EClinicalMedicine最新文献

{"title":"Efficacy of automated insulin delivery systems in people with type 1 diabetes: a systematic review and network meta-analysis of outpatient randomised controlled trials.","authors":"Anna Stahl-Pehe, Nafiseh Shokri-Mashhadi, Marielle Wirth, Sabrina Schlesinger, Oliver Kuss, Reinhard W Holl, Christina Bächle, Klaus-D Warz, Jutta Bürger-Büsing, Olaf Spörkel, Joachim Rosenbauer","doi":"10.1016/j.eclinm.2025.103190","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103190","url":null,"abstract":"<p><strong>Background: </strong>The comparative efficacy of automated insulin delivery (AID) systems and other treatment options for type 1 diabetes, accounting for the certainty of evidence (CoE), is unknown.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov and included outpatient randomised controlled trials (RCTs) published until January 8, 2025, in people with type 1 diabetes with a three-week or longer intervention of AID systems (PROSPERO registration number: CRD42023395492). We performed pairwise and network meta-analyses and used the Risk of Bias tool 2 and the Grading of Recommendations Assessment, Development and Evaluation methods to determine the CoE for each outcome.</p><p><strong>Findings: </strong>A total of 46 studies involving seven insulin treatment options and 4113 participants were included, of which 29 and 17 had low and moderate risks of bias, respectively. The intervention AID systems, including the hybrid closed-loop (HCL), advanced HCL (AHCL) and full closed-loop (FCL) systems, were evaluated in 20, 25 and 1 studies, respectively. The network meta-analysis did not indicate global inconsistencies but did indicate global publication bias for all glycaemic outcomes. The CoE varied between very low and high, depending on the treatment and outcome under consideration. Compared with pump therapy, the percentage of time in the range 70-180 mg/dl was greater with AID use (HCL: 19.7% [95% confidence interval 13.2%; 26.1%], moderate CoE; AHCL: 24.1% [18.2%; 29.9%], moderate CoE; FCL: 25.5% [11.1%; 39.9%], high CoE). Compared with pump therapy, the percentage of time above 180 mg/dl and 250 mg/dl was lower with AHCL, on average, by 19.6% (14.0%; 25.1%), moderate CoE, and 14.8% (8.8%; 20.8%), moderate CoE, respectively. The CoE was very uncertain regarding the overall effect of AID systems on the percentage of time below 70 mg/dl and 54 mg/dl and the HbA1c.</p><p><strong>Interpretation: </strong>AID systems improve glycaemic outcomes to varying degrees and with varying CoE.</p><p><strong>Funding: </strong>German Federal Ministry of Education and Research (BMBF; grant 01KG2203).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103190"},"PeriodicalIF":9.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984494","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":"Qualitative and quantitative educational disparities and brain signatures in healthy aging and dementia across global settings.","authors":"Raul Gonzalez-Gomez, Josephine Cruzat, Hernán Hernández, Joaquín Migeot, Agustina Legaz, Hernando Santamaria-García, Sol Fittipaldi, Marcelo Adrián Maito, Vicente Medel, Enzo Tagliazucchi, Pablo Barttfeld, Daniel Franco-O'Byrne, Ana María Castro Laguardia, Patricio A Borquez, José Alberto Avila-Funes, María I Behrens, Nilton Custodio, Temitope Farombi, Adolfo M García, Indira Garcia-Cordero, Maria E Godoy, Cecilia Gonzalez Campo, Kun Hu, Brian Lawlor, Diana L Matallana, Bruce Miller, Maira Okada de Oliveira, Stefanie D Pina-Escudero, Elisa de Paula França Resende, Pablo Reyes, Andrea Slachevsky, Leonel T Takada, Görsev G Yener, Carlos Coronel-Oliveros, Agustin Ibañez","doi":"10.1016/j.eclinm.2025.103187","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103187","url":null,"abstract":"<p><strong>Background: </strong>While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared.</p><p><strong>Methods: </strong>We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024.</p><p><strong>Findings: </strong>Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9-2·0] × 10^-2, <i>p</i> < 10^-5; AD: Δmean = 0·1 [-0·0 to 0·3] × 10^-2, <i>p</i> = 0·18; FTLD: Δmean = 3·5 [3·0-4·0] × 10^-2, <i>p</i> < 10^-5; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2-13·7] × 10^-2, <i>p</i> < 10^-5; AD: Δmean = 5·9 [5·2-6·7] × 10^-2, <i>p</i> < 10^-5; FTLD: Δmean = 13·2 [11·2-13·7] × 10^-2, <i>p</i> < 10^-5) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels.</p><p><strong>Interpretation: </strong>The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures.</p><p><strong>Funding: </strong>Multi-partner consortium to expand dementia research in Latin America (ReDLat).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103187"},"PeriodicalIF":9.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964385","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":"Interaction between influenza vaccine and statins affecting the risk of rhabdomyolysis in Taiwan: a nationwide case-centred analysis.","authors":"Che-Yu Chen, Miyuki Hsing-Chun Hsieh, Wan-Ting Huang, Edward Chia-Cheng Lai","doi":"10.1016/j.eclinm.2025.103171","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103171","url":null,"abstract":"<p><strong>Background: </strong>Literature suggests a potential interaction between influenza vaccination, statin use and rhabdomyolysis, but evidence is limited to case reports.</p><p><strong>Methods: </strong>Using out- and inpatient health records from Taiwan's National Health Insurance Research Database (NHIRD) between January 2016 and December 2021, we retrospectively constructed a nationwide cohort of patients aged 50 years and older, first-ever diagnosed with rhabdomyolysis, focusing on those who received an influenza vaccine within the preceding one year. We applied a case-centred analysis to evaluate the interaction between statin use and influenza vaccination within specific risk intervals: 1-7 days and 8-14 days post-vaccination, as well as 30-day and 60-day windows for statin use prior to rhabdomyolysis diagnosis. The main outcome measures were odds ratios (ORs) for statin-associated rhabdomyolysis, stratified by timing of influenza vaccination.</p><p><strong>Findings: </strong>Among the 5,602 rhabdomyolysis cases analysed, 1,765 patients were exposed to statins within 30 days, and 1,838 patients were exposed within 60 days. 74 individuals were vaccinated within 7 days prior to their diagnosis, 30 of which were taking statins inside the 30-day interval, these individuals were found to be at a significantly higher risk of statin-related rhabdomyolysis (OR: 1.67, 95% confidence interval: 1.04-2.69). A similar risk was observed when the statin risk interval was extended to 60 days, 74 vaccinated rhabdomyolysis patients with 32 within the 60 day window (OR: 1.79, 95% confidence interval: 1.12-2.87). However, this increased risk was not observed among the 97 individuals (24 patients in the 30 day window and 26 in the 60 day) who received vaccination 8-14 days before rhabdomyolysis onset (OR: 0.85, 95% confidence interval: 0.53-1.36), and not in those vaccinated outside these risk intervals.</p><p><strong>Interpretation: </strong>Our results suggest a significant temporal association between recent influenza vaccination and increased risk of statin-associated rhabdomyolysis within 7 days post-vaccination. These findings highlight the need for healthcare providers to monitor for rhabdomyolysis symptoms following influenza vaccination in patients receiving statin therapy. Further confirmation in larger prospective international studies is warranted to better understand this potential association.</p><p><strong>Funding: </strong>National Science and Technology Council of Taiwan (NSTC 112-2628-B-006-003-; NSTC 113-2628-B-006-009-) and the National Health Research Institutes of Taiwan (NHRI-11A1-CG-CO-04-2225-1; NHRI-12A1-CG-CO-04-2225-1; NHRI-13A1-CG-CO-04-2225-1; NHRI-14A1-CG-CO-04-2225-1).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103171"},"PeriodicalIF":9.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957103","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":"Identifying heterogeneity of treatment effect for antibiotic duration in bloodstream infection: an exploratory post-hoc analysis of the BALANCE randomised clinical trial.","authors":"Sean W X Ong, Ruxandra Pinto, Asgar Rishu, Steven Y C Tong, Robert J Commons, John M Conly, Gerald A Evans, Michael Fralick, Christopher Kandel, Philippe R S Lagacé-Wiens, Todd C Lee, Sylvain A Lother, Derek R MacFadden, John C Marshall, Valérie Martel-Laferrière, Michael Mayette, Emily G McDonald, John D Neary, Josef Prazak, Edward Raby, Adrian Regli, Benjamin A Rogers, Stephanie Smith, Linda R Taggart, Han Ting Wang, Terence Wuerz, Dafna Yahav, Paul J Young, Robert A Fowler, Nick Daneman","doi":"10.1016/j.eclinm.2025.103195","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103195","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The BALANCE trial demonstrated non-inferiority of 7 (vs 14) day antibiotic durations in patients with uncomplicated non-&lt;i&gt;S. aureus/lugdunensis&lt;/i&gt; bacterial bloodstream infections (BSI). However, there may be patient subgroups who benefit from longer durations. We aimed to evaluate if bedside clinical decision rules could identify these subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this post-hoc analysis of the multicentre, randomised BALANCE trial (October 17, 2014-May 5, 2023), we applied three clinical decision rules to investigate heterogeneity of treatment effect in 7-day vs 14-day antibiotic durations on 90-day all-cause mortality. We used the rules to categorize patients in BALANCE into different risk groups and calculated the unadjusted absolute risk difference (RD) for 90-day mortality in patients receiving 7- vs 14-day antibiotics within each risk group. Statistical significance was tested using an interaction test. The BALANCE trial is registered with ClinicalTrials.gov (NCT03005145).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;3581 patients were included. All three rules predicted mortality risk, but none identified statistically significant effect modification: (a) static rule (low-risk: RD -0.58, 95% CI -8.91 to 7.73; moderate-risk: RD -.01, 95% CI -3.86 to 1.83; high-risk: RD -2.65, 95% CI -7.12 to 1.81; p = 0.74); (b) dynamic rule (met rule on day 7: RD -2.18, 95% CI -4.81 to 0.45; did not meet rule: RD 1.75, 95% CI -3.89 to 7.40; p = 0.16); and (c) early clinical failure criteria (score&lt;2: RD -2.38, 95% CI -5.0 to 0.23; score ≥2: RD -0.65, 95% CI -5.06 to 3.77; p = 0.24). Results were consistent across sensitivity analyses including imputation for missing data and restricting analyses to gram-negative BSI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The decision rules included in our analyses did not identify a subgroup of patients within BALANCE that would benefit from 14 (vs 7) days of treatment. 7-day treatment duration is sufficient for most patients with uncomplicated non-&lt;i&gt;S. aureus/lugdunensis&lt;/i&gt; BSI. Future research could explore data-driven machine-learning approaches to identify comprehensive combinations of patient characteristics that may guide individualised duration of antibiotic therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;The BALANCE trial was funded by the Canadian Institutes of Health Research, Health Research Council of New Zealand, Australian National Medical Research Council, Physicians Services Incorporated Ontario and Ontario Ministry of Health and Long-term Care Innovation Fund. SWXO conducted this study as part of his PhD studies, with funding from: the Emerging & Pandemic Infections Consortium (University of Toronto, Canada); Connaught International Scholarship (University of Toronto, Canada); the Queen Elizabeth II Graduate Scholarship in Science and Technology (QEII-GSST; Government of Ontario, Canada); and the Melbourne Research Scholarship (University of Melbourne, Australia). VML is ","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"83 ","pages":"103195"},"PeriodicalIF":9.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970145","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":"Efficacy and safety of online adaptive magnetic resonance-guided fractionated stereotactic radiotherapy for brain metastases in non-small cell lung cancer (GASTO-1075): a single-arm, phase 2 trial.","authors":"Shiyang Zheng, Shouliang Ding, Biaoshui Liu, Yixin Xiong, Rui Zhou, Pengxin Zhang, Fangjie Liu, Yimei Liu, Meining Chen, Yu Situ, Mengru Wang, Xiaoyan Huang, Shaohan Yin, Wenfeng Fang, Yonggao Mou, Bo Qiu, Daquan Wang, Hui Liu","doi":"10.1016/j.eclinm.2025.103189","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103189","url":null,"abstract":"<p><strong>Background: </strong>Brain metastases (BMs) in non-small cell lung cancer (NSCLC) are associated with poor prognosis and quality of life (QoL). This study aimed to evaluate the efficacy and safety of online adaptive MR-guided fractionated stereotactic radiotherapy (FSRT) using a 1.5 T MR-Linac in this subgroup of patients.</p><p><strong>Methods: </strong>This single-arm phase 2 trial was conducted at Sun Yat-sen University Cancer Centre. Patients aged 18-75 years with NSCLC, 1-10 BMs, and an ECOG status of 0-1 were included. Key exclusion criteria included inability to undergo contrast-enhanced MRI and contraindications to bevacizumab. Patients received 30 Gy adaptive FSRT in 5 daily fractions under real-time MR guidance, with bevacizumab before (day 1) and after (day 21) FSRT. The primary endpoint was 1-year intracranial progression-free survival (IPFS); secondary endpoints included objective response rate (ORR), 1-year progression-free survival (PFS), 1-year overall survival (OS), treatment-related toxicities, and QoL. All enrolled patients were included in primary and safety analyses. This trial is registered with Clinicaltrials.gov, NCT04946019.</p><p><strong>Findings: </strong>Between June 10th, 2021 and June 29th, 2023, 70 patients were assessed for eligibility and 55 patients were enrolled (median follow-up: 22.3 months). The median age was 58 years (IQR: 51-65), with 33% (18/55) female patients, and 82% (45/55) presenting with adenocarcinoma. The 1-year IPFS rate was 78.7% (95% CI, 68.2%-90.7%), with a median IPFS of 21.9 months (95% CI, 13.8-30.1 months). The 1-year PFS rate was 63.5% (95% CI: 51.8%-78.2%), and OS was 82.4% (95% CI: 72.6%-93.6%). The ORR reached 78% (95% CI: 65.0%-88.2%). Treatment-related toxicity was minimal, with only one case (2%) of grade 1 radiation necrosis. QoL improved steadily, with the Global Health Status score increasing from 65.67 ± 16.97 to 79.33 ± 8.79 at 6 months post FSRT (p < 0.0001).</p><p><strong>Interpretation: </strong>Online adaptive FSRT using a 1.5 T MR-Linac has demonstrated effectiveness and good tolerability for BMs in patients with NSCLC. However, the relatively small sample size and short follow-up may affect result generalizability. Further randomised studies are warranted to confirm these findings and establish optimal treatment protocols.</p><p><strong>Funding: </strong>The National Natural Science Foundation of China (Grant Number 82073328).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103189"},"PeriodicalIF":9.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996249","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 landscape and trends in lifetime risks of haematologic malignancies in 185 countries: population-based estimates from GLOBOCAN 2022.","authors":"Kexin Sun, Hongliang Wu, Qian Zhu, Kai Gu, Hui Wei, Shaoming Wang, Li Li, Chunxiao Wu, Ru Chen, Yi Pang, Bingfeng Han, Hongmei Zeng, Meicen Liu, Rongshou Zheng, Wenqiang Wei","doi":"10.1016/j.eclinm.2025.103193","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103193","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Haematologic malignancies accounted for 6.6% of total cancer cases and 7.2% of total cancer-related deaths worldwide in 2022. We implemented a novel approach to estimate the lifetime risk of developing and dying from various types of haematologic malignancies at the global, regional and country-specific perspectives in 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrieved incidence and mortality rates for Hodgkin lymphoma (HL), Non-Hodgkin lymphoma (NHL), multiple myeloma (MM) and leukaemia from GLOBOCAN 2022 of 185 countries, along with the national population statistics and all-cause mortality data sourced from the United Nations. For trend analysis, we obtained consecutive cancer registry data spanning from 2003 to 2017 from the Cancer Incidence in Five Continents (CI5) Plus database. After quality control, datasets from 30 countries were included. We used the \"adjusted for multiple primaries (AMP)\" method to calculate the lifetime risk of incidence (LRI) and mortality (LRM) by cancer type, selected age interval, sex, country and geographic region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In 2022, the global lifetime risk of incidence (LRI) and mortality (LRM) for all haematologic malignancies was 1.67% and 0.98%, respectively. LRI was highest for NHL, whereas the LRM was highest for leukaemia. On a general level, males exhibited higher LRI and LRM compared to females. Both LRI and LRM increased with higher Human Development Index (HDI) levels. The LRI and LRM for haematologic malignancies were notably high in regions such as Australia/New Zealand, Northen America, as well as Northen, Western and Southern Europe, whereas they were comparatively low in Middle, Western and Eastern Africa. We observed about 5-fold regional disparity in the LRI/LRM ratio for HL, ranging from 1.50 in Middle Africa to 7.67 in Western Europe. Individuals aged 60 and above still faced 71.26% and 78.57% remaining risks for developing and dying from all haematologic malignancies. Among the 185 countries studied, NHL was the haematologic malignancy with the highest LRI in 68.65% of the countries. However, leukaemia had the highest LRM in 58.92% of these countries. MM exhibited the highest LRI and LRM particularly in islands surrounding the Caribbean Sea. Out of 30 countries with eligible consecutive cancer surveillance data, 24 exhibited significant upward trends in LRI of all haematologic malignancies, with AAPCs ranging from 0.5% in USA to 4.3% in Latvia. 25 countries showed significant upward trends in LRM, with AAPCs ranging from 1.0% in USA to 5.5% in Republic of Korea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The global lifetime risks of haematologic malignancies exhibit considerable variations across different world regions, necessitating country-specific and targeted decision-making strategies. In contrast to traditional indicators, the compositive lifetime risks provide intuitive measures with profound public health implications, offering fres","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"83 ","pages":"103193"},"PeriodicalIF":9.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985468","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 trends in men's and women's acceptance of intimate partner violence, 1999-2022: an analysis of population-based survey data from 83 countries.","authors":"Irina Bergenfeld, Vince Nguyen, Katjana Wiederkehr, Alexandria R Hadd, Eva Portillo Molina, Cari Jo Clark, Robin A Richardson","doi":"10.1016/j.eclinm.2025.103199","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103199","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is a pervasive public health issue affecting women worldwide. Attitudes about the acceptability of IPV are correlated with IPV perpetration, experience, and help-seeking; therefore, monitoring trends in attitudes is an important way to track progress towards gender equality. This study presents the most comprehensive assessment of global trends in IPV acceptance to date.</p><p><strong>Methods: </strong>Using population-based surveys including 4.37 million women and 1.22 million men across 83 countries (1999-2022), we modeled average yearly changes in the percentage of women and men with permissive IPV attitudes at the country, world region, and global levels, as well as by age group (≤25 and > 25 years).</p><p><strong>Findings: </strong>Broad variation in the acceptability of IPV was observed in men's (range = 2%-85%) and women's attitudes (range = 2%-92%) across countries. Women tended to be more accepting than men at both earlier and more recent timepoints. On average, the percentage of individuals responding that IPV was acceptable in at least one circumstance decreased significantly over time for men (3.79% [-5.02%, -2.57%]/year) and women (6.80% [-7.83%, -5.77%]/year), with no substantive differences by age group.</p><p><strong>Interpretation: </strong>The acceptability of IPV has declined substantially in the last 20 years, especially among women. Heterogeneity in changes in IPV-related attitudes across countries suggests that pooled estimates should be interpreted cautiously and that national or subnational trends may be more informative. Future research should investigate specific country- and local-level factors that may be driving changes in IPV-supportive attitudes.</p><p><strong>Funding: </strong>Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R00HD104896).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"83 ","pages":"103199"},"PeriodicalIF":9.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984254","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 investment in health and cancer control to economic growth in Commonwealth countries.","authors":"Rifat Atun, Jan Ludwig Fries, Karla Hernandez-Villafuerte, Malina Müller, Dennis Ostwald, Maike Schmitt","doi":"10.1016/j.eclinm.2025.103180","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103180","url":null,"abstract":"<p><strong>Background: </strong>There are three broad mechanisms through which health investments yield economic benefits. First, health investments in cost-effective innovations help improve health outcomes and reduce healthcare costs in a health system. Second, investments in health can help improve health and wellbeing of individuals. A healthier population is economically more productive, with a longer productive life and reduced absenteeism and presenteeism. Third, an important but often-overlooked mechanism is the benefit of health investments on the broader economy through influences on supply and demand across various other sectors of a country's economy. We examine the third mechanism in selected Commonwealth countries.</p><p><strong>Methods: </strong>We provide an analysis and estimates of GVA growth and employment effects of the Health Economy for four Commonwealth countries, namely India, Nigeria, Malaysia and the United Kingdom in 2022. Drawing on a conservative 'static estimation approach', whose bases are on the Health Economy Reporting, to provide country-specific assessment of the return on investment in cancer services and cancer prevention in the UK, for which data are available, as an illustrative 'use case'. For cancer prevention, we examine investments in vaccination for Human Papilloma Virus.</p><p><strong>Findings: </strong>In our analysis, the Gross Value Added (GVA) generated by the Health Economy in the UK amounted to about US$295 billion (8.9% of GDP; the largest sector by size) in 2022, with around US$171 billion of GVA (5.2% of GDP) generated in adjacent sectors, and through these two effects generating additional induced consumption of US$217 billion of GVA (6.6% of GDP). In India, Malaysia, and Nigeria, in 2022, total GVA generated by the Health Economy, adjacent sectors and through induced income accounted for 9.9%, 9.8% and 7.0% of the GDP respectively. In the UK, US$134 million of investment in HPV vaccination generated US$247 million of GVA in total and 2000 jobs. Whereas in India US$756 million of investment in HPV vaccination produced US$ 1149 million in total GVA and generated 155,000 jobs.</p><p><strong>Interpretation: </strong>The assessment of four Commonwealth countries reveals that the Health Economy contributes substantially to economic growth and generates substantial employment. These contributions extend beyond the health sector itself, reaching adjacent sectors along the health value chain and inducing effects throughout the broader economy. Investment in cancer prevention generates high returns with substantial addictions to GVA and employment.</p><p><strong>Funding: </strong>No external funding. Self-funded by Harvard University and Wifor Institute.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103180"},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062842","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":"Correction to \"Utilization of colorectal cancer screening tests: a systematic review and time trend analysis of nationally representative data\" [EClinicalMedicine 75 (2024) 102783].","authors":"Idris Ola, Rafael Cardoso, Michael Hoffmeister, Hermann Brenner","doi":"10.1016/j.eclinm.2025.103179","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103179","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.eclinm.2024.102783.].</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"83 ","pages":"103179"},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976903","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":"Effectiveness of a systematic home-based albuminuria screening programme to detect chronic kidney disease in high-risk individuals in primary care (SALINE): a cross-sectional screening study.","authors":"Dominique van Mil, Lyanne Marriët Kieneker, Evelien Harms, Grietje Harmanna Prins, Iris van Geer-Postmus, Maaike Mepschen, Marika Teresa Leving, Nilouq Stoker, Jan Willem Herman Kocks, Ronald Teunis Gansevoort, Hiddo Jan Lambers Heerspink","doi":"10.1016/j.eclinm.2025.103185","DOIUrl":"https://doi.org/10.1016/j.eclinm.2025.103185","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although guidelines recommend opportunistic screening for chronic kidney disease (CKD) in individuals with established risk factors, such as diabetes, hypertension, or cardiovascular disease, screening for CKD in these individuals remains suboptimal. This study aimed to evaluate the effectiveness of a systematic home-based albuminuria screening program in primary care patients at risk for CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional screening study was performed in ten general practices and five pharmacies in the Netherlands from November 2021 to May 2024. A random selection of patients aged 45-80 years at risk for CKD based on risk factors registered in their electronic medical record was invited for home-based albuminuria screening using a urine collection device for measurement of the urinary albumin-to-creatinine ratio (ACR). In those patients with confirmed increased albuminuria (ACR ≥3 mg/mmol), an elaborate screening to assess the presence of CKD and cardiovascular risk factors was performed, followed by a referral to their general practitioner (GP) for evaluation of the findings. The primary outcome was the yield of the home-based albuminuria screening and elaborate screening to detect increased albuminuria in the GP and the pharmacy setting. SALINE is registered with ClinicalTrials.gov, NCT05321095.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In total, 6380 patients (3802 via ten GPs and 2578 via five pharmacies) were invited for home-based albuminuria screening. The participation rate was 40·1% among patients invited via their GP (1524/3802), compared to 21·8% (562/2578) among those invited via their pharmacy (P &lt; 0·001). In total, 8·7% of the GP participants had confirmed increased albuminuria (133/1524), compared to 6·0% of the pharmacy participants (34/562). Of the 115 GP participants with detected increased albuminuria who completed the elaborate screening, 102 (88·7%) were identified with one or more newly diagnosed CKD or cardiovascular risk factor(s) (n = 46, 40·0%), or with a known risk factor that was outside the target range for treatment (n = 75, 65·2%). Of the pharmacy participants with detected increased albuminuria completing the home-based screening, 26 completed the elaborate screening. Of those, 22 (84·6%) were identified with one or more newly diagnosed CKD or cardiovascular risk factor(s) (n = 6, 2·3%), or with a known risk factor that was outside the target range for treatment (n = 21, 80·8%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Systematic albuminuria screening of patients at risk for CKD in primary care, when performed in addition to regular opportunistic screening, has an acceptable participation rate and yield when performed via GPs, whereas it is less effective when performed via pharmacies. Such a screening program identifies patients with yet unknown albuminuria who may benefit from starting or optimizing kidney and cardioprotective treatment. The introduction of such systemati","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"82 ","pages":"103185"},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958911","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}