Nature health最新文献

{"title":"A videogame for perceived risk of harm from opioid misuse in adolescents: a randomized controlled trial.","authors":"Tyra Boomer, Lily Hoerner, Kaitlyn Larkin, Kaitlin Maciejewski, Tassos C Kyriakides, Lynn E Fiellin","doi":"10.1038/s44360-025-00010-z","DOIUrl":"10.1038/s44360-025-00010-z","url":null,"abstract":"<p><p>The opioid epidemic greatly impacts adolescents, especially those with low perceived risk of harm-an important predictor of misuse initiation. Here, to address this, we developed and evaluated PlaySmart, a videogame targeting perceived risk, in a two-arm parallel superiority unblinded randomized controlled trial with a placebo comparator. We randomized 532 participants (mean age 16.6 years; 47% female) to PlaySmart (<i>n</i> = 269) or control games (<i>n</i> = 263). Eligible students-16-19 years old, no prior opioid misuse and 'high-risk' based on substance use or mental health screens-agreed to 60-min gameplay sessions, and provided assent and parental consent if under 18 years old. Participants played during supervised after-school sessions (1 or 2 times per week for approximately 6 weeks) at 15 Connecticut high schools. Self-reported data were collected at baseline, 6 weeks and 3 months (21 October 2021 to 27 February 2024). Follow-up rates were high (231/266 (87%) PlaySmart and 234/261 (90%) control). The primary outcome was perceived risk of harm of opioid misuse at 3 months. The secondary outcomes were self-efficacy, intentions, knowledge and attitudes (positive and negative expectancies). At 3 months, 29% of PlaySmart versus 23% of control participants reported 'great risk' with no statistically significant difference between groups (95% CI, -2% to 14%; <i>P</i> = 0.14). Self-efficacy, intentions and positive expectancies did not differ. PlaySmart participants demonstrated knowledge gains from baseline to 3 months (2.1 (95% CI, 1.4-2.7) versus 0.1 (95% CI, -0.6-0.7); <i>P</i> < 0.001), and negative expectancies gains at 6 weeks (2.3 (95% CI, 1.4-3.1) versus 0.2 (95% CI, -0.7-1.1); <i>P</i> = 0.001). Further research is needed to enhance PlaySmart, maximizing its impact on scalable opioid misuse prevention. ClinicalTrials.gov registration: NCT04941950.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 1","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping pesticide mixtures to cancer risk at the country scale with spatial exposomics.","authors":"Jorge Honles, Juan Pablo Cerapio, Claudia Monge, Agnès Marchio, Eloy Ruiz, Ramiro Fernández, Sandro Casavilca-Zambrano, Juan Contreras-Mancilla, Tatiana Vidaurre, Thomas Condom, Swann Zerathe, Olivier Dangles, Éric Deharo, Javier Herrera-Zuñiga, Pascal Pineau, Stéphane Bertani","doi":"10.1038/s44360-026-00087-0","DOIUrl":"10.1038/s44360-026-00087-0","url":null,"abstract":"<p><p>Despite decades of concern over the carcinogenic potential of agricultural pesticides, toxicological studies relying on single endpoints have yet to establish a definitive link between environmental pesticide exposure and cancer in real-world contexts. Here we use an integrative spatial Bayesian framework that merges high-resolution environmental pesticide risk modelling with comprehensive cancer registry data to map pesticide-linked cancer clusters in Peru with unprecedented precision. Our process-based model, encompassing 31 key pesticide active ingredients, together with an innovative stratification of cancer cases by developmental lineage, reveals a robust spatial association between environmental pesticide exposure risk and cancer incidence. In pesticide-associated cancer hotspots, exposomic profiling of liver tissue-a primary target of chemical carcinogens-uncovers a distinct transcriptomic signature of pesticide exposure, implicating a non-genotoxic mode of action that disrupts core regulatory circuitries sustaining cell identity. Collectively, these findings strongly support a mechanistic link between pesticide exposure and cancer, challenging assumptions of human non-carcinogenicity derived from reductionist experimental models. This study redefines the exposome as a lineage-conditioned, mechanistically tractable framework and shows how complex pesticide mixtures can contribute to carcinogenic trajectories, with profound and far-reaching implications for global health policy and socio-ecological equity.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 5","pages":"520-531"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of a large language model-based clinical decision support system in African primary healthcare.","authors":"Ambrose Agweyu, Paul Mwaniki, Wilkister Musau, Robert Korom, Lynda Isaaka, Conrad Wanyama, Sarah Kiptinness, Najib Adan, Mira Emmanuel-Fabula, Bilal A Mateen","doi":"10.1038/s44360-026-00082-5","DOIUrl":"10.1038/s44360-026-00082-5","url":null,"abstract":"<p><p>Here we conducted a retrospective evaluation of an electronic medical record-embedded large language model clinical decision support system deployed across 16 primary care clinics in Kenya, between July and September 2024. A panel of trained physicians reviewed 1,469 records. Hallucinations were uncommon, occurring in 50 encounters (3.4%, 95% confidence interval (CI) 2.5-4.5), and most often involved misexpanded acronyms or drug names. Clinical management guidance aligned with local guidelines in almost all cases (1,455; 99%, 95% CI 98.4-99.5). Despite this, clinicians did not modify documentation in 917 encounters (62%, 95% CI 59.9-64.9). Safety assessments identified actively harmful recommendations from the large language model in 115 encounters (7.8%, 95% CI 6.5-9.3), with 67 such recommendations appearing in the final documentation. Conversely, risk present in the clinician's initial notes was fully mitigated in 118 encounters (8.0%, 95% CI 6.7-9.5 overall; 12.1%, 95% CI 9.5-15.2 of amended cases). Overall, the tool showed strong potential to support quality improvement, but the asymmetric adoption of harmful versus beneficial outputs underscores the need for usability optimization, local guardrails and prospective trials to confirm patient-level benefit.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 6","pages":"607-618"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A community-codesigned LLM-powered chatbot for primary care: a randomized controlled trial.","authors":"Sairan Li, Yanzeng Li, Shuya Zhou, Xinge Tao, Changjie Yu, Muzi Shen, Wangyue Chen, En Meng, Boyou Wu, Qirui Huang, Frances S Mair, Jinchao Zhang, Jie Zhou, Lei Zou, Shasha Han","doi":"10.1038/s44360-025-00021-w","DOIUrl":"10.1038/s44360-025-00021-w","url":null,"abstract":"<p><p>With a global shortage of primary healthcare physicians-particularly in resource-limited settings-large language models (LLMs) have the potential to support and enhance patients' health awareness. Here we developed P&P Care (Population Medicine and Public Health), an LLM-powered primary care chatbot using a dual-track role-play codesign framework where community stakeholders and researchers simulated each another's perspectives across four phases: contextual understanding; cocreation; testing and refinement; and implementation and evolution. The codesigned chatbot was integrated with e-learning modules and tested in a randomized controlled trial. The trial included 2,113 participants (1,052 women and 1,061 men) from urban and rural areas across 11 Chinese provinces who were randomly assigned to receive a consultation either with preparatory e-learning via the P&P Care or without. The study met its primary endpoint with the e-learning group showing significantly higher objective health awareness (mean score 2.95 ± 1.22) compared with the consultation-only group (mean score 2.34 ± 1.02; <i>P</i> < 0.001). Codesign offers a scalable solution for deploying LLMs in resource-limited settings. Chinese Clinical Trial Registry identifier: ChiCTR2500098101.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 2","pages":"238-250"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of community and sexual contacts as drivers of MPXV clade I.","authors":"Hiroaki Murayama, Toshiaki R Asakura, Borame L Dickens, Dorothy Boyle, Jen Han Foo, Shihui Jin, Patrick K Mukadi, Keisuke Ejima, Sung-Mok Jung, Akihiro Nishi, Kiesha Prem, Audry M Wakamba, Diafuka Saila-Ngita, David Niyukuri, Akira Endo","doi":"10.1038/s44360-026-00080-7","DOIUrl":"10.1038/s44360-026-00080-7","url":null,"abstract":"<p><p>Initial investigation into the emerging mpox outbreak caused by novel monkeypox virus (MPXV) clade Ib in the eastern Democratic Republic of the Congo has identified signs of sustained human-to-human transmission and epidemiological links to sexual contacts involving female sex workers (FSWs), which have not been observed in previous clade Ia outbreaks. Using mathematical models incorporating age-dependent contact patterns, we quantified the role of frequent sexual interactions as opposed to community contacts in clade Ib's dynamics and found that this additional mode of transmission could explain its increased outbreak potential compared with clade Ia. As with the globally circulating clade IIb, which is transmitted predominantly among men who have sex with men, our findings reinforce the importance of protecting key population groups-specifically FSWs for clade Ib-in controlling ongoing mpox outbreaks.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 6","pages":"595-606"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of Zika virus epidemiology.","authors":"Kelly McCain, Anna Vicco, Christian Morgenstern, Thomas Rawson, Tristan M Naidoo, Sangeeta Bhatia, Dominic P Dee, Patrick Doohan, Keith Fraser, Anna-Maria Hartner, Sequoia I Leuba, Shazia Ruybal-Pesántez, Richard J Sheppard, H Juliette T Unwin, Kelly Charniga, Zulma M Cucunubá, Gina Cuomo-Dannenburg, Natsuko Imai-Eaton, Edward S Knock, Adam Kucharski, Mantra Kusumgar, Paul Liétar, Rebecca K Nash, Sabine van Elsland, Nuno R Faria, Anne Cori, Ruth McCabe, Ilaria Dorigatti","doi":"10.1038/s44360-025-00051-4","DOIUrl":"10.1038/s44360-025-00051-4","url":null,"abstract":"<p><p>Zika virus (ZIKV), classified as a priority pathogen by the World Health Organization, is an <i>Aedes</i>-borne arbovirus that can cause neurological complications and birth defects in newborns of mothers infected during pregnancy. We conducted a systematic review of peer-reviewed studies reporting ZIKV epidemiological parameters, transmission models and outbreaks (PROSPERO CRD42023393345) to characterize its transmissibility, seroprevalence, risk factors, disease sequelae and natural history. We performed meta-analyses of the proportions of congenital Zika syndrome, pregnancy loss among ZIKV-infected mothers and symptomatic cases. We extracted information from 574 studies. Across 418 included studies assigned a high-quality score, we extracted 969 parameters, 127 outbreak records and 154 models. Using random-effects models, we estimated proportions of congenital Zika syndrome (4.65%, 95% confidence interval (CI): 3.38-6.67%), pregnancy loss (2.48%, 95% CI: 1.62-3.78%) and symptomatic cases (51.20%, 95% CI: 38.00-64.23%). Seroprevalence estimates (<i>n</i> = 354) were retrieved beyond South America and French Polynesia. Basic reproduction number estimates (<i>n</i> = 77) ranged between 1.12 and 7.4. We found 66 human epidemiological delay estimates, including the intrinsic incubation period (<i>n</i> = 11, range: 4-12.1 days), infectious period (<i>n</i> = 15, range: 3-50 days), extrinsic incubation period (<i>n</i> = 22, range: 5.1-24.2 days) and serial interval (<i>n</i> = 27, range: 7.4-32.9 days). These data are available in the R package 'epireview' (version 1.4.5). We provide a comprehensive systematic summary of ZIKV epidemiology, revealing large heterogeneities and inconsistencies in the reporting of parameter estimates, study designs and parameter definitions and underscoring the need for standardized epidemiological definitions.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 3","pages":"355-367"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal metabolomic signatures for risk of preterm and early term birth in African American women.","authors":"Youran Tan, Donghai Liang, Stephanie M Eick, Mengyuan Ren, Douglas I Walker, Xin Hu, Zhenjiang Li, Kaitlin R Taibl, Elizabeth Corwin, Cherie C Hill, Dean P Jones, Anne L Dunlop","doi":"10.1038/s44360-026-00150-w","DOIUrl":"https://doi.org/10.1038/s44360-026-00150-w","url":null,"abstract":"<p><p>Metabolic signals identifying pregnancies at risk for preterm birth (<37 weeks) and early term birth (37-38 weeks) remain limited. Here we used high-resolution metabolomics to characterize metabolic features associated with spontaneous and medically indicated early birth. We conducted metabolome-wide association studies among 279 (discovery) and 251 (internal validation) pregnant women from the Atlanta African American Maternal-Child Cohort (2014-2018), with serum collected in early (8-14 weeks) and later (24-30 weeks) pregnancy. Distinct metabolic profiles differentiated spontaneous and medically indicated preterm birth and early term birth across pregnancy windows. Perturbations in amino acid pathways, including arginine, proline, aspartate, glutamate, methionine and cysteine metabolism, were observed. Valine, leucine and tyrosine were inversely associated with spontaneous early birth, while acylcarnitines and aldosterone were associated with medically indicated early birth. Thirteen metabolites were validated, supporting their potential as markers of pregnancies at elevated risk.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 10","pages":"1106-1120"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149123933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large language models for frontline healthcare support in low-resource settings.","authors":"Samuel Rutunda, Gwydion Williams, Kleber Kabanda, Francis Nkurunziza, Solange Uwiduhaye, Eulade Rugegamanzi, Cyprien Nshimiyimana, Vaishnavi Menon, Mira Emmanuel-Fabula, Alastair K Denniston, Xiaoxuan Liu, Emery Hezagira, Bilal A Mateen","doi":"10.1038/s44360-025-00038-1","DOIUrl":"10.1038/s44360-025-00038-1","url":null,"abstract":"<p><p>Large language models (LLMs) have demonstrated strong performance in medical contexts; however, existing benchmarks often fail to reflect the real-world complexity of low-resource health systems accurately. Here we develop a dataset of 5,609 clinical questions contributed by 101 community health workers across 4 Rwandan districts and compared responses generated by 5 LLMs (Gemini-2, GPT-4o, o3-mini, Deepseek R1 and Meditron-70B) with those from local clinicians. A subset of 524 question-answer pairs was evaluated using a rubric of 11 expert-rated metrics, scored on a 5-point Likert scale. Gemini-2 and GPT-4o were the best performers (achieving mean scores of 4.49 and 4.48 out of 5, respectively, across all 11 metrics). All LLMs significantly outperformed local clinicians (<i>P</i> < 0.001) across all metrics, with Gemini-2, for example, surpassing local general practitioners by an average of 0.83 points on every metric (range 0.38-1.10). Although performance degraded slightly when LLMs communicated in Kinyarwanda, the LLMs remained superior to clinicians and were over 500 times cheaper per response. These findings support the potential of LLMs to strengthen frontline care quality in low-resource, multilingual health systems.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 2","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined impact of smoking, alcohol and social inequalities on premature mortality in urban India.","authors":"Vendhan Gajalakshmi, Fiona Bragg, Ben Lacey, Vendhan Kanimozhi, Manigandan Chandrasekaran, Ramu Ashok Kumar, Paul Sherliker, Richard Peto, Sarah Lewington","doi":"10.1038/s44360-026-00148-4","DOIUrl":"https://doi.org/10.1038/s44360-026-00148-4","url":null,"abstract":"<p><p>Associations with mortality of social inequalities, smoking and drinking differ widely between populations. Here we recruited 500,810 adults aged ≥35 years from Chennai city during 1998-2001 in South India and followed to 2020 for verbal-autopsy-assessed cause-specific mortality. Among those initially without chronic disease, multivariable-adjusted Cox regression (censored at age 70 years) related initial characteristics to mortality rates. Even among non-smoking non-drinkers, those with no schooling had almost three times the mortality rate ratio (RR) of those with >11 years education (men, RR of 2.76, 95% confidence interval (CI) 2.58-2.95; women, RR of 2.93, 95% CI 2.69-3.19), with substantial mortality excesses from each major disease category. These social inequalities were further exacerbated by much higher smoking and drinking prevalences among less educated men. Adjusted for education, male smoking (versus not, RR of 1.26, 95% CI 1.22-1.29) and drinking (versus not, RR of 1.52, 95% CI 1.48-1.56) were independently associated with risk and together almost doubled male mortality (both versus neither, RR of 1.89, 95% CI 1.84-1.94). Few women (<0.1%) smoked or drank.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 10","pages":"1082-1091"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149123931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health effects associated with alcohol consumption: a Burden of Proof study.","authors":"Xiaochen Dai, Sneha I Nicholson, Hilary R Lawlor, Sinclair Carr, Jaimie D Steinmetz, Natalie M Chen, Susan A McLaughlin, Simon I Hay, Kanyin L Ong, Aleksandr Y Aravkin, Peng Zheng, Reed J D Sorensen, Nora M Gilbertson, Erin C Mullany, Erin M O'Connell, Christopher J L Murray, Emmanuela Gakidou","doi":"10.1038/s44360-026-00139-5","DOIUrl":"10.1038/s44360-026-00139-5","url":null,"abstract":"<p><p>The relationship between alcohol and health is complex, and the evidence relating alcohol consumption to various cardiovascular diseases, cancers and other conditions is evolving. Moreover, alcohol drinking guidelines vary widely. Here we conducted 16 systematic reviews across four databases and conservatively re-evaluated dose-response relationships between alcohol consumption and 20 health outcomes, analysing 843 cohort and case-control studies using the Burden of Proof meta-analytic framework. We found that levels of current alcohol consumption are associated with increased risks for cancers of the breast, colorectum, oesophagus, larynx, lip and oral cavities, pharynx, liver, stomach, pancreas and prostate, as well as pancreatitis, cirrhosis and other chronic liver diseases, lower respiratory infections, tuberculosis, and atrial fibrillation and flutter. We found J- or U-shaped relationships between alcohol consumption and type 2 diabetes, Alzheimer's disease and other dementias, ischaemic heart disease, ischaemic stroke and haemorrhagic stroke. While potential health impacts at low-to-moderate levels varied by outcome, high levels of alcohol consumption were associated with increased risk across all outcomes.</p>","PeriodicalId":521227,"journal":{"name":"Nature health","volume":"1 9","pages":"979-999"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}