Nature Medicine最新文献

{"title":"Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial","authors":"Philippa A. Garety, Clementine J. Edwards, Hassan Jafari, Richard Emsley, Mark Huckvale, Mar Rus-Calafell, Miriam Fornells-Ambrojo, Andrew Gumley, Gillian Haddock, Sandra Bucci, Hamish J. McLeod, Jeffrey McDonnell, Moya Clancy, Michael Fitzsimmons, Hannah Ball, Alice Montague, Nikos Xanidis, Amy Hardy, Thomas K. J. Craig, Thomas Ward","doi":"10.1038/s41591-024-03252-8","DOIUrl":"https://doi.org/10.1038/s41591-024-03252-8","url":null,"abstract":"<p>Distressing voices are a core symptom of psychosis, for which existing treatments are currently suboptimal; as such, new effective treatments for distressing voices are needed. AVATAR therapy involves voice-hearers engaging in a series of facilitated dialogues with a digital embodiment of the distressing voice. This randomized phase 2/3 trial assesses the efficacy of two forms of AVATAR therapy, AVATAR-Brief (AV-BRF) and AVATAR-Extended (AV-EXT), both combined with treatment as usual (TAU) compared to TAU alone, and conducted an intention-to-treat analysis. We recruited 345 participants with psychosis; data were available for 300 participants (86.9%) at 16 weeks and 298 (86.4%) at 28 weeks. The primary outcome was voice-related distress at both time points, while voice severity and voice frequency were key secondary outcomes. Voice-related distress improved, compared with TAU, in both forms at 16 weeks but not at 28 weeks. Distress at 16 weeks was as follows: AV-BRF, effect −1.05 points, 96.5% confidence interval (CI) = −2.110 to 0, <i>P</i> = 0.035, Cohen’s <i>d</i> = 0.38 (CI = 0 to 0.767); AV-EXT −1.60 points, 96.5% CI = −3.133 to −0.058, <i>P</i> = 0.029, Cohen’s <i>d</i> = 0.58 (CI = 0.021 to 1.139). Distress at 28 weeks was: AV-BRF, −0.62 points, 96.5% CI = −1.912 to 0.679, <i>P</i> = 0.316, Cohen’s <i>d</i> = 0.22 (CI = −0.247 to 0.695); AV-EXT −1.06 points, 96.5% CI = −2.700 to 0.586, <i>P</i> = 0.175, Cohen’s <i>d</i> = 0.38 (CI = −0.213 to 0.981). Voice severity improved in both forms, compared with TAU, at 16 weeks but not at 28 weeks whereas frequency was reduced in AV-EXT but not in AV-BRF at both time points. There were no related serious adverse events. These findings provide partial support for our primary hypotheses. AV-EXT met our threshold for a clinically significant change, suggesting that future work should be primarily guided by this protocol. ISRCTN registration: ISRCTN55682735.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"47 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142519898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using AVATAR therapy to conquer auditory hallucinations","authors":"Merete Nordentoft","doi":"10.1038/s41591-024-03312-z","DOIUrl":"https://doi.org/10.1038/s41591-024-03312-z","url":null,"abstract":"AVATAR therapy, in which patient and therapist interact with a digital embodiment of patients’ auditory hallucinations, effectively reduces distress and symptom frequency, which could be a game-changer for patients.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"61 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142519899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Correction: Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes","authors":"Muthiah Vaduganathan, Gerasimos Filippatos, Brian L. Claggett, Akshay S. Desai, Pardeep S. Jhund, Alasdair Henderson, Meike Brinker, Peter Kolkhof, Patrick Schloemer, James Lay-Flurrie, Prabhakar Viswanathan, Carolyn S. P. Lam, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faiez Zannad, Peter Rossing, Luis M. Ruilope, Stefan D. Anker, Bertram Pitt, Rajiv Agarwal, John J. V. McMurray, Scott D. Solomon","doi":"10.1038/s41591-024-03372-1","DOIUrl":"https://doi.org/10.1038/s41591-024-03372-1","url":null,"abstract":"<p>Correction to: <i>Nature Medicine</i> https://doi.org/10.1038/s41591-024-03264-4, published online 1 September 2024.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"63 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142519897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political polarization and health","authors":"Jay J Van Bavel,&nbsp;Shana Kushner Gadarian,&nbsp;Eric Knowles,&nbsp;Kai Ruggeri","doi":"10.1038/s41591-024-03307-w","DOIUrl":"10.1038/s41591-024-03307-w","url":null,"abstract":"In addition to social determinants of health, such as economic resources, education, access to care and various environmental factors, there is growing evidence that political polarization poses a substantial risk to individual and collective well-being. Here we review the impact of political polarization on public health. We describe the different forms of polarization and how they are connected to health outcomes, highlighting the COVID-19 pandemic as a case study of the health risks of polarization. We then offer strategies for mitigating potential harms associated with polarization, with an emphasis on building social trust. Finally, we propose future research directions on this topic, underscore the need for more work in a global context and encourage greater collaboration between social scientists and medical scientists. We conclude that polarization is a serious—if largely overlooked—determinant of health, whose impacts must be more thoroughly understood and mitigated. Political polarization is an understudied determinant of health. This Review describes the types of political polarization and how they impact the health of populations and individuals, including potential mitigation strategies and research priorities.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 11","pages":"3085-3093"},"PeriodicalIF":58.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41591-024-03307-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489886","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":"How health technology can ease the terrible toll of war","authors":"Natalie Healey","doi":"10.1038/s41591-024-03335-6","DOIUrl":"10.1038/s41591-024-03335-6","url":null,"abstract":"Trauma and infections increase during war, while routine cancer care is disrupted, but telemedicine, AI chatbots and electronic health records can help.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 11","pages":"3032-3035"},"PeriodicalIF":58.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41591-024-03335-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489909","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":"Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial","authors":"Ellen M. Apperloo, Jose L. Gorriz, Maria Jose Soler, Secundino Cigarrán Guldris, Josep M. Cruzado, Maria Jesús Puchades, Marina López-Martínez, Femke Waanders, Gozewijn D. Laverman, Annemarie van der Aart-van der Beek, Klaas Hoogenberg, André P. van Beek, Jacobien Verhave, Sofia B. Ahmed, Roland E. Schmieder, Christoph Wanner, David Z. I. Cherney, Niels Jongs, Hiddo J. L. Heerspink","doi":"10.1038/s41591-024-03327-6","DOIUrl":"https://doi.org/10.1038/s41591-024-03327-6","url":null,"abstract":"<p>Semaglutide reduces albuminuria and the risk of kidney disease progression in patients with type 2 diabetes and chronic kidney disease (CKD). We conducted a randomized placebo-controlled double-blind clinical trial in adults with CKD (estimated glomerular filtration rate (eGFR) ≥25 ml min⁻¹ 1.73 m⁻² and urine albumin-to-creatinine ratio (UACR) ≥30 and &lt;3,500 mg g⁻¹) and body mass index ≥27 kg m⁻². Participants were randomized to semaglutide 2.4 mg per week or placebo. The primary endpoint was percentage change from baseline in UACR at week 24. Safety was monitored throughout. Overall, 125 participants were screened, of whom 101 were randomized to semaglutide (<i>n</i> = 51) or placebo (<i>n</i> = 50). Mean age was 55.8 (s.d. 12) years; 40 participants (39.6%) were female; median UACR was 251 mg g⁻¹ (interquartile range 100, 584); mean eGFR was 65.0 (s.d. 25) ml min⁻¹ 1.73 m⁻²; and mean body mass index was 36.2 (s.d. 5.6) kg m⁻². Chronic glomerulonephritis (<i>n</i> = 25) and hypertensive CKD (<i>n</i> = 27) were the most common CKD etiologies. Treatment for 24 weeks with semaglutide compared to placebo reduced UACR by −52.1% (95% confidence interval −65.5, −33.4; <i>P</i> &lt; 0.0001). Gastrointestinal adverse events were more often reported with semaglutide (<i>n</i> = 30) than with placebo (<i>n</i> = 15). Semaglutide treatment for 24 weeks resulted in a clinically meaningful reduction in albuminuria in patients with overweight/obesity and non-diabetic CKD. ClinicalTrials.gov registration: NCT04889183.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"212 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclassification of obesity for precision prediction of cardiometabolic diseases","authors":"Daniel E. Coral, Femke Smit, Ali Farzaneh, Alexander Gieswinkel, Juan Fernandez Tajes, Thomas Sparsø, Carl Delfin, Pierre Bauvain, Kan Wang, Marinella Temprosa, Diederik De Cock, Jordi Blanch, José Manuel Fernández-Real, Rafael Ramos, M. Kamran Ikram, Maria F. Gomez, Maryam Kavousi, Marina Panova-Noeva, Philipp S. Wild, Carla van der Kallen, Michiel Adriaens, Marleen van Greevenbroek, Ilja Arts, Carel Le Roux, Fariba Ahmadizar, Timothy M. Frayling, Giuseppe N. Giordano, Ewan R. Pearson, Paul W. Franks","doi":"10.1038/s41591-024-03299-7","DOIUrl":"https://doi.org/10.1038/s41591-024-03299-7","url":null,"abstract":"<p>Obesity and cardiometabolic disease often, but not always, coincide. Distinguishing subpopulations within which cardiometabolic risk diverges from the risk expected for a given body mass index (BMI) may facilitate precision prevention of cardiometabolic diseases. Accordingly, we performed unsupervised clustering in four European population-based cohorts (<i>N</i> ≈ 173,000). We detected five discordant profiles consisting of individuals with cardiometabolic biomarkers higher or lower than expected given their BMI, which generally increases disease risk, in total representing ~20% of the total population. Persons with discordant profiles differed from concordant individuals in prevalence and future risk of major adverse cardiovascular events (MACE) and type 2 diabetes. Subtle BMI-discordances in biomarkers affected disease risk. For instance, a 10% higher probability of having a discordant lipid profile was associated with a 5% higher risk of MACE (hazard ratio in women 1.05, 95% confidence interval 1.03, 1.06, <i>P</i> = 4.19 × 10⁻¹⁰; hazard ratio in men 1.05, 95% confidence interval 1.04, 1.06, <i>P</i> = 9.33 × 10⁻¹⁴). Multivariate prediction models for MACE and type 2 diabetes performed better when incorporating discordant profile information (likelihood ratio test <i>P</i> &lt; 0.001). This enhancement represents an additional net benefit of 4−15 additional correct interventions and 37−135 additional unnecessary interventions correctly avoided for every 10,000 individuals tested.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"143 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An explainable foundation model for drug repurposing","authors":"Alaa Bessadok, Francesca Grisoni","doi":"10.1038/s41591-024-03333-8","DOIUrl":"https://doi.org/10.1038/s41591-024-03333-8","url":null,"abstract":"A foundation model leverages large-scale medical knowledge to repurpose drugs for diseases that currently lack approved treatments, and provides explanations to support clinicians’ decisions.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"35 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global genomic surveillance of monkeypox virus","authors":"James R. Otieno, Christopher Ruis, Anyebe B. Onoja, Krutika Kuppalli, Ana Hoxha, Andreas Nitsche, Annika Brinkmann, Janine Michel, Placide Mbala-Kingebeni, Daniel Mukadi-Bamuleka, Muntasir Mohammed Osman, Hanadi Hussein, Muhammad Ali Raja, Richard Fotsing, Belinda L. Herring, Mory Keita, Jairo Mendez Rico, Lionel Gresh, Amal Barakat, Victoria Katawera, Karen Nahapetyan, Dhamari Naidoo, R. Andres Floto, Jane Cunningham, Maria D. Van Kerkhove, Rosamund Lewis, Lorenzo Subissi","doi":"10.1038/s41591-024-03370-3","DOIUrl":"https://doi.org/10.1038/s41591-024-03370-3","url":null,"abstract":"<p>Monkeypox virus (MPXV) is endemic in Western and Central Africa and, in May 2022, a clade IIb lineage (B.1) caused a global outbreak outside Africa, resulting in its detection in 116 countries/territories. To understand the global phylogenetics of MPXV, we analysed all available MPXV sequences, including 10,670 sequences from 65 countries collected between 1958 and 2024. Our analysis reveals high mobility of clade I viruses within Central Africa, sustained human-to-human transmission of clade IIb lineage A viruses within the Eastern Mediterranean region, and distinct mutational signatures that can distinguish sustained human-to-human from animal-to-animal transmission. Moreover, distinct clade I sequences from Sudan suggest local MPXV circulation in areas of Eastern Africa over the past four decades. Our study underscores the importance of genomic surveillance in tracking spatiotemporal dynamics of MXPV clades and the need to strengthen such surveillance, including in some parts of Eastern Africa.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"67 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Correction: Rps14 haploinsufficiency causes a block in erythroid differentiation mediated by S100A8 and S100A9","authors":"Rebekka K Schneider,&nbsp;Monica Schenone,&nbsp;Monica Ventura Ferreira,&nbsp;Rafael Kramann,&nbsp;Cailin E Joyce,&nbsp;Christina Hartigan,&nbsp;Fabian Beier,&nbsp;Tim H Brümmendorf,&nbsp;Ulrich Germing,&nbsp;Uwe Platzbecker,&nbsp;Guntram Büsche,&nbsp;Ruth Knüchel,&nbsp;Michelle C Chen,&nbsp;Christopher S Waters,&nbsp;Edwin Chen,&nbsp;Lisa P Chu,&nbsp;Carl D Novina,&nbsp;R Coleman Lindsley,&nbsp;Steven A Carr,&nbsp;Benjamin L Ebert","doi":"10.1038/s41591-024-03350-7","DOIUrl":"10.1038/s41591-024-03350-7","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 11","pages":"3382-3382"},"PeriodicalIF":58.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41591-024-03350-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487169","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}