EClinicalMedicine最新文献

{"title":"Outcomes of endometrial cancer prevention strategies in patients with Lynch syndrome: a nationwide cohort study in the Netherlands.","authors":"Ellis L Eikenboom, Lotte van Leeuwen, Floris Groenendijk, Jorien M Woolderink, Anne M Van Altena, Monique E Van Leerdam, Manon C W Spaander, Helena C van Doorn, Anja Wagner","doi":"10.1016/j.eclinm.2024.103006","DOIUrl":"10.1016/j.eclinm.2024.103006","url":null,"abstract":"<p><strong>Background: </strong>Female Lynch syndrome carriers have an increased risk of developing endometrial cancer. Regardless, research on endometrial carcinoma tumorigenesis is scarce and no uniform, evidence-based gynaecological management guidelines exist. We therefore described gynaecological surveillance and surgery outcomes in a nation-wide Lynch syndrome cohort.</p><p><strong>Methods: </strong>For this retrospective cohort study, female Lynch syndrome carriers, prospectively registered in the Dutch Lynch syndrome database (StOET), were included up to February 28th 2022. Carriers were linked to the Dutch national pathology (PALGA) database. The number of carriers with/without gynaecological surveillance, number of index carriers with endometrial carcinoma before Lynch syndrome diagnosis were assessed, as well as uptake of risk-reducing surgery and characteristics of endometrial carcinomas including the requisite for adjuvant therapy according to current guidelines. Overall survival after endometrial carcinoma diagnosis was analyzed using Kaplan Meier time to event analyses, cumulative incidence was calculated after adjusting for competing risks (death and prophylactic hysterectomy).</p><p><strong>Findings: </strong>In total, 1046 registered female Lynch syndrome carriers were eligible for surveillance, of whom 313 (30.0%) did not have surveillance and 21.4% (n = 224 of 1046) opted for prophylactic hysterectomy. In carriers with surveillance, more cases of endometrial carcinoma and hyperplasia were found than in those without (37 endometrial carcinomas (7.3%) and 28 hyperplasias (5.5%) in 506 carriers with surveillance versus 14 (2.6%) and 4 (0.7%) in 540 carriers without surveillance, respectively); carriers with surveillance were generally younger than those without (median 56 years [IQR 48-65] versus median 65 years [IQR 49-75] at database assembly, respectively; p < 0.0001). Endometrial carcinomas were predominantly of endometrioid type and FIGO stage IA, regardless of surveillance. Adjuvant external beam radiotherapy was required in one patient in both groups. Overall survival after endometrial carcinoma diagnosis did not differ between carriers with or without surveillance or carriers with endometrial carcinoma before LS diagnosis (p = 0.51). For all endometrial carcinomas together, including index carriers, cumulative incidence was 22.7% at age 70.</p><p><strong>Interpretation: </strong>In a nation-wide cohort of Lynch syndrome carriers, nearly one-third of eligible carriers did not undergo gynaecological surveillance. Endometrial carcinomas diagnosed during surveillance were slightly more often stage FIGO IA, but this did not seem to substantially decrease the requisite for adjuvant therapy or affect overall survival, questioning effectiveness of current gynaecological management. Prospective research should further assess this, as well as patient preferences.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103006"},"PeriodicalIF":9.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002132","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":"The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review.","authors":"Susanna S van Wyk, Ntombifuthi Blose, Lester Kapanda-Phiri, Mareli Claassens, Taryn Young","doi":"10.1016/j.eclinm.2024.103010","DOIUrl":"10.1016/j.eclinm.2024.103010","url":null,"abstract":"<p><p>This systematic review evaluated the effectiveness of community-wide screening for pulmonary tuberculosis (TB) in high-burden areas by analysing randomised controlled trials (RCTs). The review focused on interventions offering TB screening to entire communities, comparing them to standard care or alternative approaches. The main outcome assessed was microbiologically confirmed TB diagnoses, including rates and prevalence. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, WHO Global Index Medicus, Web of Science, and trial registries up to 27 May 2024, without language restrictions. Screening, data extraction, and risk of bias assessment were done in duplicate. Results were not pooled. Certainty of the evidence was assessed using GRADE. PROSPERO: CRD42023453356. We included six cluster-RCTs after screening 2460 titles/abstracts and 86 full-text articles. The evidence for symptom screening was very uncertain. We found that sputum smear microscopy screening may result in little to no difference in the prevalence of culture-confirmed TB (n = 962,655, RR 1.09; 95% CI: 0.86-1.38, 1 RCT, low certainty evidence). Community-wide nucleic acid amplification test (NAAT) screening probably reduces the prevalence of NAAT-positive TB (n = 105,108, RR 0.56; 95% CI: 0.40-0.78, 1 RCT, moderate certainty evidence). Community-wide screening for pulmonary TB may reduce TB prevalence if done annually with an accurate screening test and high coverage.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103010"},"PeriodicalIF":9.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982598","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":"Beyond bronchial thermoplasty - where to now?","authors":"Peter B Noble, David Langton, Chuan T Foo, Bruce R Thompson, Alvenia Cairncross, Michael J Hackmann, Francis Thien, Graham M Donovan","doi":"10.1016/j.eclinm.2024.103017","DOIUrl":"10.1016/j.eclinm.2024.103017","url":null,"abstract":"<p><p>With the impending 'retirement' of bronchial thermoplasty (BT) for the treatment of patients with asthma, there is much to learn from this real-world experiment that will help us develop more effective future therapies with the same primary target i.e., airway smooth muscle (ASM) remodelling. This viewpoint discusses initial controversy surrounding BT (lack of an effect on forced expiratory volume in 1 s), its underutilisation, and importantly how non-standard diagnostics successfully demonstrated therapeutic response which escaped traditional lung function metrics. It is anticipated that the next iteration of BT (likely in a drug form) will have an overall greater effect on the health care system by virtue of evoking ASM remodelling as a treatable trait, and after appropriately drawing on lessons learned from the ∼fifteen-year BT saga.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103017"},"PeriodicalIF":9.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983081","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":"Effects of non-pharmacological interventions on depressive and anxiety symptoms in pregnant women: a systematic review and network meta-analysis.","authors":"Guowei Zeng, Jianfeng Niu, Ke Zhu, Fei Li, Liwen Li, Kaiming Gao, Yanlong Zhuang, Boyang Zhang, Xiaoqiang Han, Gang Ye, Zhikun Gao, Haobai Li","doi":"10.1016/j.eclinm.2024.103011","DOIUrl":"10.1016/j.eclinm.2024.103011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Given the distinctive physiological characteristics of pregnant women, non-pharmacological therapies are increasingly being used to improve depressive and anxiety symptoms. Our objective was to explore and compare the impact of various non-pharmacological interventions in improving depressive and anxiety symptoms, and to identify the most effective strategies for pregnant women with depressive and/or anxiety symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) that compared non-pharmacological interventions to usual care, from the inception of each database up to October 5, 2024. We included pregnant women with singleton pregnancies who, at baseline, exhibited early signs of depressive and/or anxiety symptoms but did not meet clinical diagnostic criteria or exceed the threshold for clinically significant symptoms. We excluded pregnant women diagnosed with schizophrenia, bipolar disorder, or severe acute psychiatric conditions, those with a history of substance abuse, and those undergoing in vitro fertilisation. We performed both pairwise meta-analyses and random-effects network meta-analyses (NMAs), calculating standardised mean differences (SMDs) with 95% credible intervals (CrI). We used the surface under the cumulative ranking probability curve (SUCRA) to estimate treatment ranking probabilities. The outcomes were assessed in two groups of participants: a high-risk pregnancy group, including pregnant women with depressive and/or anxiety symptoms and high-risk pregnancies (defined as having a history of miscarriage, pregnancy complications such as gestational hypertension, gestational diabetes mellitus, or preeclampsia, and advanced maternal age (i.e., over 35 years old); and a healthy group, including participants who exhibited depressive and/or anxiety symptoms only during pregnancy and did not have other high-risk pregnancy conditions or underlying health issues. This study is registered with PROSPERO, CRD42024523053.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We included 101 studies (92 RCTs and 9 quasi-RCTs) involving a total of 15,330 participants across 11 interventions (mindfulness, education, counseling, cognitive behavioral therapy, muscle acupoint therapy, relaxation, mind-body exercise, psychotherapy, foetal movement counting, physical exercise, and music). Among the studies included in this analysis, 73 studies exhibited a low risk of bias, 9 studies had an unclear risk of bias, and 19 studies demonstrated a high risk of bias. The results indicate that, for both high-risk pregnancy population and healthy populations, mindfulness therapy was found to be an effective non-pharmacological treatment for significantly improving depressive and anxiety symptoms in pregnant women compared with control groups. For pregnant women with depressive symptoms, mindfulness therapy (SUCRA = 80%; SMD = -0.86,","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103011"},"PeriodicalIF":9.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970148","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":"Maternal and neonatal complications of pregnant women with bipolar disorder: a systematic review and meta-analysis.","authors":"Damien Etchecopar-Etchart, Masoud Rahmati, Dong Keon Yon, Lee Smith, Laurent Boyer, Guillaume Fond","doi":"10.1016/j.eclinm.2024.103007","DOIUrl":"10.1016/j.eclinm.2024.103007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Confidence in pregnancy outcome data for women with bipolar disorder is compromised by small cohort sizes. However, comprehensive national data have been published over the last decade, but no quantitative synthesis has been established to determine the factors associated with complications in these women. Our goal is to summarise the evidence of population-based data on obstetric complications and neonatal outcomes in women with bipolar disorder compared to women without bipolar disorder.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive search was conducted of PubMed/MEDLINE, Embase, PsycINFO, Web of Science, and Google Scholar from inception to September 26th, 2024. Thirty-six outcomes were extracted from eligible articles for consideration. The study protocol was registered on PROSPERO (CRD42023369031).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Fourteen population-based retrospective cohort studies from six high-income countries (Australia, Canada, Hong-Kong, Sweden, Taiwan, and USA) involving 47,954 women with bipolar disorder and their newborns compared to 11,896,577 women without bipolar disorder, published between 2005 and 2024, were identified. During pregnancy, women with bipolar disorders seemed to exhibit an increased risk of gestational diabetes OR = 1.46, (95% Confidence Interval [1.06-2.03]; I&lt;sup&gt;2&lt;/sup&gt; = 87%), gestational hypertension OR = 1.19 (95% CI [1.02-1.40]; I&lt;sup&gt;2&lt;/sup&gt; = 41%), antepartum haemorrhage OR = 2.02 (95% CI [1.30-3.13]; I&lt;sup&gt;2&lt;/sup&gt; = 67%), and pre-eclampsia or eclampsia OR = 1.20 (95% CI [1.05-1.36]; I&lt;sup&gt;2&lt;/sup&gt; = 67%). At delivery, women with bipolar disorder were observed to face a higher risk of caesarean section OR = 1.35 (95% CI [1.26-1.45]; I&lt;sup&gt;2&lt;/sup&gt; = 56%), and postpartum haemorrhage OR = 1.39 (95% CI [1.20-1.62]; I&lt;sup&gt;2&lt;/sup&gt; = 0%). Their newborns also appear to be at high risks of very prematurity OR = 1.84 (95% CI [1.32-2.57]; I&lt;sup&gt;2&lt;/sup&gt; = 74%), infant death OR = 1.77 (95% CI [1.01-3.13]; I&lt;sup&gt;2&lt;/sup&gt; = 41%), low birth weight OR = 1.54 (95% CI [1.19-1.99]; I&lt;sup&gt;2&lt;/sup&gt; = 70%), preterm birth OR = 1.49 (95% CI [1.29-1.72]; I&lt;sup&gt;2&lt;/sup&gt; = 87%), small for gestational age OR = 1.28 (95% CI [1.14-1.45]; I&lt;sup&gt;2&lt;/sup&gt; = 57%), and congenital malformations OR = 1.29 (95% CI [1.09-1.53]; I&lt;sup&gt;2&lt;/sup&gt; = 42%). According to the AMSTAR 2 tool, these results correspond to moderate-quality evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Despite substantial heterogeneity observed, our findings suggest the presence of a broad spectrum of complications that may affect both pregnant women with bipolar disorder and their newborns. These results can serve as a basis for the development of guidelines for the prevention and management of these complications. We need additional data from other countries, particularly from low-to-moderate income countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103007"},"PeriodicalIF":9.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969989","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 biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials.","authors":"Sabri Soussi, Tuukka Tarvasmäki, Antoine Kimmoun, Mojtaba Ahmadiankalati, Feriel Azibani, Claudia C Dos Santos, Kevin Duarte, Etienne Gayat, Jacob C Jentzer, Veli-Pekka Harjola, Benjamin Hibbert, Christian Jung, Lassus Johan, Bruno Levy, Zihang Lu, Patrick R Lawler, John C Marshall, Janine Pöss, Malha Sadoune, Alexis Nguyen, Alexandre Raynor, Katell Peoc'h, Holger Thiele, Rebecca Mathew, Alexandre Mebazaa","doi":"10.1016/j.eclinm.2024.103013","DOIUrl":"10.1016/j.eclinm.2024.103013","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a heterogeneous clinical syndrome, making it challenging to predict patient trajectory and response to treatment. This study aims to identify biological/molecular CS subphenotypes, evaluate their association with outcome, and explore their impact on heterogeneity of treatment effect (ShockCO-OP, NCT06376318).</p><p><strong>Methods: </strong>We used unsupervised clustering to integrate plasma biomarker data from two prospective cohorts of CS patients: CardShock (N = 205 [2010-2012, NCT01374867]) and the French and European Outcome reGistry in Intensive Care Units (FROG-ICU) (N = 228 [2011-2013, NCT01367093]) to determine the optimal number of classes. Thereafter, a simplified classifier (Euclidean distances) was used to assign the identified CS subphenotypes in three completed randomized controlled trials (RCTs) (OptimaCC, N = 57 [2011-2016, NCT01367743]; DOREMI, N = 192 [2017-2020, NCT03207165]; and CULPRIT-SHOCK, N = 434 [2013-2017, NCT01927549]) and explore heterogeneity of treatment effect with respect to 28-day mortality (primary outcome).</p><p><strong>Findings: </strong>Four biomarker-driven CS subphenotypes ('adaptive', 'non-inflammatory', 'cardiopathic', and 'inflammatory') were identified separately in the two cohorts. Patients in the inflammatory and cardiopathic subphenotypes had the highest 28-day mortality (p (log-rank test) = 0.0099 and 0.0055 in the CardShock and FROG-ICU cohorts, respectively). Subphenotype membership significantly improved risk stratification when added to traditional risk factors including the Society for Cardiovascular Angiography and Interventions (SCAI) shock stages (increase in Harrell's C-index by 4% (<i>p</i> = 0.033) and 6% (<i>p</i> = 0.0068) respectively in the CardShock and the FROG-ICU cohorts). The simplified classifier identified CS subphenotypes with similar biological/molecular and outcome characteristics in the three independent RCTs. No significant interaction was observed between treatment effect and subphenotypes.</p><p><strong>Interpretation: </strong>Subphenotypes with the highest concentration of biomarkers of endothelial dysfunction and inflammation (inflammatory) or myocardial injury/fibrosis (cardiopathic) were associated with mortality independently from the SCAI shock stages.</p><p><strong>Funding: </strong>Dr Sabri Soussi was awarded the Canadian Institutes of Health Research (CIHR) Doctoral Foreign Study Award (DFSA) and the Merit Awards Program (Department of Anesthesiology and Pain Medicine, University of Toronto, Canada) for the current study.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"103013"},"PeriodicalIF":9.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969313","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":"Interventions used to reduce infectious aerosol concentrations in hospitals-a review.","authors":"Gráinne Brady, Fiona Bennin, Rosaline De Koning, Cecilia Vindrola-Padros, Sigrún Eyrúnardóttir Clark, Manish K Tiwari, Simon Watt, Andrea Ducci, Ryo Torii, Danielle Morris, Elizabeth Lloyd-Dehler, Jerry Slann, Fiona Stevenson, Zarnie Khadjesari, Hakim-Moulay Dehbi, Lena Ciric, Ruth Epstein, John Rubin, Catherine F Houlihan, Rachael Hunter, Laurence B Lovat","doi":"10.1016/j.eclinm.2024.102990","DOIUrl":"10.1016/j.eclinm.2024.102990","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic highlighted the need for improved infectious aerosol concentrations through interventions that reduce the transmission of airborne infections. The aims of this review were to map the existing literature on interventions used to improve infectious aerosol concentrations in hospitals and understand challenges in their implementation.</p><p><strong>Methods: </strong>We reviewed peer-reviewed articles identified on three databases, MEDLINE, Web of Science, and the Cochrane Library from inception to July 2024. 6417 articles were identified, 160 were reviewed and 18 were included.</p><p><strong>Findings: </strong>Results on aerosol concentration were discussed in terms of three categories: (1) filtration and inactivation of aerosol particles; (2) effect of airflow and ventilation on aerosol concentrations; and (3) improvements or reduction in health conditions. The most common device or method that was outlined by researchers was high efficiency particulate air (HEPA) filters which were able to reduce aerosol concentrations under investigation across the included literature. Some articles were able to demonstrate the effectiveness of interventions in terms of improving health outcomes for patients.</p><p><strong>Interpretation: </strong>The key finding is that infectious aerosol concentration improvement measures based on filtration, inactivation, improved air flow dynamics, and ventilation reduce the likelihood of nosocomial infections. However limitations of such approaches must be considered such as noise pollution and effects on ambient humidity. Whilst these efforts can contribute to improved air quality in hospitals, they should be considered with the other interacting factors such as microclimates, room dimensions and use of chemical products that effect air quality.</p><p><strong>Funding: </strong>This study is funded by the National Institute for Health and Care Research (NIHR) (NIHR205439).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"102990"},"PeriodicalIF":9.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969842","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 trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study.","authors":"Soeun Kim, Hayeon Lee, Selin Woo, Hyeri Lee, Jaeyu Park, Tae Kim, Guillaume Fond, Laurent Boyer, Masoud Rahmati, Lee Smith, Guillermo F López Sánchez, Elena Dragioti, Christa J Nehs, Jinseok Lee, Hyeon Jin Kim, Jiseung Kang, Dong Keon Yon","doi":"10.1016/j.eclinm.2024.102985","DOIUrl":"10.1016/j.eclinm.2024.102985","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Drug use disorder (DUD) poses a major public health crisis globally, necessitating immediate attention to global trends and future projections to develop effective health policies and interventions. Thus, we aimed to estimate the global trends in DUD mortality rates from 1990 to 2021 and future projections of DUD deaths until 2040 across 73 countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this time-series analysis and modelling study, we investigated the global trends in DUD mortality rates from 1990 to 2021 using the WHO Mortality Database and forecasted future trends through 2040. Global trend analysis was analysed using a locally weighted scatter plot smoother (LOESS) curve, and future projections were calculated based on a Bayesian age-period-cohort analysis. In addition, we performed a decomposition analysis to identify the variations in DUD deaths, specifically examining factors such as population growth, ageing, and epidemiological changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Of the 73 countries included in the analysis of DUD mortality, 45 were high-income countries (HICs), and 28 were low to middle-income countries (LMICs). The LOESS estimates of the global DUD mortality rate were 1.84 deaths per 1,000,000 people (95% CI, -0.44 to 4.12) in 1990 and 13.09 deaths per 1,000,000 people (95% CI, 10.74-15.43) in 2021. Notably, HICs showed a significant increase in DUD mortality from 1.43 deaths per 1,000,000 people (95% CI, -1.55 to 4.42) in 1990 to 17.19 deaths per 1,000,000 people (95% CI, 13.84-20.53) in 2021. A significant increase in DUD mortality was observed among individuals aged 25-64 and males. Our analysis also identified associations between DUD mortality rates and several log-transformed parameters, including Human Development Index (β, 14.92; p &lt; 0.0001), Socio-demographic Index (β, 11.80; p &lt; 0.0001), reverse Gender Gap Index (β, -12.02; p &lt; 0.0001), and Gini coefficient (β, -1.84; p &lt; 0.0001). From 1990 to 2021, the increase in the number of DUD deaths globally can be attributed to two prominent factors: epidemiological change and population growth. In HICs, the impacts of epidemiological changes for increasing DUD mortality rates were particularly prominent compared to other factors. In the Bayesian age-period-cohort models, the predicted number of global DUD deaths up to 2040 were estimated to increase from 25.95 deaths per 1,000,000 people (95% credible interval [CrI], 24.72-27.28) in 2021 to 38.45 (95% CrI, 30.48-49.33) in 2030, and 42.43 (95% CrI, 23.67-77.77) in 2040.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;An increasing trend in global DUD mortality was observed from 1990 to 2021, especially in HICs. Future DUD deaths were also predicted to increase until 2040 at the global level. Therefore, these findings suggest urgent and proactive strategies for DUD to reduce the mortality rates related to DUD are needed. However, further prospective research that accounts for potential confounding factors, s","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"102985"},"PeriodicalIF":9.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969048","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 assessment of leukemia care quality: insights from the quality of care index (QCI) from 1990 to 2021.","authors":"Yuzhe Pan, Qian Liu, Nan Zhang, Shuang Peng, Xinqi Li, Fuling Zhou","doi":"10.1016/j.eclinm.2024.102996","DOIUrl":"10.1016/j.eclinm.2024.102996","url":null,"abstract":"<p><strong>Background: </strong>While advancements in leukemia care have been made, the global quality of care remains a concern. This study utilizes a modified quality of care index (QCI) to assess the global status of leukemia care.</p><p><strong>Methods: </strong>We analyzed data from the global burden of disease (GBD) study spanning 1990-2021. The QCI was constructed using principal component analysis, based on the weighted variances of key indicators. We compared the original QCI with our modified version, analyzed QCI trends across different age groups and leukemia subtypes, identified key influencing factors using linear mixed models (LMM), and used spatial autocorrelation analysis to verify the autocorrelation of the socio-demographic index (SDI) region. Then we employed the bayesian age-period-cohort (BAPC) model to predict future QCI trends.</p><p><strong>Findings: </strong>Between 1990 and 2021, both the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) for leukemia exhibited a consistent decline. Our modified QCI method outperformed the original approach, particularly when the variance explained by the first principal component was below 80%, demonstrating higher correlation with the healthcare access and quality index (HAQI) (Pearson r = 0.91 vs. 0.89) and improved explanatory power (R² = 0.82 vs. 0.79). Over past three decades, QCI was highest in San Marino (97.72%) and lowest in Fiji (3.51%), with significant regional variations across SDI levels (<i>F</i> = 133.40, <i>p</i> < 2e-16). High-SDI regions had the highest QCI (78.50%; 95% confidence interval: 77.20%, 79.70%). QCI trends varied by age, peaking at 94.49% in the 15-19 age group in 2021 and declining to 0.44% in the 75-79 age group. LMM analysis identified sex, age, year, SDI region, and leukemia subtype as significant QCI determinants. Spatial autocorrelation analysis confirmed positive autocorrelation within SDI regions (Global <i>Moran's I</i> = 0.87, <i>p</i> < 2e-16). Projections suggest a generally fluctuating upward trend in QCI for leukemia, reaching 79.58% by 2046.</p><p><strong>Interpretation: </strong>The QCI serves as an effective metric for evaluating the quality of leukemia care. Our findings reveal a strong association between leukemia QCI and regional economic and educational development. Age is a critical factor, with an aging population contributing to a potential decline in QCI. These results underscore the urgent need for targeted interventions to enhance health services for older adults and to improve care quality in economically disadvantaged regions.</p><p><strong>Funding: </strong>This study was supported by the National Natural Science Foundation of China (General Program) (No. 82370176) and the Key Research and Development Program of Hubei Province (No. CZKYXM2023036JZ).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"102996"},"PeriodicalIF":9.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970076","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 of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis.","authors":"Dimitra V Pouliopoulou, Nicole Billias, Joy C MacDermid, Erin Miller, Kelly K O'Brien, Kieran L Quinn, Monali S Malvankar-Mehta, Tiago V Pereira, Angela M Cheung, Fahad Razak, Saverio Stranges, Pavlos Bobos","doi":"10.1016/j.eclinm.2024.102993","DOIUrl":"10.1016/j.eclinm.2024.102993","url":null,"abstract":"<p><strong>Background: </strong>Given the chronic immune activation and inflammatory milieu associated with Long COVID and HIV, we assessed the prevalence of Long COVID in adults living with HIV; and investigated whether adults living with HIV were associated with increased chance of developing Long COVID compared to adults living without HIV.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched Medline, EMBASE, CINHAL, PubMed and CENTRAL from inception until June 14th, 2024, for observational studies that measured the prevalence of Long COVID in adults living with HIV and the odds of developing Long COVID following a SARS-CoV-2 infection in people living with HIV compared to people living without HIV. Reviews, case reports, randomised control trials and editorials were excluded. The search was conducted without language restrictions. We performed meta-analysis of proportions to synthesise prevalence estimates using logit transformation and a sensitivity analysis using mixed-effects logistic regression. We used random-effects meta-analyses to summarize the odds ratio (OR) of developing Long COVID in adults living with HIV compared to adults living without HIV and conducted a sensitivity analysis including only studies with covariate-adjusted estimates that was planned a-priori. We used ROBINS-E for the risk of bias assessment and GRADE to rate the certainty of evidence. We identified statistical heterogeneity using Cochran's Q test and quantified it using the I² statistic. For the Q test, a <i>P</i> < 0.10 was considered statistically significant. PROSPERO registration: CRD42024577616.</p><p><strong>Findings: </strong>Our search returned 831 results, of which 8 studies (4489 participants) were deemed eligible for inclusion in the systematic review and meta-analysis. The prevalence of Long COVID in adults with HIV was 43% (95% CI: 32-54%, 8 studies; 1227 participants; low certainty, I² < 0.0001). The association of HIV status with Long COVID was inconclusive, with wide confidence intervals (OR: 1.16, 95% CI: 0.58-2.29; 4 studies; 3556 participants, low certainty, I² = 0.013). When the analysis was restricted to studies reporting covariate-adjusted estimates, adults living with HIV were associated with a higher odds of Long COVID than those not living with HIV (OR: 2.21, 95% CI: 1.12-4.36; 2 studies; 374 participants, low certainty, I² = 0.51).</p><p><strong>Interpretation: </strong>Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"79 ","pages":"102993"},"PeriodicalIF":9.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969994","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}