Lancet Regional Health-Europe最新文献

{"title":"Treatment outcomes of extensively drug-resistant tuberculosis in Europe: a retrospective cohort study","authors":"Yousra Kherabi ,&nbsp;Ole Skouvig Pedersen ,&nbsp;Christoph Lange ,&nbsp;François Bénézit ,&nbsp;Dumitru Chesov ,&nbsp;Luigi Ruffo Codecasa ,&nbsp;Andrii Dudnyk ,&nbsp;Nana Kiria ,&nbsp;Olha Konstantynovska ,&nbsp;Dhiba Marigot-Outtandy ,&nbsp;Traian-Constantin Panciu ,&nbsp;Corentin Poignon ,&nbsp;Sirje Sasi ,&nbsp;Dagmar Schaub ,&nbsp;Varvara Solodovnikova ,&nbsp;Laima Vasiliauskaitè ,&nbsp;Lusine Yeghiazaryan ,&nbsp;Gunar Günther ,&nbsp;Lorenzo Guglielmetti ,&nbsp;Yousra Kherabi","doi":"10.1016/j.lanepe.2025.101380","DOIUrl":"10.1016/j.lanepe.2025.101380","url":null,"abstract":"<div><h3>Background</h3><div>In 2021, World Health Organization revised of definition of extensive drug-resistant tuberculosis. We aimed to determine treatment outcomes of individuals affected by extensively drug-resistant tuberculosis in Europe.</div></div><div><h3>Methods</h3><div>This observational, retrospective cohort study included patients diagnosed with extensively drug-resistant tuberculosis in the World Health Organization European Region from 2017 to 2023. Participating centres collected consecutive, detailed individual data for extensively drug-resistant tuberculosis patients. Data were analysed with meta- and regression methods, accounting for between-country heterogeneity.</div></div><div><h3>Findings</h3><div>Among 11,003 patients with multidrug-resistant/rifampicin-resistant tuberculosis, 188 (1·7%) from 16 countries had extensively drug-resistant tuberculosis. Of these, 48·4% harboured strains with resistance to bedaquiline (n = 91/188), 34·0% to linezolid (n = 64/188), and 17·6% to both (n = 33/188). The individual composition of anti-tuberculosis regimens was highly variable, with 151 different drug combinations. Among the 156/188 (83·0%) patients with available treatment outcomes, the pooled percentage of successful outcomes was 40·2% (95% confidence interval [95% CI] 28·4%–53·2%). In patients with unsuccessful treatment outcomes (101/156), most experienced treatment failure (n = 57/156 [pooled proportion 37·1%], 95% CI: 26·1%–49·7%) or death (n = 30/156 [pooled proportion 21·3%], 95% CI: 15·7%–28·2%). After adjustment for disease severity, each additional likely effective drug decreased the odds of unsuccessful outcomes (adjusted odds ratio: 0·65, 95% CI: 0·45–0·96) (p = 0·026), whereas being treated in an upper-middle-income country increased the odds of unsuccessful outcomes compared with being treated in a high-income country (adjusted odds ratio: 13·7, 95% CI: 3·7–50·2) (p &lt; 0·001). Compared with other levels of drug resistance, treatment outcomes were significantly worse for extensively drug-resistant tuberculosis.</div></div><div><h3>Interpretation</h3><div>Only four out of ten patients affected by extensively drug-resistant tuberculosis achieved successful treatment outcomes. These findings highlight the need for adequate, individualised treatment regimens and optimised drug susceptibility testing.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"56 ","pages":"Article 101380"},"PeriodicalIF":13.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144623474","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 citizens’ support for humanitarian aid funded by the EU: a secondary analysis of Eurobarometer data from the 27 EU Member States","authors":"Georgios Ktenidis ,&nbsp;Constantine I. Vardavas ,&nbsp;Filippos T. Filippidis ,&nbsp;Philippos Orfanos ,&nbsp;Pagona Lagiou","doi":"10.1016/j.lanepe.2025.101369","DOIUrl":"10.1016/j.lanepe.2025.101369","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101369"},"PeriodicalIF":13.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144623845","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":"Secondary prevention of cardiovascular disease: is it time for the polypill to be standard treatment?","authors":"Tom Marshall","doi":"10.1016/j.lanepe.2025.101384","DOIUrl":"10.1016/j.lanepe.2025.101384","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101384"},"PeriodicalIF":13.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604521","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":"Game of stones: making a decision about economic value of a weight-loss intervention","authors":"Joseph A. Ladapo","doi":"10.1016/j.lanepe.2025.101375","DOIUrl":"10.1016/j.lanepe.2025.101375","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101375"},"PeriodicalIF":13.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549474","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":"Progression of biological markers in spinocerebellar ataxia type 3: longitudinal analysis of prospective data from the ESMI cohort","authors":"Moritz Berger ,&nbsp;Hector Garcia-Moreno ,&nbsp;Mónica Ferreira ,&nbsp;Jeannette Hubener-Schmid ,&nbsp;Tamara Schaprian ,&nbsp;Philipp Wegner ,&nbsp;Tim Elter ,&nbsp;Kennet M. Teichmann ,&nbsp;Magda M. Santana ,&nbsp;Marcus Grobe-Einsler ,&nbsp;Demet Oender ,&nbsp;Berkan S.C. Koyak ,&nbsp;Sarah Bernsen ,&nbsp;Luís Pereira de Almeida ,&nbsp;Patrick Silva ,&nbsp;Joana Afonso Ribeiro ,&nbsp;Inês Cunha ,&nbsp;Cristina Gonzalez-Robles ,&nbsp;Shamsher Khan ,&nbsp;Amanda Heslegrave ,&nbsp;Jennifer Faber","doi":"10.1016/j.lanepe.2025.101339","DOIUrl":"10.1016/j.lanepe.2025.101339","url":null,"abstract":"<div><h3>Background</h3><div>Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominantly inherited adult-onset disease. We aimed to describe longitudinal changes in clinical and biological findings and to identify predictors for clinical progression.</div></div><div><h3>Methods</h3><div>We used data from participants enrolled in the ESMI cohort collected between Nov 09, 2016 and July 18, 2023. The data freeze included data from 14 sites in five European countries and the United States. We assessed ataxia with the Scale for the Assessment and Rating of Ataxia (SARA). We measured disease-specific mutant ataxin-3 protein (ATXN3) and neurofilament light chain (NfL) in plasma and performed MRIs. Data were analysed by regression modelling on a timescale defined by onset. The onset of abnormality of a marker was defined as the time at which its value, as determined by modelling, exceeded the mean ± 2 SD of healthy controls. To study responsiveness of markers, we determined the sensitivity to change ratios (SCSs).</div></div><div><h3>Findings</h3><div>Data from 291 SCA3 mutation carriers before and after clinical onset and 121 healthy controls were included. NfL levels became abnormal in SCA3 mutation carriers more than 20 years (−21.5 years [95% CI n.d.–9.5]) before onset. The earliest MRI abnormality was volume loss of medulla oblongata (−4.7 years [95% CI n.d.–3.3]). The responsiveness of markers depended on the disease stage. Across all stages, pons volume had the highest responsiveness with an SCS of 1.35 [95% CI 1.11–1.78] exceeding that of SARA (0.99 [95% CI 0.88–1.11]). In SCA3, lower age (p = 0.0459 [95% CI of slope change −0.0018 to 0.0000]) and lower medulla oblongata volume (p &lt; 0.0001 [95% CI of slope change −0.0298 to −0.0115]) were predictors of SARA progression.</div></div><div><h3>Interpretation</h3><div>Our study provides quantitative information on the progression of biological markers in SCA3 mutation carriers before and after onset of ataxia, and allowed the identification of predictors for clinical progression. Our data could prove useful for the design of future clinical trials.</div></div><div><h3>Funding</h3><div>H<span>EU Joint Programme – Neurodegenerative Disease Research</span> (JPND) (<span>Federal Ministry of Education and Research</span>, Germany; <span>The Netherlands Organisation for Health Research and Development</span>; <span>Foundation for Science and Technology</span>, Portugal; <span>Medical Research Council, Regional Fund for Science and Technology</span>, Azores), and <span>Servier</span>. At the US sites this work was in part supported by the <span>National Ataxia Foundation</span> and the <span>National Institute of Neurological Disorders and Stroke</span> (NINDS) grant <span><span>R01NS080816</span></span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101339"},"PeriodicalIF":13.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534425","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":"Responses to the Third Lancet Commission on Investing in Health from Denmark, Germany, and Norway","authors":"Tobias Alfvén ,&nbsp;Angela Y. Chang ,&nbsp;Hanna Ohm Cleaver ,&nbsp;Anna-Katharina Hornidge ,&nbsp;Steven L.B. Jensen ,&nbsp;Eirik Mofoss ,&nbsp;Fride Nordstrand Nilsen ,&nbsp;Ole F. Norheim ,&nbsp;Marco Schäferhoff ,&nbsp;Martin Siegel ,&nbsp;Christoph Strupat","doi":"10.1016/j.lanepe.2025.101377","DOIUrl":"10.1016/j.lanepe.2025.101377","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"56 ","pages":"Article 101377"},"PeriodicalIF":13.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534439","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 impact of domestic abuse on suicide","authors":"Vishal Bhavsar ,&nbsp;Sandi Dheensa","doi":"10.1016/j.lanepe.2025.101376","DOIUrl":"10.1016/j.lanepe.2025.101376","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101376"},"PeriodicalIF":13.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535130","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":"Peptide receptor radionuclide therapy in G3 gastroenteropancreatic neuroendocrine tumors: a missed opportunity for European patients?","authors":"Francesco Panzuto ,&nbsp;Mauro Cives ,&nbsp;Jonathan Strosberg","doi":"10.1016/j.lanepe.2025.101378","DOIUrl":"10.1016/j.lanepe.2025.101378","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"55 ","pages":"Article 101378"},"PeriodicalIF":13.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535131","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":"Cancelled elective operations and 28-day breaches in the NHS in England: an interrupted time series analysis of the 2002 penalty policy, 2008 recession, and COVID-19 pandemic (1994–2023)","authors":"Laura Quinn ,&nbsp;Paul Bird ,&nbsp;Timothy P. Hofer ,&nbsp;Richard Lilford","doi":"10.1016/j.lanepe.2025.101368","DOIUrl":"10.1016/j.lanepe.2025.101368","url":null,"abstract":"<div><h3>Background</h3><div>In 2002, the English National Health Service (NHS) introduced financial penalties for hospitals failing to provide elective operations within 28 days of last-minute cancellations. This study investigates the impact of this policy, the 2008 global recession, and the COVID-19 pandemic on cancelled operations and breaches of the 28-day standard.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study using publicly available NHS England data from 1994 to 2023. Interrupted time series analysis assessed changes in cancelled operations and breaches of the 28-day standard across three key periods: pre- and post-2002 policy implementation, post-2008 recession, and post-COVID-19 pandemic. Subgroup analysis by hospital trust A&amp;E department presence on breaches of the 28-day standard was performed.</div></div><div><h3>Findings</h3><div>Elective admissions nearly doubled over 30 years, rising from just over 1 million per quarter in 1994 (1,054,818) to almost 2 million in 2023 (1,975,508), an 87% increase. Cancellation rates increased leading up to the 2002 policy change but fell rapidly below 1% afterwards and remained stable. The 2008 recession and COVID-19 pandemic did not impact cancellation rates, but did increase breaches of the 28-day standard. Breaches rose before the 2002 policy, dropped rapidly afterwards (−9.6%, 95% CI: −11.2, −9.0), but increased after the recession and notably post-pandemic (13.0%, 95% CI: 4.9%, 21.0%), remaining high and negating earlier gains. Hospitals with A&amp;E departments experienced higher post-pandemic increases in breach rates (12.7%, 95% CI: 10.8, 14.7) compared to those without (0.3%, 95% CI: −3.7, 4.4).</div></div><div><h3>Interpretation</h3><div>The 2002 policy effectively reduced breaches of the 28-day standard for many years but could not be maintained after the COVID-19 pandemic, when breach rates reached high levels, especially hospitals with A&amp;E departments that could not protect elective beds. Effective targets require sufficient resource capacity and demand management, ignoring such constraints can lead to self-defeating, unjust policies.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research Applied Research Collaboration West Midlands</span> (<span><span>NIHR200165</span></span>).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"56 ","pages":"Article 101368"},"PeriodicalIF":13.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534441","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":"External exposome and incident asthma across the life course in 14 European cohorts: a prospective analysis within the EXPANSE project","authors":"Zhebin Yu ,&nbsp;Sara Kress ,&nbsp;Natalia Blay ,&nbsp;Petr Gregor ,&nbsp;Hanna-Maria Kukk ,&nbsp;Miriam Leskien ,&nbsp;Renata Majewska ,&nbsp;Max J. Oosterwegel ,&nbsp;Daniel Szabó ,&nbsp;Margreet ten Have ,&nbsp;Jana Klánová ,&nbsp;Ondřej Mikeš ,&nbsp;Anna Bergström ,&nbsp;Alonso Bussalleu ,&nbsp;Rafael de Cid ,&nbsp;Andrea Dalecka ,&nbsp;Payam Dadvand ,&nbsp;Saskia van Dorsselaer ,&nbsp;Krista Fischer ,&nbsp;Kees de Hoogh ,&nbsp;Erik Melén","doi":"10.1016/j.lanepe.2025.101314","DOIUrl":"10.1016/j.lanepe.2025.101314","url":null,"abstract":"<div><h3>Background</h3><div>The joint impact of exposure to multiple urban environmental factors on asthma remains unclear.</div></div><div><h3>Methods</h3><div>We analysed data from 14 European cohorts to assess the impact of the urban exposome on asthma incidence across the life course. We linked three external exposome domains (air pollution, built environment, ambient temperature) to the participants’ home addresses at baseline. We performed k-means clustering within each domain and assessed associations of clusters with asthma adjusting for potentially relevant covariates in cohort-specific analyses, with subsequent separate meta-analyses for birth and adult cohorts. An environmental risk score using a coefficient-weighted sum approach was used to assess the impact of combining the three domains.</div></div><div><h3>Findings</h3><div>A total of 7428 incident asthma cases were identified among 349,037 participants (from birth up to age 70+). Overall, we observed higher risks of asthma for clusters characterized by high particulate matter and nitrogen dioxide exposure in adults (OR_meta = 1.13, 95%CI:1.01–1.25), and clusters characterized by high built-up area and low levels of greenness in both children and adults (OR_meta = 1.36, 95%CI: 1.14–1.64 for birth cohorts and OR_meta = 1.15, 95%CI: 1.03–1.28 for adult cohorts, respectively). The joint exposure using the environment risk score combining the three domains was consistently associated with higher risks of incident asthma (OR_meta = 1.13, 95%CI: 1.07–1.20 for birth cohorts, OR_meta = 1.15, 95%CI: 1.10–1.20 for adult cohorts per 20% increase). On average 11.6% of the incident asthma cases could be attributed to environmental risk score above cohort-specific median levels.</div></div><div><h3>Interpretation</h3><div>Multiple environmental exposures jointly contribute to incident asthma risk across the life course. Urban planning accounting for these factors may help mitigate asthma development.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>European Union’s Horizon 2020</span> research and innovation program under agreement No <span><span>874627</span></span> (EXPANSE).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101314"},"PeriodicalIF":13.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518040","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}