Lancet Regional Health-Europe最新文献

{"title":"Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional study","authors":"Antero Ylänen ,&nbsp;Juhani Isojärvi ,&nbsp;Antti Virtanen ,&nbsp;Helena Leijon ,&nbsp;Tiina Vesterinen ,&nbsp;Aapo L. Aro ,&nbsp;Heini Huhtala ,&nbsp;Eeva Kokko ,&nbsp;Ilkka Pörsti ,&nbsp;Marianna Viukari ,&nbsp;Pasi I. Nevalainen ,&nbsp;Niina Matikainen","doi":"10.1016/j.lanepe.2025.101226","DOIUrl":"10.1016/j.lanepe.2025.101226","url":null,"abstract":"<div><h3>Background</h3><div>Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain part of the risk for disease-induced sudden death (DSD).</div></div><div><h3>Methods</h3><div>In this study, autopsies and histopathological analyses, including aldosterone synthase staining of adrenal glands, were performed on 403 consecutive individuals who experienced sudden death. These individuals were classified into 258 cases of DSD and 144 deaths caused by trauma, suicide, or intoxication, i.e., non-disease-induced sudden death (nDSD). This trial was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05446779</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>Adrenal histopathology revealed changes in 31 (7.7%) subjects of the cohort. Of these, the most prevalent findings [25 (6.2%)] were aldosterone-producing adenomas (APA) or nodules (APN), which were associated with myocardial infarction and atherosclerosis at autopsy. Individuals in the DSD group and the subgroup with sudden cardiac death (SCD) were more likely to have APA or APN than individuals in the nDSD group [23 (8.9%) vs. 2 (1.4%), p = 0.002; 16 (8.8%) vs. 2 (1.4%), p = 0.003, respectively]. APA or APN were explanatory factors for DSD (odds ratio [OR] 6.47, 95% confidence interval [CI] 1.40–29.88, p = 0.017) and SCD (OR 10.68, 95% CI 2.02–56.43, p = 0.005). Other findings included two pheochromocytomas, one bilateral adrenal metastasis, and two unilateral adrenal metastases.</div></div><div><h3>Interpretation</h3><div>In this exploratory study, APA or APN were more frequently seen in DSD and SCD than nDSD cases. Whether primary aldosteronism constitutes a novel risk factor for sudden death warrants further study.</div></div><div><h3>Funding</h3><div>Finnish State Research funds and independent research foundations: <span>Aarne Koskelo Foundation</span>, the <span>Finnish Kidney Foundation</span>, and the <span>Finnish Foundation for Cardiovascular Research</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101226"},"PeriodicalIF":13.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143304207","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":"Estimation of respiratory syncytial virus-associated hospital admissions in five European countries: a modelling study","authors":"Caroline Klint Johannesen ,&nbsp;David Gideonse ,&nbsp;Richard Osei-Yeboah ,&nbsp;Toni Lehtonen ,&nbsp;Ombeline Jollivet ,&nbsp;Rachel A. Cohen ,&nbsp;Arantxa Urchueguía-Fornes ,&nbsp;María Herrero-Silvestre ,&nbsp;Mónica López-Lacort ,&nbsp;Rolf Kramer ,&nbsp;Thea K. Fischer ,&nbsp;Terho Heikkinen ,&nbsp;Harish Nair ,&nbsp;Harry Campbell ,&nbsp;Michiel van Boven","doi":"10.1016/j.lanepe.2025.101227","DOIUrl":"10.1016/j.lanepe.2025.101227","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory syncytial virus (RSV) can cause severe disease, notably among infants, older adults, and individuals with comorbidities. Non-systematic testing and differences in coding practices affect direct measures of the hospital disease burden. We aim to tackle this issue and estimate RSV-associated respiratory hospital admissions through time series modelling of hospital admissions.</div></div><div><h3>Methods</h3><div>The number of RSV hospital admissions in Denmark, England, Finland, the Netherlands, and Spain were estimated with attribution analyses, using age-specific respiratory tract infection (RTI) admissions combined with virological data, both from routinely collected healthcare data. Analyses covered the years 2016–2023.</div></div><div><h3>Findings</h3><div>The attributed incidence of RSV per 100,000 children 0–2 months ranged from 1715 in Denmark to 3842 in England. In older adults, substantial differences in the incidence of ICD-10 coded RSV hospitalisations were found, while the attributed RSV incidence was more comparable, ranging from approximately 100 per 100,000 in adults 65–74 years to 200 per 100,000 persons 75–84 years and 500 per 100,000 persons 85 years and older.</div></div><div><h3>Interpretation</h3><div>RSV-attributed time series exhibit a high degree of synchronicity between participating countries, suggesting that this method for attribution addresses the known issues with underdiagnosis and misclassification. In the older age groups, a substantial proportion of RTI hospitalisations is attributed to RSV, underscoring the relevance of RSV as a cause of severe respiratory infections.</div></div><div><h3>Funding</h3><div>This project has received funding from the <span>Innovative Medicines Initiative</span> 2 Joint Undertaking under grant agreement <span><span>101034339</span></span>. This Joint Undertaking receives support from the <span>European Union’s Horizon 2020</span> research and innovation programme and <span>EFPIA</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101227"},"PeriodicalIF":13.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143304135","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":"School phone policies and their association with mental wellbeing, phone use, and social media use (SMART Schools): a cross-sectional observational study","authors":"Victoria A. Goodyear ,&nbsp;Amie Randhawa ,&nbsp;Péymane Adab ,&nbsp;Hareth Al-Janabi ,&nbsp;Sally Fenton ,&nbsp;Kirsty Jones ,&nbsp;Maria Michail ,&nbsp;Breanna Morrison ,&nbsp;Paul Patterson ,&nbsp;Jonathan Quinlan ,&nbsp;Alice Sitch ,&nbsp;Rebecca Twardochleb ,&nbsp;Matthew Wade ,&nbsp;Miranda Pallan","doi":"10.1016/j.lanepe.2025.101211","DOIUrl":"10.1016/j.lanepe.2025.101211","url":null,"abstract":"<div><h3>Background</h3><div>Poor mental health in adolescents can negatively affect sleep, physical activity and academic performance, and is attributed by some to increasing mobile phone use. Many countries have introduced policies to restrict phone use in schools to improve health and educational outcomes. The SMART Schools study evaluated the impact of school phone policies by comparing outcomes in adolescents who attended schools that restrict and permit phone use.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional observational study with adolescents from 30 English secondary schools, comprising 20 with restrictive (recreational phone use is not permitted) and 10 with permissive (recreational phone use is permitted) policies. The primary outcome was mental wellbeing (assessed using Warwick–Edinburgh Mental Well-Being Scale [WEMWBS]). Secondary outcomes included smartphone and social media time. Mixed effects linear regression models were used to explore associations between school phone policy and participant outcomes, and between phone and social media use time and participant outcomes. Study registration: ISRCTN77948572.</div></div><div><h3>Findings</h3><div>We recruited 1227 participants (age 12–15) across 30 schools. Mean WEMWBS score was 47 (SD = 9) with no evidence of a difference between groups (adjusted mean difference −0.48, 95% CI −2.05 to 1.06, p = 0.62). Adolescents attending schools with restrictive, compared to permissive policies had lower phone (adjusted mean difference −0.67 h, 95% CI −0.92 to −0.43, p = 0.00024) and social media time (adjusted mean difference −0.54 h, 95% CI −0.74 to −0.36, p = 0.00018) during school time, but there was no evidence for differences when comparing usage time on weekdays or weekends.</div></div><div><h3>Interpretation</h3><div>There is no evidence that restrictive school policies are associated with overall phone and social media use or better mental wellbeing in adolescents. The findings do not provide evidence to support the use of school policies that prohibit phone use during the school day in their current form, and indicate that these policies require further development.</div></div><div><h3>Funding</h3><div><span>Public Health Research Programme</span>, <span>National Institute for Health and Care Research</span>, <span>Department of Health and Social Care</span>, UK.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101211"},"PeriodicalIF":13.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685957","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":"Association between cardiometabolic diseases and the risk and progression of motor neuron diseases in Sweden: a population-based case–control study","authors":"Charilaos Chourpiliadis ,&nbsp;Anikó Lovik ,&nbsp;Christina Seitz ,&nbsp;Yihan Hu ,&nbsp;Jing Wu ,&nbsp;Petter Ljungman ,&nbsp;Rayomand Press ,&nbsp;Kristin Samuelsson ,&nbsp;Caroline Ingre ,&nbsp;Fang Fang","doi":"10.1016/j.lanepe.2024.101173","DOIUrl":"10.1016/j.lanepe.2024.101173","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The evidence on the link between cardiometabolic diseases (CMDs) and motor neuron diseases (MNDs) remains inconsistent. We aimed to determine whether there is an association of CMDs, namely, any cardiovascular disease, cardiac arrhythmia, heart failure, thromboembolic disease, hypertension, cerebrovascular disease, ischemic heart disease, diabetes mellitus type 2, and hypercholesterolemia with the risk and progression of MNDs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We included 1463 MND patients (amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS), progressive spinal muscular atrophy (PSMA), and unspecified MND) diagnosed from January 1, 2015, to July 1, 2023, in Sweden according to the Swedish Motor Neuron Disease Quality Registry (i.e., cases), up to 5 MND-free population controls per case (N = 7311) who were individually matched to the cases on age and sex, and the full siblings (N = 2002) and spouses (N = 1220) of MND patients (i.e., relative controls). Conditional logistic regression models were used to estimate the risk of MND diagnosis in relation to previous CMDs, through comparing MND patients to population controls or relative controls. MND patients were followed from diagnosis to assess the role of pre-diagnostic CMDs on disease progression. A joint longitudinal-survival model was used to estimate risk of mortality (or use of invasive ventilation) in relation to CMDs after taking into account the longitudinal changes of ALS functional rating scale-revised (ALSFRS-R) in the time-to-event analysis. Hierarchical clustering with the Ward's linkage and a dissimilarity matrix created by Gower's method was used to identify clusters of MND patients with distinct phenotypes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among the CMDs studied, a history of diabetes mellitus type 2 (OR 0.75; 95% CI 0.62, 0.93) or hypercholesterolemia (OR 0.82; 95% CI 0.71, 0.94) more than one year before diagnosis was associated with a lower risk for MNDs. The associations persisted for more than five years before MND diagnosis. MND patients with a history of any cardiovascular disease (HR 1.43; 95% CI 1.13, 1.81), arrhythmia (HR 1.42; 95% CI 1.04, 1.93), heart failure (HR 1.79; 95% CI 1.02, 3.14), hypertension (HR 1.41; 95% CI 1.12, 1.77), or hypercholesterolemia (HR 1.28; 95% CI 1.01, 1.62) had an increased mortality risk, compared to others, after taking into consideration the longitudinal changes in ALSFRS-R. Cluster analysis identified two clusters of MND patients, where one cluster demonstrated higher age, worse functional status, and higher prevalence of CMDs at the time of diagnosis as well as a higher mortality and faster functional decline during follow-up, compared to the ones included in the other cluster.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Diabetes mellitus type 2 and hypercholesterolemia were associated with a lower future risk of MND. On the other hand, most of the CMDs were indicative of a poor disease ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101173"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933521","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":"Do national cancer control plans address care and research for children, adolescents, and young adults? A review of status, priorities, and recommendations across 41 European countries","authors":"Joan Prades ,&nbsp;Olga Kozhaeva ,&nbsp;Maria Otth ,&nbsp;Pamela Kearns ,&nbsp;Ruth Ladenstein ,&nbsp;Carmelo Rizzari ,&nbsp;Delphine Heenen ,&nbsp;Uta Dirksen ,&nbsp;Cormac Owens ,&nbsp;Deyan Lazarov ,&nbsp;Ciara Sheehan ,&nbsp;Josep M. Borras ,&nbsp;Gilles Vassal","doi":"10.1016/j.lanepe.2024.101155","DOIUrl":"10.1016/j.lanepe.2024.101155","url":null,"abstract":"<div><div>Paediatric cancers, although rare, are the leading cause of disease-related mortality in European children above one year. A key pillar of the European Health Union, Europe's Beating Cancer Plan (EBCP) puts a spotlight on childhood cancer. National Cancer Control Plans (NCCPs) have a key role but did not address childhood cancers sufficiently previously. This study considered the NCCPs of 41 European countries in relation to children and adolescents and young adults (AYAs). Twenty two NCCPs informed a structured narrative analysis. Four NCCPs were categorised as having comprehensive paediatric oncology content. Findings emphasise access to care through centralisation combined with local delivery of low-risk interventions and the role of multidisciplinary teams. Survivorship, AYA care, registries, and voluntary associations were addressed to varying degrees. Supportive care was among the weakest areas in the 22 NCCPs. Recommendations were presented to strengthen paediatric oncology in NCCPs and enrich the EBCP vision towards improved survival and reduced inequalities across Europe.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101155"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980673","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":"Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study","authors":"Olav Erich Yri ,&nbsp;Guro Lindviksmoen Astrup ,&nbsp;Astrid Telhaug Karlsson ,&nbsp;Rene van Helvoirt ,&nbsp;Marianne Jensen Hjermstad ,&nbsp;Kristin Moksnes Husby ,&nbsp;Jon Håvard Loge ,&nbsp;Jo-Åsmund Lund ,&nbsp;Tonje Lundeby ,&nbsp;Ørnulf Paulsen ,&nbsp;Eva Skovlund ,&nbsp;Marius-Ioan Taran ,&nbsp;Rebecca Rootwelt Winther ,&nbsp;Nina Aass ,&nbsp;Stein Kaasa","doi":"10.1016/j.lanepe.2024.101181","DOIUrl":"10.1016/j.lanepe.2024.101181","url":null,"abstract":"<div><h3>Background</h3><div>A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions.</div></div><div><h3>Methods</h3><div>This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox’ proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups.</div></div><div><h3>Findings</h3><div>For the total cohort (<em>N</em> = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2–6.7). ECOG 2–4, uncontrolled extracranial metastases, and ≥5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3–4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3–3.5]; ECOG 3–4: 2.1 [1.5–2.7]). Patients surviving &lt;6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving &gt;6 months reported stable scores over time.</div></div><div><h3>Interpretation</h3><div>Patients with ECOG 2–4, especially those with uncontrolled extracranial metastases and ≥5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival &lt;6 months and specifically advise against WBRT.</div></div><div><h3>Funding</h3><div>The <span>South-Eastern Norway Regional Health Authority</span>; The <span>Norwegian Cancer Society</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101181"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980674","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":"Dose-dense anthracycline- and taxane-based chemotherapy remains the preferred treatment for selected patients with high-risk early breast cancer","authors":"Matteo Lambertini ,&nbsp;Bo Nordenskjold","doi":"10.1016/j.lanepe.2025.101212","DOIUrl":"10.1016/j.lanepe.2025.101212","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101212"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143133957","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":"Comparative effectiveness of different therapies for Clostridioides difficile infection in adults: a systematic review and network meta-analysis of randomized controlled trials","authors":"Dániel Steve Bednárik ,&nbsp;Kincső Csepke Földvári-Nagy ,&nbsp;Viktor Simon ,&nbsp;Anett Rancz ,&nbsp;Noémi Gede ,&nbsp;Dániel Sándor Veres ,&nbsp;Panagiotis Paraskevopoulos ,&nbsp;Tamás Schnabel ,&nbsp;Bálint Erőss ,&nbsp;Péter Hegyi ,&nbsp;Katalin Lenti ,&nbsp;László Földvári-Nagy","doi":"10.1016/j.lanepe.2024.101151","DOIUrl":"10.1016/j.lanepe.2024.101151","url":null,"abstract":"<div><h3>Background</h3><div><em>Clostridioides difficile</em> infection (CDI) is a leading cause of healthcare-associated diarrhea, with substantial morbidity and mortality. CDI is a severe and growing problem with numerous treatment options. We evaluated the effectiveness of all therapies in recurrent and non-recurrent infections and their prevention.</div></div><div><h3>Methods</h3><div>This network meta-analysis and systematic review of randomized controlled trials (RCTs) compared all CDI therapies and preventions. We included RCTs published until 19 August 2024 and focused on adult population. We performed a systematic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Inclusion criteria were patients: adults (&gt;16) treated against CDI; study type: randomized controlled trial; outcome: cure rate, recurrence or effectiveness of prevention. Any publication not meeting all criteria was considered to be ineligible and excluded. We applied random-effects meta-analysis using frequentist methods. We reported our main results as odds ratios (as a symmetric effect size measure, OR) with 95% confidence interval (95% CI). We used the Cochrane risk-of-bias tool to assess the risk of bias. Our study protocol was preregistered in PROSPERO (CRD42022371210).</div></div><div><h3>Findings</h3><div>We assessed 73 RCTs with 28 interventions, involving 27,959 patients (49.2% female) in five networks. Fecal microbiota transplantation (FMT) was the most effective treatment in terms of the cure rate overall (P-score: 0.9952) and in recurrent cases (P-score: 0.9836). In recurrent cases, fidaxomicin (P-score: 0.6734) showed significantly greater effectiveness than vancomycin (P-score: 0.3677) and tolevamer (P-score: 0.0365). For non-recurrent CDI treatments ridinilazole, fidaxomicin, FMT and nitazoxanide were equally effective. Ridinilazole (P-score: 0.7671) and fidaxomicin (P-score: 0.7627) emerged as the most effective in preventing recurrence. Probiotics were not effective in preventing CDI, since network meta-analyses did not show significant differences between probiotics and placebo. In probiotics’ subgroups pairwise meta-analyses <em>Lactobacillaceae</em> proved to be significantly more effective in prevention than placebo. Oral and colonoscopic FMT administration methods were equally effective. The study-level aggregated risk of bias of the publications included ranged from low to high. We observed relevant heterogeneity among studies in therapeutic doses, treatment durations, and follow-up times.</div></div><div><h3>Interpretation</h3><div>The superiority of FMT in the treatment of CDI highlights the potential for increased use of FMT in clinical settings. Further research on optimizing FMT protocols and exploring its long-term safety and efficacy in larger samples is needed. Our findings suggest that the preventive use of probiotics might be questioned.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101151"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163874","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":"The Nordic model fails to protect vulnerable children","authors":"Věra Skalická ,&nbsp;Terje Andreas Eikemo","doi":"10.1016/j.lanepe.2025.101217","DOIUrl":"10.1016/j.lanepe.2025.101217","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101217"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082002","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":"Internal mammary node irradiation in 4541 node-positive breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (DBCG IMN2): a prospective, nationwide, population-based cohort study","authors":"Anders W. Mølby Nielsen ,&nbsp;Lise B.J. Thorsen ,&nbsp;Demet Özcan ,&nbsp;Louise W. Matthiessen ,&nbsp;Else Maae ,&nbsp;Marie L.H. Milo ,&nbsp;Mette H. Nielsen ,&nbsp;Trine Tramm ,&nbsp;Jens Overgaard ,&nbsp;Birgitte V. Offersen ,&nbsp;DBCG RT Committee","doi":"10.1016/j.lanepe.2024.101160","DOIUrl":"10.1016/j.lanepe.2024.101160","url":null,"abstract":"<div><h3>Background</h3><div>Internal mammary node irradiation (IMNI) improves overall survival (OS) in node-positive breast cancer patients. However, the effect is not documented in breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (RT). Therefore, the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate the effect of IMNI in node-positive breast cancer patients treated with newer systemic therapies and 3D-based RT.</div></div><div><h3>Methods</h3><div>DBCG IMN2 was a nationwide population-based cohort study prospectively allocating node-positive breast cancer patients with right-sided tumours to IMNI and patients with left-sided tumours to no IMNI in six RT centres. Exclusion criteria were prior malignancies, bilateral breast cancer, neoadjuvant systemic therapy, recurrence before RT, or non-standard RT. Systemic treatment included taxane-based chemotherapy, aromatase inhibitors, and trastuzumab. The primary end-point was OS. Secondary endpoints were breast cancer mortality and distant metastasis. Cox regression analyses were used for adjusted hazard ratios (HR). <span><span>Clinicaltrial.gov</span><svg><path></path></svg></span> ID: <span><span>NCT06549920</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>In the period January 2007–May 2014, a total of 4541 patients were included. Patient characteristics were distributed evenly between right- and left-sided patients. Median follow-up was 13.7 years for OS. Survival rates at 15 years were 65.0% in patients with IMNI and 60.8% without leading to an adjusted HR of 0.85 (95% CI, 0.76–0.94; p = 0.0016) for OS. Corresponding HRs were 0.84 (95% CI, 0.74–0.95; p = 0.0077) for breast cancer mortality and HR 0.87 (95% CI, 0.78–0.98; p = 0.026) for distant metastasis. No subgroups were identified for the omission of IMNI. The 15-year cumulative incidence of death from ischemic or valvular heart disease was 0.2% (95% CI, 0.0–0.5) in right-sided and 0.7% (95% CI, 0.4–1.2) in left-sided patients.</div></div><div><h3>Interpretation</h3><div>IMNI reduced distant metastasis and breast cancer mortality and improved OS in node-positive breast cancer patients, despite treatment with newer systemic therapies and 3D-based RT.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>Danish Cancer Society</span> and Department <span>of Clinical Medicine</span>, <span>Aarhus University</span>, Denmark.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101160"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985375","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}