PLoS Medicine最新文献

{"title":"Carbon footprint of the Chinese healthcare service: An environmentally extended input-output analysis.","authors":"Juan Liang, Rui Wu, Peng Bi, Shi-Lu Tong, Rui Zhang, Xiao-Yuan Yao, Xin Jin, Yong-Hong Li","doi":"10.1371/journal.pmed.1004738","DOIUrl":"10.1371/journal.pmed.1004738","url":null,"abstract":"<p><strong>Background: </strong>With the healthcare sector contributing nearly 5% of total global greenhouse gas (GHG) emissions globally, a precise assessment of their carbon footprint is crucial for achieving carbon neutrality targets. This study aims to comprehensively assess the carbon footprint of Chinese healthcare service providers, to identify their driving activities and sources across different time periods, and to provide a solid foundation for the development of effective emission reduction policies in healthcare service in China.</p><p><strong>Methods and findings: </strong>The data on overall national health expenditures for 2012 and 2018, as well as expenditures by different levels of hospitals, various hospital departments, and specific diseases, were sourced from China's Health Statistics Yearbooks and national input-output tables (IOTs). Environmentally extended input-output analysis (EEIOA) and structural path analysis (SPA) were utilized to assess the carbon footprint of healthcare services in China in 2012 and 2018. Overall, the total carbon footprint of Chinese healthcare service providers increased by 51 MtCO2e (15%) in 2018 compared to that in 2012, accounting for about 3.7% of the total domestic GHG emissions. In 2018, public hospitals made the largest contribution to the carbon footprint within the national health expenditure categories, with their carbon emissions increasing by 29 MtCO2e (19%). Among medical institutions, procurement was the largest contributor to the carbon footprint, with emissions increasing by 46 MtCO2e (25%). Within hospital departments, the internal medicine department had the highest carbon footprint, reaching 47.66 MtCO2e (26%) in 2018. When classified by hospital grades, tertiary hospitals contributed the most, emitting 126.50 MtCO2e (70%). When classified by disease category, circulatory system diseases had the largest carbon footprint of 12.68 MtCO2e (19%), while malignant neoplasms were the primary contributor among subcategory diseases, emitting 5.52 MtCO2e (8%). The main limitation of this study lies in the fact that national IOTs are updated approximately every 5 years, and data for methane (CH₄) and nitrous oxide (N₂O) have not been updated since 2018. As a result, the analysis could only be performed for the years 2012 and 2018.</p><p><strong>Conclusions: </strong>These findings highlighted the substantial GHG emission contributions in China from public hospitals, especially tertiary hospitals, procurement activities, Internal Medicine Departments, and specific diseases in the carbon footprint. The findings provided robust scientific evidence for formulating strategies to reduce carbon emissions within the healthcare service in China and will also have implications for other countries.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004738"},"PeriodicalIF":9.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139139","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 between lower fasting plasma glucose levels during oral glucose tolerance test and adverse perinatal outcomes: A Chinese cohort study.","authors":"Lulu Wang, Chao Tang, Mengqiu Cheng, Yanhui Hao, Siyue Chen, Siwei Zhang, Chen Zhang, Ben W Mol, Yanting Wu, Hefeng Huang","doi":"10.1371/journal.pmed.1004722","DOIUrl":"10.1371/journal.pmed.1004722","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether fasting plasma glucose (FPG) level within the normal range as defined by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is associated with perinatal outcomes. This study explored the associations between FPG levels lower than the IADPSG threshold during oral glucose tolerance test (OGTT) and adverse perinatal outcomes in women with or without gestational diabetes mellitus (GDM).</p><p><strong>Methods and findings: </strong>From January 1, 2017, to May 31, 2022, this single-center retrospective cohort study included 33,417 women with singleton pregnancies at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. All women underwent a 75-g OGTT at 24-28 gestational weeks. The primary endpoint was a composite of adverse outcomes, including gestational hypertension, preeclampsia, fetal death and stillbirth, preterm birth, primary cesarean delivery, and small or large for gestational age. Overall, 3,108 (9.5%) women had IADPSG-defined GDM and of whom 2,426 (76.3%) had FPG levels below the IADPSG threshold. Compared to the GDM population, non-GDM women with borderline-normal FPG levels were at significantly greater risk of adverse outcomes with an adjusted odds ratio (aOR) of 1.62 (95% CI [1.20, 2.19]; p = 0.002) at 4.6 mmol/L, an aOR of 1.50 (95% CI [1.05, 2.13]; p = 0.025) at 4.8 mmol/L, and an aOR of 1.58 (95% CI [1.05, 2.40]; p = 0.030) at 4.9 mmol/L glucose level. Nonetheless, non-GDM women demonstrated significantly lower risk (aOR 0.66, 95% CI [0.44, 0.98]; p = 0.038) compared to GDM counterparts exhibiting low fasting glycemia at 3.9 mmol/L. However, this study was limited by its retrospective design and may lack generalizability to other ethnic groups.</p><p><strong>Conclusions: </strong>Even at FPG levels lower than the IADPSG threshold, FPG was significantly associated with adverse perinatal outcomes, and the associations presented different patterns in women with and without GDM.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004722"},"PeriodicalIF":9.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132220","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: Direct and indirect impacts of the COVID-19 pandemic on life expectancy and person-years of life lost with and without disability: A systematic analysis for 18 European countries, 2020-2022.","authors":"Sara Ahmadi-Abhari, Piotr Bandosz, Martin J Shipley, Joni V Lindbohm, Abbas Dehghan, Paul Elliott, Mika Kivimaki","doi":"10.1371/journal.pmed.1004757","DOIUrl":"10.1371/journal.pmed.1004757","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pmed.1004541.].</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004757"},"PeriodicalIF":9.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092642","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":"A need for new tools for prevention of malaria in pregnancy.","authors":"Makoto Saito, Rose McGready","doi":"10.1371/journal.pmed.1004729","DOIUrl":"10.1371/journal.pmed.1004729","url":null,"abstract":"<p><p>Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a chemoprevention strategy against malaria in pregnancy. A recent PLOS Medicine study highlights the need for better understanding of the mechanism by which IPTp-SP reduces low birthweight, as well as novel measures to prevent malaria earlier in gestation.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004729"},"PeriodicalIF":9.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092617","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":"Psilocybin-assisted group psychotherapy and mindfulness-based stress reduction for frontline healthcare provider COVID-19-related depression and burnout: A randomized controlled trial.","authors":"Benjamin R Lewis, John Hendrick, Kevin Byrne, Madeleine Odette, Chaorong Wu, Eric L Garland","doi":"10.1371/journal.pmed.1004519","DOIUrl":"10.1371/journal.pmed.1004519","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression and burnout, which are common among healthcare workers, were exacerbated by the COVID-19 pandemic. Mindfulness-Based Stress Reduction (MBSR) and psilocybin have been reported to reduce depressive symptoms, but the efficacy of the combination requires comparison to an active treatment control. We sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR versus MBSR alone for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic. We hypothesized that psilocybin would augment the antidepressant effects of MBSR in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;We conducted a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. (ClinicalTrials.gov Identifier: NCT05557643) Participants were enrolled between January 2nd, 2023 and January 16th, 2024, and randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25 mg psilocybin. Evaluation of safety and feasibility of enrollment and retention was a primary objective of the study. The primary efficacy endpoint was change in depressive symptoms, as measured by the Quick Inventory of Depressive Symptoms (QIDS-SR-16) at 2 weeks post-intervention. Symptoms of depression and burnout were assessed at baseline, and 2 weeks and 6 months post-intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events (AEs) and suicidality were assessed through a 6-month follow-up. Twenty-five participants were enrolled and randomized. Safety was a study outcome and assessed by rate and severity of AEs and any incident suicidality or significant mental health symptoms. Baseline and outcome data were summarized using descriptive statistics, with continuous variables reported as means and standard deviations. We recorded 12 study-related, Grade 1-2 AEs and no serious AEs. In a linear mixed model analysis (LMM), the MBSR + PAP arm evidenced a significantly larger decrease in QIDS-SR-16 score than the MBSR-only arm from baseline to 2-weeks post-intervention (between-groups effect = 4.6, 95% CI [1.51, 7.70]; p = 0.008). This effect waned at the 6-month follow-up. Secondary outcome measures for burnout (subscales of the MBI-HSS-MP), demoralization (DS II), and connectedness (WCS) favored the MBSR + PAP arm; however, these effects did not survive correction for multiple comparisons. A mixed RM-ANCOVA was conducted to control for baseline differences in outcome measures. Sensitivity analyses were conducted, adjusting for baseline differences in gender and clustering ","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004519"},"PeriodicalIF":9.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092614","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":"Dihydroartemisinin-piperaquine plus sulfadoxine-pyrimethamine versus either drug alone for intermittent preventive treatment of malaria in pregnancy: A double-blind, randomized, controlled phase 3 trial from Uganda.","authors":"Abel Kakuru, Jimmy Kizza, Miriam Aguti, Harriet Adrama, John Ategeka, Peter Olwoch, Miriam Nakalembe, Joaniter I Nankabirwa, Bishop Opira, Nida Ozarslan, Anju Ranjit, Erin Dela Cruz, Tamara D Clark, Michelle E Roh, Stephanie L Gaw, Prasanna Jagannathan, Philip J Rosenthal, Moses R Kamya, Grant Dorsey","doi":"10.1371/journal.pmed.1004582","DOIUrl":"10.1371/journal.pmed.1004582","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To mitigate adverse consequences of malaria in pregnancy, the World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine. However, the effectiveness of IPTp with sulfadoxine-pyrimethamine has been threatened by widespread Plasmodium falciparum resistance, especially in East and Southern Africa. For IPTp, dihydroartemisinin-piperaquine has shown superior antimalarial effects compared to sulfadoxine-pyrimethamine, but sulfadoxine-pyrimethamine has been associated with improved birth outcomes compared to dihydroartemisinin-piperaquine. We hypothesized that a combination of both dihydroartemisinin-piperaquine and sulfadoxine-pyrimethamine would provide superior birth outcomes compared to either drug alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;We conducted a double-blinded, randomized, controlled trial of 2,757 pregnant women in Uganda, where resistance of malaria parasites to sulfadoxine-pyrimethamine is widespread. Women were randomly assigned (1:1:1) to monthly IPTp with sulfadoxine-pyrimethamine, dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus sulfadoxine-pyrimethamine. The primary outcome was the risk of a composite adverse birth outcome defined as any of the following: spontaneous abortion, stillbirth, low birthweight (LBW, &lt; 2,500 g), preterm delivery (&lt;37 weeks), small-for-gestational age, or neonatal death. Secondary outcomes included specific individual adverse birth outcomes, measures of malaria during pregnancy, and safety/tolerability. Combining dihydroartemisinin-piperaquine plus sulfadoxine-pyrimethamine did not reduce the risk of a composite adverse birth outcome compared to dihydroartemisinin-piperaquine (30.0% versus 30.9%, relative risk (RR) 0.97 [95% CI 0.84-1.12]; p = 0.70) or sulfadoxine-pyrimethamine (30.0% versus 26.4%, RR 1.14 [95% CI 0.98-1.33]; p = 0.10). The risk of a composite adverse birth outcome was higher with dihydroartemisinin-piperaquine compared to sulfadoxine-pyrimethamine (30.9% versus 26.4%, RR 1.17 [95% CI 1.01-1.36]; p = 0.04). Considering individual adverse birth outcomes, combining dihydroartemisinin-piperaquine plus sulfadoxine-pyrimethamine was associated with a higher risk of small-for-gestational age (23.4% versus 18.7%, RR 1.25 [95% CI 1.04-1.51]; p = 0.02) and low birthweight (8.6% versus 5.8%, RR 1.48 [95 CI 1.04-2.12]; p = 0.03) compared to sulfadoxine-pyrimethamine and a higher risk of preterm delivery (5.3% versus 3.1%, RR 1.73 [95% CI 1.07-2.79]; p = 0.03) compared to dihydroartemisinin-piperaquine. During pregnancy, compared to sulfadoxine-pyrimethamine, dihydroartemisinin-piperaquine was associated with a 94% reduction in the incidence of symptomatic malaria (0.46 versus 0.03 episodes per person-year, incidence rate ratio 0.06 [95% CI 0.03-0.12]; p &lt; 0.001) and a 97% reduction in the risk of microscopic parasitemia (17.7% versus 0.6%, RR 0.03 [95% CI 0.02-0.05]","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004582"},"PeriodicalIF":9.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087700","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":"Associations between falls and other serious adverse events and antihypertensive medication in individuals with dementia: An observational cohort study.","authors":"Takeshi Fujiwara, Constantinos Koshiaris, Ting Cai, Ariel Wang, Joseph Lee, Sarah Lay-Flurrie, Amitava Banerjee, Andrew Clegg, Rupert A Payne, Subhashisa Swain, Margaret Ogden, Satoshi Hoshide, Kazuomi Kario, F D Richard Hobbs, Richard J McManus, James P Sheppard","doi":"10.1371/journal.pmed.1004731","DOIUrl":"10.1371/journal.pmed.1004731","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The balance of benefits and risks associated with lowering blood pressure levels in individuals with dementia remains controversial with a lack of evidence for possible harms associated with antihypertensive treatment. We examined the association between antihypertensive medication and serious adverse events in individuals with dementia compared to those without dementia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;This was a retrospective analysis using nationally representative UK general practice population between 1998 and 2018, from electronic health records (Clinical Practice Research Datalink, CPRD, GOLD). Eligible individuals were aged ≥40 years, with a systolic blood pressure 130-179 mmHg, and not previously prescribed antihypertensive treatment. The diagnosis of dementia was based on clinical codes in the electronic health record. Individuals were allocated to the exposure group if they were prescribed at least one antihypertensive medication during a 12-month exposure period. Those who were not prescribed any antihypertensive medication during the exposure period were allocated to the control group. The primary outcome was the first hospitalisation or death from a fall within 10 years of the follow-up period. Secondary outcomes were first hospitalisation or death from hypotension, syncope, and fracture. In a population of 1,219,732 individuals, 23,510 had dementia. Antihypertensive medications were newly prescribed in 4,062/23,510 (17.3%) individuals with dementia and 142,385/1,196,222 (11.9%) individuals without dementia in the 12-month exposure period. In the primary analyses, which adjusted for the propensity score and a previous history of the outcome of interest, antihypertensive treatments were associated with a small increased risk of hospitalisation or death from falls (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.08, 1.22), hypotension (aHR 1.51, 95%CI 1.29, 1.78), syncope (aHR 1.34, 95%CI 1.11, 1.61), but not fracture (aHR 1.05, 95%CI 0.96, 1.15), in individuals with dementia. These findings were consistent across different analytic approaches, including multivariable adjustment, propensity score matching, and inverse probability treatment weighting. In individuals without dementia, the association between antihypertensive treatment and serious adverse events was similar, with a small increased risk of hospitalisation or death from falls (aHR 1.07, 95%CI 1.05, 1.10). However, the absolute fall risk associated with antihypertensive treatment was significantly higher in individuals with dementia (47 per 10,000 individuals per year, 95%CI 26, 70) compared to those without (14 per 10,000 individuals per year, 95%CI 10, 18). The absolute risks of hypotension and syncope with antihypertensive treatment were also higher in the individuals with dementia compared to those without. The main limitation is the possibility of unmeasured confounding, and heterogeneity in dementia diagnos","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004731"},"PeriodicalIF":9.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082296","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 association of the planetary health diet with type 2 diabetes incidence and greenhouse gas emissions: Findings from the EPIC-Norfolk prospective cohort study.","authors":"Solomon A Sowah, Fumiaki Imamura, Daniel B Ibsen, Pablo Monsivais, Nicholas J Wareham, Nita G Forouhi","doi":"10.1371/journal.pmed.1004633","DOIUrl":"10.1371/journal.pmed.1004633","url":null,"abstract":"<p><strong>Background: </strong>The planetary health diet (PHD) has been proposed as a dietary index with potential co-benefits for human and planetary health. Evidence is limited on its association with type 2 diabetes (T2D) incidence and greenhouse gas (GHG) emissions. Our objective was to assess the associations of adherence to the PHD with incident T2D and GHG emissions.</p><p><strong>Methods and findings: </strong>We analysed data from 23,722 participants (55% female), with a mean (standard deviation, SD) age of 59.1 (9.3) in the UK-based EPIC-Norfolk prospective cohort study. Dietary intake was assessed across three time points (1993-1997, 1998-2000 and 2004-2011) using a food frequency questionnaire. We assessed adherence to the PHD (theoretical score range 0-140 points) based on the consumption of 13 food groups and two nutrients. Cox proportional hazards regression models, which accounted for time-varying covariates, were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for T2D. Linear regression models were used to analyse the association between the PHD and estimated GHG emissions. During a mean follow-up period of 19.4 (SD 6.8) years, 3,496 cases of incident T2D were recorded over 461,086 person-years. Greater adherence to the PHD was associated with lower T2D incidence; comparing the highest PHD quintile (85.7-117.8 points) to the lowest (33.9-68.4 points), the HR (95% CI) was 0.68 (0.61, 0.76) in the most adjusted model including socio-demographic, behavioural factors, energy intake, adiposity, and prevalent cardiovascular disease or cancer. The estimated population attributable fraction (PAF) for incident T2D due to adherence below the 80th percentile (85.7 points) was 12.3% (95% CI: 9.2%, 15.3%). Those in the highest quintile of the PHD had approximately 18% lower GHG emissions compared to those in the lowest (β5th/1st -18.4% (95% CI: -19.3%, -17.5%)). The main limitation of this research is the possibility of residual confounding due to the observational design of this study.</p><p><strong>Conclusions: </strong>Our findings of a lower incidence of T2D and reduced GHG emissions among those with higher adherence to the PHD support the promotion of this diet for the population-level prevention of T2D and for planetary sustainability.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004633"},"PeriodicalIF":9.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076118","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":"Prescribed opioid analgesic use in pregnancy and risk of neurodevelopmental disorders in children: A retrospective study in Sweden.","authors":"Emma N Cleary, Ayesha C Sujan, Martin E Rickert, Franziska Fischer, Tyra Lagerberg, Zheng Chang, Paul Lichtenstein, Patrick D Quinn, Anna Sara Öberg, Brian M D'Onofrio","doi":"10.1371/journal.pmed.1004721","DOIUrl":"10.1371/journal.pmed.1004721","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The extent to which the documented association between prenatal prescribed opioid analgesic (POA) exposure and neurodevelopmental disorders in children is causal or due to confounding is unknown. The objective of this study was to evaluate associations between dose and duration of POA exposure during pregnancy and autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in children while minimizing bias due to confounding and other sources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;This retrospective study analyzed a population-based cohort of births using national register data from Sweden. The ASD analysis cohort consisted of 1,267,978 children born in Sweden from July 1st, 2007 to December 31st, 2018, with follow-up through 2021. A shorter eligibility period was used to study ADHD given its later age of typical diagnosis, consisting of 918,771 children born through December 31st, 2015. Text-mining algorithms were used to derive cumulative dose and duration of POA exposure during pregnancy from filled POA prescriptions, as well as to identify prescriptions that were to be taken on an \"as needed\" basis. Outcomes were identified through inpatient or outpatient clinical diagnosis of ASD and ADHD or dispensed ADHD medications. Cox proportional hazards regression models were adjusted for measured covariates from multiple domains. Several designs were used to help address unmeasured confounding: comparisons with children whose birthing parent had a diagnosed painful condition but did not receive POAs, children whose birthing parent received POAs in the year before but not during pregnancy, and siblings who were not exposed to POAs. Of the 1,267,978 children, 48.6% were female and 4.4% were exposed to POAs during pregnancy. At age 10, cumulative incidence of ASD was 2.0% among children unexposed to POAs, 2.9% among children exposed to a low dose across pregnancy, and 3.6% among children exposed to a high dose. In unadjusted models (e.g., hazard ratio [HR]high, 1.74, 95% confidence interval [CI], 1.63, 1.87) and when accounting for measured covariates, cumulative maximum dose was associated with increased risk of ASD (e.g., HRhigh, 1.34, 95% CI, 1.24, 1.44). However, the associations were largely or fully attenuated when using alternative designs (particularly when comparing to children whose birthing parent received POAs before but not during pregnancy: HRhigh, 1.10, 95% CI, 1.00, 1.21). No associations were observed in the sibling comparison (HRhigh, 0.99, 95% CI, 0.81, 1.21). This overall pattern of associations was also observed when considering duration of exposure, and in numerous sensitivity analyses, as well as for analyses of ADHD. A main limitation of this study was that the distribution of dose and duration of POAs prescribed to birthing parents in Sweden limited our ability to explore the effects of extremely high dose and duration on risk for neurodevelopmental disorders.&lt;/p&gt;&lt;p&gt;&lt;s","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004721"},"PeriodicalIF":9.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076421","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":"Effect of Paxlovid treatment during acute COVID-19 on Long COVID onset: An EHR-based target trial emulation from the N3C and RECOVER consortia.","authors":"Alexander Preiss, Abhishek Bhatia, Leyna V Aragon, John M Baratta, Monika Baskaran, Frank Blancero, Michael Daniel Brannock, Robert F Chew, Iván Díaz, Megan Fitzgerald, Elizabeth P Kelly, Andrea G Zhou, Thomas W Carton, Christopher G Chute, Melissa Haendel, Richard Moffitt, Emily Pfaff","doi":"10.1371/journal.pmed.1004711","DOIUrl":"10.1371/journal.pmed.1004711","url":null,"abstract":"<p><strong>Background: </strong>Preventing and treating post-acute sequelae of COVID-19 infection (PASC), commonly known as Long COVID, has become a public health priority. This study tests whether Paxlovid treatment in the acute phase of COVID-19 could help prevent the onset of PASC.</p><p><strong>Methods and findings: </strong>We used electronic health records from the National Clinical Cohort Collaborative to define a cohort of 445,738 patients who had COVID-19 since April 1, 2022, and were eligible for Paxlovid treatment due to risk for progression to severe COVID-19. We used the target trial emulation framework to estimate the effect of Paxlovid treatment on PASC incidence. We emulated a series of six sequential trials: one for each day of a 5-day treatment grace period. For each sequential trial, the treatment group was defined as patients prescribed Paxlovid on the trial start day, and the control group was defined as all patients meeting eligibility criteria who remained untreated on the trial start day. We pooled individual record-level data from the sequential trials for analysis. The follow-up period was 180 days. The primary outcome was overall PASC incidence measured using a computable phenotype. Secondary outcomes were incident cognitive, fatigue, and respiratory symptoms in the post-acute period. We controlled for a wide range of demographic and medical history covariates. Compared to the control group, Paxlovid treatment did not have a significant effect on overall PASC incidence or incident respiratory symptoms. It had a small protective effect against cognitive (relative risk [RR] 0.91; 95% CI [0.84, 0.98]; p = 0.019) and fatigue (RR 0.94; 95% CI [0.90, 0.98]; p = 0.002) symptoms. Finally, we estimated Paxlovid's effect on overall PASC incidence across strata of age, COVID-19 vaccination status, and Charlson Comorbidity Index (CCI) prior to COVID-19. We found small protective effects among patients aged 65 years or more (RR 0.92; 95% CI [0.88, 0.97]; p < 0.001; absolute risk difference [ARD] -0.43%; number needed to treat [NNT] 233) and with a CCI of 3 or 4 (RR 0.83; 95% CI [0.75, 0.92]; p < 0.001; ARD -1.30%; NNT 76). This study's main limitation is that the causal interpretation relies on the assumption that we controlled for all confounding variables.</p><p><strong>Conclusions: </strong>Although some prior observational studies suggested that Paxlovid held promise as a PASC preventive, this study-with a large, nationally sampled cohort; a contemporary study period; and causal inference methodology-found that Paxlovid treatment during acute COVID-19 had no effect on subsequent PASC incidence. Stratified analyses suggest that Paxlovid may have a small protective effect among higher-risk patients, but the NNT is high. In conclusion, we see Paxlovid as unlikely to become a definitive solution for PASC prevention.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 9","pages":"e1004711"},"PeriodicalIF":9.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070853","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}