Lancet Regional Health-Europe最新文献

{"title":"Comparison of machine learning and human prediction to identify trauma patients in need of hemorrhage control resuscitation (ShockMatrix study): a prospective observational study","authors":"Tobias Gauss ,&nbsp;Arthur James ,&nbsp;Clelia Colas ,&nbsp;Nathalie Delhaye ,&nbsp;Mathilde Holleville ,&nbsp;Benjamin Bijok ,&nbsp;Marie Werner ,&nbsp;Alain Meyer ,&nbsp;Véronique Ramonda ,&nbsp;Eric Cesareo ,&nbsp;Hugues de Cherisey ,&nbsp;Sofiane Medjkoune ,&nbsp;Samia Salah ,&nbsp;Jean-Pierre Nadal ,&nbsp;Jean-Denis Moyer ,&nbsp;Antoine Vilotitch ,&nbsp;Pierre Bouzat ,&nbsp;Julie Josse","doi":"10.1016/j.lanepe.2025.101340","DOIUrl":"10.1016/j.lanepe.2025.101340","url":null,"abstract":"<div><h3>Background</h3><div>Machine learning could improve the timely identification of trauma patients in need of hemorrhage control resuscitation (HCR), but the real-life performance remains unknown. The ShockMatrix study aimed to compare the predictive performance of a machine learning algorithm with that of clinicians in identifying the need for HCR.</div></div><div><h3>Methods</h3><div>Prospective, observational study in eight level-1 trauma centers. Upon receiving a prealert call, trauma clinicians in the resuscitation room entered nine predictor variables into a dedicated smartphone app and provided a subjective prediction of the need for HCR. These predictors matched those used in the machine learning model. The primary outcome, need for HCR, was defined as: transfusion in the resuscitation room, transfusion of more than four red blood cell units in 6 h of admission, any hemorrhage control procedure within 6 h, or death from hemorrhage within 24 h. The human and machine learning performances were assessed by sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and net clinical benefit. Human and machine learning agreement was assessed with Cohen's kappa coefficient.</div></div><div><h3>Findings</h3><div>Between August 2022 and June 2024, out of 5550 potential eligible patients, 1292 were ultimately included in the analyses. The need for HCR occurred in 170/1292 patients (13%). The results showed a positive likelihood ratio of 3.74 (95% confidence interval [CI]: 3.20–4.36) and a negative likelihood ratio of 0.36 (95% CI: 0.29–0.46) for the human prediction and a positive likelihood ratio of 4.01 (95% CI: 3.43–4.70) and negative likelihood ratio of 0.35 (95% CI: 0.38–0.44) for the machine learning prediction. The combined use of human and machine learning prediction yielded a sensitivity of 83% (95% CI: 77–88%) and a specificity of 73% (95% CI: 70–75%). The Cohen's kappa coefficient showed an agreement of 0.51 (95% CI: 0.48–0.55).</div></div><div><h3>Interpretation</h3><div>The prospective ShockMatrix temporal validation study suggests a comparable human and machine learning performance to predict the need for HCR using real-life and real-time information with a moderate level of agreement between the two. Machine learning enhanced decision awareness could potentially improve the detection of patients in need of HCR if used by clinicians.</div></div><div><h3>Funding</h3><div>The study received no funding.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101340"},"PeriodicalIF":13.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory syncytial virus prophylaxis with nirsevimab: impact beyond hospitalisations","authors":"Cristina Calvo ,&nbsp;María Luz García-García","doi":"10.1016/j.lanepe.2025.101349","DOIUrl":"10.1016/j.lanepe.2025.101349","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101349"},"PeriodicalIF":13.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for urgent action on chronic kidney disease across Europe","authors":"Charles J. Ferro ,&nbsp;Christoph Wanner ,&nbsp;Valerie Luyckx ,&nbsp;Monica Fontana ,&nbsp;Daniel Gallego ,&nbsp;Raymond Vanholder ,&nbsp;Roser Torra ,&nbsp;Alberto Ortiz ,&nbsp;Stronger Kidneys Taskforce of the European Renal Association, the European Kidney Health Alliance and the European Kidney Patients Federation","doi":"10.1016/j.lanepe.2025.101347","DOIUrl":"10.1016/j.lanepe.2025.101347","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101347"},"PeriodicalIF":13.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Income inequalities and mortality by generation among individuals with a foreign background in Sweden: a population-based study","authors":"Alexander Miething ,&nbsp;Andrea Dunlavy ,&nbsp;Sol P. Juárez","doi":"10.1016/j.lanepe.2025.101344","DOIUrl":"10.1016/j.lanepe.2025.101344","url":null,"abstract":"<div><h3>Background</h3><div>Evidence shows that both the mortality advantage and the lower income inequalities in mortality that characterise recent international migrants tend to disappear with time spent in the receiving country. This study examines whether absolute and relative income inequalities in mortality also increase by migrant generation in Sweden.</div></div><div><h3>Methods</h3><div>Longitudinal data from Sweden’s population registries (2004–2018) was used to identify residents aged 25–64. An open cohort design was employed using slope (SII) and relative (RII) indices of inequality from negative binomial regressions to estimate associations between income rank position and all-cause mortality among majority population Swedes and individuals with a foreign background, classified by generation and by European or non-European origin. Sub-analyses assessed the contribution of external causes to income inequalities in mortality.</div></div><div><h3>Findings</h3><div>Male descendants of migrants with non-European backgrounds exhibited higher relative income inequalities in mortality (ranging from RII_G2.₅: 6.72 to RII_G2: 11.47) than first generation non-European migrant (RII: 1.7; 95% confidence interval (CI): 1.28–2.26) and majority population men (RII: 4.73; 95% CI: 4.36–5.12). External causes accounted for 56–60% of these inequalities in mortality. Absolute income inequalities in mortality among men showed similar patterns to those observed for relative inequalities. Women showed lower absolute and relative inequalities compared to men across origins and by generation.</div></div><div><h3>Interpretation</h3><div>Income-related inequalities in mortality appear to increase by migrant generation, particularly among men with non-European backgrounds, with external causes playing a significant role. Health and non-health targeted interventions focusing on social determinants are needed to address income inequalities in mortality.</div></div><div><h3>Funding</h3><div><span>Swedish Research Council for Health, Working Life and Welfare</span>, and <span>Swedish Research Council</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101344"},"PeriodicalIF":13.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small cuts, big impact: rethinking liver surgery","authors":"Moritz Schmelzle","doi":"10.1016/j.lanepe.2025.101345","DOIUrl":"10.1016/j.lanepe.2025.101345","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101345"},"PeriodicalIF":13.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing prognostic precision in unplanned oncology admissions: the promise of the PROMISE–CTI score","authors":"Mustafa Atçı,&nbsp;Emir Çelik,&nbsp;Irfan Cicin","doi":"10.1016/j.lanepe.2025.101336","DOIUrl":"10.1016/j.lanepe.2025.101336","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101336"},"PeriodicalIF":13.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and long-term effects of prophylactic and post-excision human papillomavirus vaccination on recurrent high-grade cervical intraepithelial neoplasia relative to margin status: a retrospective cohort study in the Czech Republic","authors":"Marek Petráš ,&nbsp;Danuše Lomozová ,&nbsp;Vladimír Dvořák ,&nbsp;Vladimír Dvořák Jr. ,&nbsp;Jana Malinová ,&nbsp;Markéta Trnková ,&nbsp;Ivan Fišer ,&nbsp;Pavel Dlouhý ,&nbsp;Jozef Rosina ,&nbsp;Ivana Králová Lesná","doi":"10.1016/j.lanepe.2025.101337","DOIUrl":"10.1016/j.lanepe.2025.101337","url":null,"abstract":"<div><h3>Background</h3><div>The effect of human papillomavirus (HPV) vaccination on cervical intraepithelial neoplasia grade 2 or worse (CIN2+) recurrence with respect to cone margin positivity is unknown. Most studies assessed this effect beyond two months post-conisation. We aimed to determine both the duration and early onset of effect in women who had been prophylactically vaccinated or vaccinated after conisation, considering cone margin status.</div></div><div><h3>Methods</h3><div>This cohort study used data from one of the central laboratories in the Czech Republic, covering approximately 33% of women undergoing national cervical cancer screening. It included women treated for CIN2+ between 2010 and 2024 who had received either prophylactic HPV vaccination (available through the national immunisation program since 2011) or post-conisation vaccination (recommended by the Czech Gynaecological and Obstetrical Society since 2008). The vaccination effect was estimated using the incidence rate ratio (IRR) from a Poisson regression model, calculated as 100 × (1–IRR).</div></div><div><h3>Findings</h3><div>Of the 10,054 women enrolled, 919 were vaccinated after conisation, 502 prophylactically, and 169 had undetermined timing of vaccination. Throughout the follow-up period, CIN2+ recurrence was observed in 513 unvaccinated women, with a rate of 14·61 per 1000 person-years (py), in 14 prophylactically vaccinated women, with a rate of 5·84 (54% reduction; 95% confidence interval [CI]: 22–73%), and in 15 women vaccinated post-excision, with a rate of 3·37 (74% reduction; 95% CI: 57–85%). The high recurrence rate of 58·59 per 1000 py within six months of conisation was reduced by 80% (95% CI: 19–95%) with prophylactic vaccination and by 89% (95% CI: 57–97%) with incomplete post-excision vaccination. Among a total of 1771 women with a positive cone margin, recurrence was identified in 272 of 1568 unvaccinated women, corresponding to a recurrence rate of 51·62 per 1000 py. A reduction was observed in 84 prophylactically vaccinated and in 119 women vaccinated post-excision, with only 6 recurrence cases documented in each group. This corresponded to recurrence rates of 14·94 (62% reduction; 95% CI: 14–83%) and 9·78 per 1000 py (79% reduction; 95% CI: 52–90%), respectively.</div></div><div><h3>Interpretation</h3><div>Regardless of timing, HPV vaccination has a beneficial long-term effect in lowering the risk of CIN2+ recurrence. Despite the greater reduction in relapse achieved by post-excision vaccination, the difference compared with the prophylactic one was not statistically significant. The most pronounced benefit was observed within the first six months post-conisation, particularly in women with a positive cone margin.</div></div><div><h3>Funding</h3><div>Cooperatio 31 fund, <span>Health Sciences</span>, <span>Charles University</span>, Prague, Czech Republic.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101337"},"PeriodicalIF":13.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon emissions from clinical activities by speciality in secondary and tertiary care in England: an exploratory cross-sectional analysis of routine administrative data","authors":"Hasina Begum ,&nbsp;William K. Gray ,&nbsp;Robin M. Simpson ,&nbsp;Rose Ingleton ,&nbsp;Manraj K. Phull","doi":"10.1016/j.lanepe.2025.101333","DOIUrl":"10.1016/j.lanepe.2025.101333","url":null,"abstract":"<div><h3>Background</h3><div>The National Health Service (NHS) in England has committed to achieving net zero carbon emissions by 2045. A key early step in this journey is to understand where opportunities to decarbonise healthcare exist. The aim of this paper is to explore the potential to use available activity and emissions intensity data to investigate the carbon emissions of different specialty-level clinical activities in secondary and tertiary care in the NHS in England.</div></div><div><h3>Methods</h3><div>This was an exploratory, cross-sectional analysis of routine administrative data from secondary and tertiary care in the NHS in England. We included data for all patients admitted to hospital (including outpatient attendances, but excluding emergency attendances without subsequent admission) in England during the financial year 2022/23. The Hospital Episodes Statistics dataset and Theatre Productivity Data Collection were used. Carbon emissions factors were taken from published sources and linked to activity volumes to quantify the carbon emissions at a clinical activity level.</div></div><div><h3>Findings</h3><div>Data for 17,024,278 hospital admissions and 101,973,593 outpatient attendances were analysed. Outpatient attendances accounted for 45% of the measured carbon emissions. Of the remaining 55% relating to admitted patient care, emergency admissions accounted for 45% (82% of admitted patient care), in-patient elective activity 7% and day case activity 3%. The top 20 clinical specialties accounted for 79% of the carbon emissions, with general internal medicine, trauma and orthopaedics and general surgery the three highest carbon emitting specialties.</div></div><div><h3>Interpretation</h3><div>These data provide insight into the carbon emissions of specific elements of secondary and tertiary care activity in England. Such activity-level (and even more granular procedure-level and patient pathway-level) analysis is needed to inform carbon hotspot identification, intervention development and implementation to reduce the carbon emissions of care. As more granular data become available (e.g., on pharmaceutical use), such estimates will become more comprehensive.</div></div><div><h3>Funding</h3><div>This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101333"},"PeriodicalIF":13.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health outcomes up to 3 years and post-exertional malaise in patients after hospitalization for COVID-19: a multicentre prospective cohort study (CO-FLOW)","authors":"Julia C. Berentschot ,&nbsp;L. Martine Bek ,&nbsp;Manon Drost ,&nbsp;Rita J.G. van den Berg-Emons ,&nbsp;Gert-Jan Braunstahl ,&nbsp;Gerard M. Ribbers ,&nbsp;Joachim G.J.V. Aerts ,&nbsp;Merel E. Hellemons ,&nbsp;Majanka H. Heijenbrok-Kal","doi":"10.1016/j.lanepe.2025.101290","DOIUrl":"10.1016/j.lanepe.2025.101290","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Many patients experience long-lasting health problems after COVID-19. The study aimed to assess 3-year trajectories of a comprehensive set of patient-reported outcome measures (PROMs) in patients hospitalized for COVID-19, particularly focusing on the 2- to 3-year trajectory. Additionally, we evaluated prevalence of post-exertional malaise (PEM) at 3 years, its risk factors, co-occurring health problems, and the 3-year trajectories of patients with and without PEM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The CO-FLOW multicentre prospective cohort study followed up adults hospitalized for COVID-19 in 7 hospitals, located in the Netherlands. Study assessments were performed at 3, 6, 12, 24, and 36 months post-discharge, conducted between July 1, 2020, and May 22, 2024. PROMs on recovery, symptoms, fatigue, mental health, cognition, participation, sleep quality, work status, health-related quality of life (HRQoL), and PEM were collected. Generalized estimating equations were used to assess health trajectories and multivariable logistic regression to identify risk factors for PEM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In total, 299/344 (87%) patients completed the 3-year follow-up and were included in the analysis. Complete recovery rates increased (p &lt; 0.001), from 12% at 3 months to 24% at 3 years. Symptoms of impaired fitness, fatigue, and muscle weakness (all p &lt; 0.0019) and PROMs for fatigue score, participation, return to work, and HRQoL (all p &lt; 0.005) improved significantly over time, while PROMs for cognitive failures worsened (p &lt; 0.001). Between the 2- and 3-year visits, memory problems (OR 1.4 [1.1–1.7], p &lt; 0.001), and scores of fatigue (MD +1.0 [0.4–1.6], p = 0.002), cognitive failures (MD +2.2 [0.9–3.4], p &lt; 0.001), and SF-36 mental component summary (−2.2 [−3.1 to −1.3], p &lt; 0.001) significantly worsened. At 3 years, 66% of patients experienced fatigue, 63% impaired fitness, 59% memory problems, and 53% concentration problems. PROMs showed that 62% reported poor sleep quality, 55% fatigue, and 28% cognitive failures. PEM was reported by 105/292 (36%) patients at 3 years; risk factors were female sex (OR 3.4 [95% CI 1.9–6.0], p &lt; 0.001), pre-existing pulmonary disease (3.0 [1.7–5.6], p &lt; 0.001), physical inactivity pre-COVID-19 (2.3 [1.2–4.1], p = 0.008), and ICU treatment for COVID-19 (1.8 [1.02–3.0], p = 0.04). Concurrent fatigue, cognitive failures, and dyspnea were more common in patients with (42%) than without (6%) PEM. Patients with PEM showed poor health outcomes throughout the entire follow-up period, including worsening fatigue and HRQoL during the third year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Many health problems persisted up to 3 years post-discharge, with self-reported fatigue and cognitive problems worsening in the third year. PEM was common, and linked to a more severe phenotype of long COVID. These findings highlight the urgent need to optimize treatment opt","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101290"},"PeriodicalIF":13.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soldiers of Ukraine","authors":"The Lancet Regional Health – Europe","doi":"10.1016/j.lanepe.2025.101341","DOIUrl":"10.1016/j.lanepe.2025.101341","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101341"},"PeriodicalIF":13.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}