions. For 1997-type severity, we found some evidence of secondary infections being more severe than primary infections and found that dengue was significantly less severe in the Americas when compared to Asia, though this disparity between regions was sensitive to the inclusion of cases with unknown prior exposure status. There was no significant difference between regions for 2009-type severity and hospitalisations. The paucity of published studies from Africa limited the extent to which we could investigate dengue severity in this region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;This study provides evidence that, according to the published literature, prior dengue exposure has a stronger association with the development of severe disease than the serotype of infection. Better characterising the local population-level immunity remains a current priority for outbreak response and healthcare demand planning.&lt;/p&gt;&lt;p&gt;&lt;","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104218"},"PeriodicalIF":12.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165198","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":"Contribution of short-term changes in a composite health score on pathways linking social disadvantage and health: evidence from the UK biobank prospective cohort study.","authors":"Helene Colineaux, Rin Wada, Ruben Colindres Zuehlke, David Tang, Lola Neufcourt, Erlend Hoftun Farbu, Raphaële Castagné, Sameline Grimsgaard, Tom Wilsgaard, Torkjel M Sandanger, Michelle Kelly-Irving, Cyrille Delpierre, Dragana Vuckovic, Marc Chadeau-Hyam","doi":"10.1016/j.eclinm.2026.104221","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104221","url":null,"abstract":"<p><strong>Background: </strong>Chronic and repeated exposure to external stresses may be embodied and generate an adverse biological response, in-turn affecting health. We investigated the role of 4-year change in a Biological Health Score (BHS) in the pathway linking social exposures to all-cause mortality, atherosclerotic cardiovascular disease (AS-CVD), and cancer incidence.</p><p><strong>Methods: </strong>In this prospective cohort study, we analysed 20,048 participants (10,266 women and 9782 men, aged 37-73 years at baseline) from the UK Biobank prospective cohort with repeated biomarker assessments. The BHS was derived from 15 biomarkers covering cardiovascular, metabolic, inflammatory, liver, and renal systems. We examined associations between BHS change and six social exposures using sex-stratified linear models. Associations between BHS change and subsequent all-cause mortality, AS-CVD incidence, and cancer incidence (ascertained through registry linkage until December 2022) were estimated using sex-specific Cox proportional hazards models adjusted for baseline BHS and time between assessments, with sequential adjustment for additional exposures. Finally, we assessed whether BHS change mediated associations between social exposures and health outcomes using counterfactual mediation analysis.</p><p><strong>Findings: </strong>Total BHS increased over a mean interval of 4.3 years in both men and women, as did all sub-scores except the cardiovascular one. Lower education, low qualification, and financial difficulties were associated with greater increases in BHS. A 1-unit increase in BHS change was associated with: higher all-cause mortality in both men (hazard ratio [HR] 1.46, 95% CI 1.25-1.71) and women (1.26, 1.02-1.56); higher AS-CVD incidence in men (1.33, 1.13-1.57) and women (1.24, 1.03-1.48) and higher cancer incidence in men (1.16, 1.01-1.41) and women (1.29, 1.06-1.58). While no clear mediation by BHS change was observed for women, AS-CVD, or cancer, BHS change explained a small but statistically significant proportion of the association between low income and financial difficulties and mortality, in men.</p><p><strong>Interpretation: </strong>Whilst acknowledging the limitations of our dataset, we show that changes in a composite biological score over a few years, independent of age and baseline score, are socially-patterned and associated with subsequent mortality and cardiovascular disease, suggesting that repeated biological measurements may provide complementary information beyond single time-point assessments. Future research should extend these analyses to multiple repeated measurements, enabling the exploration of the dynamics of the embodiment of time-resolved external stresses and their effects on health.</p><p><strong>Funding: </strong>Research Council of Norway, European Commission.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104221"},"PeriodicalIF":12.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164372","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":"Comorbid insomnia and sleep apnea (COMISA) and incident cardiovascular risk: a prospective analysis from the HypnoLaus cohort.","authors":"Geoffroy Solelhac, Théo Imler, Nicola-Andrea Marchi, Sébastien Baillieul, Sandra Van Den Broecke, Gabriela Caetano, Grégory Heiniger, Adrien Waeber, Isabel Ericson, Virginie Bayon, Anne-Sophie Lombardi, José Haba-Rubio, Peter Vollenweider, Pedro Marques-Vidal, Raphaël Heinzer","doi":"10.1016/j.eclinm.2026.104227","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104227","url":null,"abstract":"<p><strong>Background: </strong>Comorbid insomnia and obstructive sleep apnea (COMISA) is a prevalent and clinically relevant phenotype. While both insomnia and OSA have been individually associated with increased cardiovascular risk, few longitudinal studies have evaluated their combined impact on incident cardiovascular events in the general population.</p><p><strong>Methods: </strong>A total of 1860 participants from the CoLaus|PsyCoLaus cohort, originally recruited between 2003 and 2008 and assessed in the HypnoLaus study between 2009 and 2013, were included, all of whom underwent full-night polysomnography and completed the Pittsburgh Sleep Quality Index (PSQI). OSA was defined as an apnea-hypopnea index (AHI) ≥15 events/h. Insomnia symptoms were defined as difficulty initiating or maintaining sleep ≥3 times/week over the past month. Participants were classified into four groups: reference (no insomnia, no OSA), insomnia alone, OSA alone, and COMISA. Incident cardiovascular events (coronary heart disease, myocardial infarction, stroke, or cardiovascular death) were adjudicated by an expert committee over a median follow-up period of 7.92 years [IQR: 6.30-8.77]. Cox regression models were adjusted for demographic, behavioral, and clinical covariates.</p><p><strong>Findings: </strong>Compared to the reference group, COMISA was independently associated with an increased risk of incident cardiovascular events (HR 1.78, 95% CI: 1.09-2.92, p = 0.021), while no significant association was observed for insomnia (HR 0.59, 95% CI: 0.31-1.11, p = 0.10) or OSA alone (HR 1.33, 95% CI: 0.84-2.10, p = 0.22). A significant interaction between OSA and insomnia was observed (p = 0.035). Results were consistent in participants without prior cardiovascular events and across alternative definitions of COMISA.</p><p><strong>Interpretation: </strong>COMISA, but not OSA or insomnia alone, was associated with increased incident cardiovascular events. These findings highlight the need to identify and treat COMISA as a distinct and high-risk phenotype in cardiovascular prevention strategies.</p><p><strong>Funding: </strong>Faculty of Biology and Medicine of Lausanne, Lausanne University Hospital, Swiss National Science Foundation, Leenaards Foundation, GlaxoSmithKline, Ligue Pulmonaire Vaudoise.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104227"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164394","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":"Risk of mortality after emergency department presentation for self-harm among children and adolescents in Wales: a population-based cohort study.","authors":"Gabrielle M Beaudry, Kirstie O'Hare, Rongqin Yu, Seena Fazel, Ian Kelleher","doi":"10.1016/j.eclinm.2026.104230","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104230","url":null,"abstract":"<p><strong>Background: </strong>Self-harm in childhood and adolescence is associated with substantial morbidity and premature mortality, particularly from suicide. We aimed to quantify the risk of cause-specific and all-cause mortality following emergency department (ED) presentations for self-harm.</p><p><strong>Methods: </strong>In this retrospective population-based cohort study, we used anonymised, linked electronic health records from the Secure Anonymised Information Linkage (SAIL) Databank. We included children and adolescents aged 5-18 years who presented to EDs in Wales between 2008 and 2023. Individuals with at least one ED presentation for self-harm were assigned to the exposed group, and those with no recorded self-harm presentations formed the comparison group. Follow-up began at the index ED presentation and continued until death, possible emigration, or end of data availability. The primary outcome was suicide; secondary outcomes included accidental death, other causes of death, and all-cause mortality. Associations between self-harm and cause-specific mortality were estimated using Cox proportional hazards models adjusted for age and sex. Kaplan-Meier failure curves (1 - survival) were estimated separately for each cause of death.</p><p><strong>Findings: </strong>Between 2008 and 2023, we identified 611,336 young people who presented to EDs, of whom 14,007 (2.3%) had at least one self-harm presentation. During follow-up, 1451 deaths were recorded. Mortality was higher among those presenting with self-harm compared with controls without self-harm presentations (114 [0.8%] vs 1337 [0.2%], adjusted hazards ratio [aHR] 3.1, 95% CI 2.6-3.8). Suicide risk was markedly elevated in the first year after presentation (aHR 13.4, 95% CI 4.7-38.0) and remained increased during follow-up (aHR 4.9, 95% CI 3.4-6.9). There was a similarly increased risk of accidental death within one year (aHR 13.9, 95% CI 6.2-31.1) and after one year (aHR 5.5, 95% CI 3.9-7.7). No clear association between self-harm and other causes of death was observed.</p><p><strong>Interpretation: </strong>ED presentation for self-harm identifies young people at elevated risk of premature mortality. Preventive interventions should extend beyond suicide alone to address accidental deaths, particularly in the period immediately following presentation.</p><p><strong>Funding: </strong>McGill Global Health Programs Fellowship; John Fell Fund; NIHROxford Health Biomedical Research Centre; Academy of Medical Sciences; UK Department for Business, Energy and Industrial Strategy.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104230"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165126","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, regional, and national burden of tetanus in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.","authors":"","doi":"10.1016/j.eclinm.2026.104202","DOIUrl":"10.1016/j.eclinm.2026.104202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tetanus is a life-threatening, vaccine-preventable disease. Its incidence decreased substantially following global initiatives such as the Expanded Programme on Immunization (EPI) and Maternal and Neonatal Tetanus Elimination (MNTE). Despite these efforts, tetanus elimination has not been achieved, and significant disparities in morbidity and mortality persist across various regions. Therefore, we sought to investigate the global, regional, and national burden of tetanus from 1990 to 2023, using data from the Global Burden of Disease Study (GBD) 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We estimated the global burden of tetanus across 204 countries and territories, seven GBD super-regions, and 21 GBD regions from 1990 to 2023. For investigation, tetanus was defined based on International Classification of Diseases (ICD)-10 codes A33-A35.0 and Z23.5 and ICD-9 codes 037-037.9, 771.3, and V03.7. The tetanus case fatality rate (CFR) was defined as the ratio of fatal tetanus cases to the total number of tetanus cases within a given sample. Incidence and prevalence of tetanus were estimated by linking cause-specific mortality estimates with modeled CFRs and disease-duration assumptions. Disease burden was quantified using age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates per 100,000 population, along with corresponding 95% uncertainty intervals (UIs) and total percent change over the study period. Estimates were stratified by age group, sex, and Socio-demographic Index (SDI) across countries and regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Global age-standardized incidence rate of tetanus significantly decreased from 11.32 (95% UI, 7.98-16.36) per 100,000 population in 1990 to 0.70 (0.40-1.22) in 2023, representing a 93.8% decrease. The global age-standardized DALY rate also declined by 95.37% between 1990 and 2023. In 2023, the highest age-standardized DALY burden was estimated in sub-Saharan Africa (46.07 [95% UI, 25.71-77.17] per 100,000 population) and South Asia (20.47 [11.99-32.50]), whereas Southeast Asia had the highest age-standardized prevalence and incidence rates. In contrast, high-income regions and Central Europe, Eastern Europe, and Central Asia had the lowest burden of tetanus in 2023, with near-zero incidence and mortality. Tetanus burden showed a strong inverse association with SDI across all epidemiological measures. At the national level, Somalia, the Lao People's Democratic Republic, and Chad had the highest age-standardized DALY rates. Pronounced age- and sex-specific patterns were observed, with the highest rates concentrated among neonates younger than 28 days and generally higher rates in males than in females across most age groups. Although absolute rates declined over time, these demographic inequities persisted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Over the past three decades, global initiatives such as the EPI and MNTE have led to a substantial re","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104202"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105766","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":"Non-pharmacological executive function interventions for children and adolescents with neurodevelopmental disorders: a systematic review and network meta-analysis.","authors":"Xiao Liang, Ming Chen, Raffy C F Chan, Jeremy R Chang, Michael K Yeung, Chun Liang Hsu, Chang Liu, Yajun Chen, Richard H Xu, Bin-Rang Yang, Chao Yan, Hui Qiu, Andy C Y Tse, David H K Shum, Raymond C K Chan, Shirley X Li","doi":"10.1016/j.eclinm.2026.104228","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104228","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children and adolescents with neurodevelopmental disorders (NDDs) frequently experience executive dysfunction. Although non-pharmacological interventions are commonly recommended to address these challenges, their relative effectiveness across intervention types and executive-function domains remain unclear. We aimed to systematically compare the effectiveness of non-pharmacological interventions for improving overall and domain-specific task-based executive function outcomes in children and adolescents with NDDs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review, pairwise meta-analysis, and network meta-analysis of randomized controlled trials. Comprehensive searches were performed across APA PsycINFO, CINAHL Complete, MEDLINE, Web of Science, ERIC, and Embase from database inception through July 2024, with search updates subsequently completed on September 24, 2025, and August 24, 2026. Studies identified in the 24 August 2026 update were not incorporated into the existing analyses. The quantitative synthesis therefore remains based on studies identified through 24 September 2025. We included trials of participants aged 5-18 years with formally identified neurodevelopmental disorders that compared an eligible non-pharmacological intervention with another eligible intervention or control and reported performance-based executive-function outcomes; non-randomized studies and studies without an eligible task-based outcome were excluded. Eligibility was not restricted by participant sex or gender. The primary outcome was overall task-based executive-function performance at the first post-intervention assessment. Heterogeneity was assessed using Cochran's Q and I&lt;sup&gt;2&lt;/sup&gt;. Risk of bias and methodological quality were assessed using the Cochrane Risk of Bias 2.0 tool and the Physiotherapy Evidence Database (PEDro) scale. Confidence in the network estimates was assessed using Confidence in Network Meta-Analysis (CINeMA), informed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles. This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO), CRD42024540385.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Collectively, 2087 records were identified, and 118 studies involving 5863 participants (76.10% [4462 of 5863] male and 23.90% [1401 of 5863] female) and 141 independent intervention arms were included; 83 of the 118 studies involved populations with attention-deficit/hyperactivity disorder (ADHD). The 141 intervention arms were organized into 5 broad categories for pairwise meta-analysis: computerized cognitive training, non-computerized executive function training, mindfulness training, neurofeedback training, and physical activity training. Twelve specific intervention types were investigated using frequentist random-effects network meta-analysis. Risk of bias was predominantly rated as having some concerns, the mean PEDro sco","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104228"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165713","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":"Trends in the incidence of atrial fibrillation and the prescription of oral anticoagulants in adults with chronic obstructive pulmonary disease in UK primary care (2010-2022): a cohort study.","authors":"Brianna Murray, Sarah Beradid, Pierre Ernst, Samy Suissa, Christel Renoux","doi":"10.1016/j.eclinm.2026.104245","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104245","url":null,"abstract":"<p><strong>Background: </strong>Understanding the burden of atrial fibrillation (AF) and oral anticoagulant (OAC) use in patients with chronic obstructive pulmonary disease (COPD) is important for stroke prevention in this high-risk population. We assessed trends in AF incidence and OAC initiation among patients with COPD in UK primary care from 2010 to 2022.</p><p><strong>Methods: </strong>We assembled a cohort of all patients at least 50 years of age who contributed data to the UK Clinical Practice Research Datalink between January 1, 2010, and December 31, 2022, who had a physician diagnosis of COPD before or during the study period. Patients were followed-up until AF diagnosis, study end date (December 2022), death, or transfer out of practice. We estimated annual incidence rates of AF and subsequent OAC initiation using Poisson regression, stratified by age, sex, ethnicity, and COPD severity. We assessed predictors of AF and OAC initiation using Cox proportional hazards regression models.</p><p><strong>Findings: </strong>444,668 patients with COPD were included (mean age 70 years, 51.8% male), contributing 2,284,799 person-years of follow-up. 37,645 (8.5%) patients were diagnosed with AF during the study period. The incidence of AF increased from 13.8 per 1000 person-years in 2010 to 19.3 in 2022 [rate ratio (RR) 1.29; 95% confidence interval (CI) 1.07-1.56], and was higher in males, White individuals, those over 80 years, and patients with severe COPD. Only 23,094 patients (66.3%) were prescribed an OAC in the year following AF diagnosis, though OAC use increased 2.9-fold during this period (RR 2.91; 95% CI 2.33-3.65). OAC initiation remained lowest among patients aged 50-59 and ≥90 years, and non-White individuals. OAC use was also up to 25.0% (adjusted hazard ratio 0.75; 95% CI 0.69, 0.81) less prevalent among those with severe COPD.</p><p><strong>Interpretation: </strong>AF incidence and OAC initiation increased among patients with COPD in UK primary care over 2010-2022. However, OAC use remained suboptimal, especially among older patients, non-White individuals, and those with severe COPD. These potential treatment gaps highlight the need for further research on stroke prevention strategies in this high-risk population.</p><p><strong>Funding: </strong>This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104245"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166437","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":"Overview of systematic reviews and meta-analyses on problematic video game use and gaming disorder in adolescents and young adults.","authors":"Jason M Nagata, Christiane K Helmer, Oliver H Huang, Sahana Nayak, Kevin Bao, Stephanie Zhang, Kevin Handoko, Elizabeth J Li, Megan A Moreno, Jason M Lavender","doi":"10.1016/j.eclinm.2026.104195","DOIUrl":"10.1016/j.eclinm.2026.104195","url":null,"abstract":"<p><strong>Background: </strong>Problematic video game use and disordered gaming are increasingly recognized adolescent health concerns.</p><p><strong>Methods: </strong>This overview summarizes assessment, epidemiology, risk factors, health outcomes, and treatment of problematic and disordered gaming among adolescents and young adults. PubMed, Web of Science, and PsycInfo were searched for reviews published from 9/1/2016 to 5/26/2026. At least two reviewers screened and extracted data. Risk-of-bias assessments were summarized. This review is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY #202670067).</p><p><strong>Findings: </strong>Of 98 unique records, 51 were included. Prevalence varied by region, sociodemographics, and diagnostic definitions, with gaming disorder or internet gaming disorder affecting 6-10% of adolescents and young adults worldwide. Earlier gaming initiation, maladaptive gaming patterns, poorer mental health, and controlling parenting were associated with increased risk. Problematic gaming was linked to adverse physical, sleep, neurobiological, and mental health outcomes. Cognitive behavioral therapy showed the strongest therapeutic evidence. Evidence certainty was low-to-moderate.</p><p><strong>Interpretation: </strong>The findings highlight the importance of early identification of problematic and disordered gaming among youth who begin gaming young, or experience mental health symptoms, social difficulties, or limited parental support. Future research should refine diagnostic criteria, evaluate treatments through randomized trials, and clarify developmental mechanisms.</p><p><strong>Funding: </strong>JMN was supported by the National Institutes of Health and Rise Together, a donor-advised fund sponsored and administered by the National Philanthropic Trust.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104195"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105790","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":"Safety and efficacy of SOM3355 in patients with Huntington's disease (SOMCT03): a phase 2b, randomised, placebo-controlled, multicentre, dose-ranging study.","authors":"Jaime Kulisevsky, David Craufurd, Jan Lewerenz, Cesa Scaglione, Ferdinando Squitieri, Katia Youssov, Jean-Marc Burgunder, Aileen Ferré, Silvia Panigone, Rossella Medori","doi":"10.1016/j.eclinm.2026.104234","DOIUrl":"https://doi.org/10.1016/j.eclinm.2026.104234","url":null,"abstract":"<p><strong>Background: </strong>SOM3355 is a β1-blocker and a vesicular monoamine transporter type 1 and 2 inhibitor developed for the treatment of Huntington's disease (HD). Its novel polypharmacology makes it suited for the effective and safe treatment of chorea and other HD symptoms.</p><p><strong>Methods: </strong>SOMCT03 was a double-blind, randomised, placebo-controlled, parallel-group phase 2b study conducted at 23 sites across seven European countries. Eligible adults with genetically confirmed HD and baseline Total Maximal Chorea (TMC) score ≥10 were randomly assigned (1:1:1) to either orally administered SOM3355 400 mg/day, SOM3355 600 mg/day, or placebo for 12 weeks. The primary efficacy endpoint was the TMC score change from baseline to end of maintenance analysed in the modified intention-to-treat population (mITT) using a mixed-effect model for repeated measures. Values are reported as least-squares mean estimates between active treatments and placebo, with their confidence intervals. Safety assessments included clinical scales for suicidality, depression, sleepiness, akathisia, cognition, and behavioural symptoms in HD. SOMCT03 is registered with EudraCT (2021-003453-28) and ClinicalTrials.gov (NCT05475483).</p><p><strong>Findings: </strong>Between August 2, 2022, and June 25, 2024, 139 patients (66 females and 73 males) were enrolled and received the assigned treatment and were included in the mITT and safety populations. The TMC least-squares mean (LSM) difference between SOM3355 600 mg/day and placebo was -1.0 (CI -2.3 to 0.3, p = 0.0961) in the mITT population. In the predefined sensitivity analysis of 122 patients not taking concomitant antipsychotics (88% of mITT) SOM3355 600 mg/day showed a statistically significant difference from placebo with a LSM difference of -1.3 (CI -2.5 to -0.0; p = 0.0449). In the post-hoc analysis with 57 patients not taking antipsychotics and baseline TMC >12 (41% of mITT), SOM3355 600 mg/day reduced TMC score in -4.5, with a LSM difference vs. placebo of -1.8 (CI -3.4 to -0.2, p = 0.0320). The most reported adverse event per group was bradycardia, six (12%) with SOM3355 600 mg/day and two (5%) with SOM3355 400 mg/day. No suicidality or suicide attempts were reported in patients treated with SOM3355. SOM3355 600 mg/day showed a trend in decreasing depression, anxiety, apathy, and some abnormal behaviours.</p><p><strong>Interpretation: </strong>Although the primary efficacy outcome of this phase 2b study was not met, these findings show SOM3355 600 mg/day is safe and well-tolerated. Prespecified sensitivity analyses showed preliminary evidence that SOM3355 600 mg/day is efficacious in patients with HD not taking concomitant antipsychotics. Further research is needed to confirm these safety data and to investigate the effectiveness of SOM3355. A phase 3 study is planned.</p><p><strong>Funding: </strong>SOM Innovation Biotech SA (SOM Biotech).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"100 ","pages":"104234"},"PeriodicalIF":12.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164815","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}