Lancet Regional Health-Europe最新文献

{"title":"Long-term outcomes of depression up to 10-years after stroke in the South London Stroke Register: a population-based study","authors":"Lu Liu , Iain J. Marshall , Xianqi Li , Ajay Bhalla , Lidan Liu , Ruonan Pei , Charles D.A. Wolfe , Matthew D.L. O'Connell , Yanzhong Wang","doi":"10.1016/j.lanepe.2025.101324","DOIUrl":"10.1016/j.lanepe.2025.101324","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence on the long-term outcomes of post-stroke depression (PSD) is limited, with most studies relying on short follow-ups and cross-sectional designs. We aim to examine (1) associations between depression at 3-months and long-term outcomes-including mortality, stroke recurrence, functional ability and quality of life (QoL)- up to 10-years; (2) the impact of depression recovery and timing of onset on these associations.</div></div><div><h3>Methods</h3><div>Data were from the South London Stroke Register (1-January-1997–20-April-2023). Depression was defined as a score >7 on the Hospital Anxiety and Depression Scale. Physical disability was measured using Barthel Index; instrumental activity of daily living (IADL) using the Frenchay Activities Index; and QoL using the Short Form-12, which provides physical and mental health summary scores. Outcomes were assessed annually up to 10-years. Cox proportional hazards models estimated the associations between PSD and mortality and stroke recurrence, while generalized estimating equation was used for physical disability and IADL and linear mixed models for QoL, adjusting for covariates.</div></div><div><h3>Findings</h3><div>Among 2581 stroke survivors assessed at 3-months, 918 (35.6%) exhibited depression symptom. PSD at 3-month was associated with higher mortality risk (aHR 1.18, 95% CI [1.03–1.36]), but not with stroke recurrence (0.85 [0.64–1.14]) over a 10-year follow-up. The number of patients in analysing the association with physical disability, IADL and QoL was 1388, 1167, and 1292 respectively. PSD was also linked to increased odds of physical disability (aOR 2.94, 95% CI [2.12–4.09]), IADL impairment (2.89 [2.13–3.92]) and lower physical (β = −5.93, 95% CI [−7.26 to −4.60]) and mental QoL (−7.56 [−8.99 to −6.13]) scores. Compared to patients with PSD at both 3-months and 1-year, those recovered by 1-year had similar mortality risk (0.95 [0.76–1.16]), but lower stroke recurrence (0.47 [0.25–0.92]), lower occurrence of physical disability (0.55 [0.36–0.85]) and IADL impairment (0.56 [0.36–0.89]), and improved physical (3.55 [1.30–5.80]) and mental (10.91 [8.56–13.25]) QoL. PSD at 1-year or 5-years was also associated with increased mortality (1-year: 1.33 [1.15–1.53], 5-year: 1.37 [1.10–1.71]), increased risks of physical disability (1-year: 2.20 [1.77–2.74], 5-year: 2.42 [1.39–4.22]) and IADL impairment (1-year: 3.00 [2.22–4.06]; 5-year: 2.69 [1.76–4.11]) and lower physical (1-year: −6.49 [−7.60 to −5.38]; 5-year: −6.78 [−8.30 to −1.24]) and mental QoL (1-year: −12.04 [−13.25 to −10.83]; 5-year: −6.76 [−8.81 to −4.72]) scores.</div></div><div><h3>Interpretation</h3><div>PSD had lasting impact on stroke recovery, extending significantly beyond the acute phase. As recovery from depression within 1-year is associated with improved health outcomes, further research is needed to develop effective PSD interventions and enhance long-term stroke prognosis.</div><","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101324"},"PeriodicalIF":13.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948532","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":"Intermuscular adipose tissue and lean muscle mass assessed with MRI in people with chronic back pain in Germany: a retrospective observational study","authors":"Sebastian Ziegelmayer , Hartmut Häntze , Christian Mertens , Felix Busch , Tristan Lemke , Jakob Nikolas Kather , Daniel Truhn , Su Hwan Kim , Benedikt Wiestler , Markus Graf , Avan Kader , Fabian Bamberg , Christopher L. Schlett , Jakob B. Weiss , Jeanette Schulz-Menger , Steffen Ringhof , Elif Can , Tobias Pischon , Thoralf Niendorf , Jacqueline Lammert , Keno Bressem","doi":"10.1016/j.lanepe.2025.101323","DOIUrl":"10.1016/j.lanepe.2025.101323","url":null,"abstract":"<div><h3>Background</h3><div>Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI).</div></div><div><h3>Methods</h3><div>This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site.</div></div><div><h3>Findings</h3><div>Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; median age 49 years IQR 41; 57), 21.8% (n = 6003; n = 2999/50.0% female, n = 3004/50% male; median age 53 years IQR 46; 60) reported CBP, compared to 78.2% (n = 21,515; n = 9194/42.7% female, n = 12,321/57.3% male; median age 48 years IQR 39; 56) who did not. CBP prevalence was highest in those with low (<500 MET min/week) or high (>5000 MET min/week) self-reported physical activity levels (24.6% (n = 10,892) and 22.0% (n = 3800), respectively) compared to moderate (500–5000 MET min/week) levels (19.4% (n = 12,826); p < 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13–1.30; p < 0.0001) was associated with an increased likelihood of chronic back pain (CBP), whereas higher lean muscle mass (LMM) (OR 0.87 per 2-unit Z-score; 95% CI 0.79–0.95; p = 0.003) was associated with a reduced likelihood of CBP. Stratified analyses confirmed these associations persisted in individuals with osteoarthritis (OA-CBP LMM: 22.9 cm<sup>3</sup>/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm<sup>3</sup>/kg/m; InterMAT: 6.96% both p < 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm<sup>3</sup>/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm<sup>3</sup>/kg/m; InterMAT: 7.9% p = 0.16 and p = 0.0019). Higher pain intensity (Pain Intensity Numerical Rating Scale ≥4) correlated with lower LMM (2-unit Z-score deviation = OR, 0.63; 95% CI, 0.57–0.70; p < 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13–1.30; p < 0.0001), independent of physical activity, osteoporosis and osteoarthritis.</div></div><div><h3>Interpretation</h3><div>This large, population-based study highlights the associations of InterMAT and LMM with CBP. Given the limitations of the cross-sectional design, our findings can be seen as an impetus for further causal investigations within a broader, multidisciplinary framework to guide ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101323"},"PeriodicalIF":13.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941628","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":"Risk of exacerbations, hospitalisation, and mortality in adults with physician-diagnosed chronic obstructive pulmonary disease with normal spirometry and adults with preserved ratio impaired spirometry in Sweden: retrospective analysis of data from a nationwide cohort study","authors":"Oskar Wallström , Caroline Stridsman , Helena Backman , Sigrid Vikjord , Anne Lindberg , Fredrik Nyberg , Lowie E.G.W. Vanfleteren","doi":"10.1016/j.lanepe.2025.101322","DOIUrl":"10.1016/j.lanepe.2025.101322","url":null,"abstract":"<div><h3>Background</h3><div>Physician diagnosed COPD with normal spirometry (dnsCOPD) (sometimes labeled pre-COPD) and Preserved Ratio Impaired Spirometry (PRISm) has been studied in population-based cohorts, but not in physician diagnosed COPD (dCOPD) patients from routine clinical practice. The Swedish National Airway Register (SNAR) is a large nationwide register including data from dCOPD patients from over 1000 clinics across all regions of Sweden and is representative of the COPD care in Sweden. We aimed to identify and characterize patients with dnsCOPD, PRISm and spirometrically confirmed COPD (sCOPD) from dCOPD patients in SNAR, stratify them further according to symptoms and exacerbations risk using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) A/B/E classification, and assess differences in risk for exacerbations, cause-specific hospitalisations and mortality.</div></div><div><h3>Methods</h3><div>We enrolled patients aged ≥30 years with dCOPD in the SNAR from 1 January 2014 to 30 June 2022 with complete spirometry i.e., postbronchodilator values for both forced expiratory volume in 1 s (FEV<sub>1</sub>) and forced vital capacity (FVC) (index date). Patients with concomitant asthma were excluded. Patients were stratified into dnsCOPD (FEV<sub>1</sub>/FVC ≥0.7 and FEV<sub>1</sub> ≥80% predicted), PRISm (FEV<sub>1</sub>/FVC ≥0.7 and FEV<sub>1</sub> <80% predicted) and sCOPD (FEV<sub>1</sub>/FVC <0.7). Further substratification was based on GOLD A/B/E (A: COPD assessment test (CAT) score <10 points and <2 moderate, 0 severe exacerbations within 1 year before the index date, B: CAT-score ≥10 points and <2 moderate, 0 severe exacerbations, E: ≥2 moderate or ≥1 severe exacerbation(s)). Patients were followed until 31 November 2022. Competing risk regression was used to calculate subdistribution hazard ratios (SHR)s with 95% confidence intervals (CIs) for exacerbation, hospitalisation and mortality.</div></div><div><h3>Findings</h3><div>Of 45,653 patients with dCOPD, 5.4% had dnsCOPD, 11.4% had PRISm and 83.3% had sCOPD. Smoking history was similar between groups (ever smoker: dnsCOPD: 79% PRISm: 82% sCOPD: 86%) and inhalation therapy was common in all groups (any inhaler: 75%, 80% and 80%, triple combination: 22%, 28% and 35%). Patients with PRISm had a high prevalence of obesity (dnsCOPD: 30%, PRISm: 43%, COPD: 22%), cardiovascular disease (dnsCOPD: 39%, PRISm: 48%, COPD: 41%) and diabetes (dnsCOPD: 10%, PRISm: 17%, COPD: 9%). Baseline GOLD group B or E were highly prevalent in dnsCOPD (B: 54%, E: 11%), PRISm (B: 59%, E: 14%), as well as in COPD (B: 54%, E: 17%). DnsCOPD and PRISm patients had lower risk of exacerbations (SHR 0.69, 95%CI 0.64–0.74 and 0.85, 95%CI 0.81–0.89), respiratory hospitalisation (0.40, 95%CI 0.34–0.46 and 0.68, 95%CI 0.62–0.73), and respiratory mortality (0.22, 95%CI 0.13–0.37 and 0.60, 95%CI 0.48–0.75) compared to sCOPD. Cardiovascular mortality was lower in dnsCOPD (0.41, 95%CI 0.1","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101322"},"PeriodicalIF":13.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948531","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":"The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions","authors":"Anil Menon ,&nbsp;Nolan M. Kavanagh ,&nbsp;Michelle Falkenbach ,&nbsp;Matthias Wismar ,&nbsp;Scott L. Greer","doi":"10.1016/j.lanepe.2025.101326","DOIUrl":"10.1016/j.lanepe.2025.101326","url":null,"abstract":"<div><div>Around the world, institutional trust is declining while democratic discontent is rising. What role do health and health systems play in this crisis? We review decades of interdisciplinary research to describe how health and health systems are linked to democratic trust and engagement. When individuals or communities experience a decline in their health, they feel “let down” by the health system and other public institutions meant to support their well-being. Consequently, they are less likely to vote. Those who continue to vote are increasingly drawn to anti-establishment, anti-democratic parties that promise to radically reform the system. Once in power, however, these parties often weaken public health protections or exclude select populations from the health system. The result can be a self-reinforcing feedback loop between declining health and political discontent. We conclude by offering concrete suggestions for improving population health while rebuilding trust in health systems and democratic institutions more broadly.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101326"},"PeriodicalIF":13.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941274","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":"From battlefields to global health: the war-driven spread of multidrug-resistant bacteria","authors":"Guido Granata ,&nbsp;Nicola Petrosillo","doi":"10.1016/j.lanepe.2025.101325","DOIUrl":"10.1016/j.lanepe.2025.101325","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101325"},"PeriodicalIF":13.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935290","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":"Efficacy and safety of varenicline and bupropion, in combination and alone, for alcohol use disorder: a randomized, double-blind, placebo-controlled multicentre trial","authors":"Bo Söderpalm ,&nbsp;Helga Lidö ,&nbsp;Johan Franck ,&nbsp;Anders Håkansson ,&nbsp;Daniel Lindqvist ,&nbsp;Markus Heilig ,&nbsp;Joar Guterstam ,&nbsp;Markus Samuelson ,&nbsp;Barbro Askerup ,&nbsp;Cecilia Wallmark-Nilsson ,&nbsp;Andrea de Bejczy","doi":"10.1016/j.lanepe.2025.101310","DOIUrl":"10.1016/j.lanepe.2025.101310","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Alcohol use disorder (AUD) is associated with an enormous burden of disease and cost to society. The dopamine deficiency hypothesis posits that negative reinforcement generated by a low brain dopamine state drives ethanol intake. Here, we evaluated the efficacy and safety of combined administration of two dopamine-enhancing drugs, varenicline (a partial nicotinic acetylcholine receptor agonist) and bupropion (a weak dopamine-reuptake inhibitor) on alcohol intake in AUD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants aged 25–70 years with moderate-to-severe AUD (defined as ≥4/11 Diagnostic and Statistical Manual of Mental Disorders [DSM]-5 criteria) were enrolled in this randomized, double-blind, placebo-controlled trial, done at four outpatient clinics in Sweden. Participants were randomly assigned (block size 8) 1:1:1:1 to Placebo + Placebo, Varenicline + Bupropion, Varenicline + Placebo, or Placebo + Bupropion. After a 1-week titration period, Varenicline was taken as 1 mg orally twice per day and bupropion as 150 mg orally twice per day for 12 weeks. Participants, investigators, and all study personnel were unaware of treatment allocation. The two primary outcomes were phosphatidylethanol in blood (B-PEth) and self-reported percentage heavy drinking days (%HDD), assessed over a steady state 10-week-period (from start of week 2 to end of week 11). Modified intention-to-treat (mITT) and per protocol analyses (PP) were performed using a sequential hierarchical statistical method. This registered study (EudraCT 2018–000048-24; &lt;span&gt;&lt;span&gt;clinicaltrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; &lt;span&gt;&lt;span&gt;NCT04167306&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;) is completed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between March 4, 2019, and December 14, 2022, 384 participants were randomly assigned: Placebo + Placebo = 97, Varenicline + Bupropion = 100, Varenicline + Placebo = 96, Placebo + Bupropion = 91. 72% participants were male (277/384) and 28% female (107/384), median age 57 (13) years. In the mITT analyses, Varenicline + Bupropion reduced B-PEth (Cohen's d [d] = 0·39, p = 0·004) and %HDD (d = 0·31, p = 0·008) vs Placebo + Placebo. Varenicline + Placebo also reduced B-PEth (d = 0·30, p = 0·005) and %HDD (d = 0·36, p = 0·023) vs Placebo + Placebo. For both primary endpoints, differences between the Varenicline + Bupropion and Varenicline + Placebo groups were not statistically significant (B-PEth: d = 0·022, p = 0·97, %HDD: d = 0·027, p = 0·76), precluding further comparisons according to the statistical hierarchy. In PP analyses, both primary outcomes were reduced with Varenicline + Bupropion (d = 0·43 [B-PEth]; d = 0·41 [%HDD]) and Varenicline + Placebo (d = 0·29 [B-PEth]; d = 0·34 [%HDD]) compared with Placebo + Placebo. Nausea, the only safety concern, was more common in the Varenicline + Placebo group than in the Placebo + Placebo group (49/96 vs 11/97, p &lt; 0·0001) and of longer median duration (45 (70) vs 10","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101310"},"PeriodicalIF":13.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935291","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":"Antimicrobial resistance in Neisseria gonorrhoeae and its risk groups in 23 European countries in 2022 within the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP): a retrospective observational study","authors":"Susanne Jacobsson ,&nbsp;Michelle J. Cole ,&nbsp;Daniel Schröder ,&nbsp;Melissa Jansen van Rensburg ,&nbsp;Michaela Day ,&nbsp;Csaba Ködmön ,&nbsp;Magnus Unemo","doi":"10.1016/j.lanepe.2025.101318","DOIUrl":"10.1016/j.lanepe.2025.101318","url":null,"abstract":"<div><h3>Background</h3><div>Since 2009, the European Centre for Disease Prevention and Control (ECDC) has coordinated the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) to monitor antimicrobial resistance (AMR) in <em>Neisseria gonorrhoeae</em> across the European Union and European Economic Area (EU/EEA). The aims of this study were to report Euro-GASP 2022 data and to compare with the most recently published Euro-GASP data (from 2016 to 2019), to identify changes in AMR and in risk groups for AMR.</div></div><div><h3>Methods</h3><div>In this observational study, 23 EU/EEA countries submitted AMR data for gonococcal isolates from 2022, linked to patient epidemiological data, to The European Surveillance System (TESSy). Statistical analyses (Z-test) were used to determine the significance of the differences between the epidemiological data and proportion of AMR isolates in 2022 versus 2019 and 2016. The risk factors associated with AMR isolates were assessed using univariate and multivariable logistic regression analyses of odds ratios.</div></div><div><h3>Findings</h3><div>Ceftriaxone resistance in 2022 (0.03%, 1/3008) remained low (0.06% (2/3239) in 2019), and cefixime resistance (0.3%, 10/3008) had decreased (0.8% (26/3239) in 2019). Azithromycin resistance (24.9%, 749/3008) and ciprofloxacin resistance (65.8%, 1980/3008) had increased (9.0% (284/3159) and 57.4% (1665/2884), respectively, in 2019). A marked increase in the number (575; 502 in 2019) and proportion (19.2%; 15.8% in 2019) of female gonorrhoea cases was also identified in 2022. In the univariate analysis, azithromycin resistance was associated with oropharyngeal (OR 1.67, CI 1.28–2.18; p &lt; 0.0001) and anorectal infections (OR 1.38, CI 1.08–1.76; p = 0.0094), men-who-have-sex-with-men (MSM) (OR 3.88, CI 2.80–5.37; p &lt; 0.0001), and females (1.71, CI 1.21–2.41; p = 0.0022). In the multivariable logistic regression model, only azithromycin resistance and MSM remained associated (OR 2.85, CI 1.33–4.73; p = 0.0040).</div></div><div><h3>Interpretation</h3><div>While ceftriaxone resistance remains sporadically detected in Euro-GASP, the increase in reports of occasional ceftriaxone resistance in EU/EEA countries and substantial increase in azithromycin resistance underscore the urgent need for enhanced AMR surveillance. The Euro-GASP data is crucial for refining treatment guidelines and mitigating the spread of AMR gonococcal strains. Novel effective antimicrobials for gonorrhoea treatment remain imperative.</div></div><div><h3>Funding</h3><div><span>ECDC</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101318"},"PeriodicalIF":13.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929387","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":"Prevalence and incidence of moderate and severe mental illness in the second postpartum year in England (1995–2020): a national retrospective cohort study using primary care data","authors":"Ellie Jones ,&nbsp;Laura Quinn ,&nbsp;Jamie-Rae Tanner ,&nbsp;Jelena Jankovic ,&nbsp;Giles Berrisford ,&nbsp;Christine MacArthur ,&nbsp;Beck Taylor","doi":"10.1016/j.lanepe.2025.101312","DOIUrl":"10.1016/j.lanepe.2025.101312","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal mental illness affects around 20% of women in pregnancy and the first postpartum year with little evidence regarding persistence and incidence in the second year. This study aimed to describe prevalence and incidence of moderate and severe mental illness in the second postpartum year to estimate the proportion of women who could benefit from extension of England's specialist perinatal mental health services to two years.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using United Kingdom primary care Clinical Practice Research Datalink GOLD. All women registered with a General Practitioner with third trimester, delivery code or postpartum medical record 1995–2020 were included. Secondary objectives were to investigate mental illness type and associated factors.</div></div><div><h3>Findings</h3><div>2,132,754 pregnancies from 1,361,497 women were included. Prevalence of mental illness likely to need specialist PMH services in second postpartum year increased significantly from 3.1% (n = 2643/85,756) in 1995 to 7.4% (n = 2473/34,098) in 2018. Incident cases increased from 1.9% (n = 1630/85,756) in 1995 to 3.8% (n = 1285/34,098) in 2018 representing 56.6% (n = 69,926/123,510) of all cases in the second year. Adjusted analysis showed odds of mental illness in second year were higher: for women in most ages vs 30–34 yrs; for each additional pregnancy (OR: 1.16, 95% CI: 1.13, 1.19 two vs one); for preterm births (OR: 1.21, 95% CI: 1.15, 1.27), near term (OR: 1.21, 95% CI: 1.17, 1.25) or post-term (OR: 1.07, 95% CI: 1.04, 1.09) vs term; with history of mental illness (OR: 2.46, 95% CI: 2.41, 2.52), smoking (OR: 1.37, 95% CI: 1.35, 1.39), substance use disorder (OR: 1.54, 95% CI: 1.48, 1.60), and for each year vs 1995. Separate analysis using a subset of data showed odds of mental illness were higher for women in all quintiles vs least deprived and for women of white ethnicity vs all other ethnicities. Although severity could not be accurately measured, most recorded illnesses would require specialist perinatal mental health input.</div></div><div><h3>Interpretation</h3><div>Extension of specialist perinatal mental health services to two years postpartum is justified.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research Applied Research Collaboration West Midlands</span> (NIHR200165).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101312"},"PeriodicalIF":13.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922396","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":"Prediction of 90-day mortality among cancer patients with unplanned hospitalisation: a retrospective validation study of three prognostic scores","authors":"Galip Can Uyar ,&nbsp;Oriol Mirallas ,&nbsp;Kadriye Başkurt ,&nbsp;Berta Martin-Cullell ,&nbsp;Enes Yeşilbaş ,&nbsp;Jordi Recuero-Borau ,&nbsp;Seher Kaya ,&nbsp;Victor Navarro Garcés ,&nbsp;Sevgi Eryıldız Yücel ,&nbsp;Kreina Sharela Vega Cano ,&nbsp;Diego Gómez-Puerto ,&nbsp;Anna Pedrola Gómez ,&nbsp;Clara Salva de Torres ,&nbsp;Ömür Berna Çakmak Öksüzoğlu ,&nbsp;Sonia Serradell ,&nbsp;Rodrigo Dienstmann ,&nbsp;Osman Sütcüoğlu","doi":"10.1016/j.lanepe.2025.101317","DOIUrl":"10.1016/j.lanepe.2025.101317","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Accurate prediction of 90-day mortality in hospitalised cancer patients is critical for guiding personalised treatment decisions and optimising oncologic care. However, existing prognostic models often lack sufficient precision, particularly in distinguishing between high- and low-risk patients. In this retrospective study, we independently evaluated the prognostic performance of three scoring systems—the Prognostic Score for Hospitalised Cancer Patients (PROMISE), the Gustave Roussy Immune (GRIm) score, and the C-reactive protein–Triglyceride–Glucose Index (CTI)—in patients admitted for unplanned hospitalisations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective observational study was conducted at the Medical Oncology Clinic of Ankara Etlik City Hospital, Turkey, and included patients aged 18 years or older with a diagnosis of cancer who were hospitalised unexpectedly between February 2023 and February 2024. Laboratory data were retrieved from the institutional hospital information system. The PROMISE score was calculated using its original specification via the online tool (&lt;span&gt;&lt;span&gt;https://promise.vhio.net/&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;). The GRIm score was calculated based on neutrophil-to-lymphocyte ratio (NLR), albumin, and lactate dehydrogenase (LDH). The CTI score was computed as: CTI = [0.412 × ln (C-reactive protein [CRP])] + ln [Triglyceride × Glucose/2], with a cut-off value of 4.78. A PROMISE–CTI Combined score was derived using regression-based weighting. Risk stratification was performed for all three scores using validated thresholds. Statistical analyses included Kaplan–Meier survival analysis, log-rank tests, univariable and multivariable logistic regression to assess predictors of 90-day mortality, and receiver operating characteristic (ROC) curve analysis to evaluate discriminatory performance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 1657 hospitalised cancer patients screened during the study period, 1109 met the inclusion criteria and were included in the analysis. PROMISE and GRIm scores were calculated for all 1109 patients, while CTI score was assessed in 333 patients with complete laboratory data. The 90-day mortality rate was 63.7% (n = 707). High PROMISE score (OR: 3.32, 95% CI: 1.40–7.86; p = 0.006) and high CTI score (OR: 2.85, 95% CI: 1.32–6.18; p = 0.008) were associated with increased 90-day mortality. Low PROMISE score (OR: 0.22, 95% CI: 0.10–0.49; p = 0.001) and low CTI score (OR: 0.35, 95% CI: 0.17–0.73; p = 0.003) were associated with reduced 90-day mortality. High GRIm score (OR: 1.83, 95% CI: 0.83–2.91; p = 0.07) and low GRIm score (OR: 0.73, 95% CI: 0.47–1.20; p = 0.08) were not significantly associated with 90-day mortality. The area under the curve (AUC) of the PROMISE–CTI Combined score was 0.884 (95% CI: 0.849–0.919; p &lt; 0.0001). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the PROMISE–CT","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101317"},"PeriodicalIF":13.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922449","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":"From inertia to impact: delivering real solutions for non-communicable diseases","authors":"The Lancet Regional Health – Europe","doi":"10.1016/j.lanepe.2025.101315","DOIUrl":"10.1016/j.lanepe.2025.101315","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101315"},"PeriodicalIF":13.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894953","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}