Lancet Regional Health-Europe最新文献

{"title":"Out-of-home care placement, psychiatric disorders, and risk of homelessness: a population-based cohort study","authors":"Sandra Feodor Nilsson , Thomas Munk Laursen , Anne Ranning , Anne A.E. Thorup , Merete Nordentoft , Seena Fazel","doi":"10.1016/j.lanepe.2025.101381","DOIUrl":"10.1016/j.lanepe.2025.101381","url":null,"abstract":"<div><h3>Background</h3><div>Family adversity and childhood abuse have been associated with an increased risk of homelessness in adulthood. However, to our knowledge, no population-based longitudinal studies have examined the association between out-of-home placement and subsequent homelessness, while accounting for psychiatric disorders and parental background. Thus, we aimed to investigate the association between out-of-home placement and psychiatric disorders during childhood or adolescence and homelessness later in life.</div></div><div><h3>Methods</h3><div>We used data from a nationwide, register-based birth cohort in Denmark from 1 January 1983 to 31 December 2003, who were alive at any point from 1 January 2001 to 31 December 2021. Children and adolescents (aged 0–17) were followed up from their 18th birthday for risk of homelessness. We investigated associations using national registers with information on homelessness and psychiatric disorders. We examined individuals with any out-of-home placement history with and without psychiatric disorders diagnosed up to age 18 according to the first episode of homelessness after age 18, defined as first contact with a shelter. We estimated the cumulative incidence function using an Aalen-Johansen estimator. Hazard ratios (HRs) for the association between out-of-home placement, psychiatric disorder, and homelessness were estimated by sex using Cox proportional-hazard regression analyses, adjusted for birth year, parental sociodemographic factors and psychiatric disorders. Additionally, we employed a stratified Cox model (stratified by mother) to examine the contribution of within-family covariates.</div></div><div><h3>Findings</h3><div>The study cohort included 1,226,130 Danish residents aged 18–39 years. Of these, 53,281 individuals (4·3%) had experienced out-of-home placement during childhood or adolescence. By age 39, 12·2% (95% CI 11·6–12·7) of males and 6·3% (95% CI 5·9–6·7) of females with a history of out-of-home placement experienced homelessness. This corresponds to a substantially increased risk compared to people without such a history, with adjusted HRs of 7·1 (95% CI 6·7–7·5) for males and 9·0 (8·2–9·8) for females. In sibling analyses restricted to 955,287 individuals and adjusted for birth year, out-of-home placement was associated with a 3-fold increased risk of homelessness compared to siblings without such a history (aHR 2·8 (95% CI 2·4–3·3) for males and aHR 3·2 (2·4–4·1) for females). Homelessness risk was even higher for individuals with a history of both out-of-home placement and psychiatric disorder, particularly when psychiatric diagnosis occurred after the first placement. In the full cohort, adjusted HRs were 11·8 (95% CI 10·8–13·0) for males and 19·3 (16·9–21·9) for females, compared to individuals with neither out-of-home placement nor psychiatric disorder.</div></div><div><h3>Interpretation</h3><div>Individuals with a history of out-of-home placement are at higher risk ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"56 ","pages":"Article 101381"},"PeriodicalIF":13.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679450","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":"Evaluation of a national digital pre-implantation biopsy service for deceased-donor kidney transplantation in the UK (Pithia trial); a stepped-wedge cluster randomised registry trial","authors":"Dominic M. Summers , John O.O. Ayorinde , Desley A. Neil , Karla Hemming , Laura Smith , Jennifer Mehew , Helen Thomas , Rosie Brown , Suzie Phillips , Emma Laing , Anna Sidders , Alison J. Deary , Rachel J. Johnson , Victoria Bardsley , Sathia Thiru , Meryl H. Griffiths , Ranmith Perera , Owen Cain , Candice Roufosse , Naomi Simmonds , Gavin J. Pettigrew","doi":"10.1016/j.lanepe.2025.101390","DOIUrl":"10.1016/j.lanepe.2025.101390","url":null,"abstract":"<div><h3>Background</h3><div>Pre-implantation biopsy may help select kidneys retrieved from elderly deceased donors for transplantation, but concerns persist that it may cause unnecessary discard of kidneys that would have provided acceptable transplant function. The PITHIA trial tested the hypothesis that introduction of a National Digital Pathology Service (NDPS) would increase the proportion of kidneys transplanted from elderly donors and/or improve their function.</div></div><div><h3>Methods</h3><div>A stepped-wedge cluster randomised controlled registry trial delivered the NDPS to 22 UK kidney transplant centres (clusters) in 5 sequences at four-monthly intervals, using a restricted randomisation technique to ensure similar cluster sizes in the intervention and control status. Upon access to the intervention, centres could request urgent pre-implantation biopsy on kidneys from deceased donors aged 60 years or older. Co-primary outcome measures were the proportion of kidneys transplanted upon first offer according to whether the centre had access or not to the biopsy service, and the 1-year eGFR of the kidneys that were transplanted. Analysis adjusts for clustering and underlying secular trends, with 97.5% Confidence Intervals (CI) reported to reflect the two co-primary outcomes. The trial is complete (Trial Registration Number: ISRCTN 11708741).</div></div><div><h3>Findings</h3><div>The trial commenced on 1st October 2018 and ended on 31st January 2022. Of the 2502 eligible kidneys offered, 1355 single and 67 dual transplants were performed. Regarding the first primary endpoint, a non-significantly lower proportion of those kidneys first offered to centres with access to the biopsy service were transplanted compared with those offered to centres without access (295 of 1241 (23.8%) vs. 377 of 1261 (29.9%): adjusted Odds Ratio (97.5% CI) 0.91 (0.60–1.39); p = 0.6083). For the second primary endpoint, the adjusted mean (SE) 1-year eGFR of the transplant kidneys was similar, irrespective of whether the implanting centre had access to the biopsy service or not (43.7 (1.3) ml/min/1.73 m<sup>2</sup> vs. 42.2 (1.3) ml/min/1.73 m<sup>2</sup>; adjusted mean difference (97.5% CI) 1.53 (−2.33 to 5.40); p = 0.37). Secondary outcome analysis of how the biopsy service was adopted revealed that biopsies were performed on 287 of the 1493 (19.2%) kidneys offered to at least one centre with access to the biopsy service, with marked variation between transplant centres in requests for biopsy, and in implantation rates of biopsied kidneys. Nevertheless, 191 (66.6%) of biopsied kidneys were transplanted, compared with 643 of the 1009 (63.7%) kidneys only ever offered to centres without biopsy access, and 588 of the 1206 (48.8%) kidneys that were not biopsied, despite being offered to at least one centre with biopsy access.</div></div><div><h3>Interpretation</h3><div>Implementation of the NDPS did not significantly increase transplantation rates of elderly decease","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"56 ","pages":"Article 101390"},"PeriodicalIF":13.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679606","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":"Can predicting future pregnancies after loss personalise miscarriage care?","authors":"Lara Catherine Morley , Tina Jayne Shillito","doi":"10.1016/j.lanepe.2025.101394","DOIUrl":"10.1016/j.lanepe.2025.101394","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101394"},"PeriodicalIF":13.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657266","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":"Excess mortality and hospitalisations associated with respiratory syncytial virus, influenza, and COVID-19 among adults in Denmark (2015–2024): a modelling study","authors":"Amanda Marie Egeskov-Cavling ,&nbsp;Chelsea L. Hansen ,&nbsp;Caroline Klint Johannesen ,&nbsp;Birgitte Lindegaard ,&nbsp;Samir Bhatt ,&nbsp;Cecile Viboud ,&nbsp;Thea K. Fischer","doi":"10.1016/j.lanepe.2025.101396","DOIUrl":"10.1016/j.lanepe.2025.101396","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the long-term epidemiology trends of RSV, influenza, and COVID-19 is essential for planning of vaccination strategies and healthcare system epidemic preparedness. This is the first study to provide a comprehensive estimation of both excess mortality and hospitalisations among adults for these respiratory viruses in a European setting. We aim to estimate excess mortality and excess hospitalisations for RSV, influenza, and COVID-19 among adults ≥18 years in Denmark from January 2015 to March 2024.</div></div><div><h3>Methods</h3><div>This nationwide time-trend modelling study investigates weekly mortality and hospitalisation rates surpassing the seasonal baseline for RSV, influenza, and COVID-19 among adults in Denmark. Data from the Cause of Death Register, the Danish National Patient Registry, and respiratory virus surveillance data were analysed with Generalized Additive Models (GAM) using a negative binomial likelihood function, including RSV, influenza, COVID-19 variants, and time effects to account for seasonality and trend.</div></div><div><h3>Findings</h3><div>We estimated 3944 RSV-attributed, 5675 influenza-attributed, and 5636 COVID-19-attributed deaths. Among adults aged 65 or older, the annual mortality rates were 31.2 per 100,000 for RSV, 42.9 for influenza, and 88.5 for COVID-19. Furthermore, we estimated annual admission rates for those aged 65 and older of 177.4 per 100,000 for RSV, 164.6 for influenza, and 398.7 for COVID-19.</div></div><div><h3>Interpretation</h3><div>This modelling study reveals a substantial impact of RSV on individuals aged 65 and older, with a notable increase in RSV-attributed deaths and hospitalisations in recent years likely due to expanded respiratory testing after the COVID-19 pandemic. Our findings highlight the need for increased awareness in previously considered lower-risk patients, and establish benchmarks for evaluating preventive interventions.</div></div><div><h3>Funding</h3><div>This study received funding from <span>Independent Research Fund Denmark</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101396"},"PeriodicalIF":13.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657206","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":"European Academy of Neurology (EAN) congress 2025","authors":"Heather Brown","doi":"10.1016/j.lanepe.2025.101395","DOIUrl":"10.1016/j.lanepe.2025.101395","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101395"},"PeriodicalIF":13.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657268","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":"Primary endpoint acceptance and its association with benefit ratings and market access in German health technology assessments: a retrospective cohort study","authors":"Gerrit Müller ,&nbsp;Matthias Granold ,&nbsp;Reinhard Busse ,&nbsp;Andreas Hahn","doi":"10.1016/j.lanepe.2025.101382","DOIUrl":"10.1016/j.lanepe.2025.101382","url":null,"abstract":"<div><h3>Background</h3><div>In Germany, the Health Technology Assessment process, governed by the Federal Joint Committee (G-BA), evaluates relative efficacy and safety of newly European Medicines Agency (EMA)-approved drugs against the standard of care using patient-relevant endpoints. This study aimed to investigate the impact of the acceptance of the primary endpoint on the likelihood of an additional benefit and patient access in assessments that fulfilled criteria for study design and comparator for both authorities.</div></div><div><h3>Methods</h3><div>We examined whether the acceptance of the primary endpoint by G-BA resulted in a higher likelihood of a positive benefit rating and a reduced risk of market withdrawal by pharmaceutical companies of drugs that underwent a benefit assessment between 2011 and 2023, in which an RCT with an adequate comparator according to G-BA served as evidence base. These objectives were tested using a stratified Mantel–Haenszel test (stratified for oncological and non-oncological benefit assessments).</div></div><div><h3>Findings</h3><div>In 433 benefit assessments, G-BA accepted the primary endpoints used by the EMA in only 238 cases (54.97%). Acceptance was linked to a higher probability of a positive rating, compared to assessments without (OR 2.64, 0.95 confidence interval [1.74; 4.00]). Furthermore, assessments with accepted primary endpoints were less often associated with market withdrawal (OR 0.70 [0.40; 1.24]). Of note, 152 benefit assessments (35.10%) resulted in a non-positive rating despite using a study cohort with evidence that should cover both evaluation scopes, indicating a potential discrepancy between EMA and G-BA in the assessments of new drugs.</div></div><div><h3>Interpretation</h3><div>The study highlights a significant harmonisation gap between EMA and G-BA in the evaluation of innovative drugs, affecting benefit ratings and potentially market access. The acceptance of primary endpoints by G-BA is crucial for positive ratings. However, the differing evaluation of high-quality evidence can also be attributed to other critical factors, such as equivalent consideration of other study endpoints and slicing of the study population.</div></div><div><h3>Funding</h3><div>None. GM, MG, and AH are employed by Takeda. The authors are solely responsible for the content.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101382"},"PeriodicalIF":13.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657205","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":"European Society for Medical Oncology (ESMO) Gastrointestinal Cancers congress 2025","authors":"Ivana Nedic","doi":"10.1016/j.lanepe.2025.101400","DOIUrl":"10.1016/j.lanepe.2025.101400","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101400"},"PeriodicalIF":13.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657269","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":"Cancer risk with GLP-1RA: what can real-world data really tell us?","authors":"Niels Jessen ,&nbsp;Henrik Støvring","doi":"10.1016/j.lanepe.2025.101383","DOIUrl":"10.1016/j.lanepe.2025.101383","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101383"},"PeriodicalIF":13.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633354","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":"Mortality related to multidrug-resistant microorganism infections: differentiating crude mortality from attributable mortality–author's reply","authors":"José Miguel Cisneros ,&nbsp;Germán Peñalva ,&nbsp;Rafael Cantón ,&nbsp;María Teresa Pérez- Rodríguez ,&nbsp;Juan José González-López ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;José Ramón Paño-Pardo","doi":"10.1016/j.lanepe.2025.101393","DOIUrl":"10.1016/j.lanepe.2025.101393","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101393"},"PeriodicalIF":13.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657267","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":"Optimising evaluation pathways for non-traumatic abdominal pain in emergency settings","authors":"Marcello Covino ,&nbsp;Nicola Bonadia","doi":"10.1016/j.lanepe.2025.101387","DOIUrl":"10.1016/j.lanepe.2025.101387","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101387"},"PeriodicalIF":13.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633355","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}