Lancet Regional Health-Europe最新文献

{"title":"Defining child maltreatment for research and surveillance: an international, multi-sectoral, Delphi consensus study in 34 countries in Europe and surrounding regions","authors":"Laura Elizabeth Cowley ,&nbsp;Diogo Lamela ,&nbsp;Katarzyna Drabarek ,&nbsp;Leonor Bettencourt Rodrigues ,&nbsp;Athanasios Ntinapogias ,&nbsp;Aideen Naughton ,&nbsp;Geoff Debelle ,&nbsp;Ravit Alfandari ,&nbsp;Andreas Jud ,&nbsp;Gabriel Otterman ,&nbsp;Taina Laajasalo ,&nbsp;Cindy W. Christian ,&nbsp;Vaska Stancheva-Popkostadinova ,&nbsp;Luciana Caenazzo ,&nbsp;Virginia Soldino ,&nbsp;Rachael Vaughan ,&nbsp;Alison Kemp ,&nbsp;Ulugbek Nurmatov ,&nbsp;Lisa Hurt","doi":"10.1016/j.lanepe.2024.101196","DOIUrl":"10.1016/j.lanepe.2024.101196","url":null,"abstract":"<div><div>Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to quantify child maltreatment and identify interventions and services are constrained by a lack of uniform definitions. We conducted a European Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research. Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries completed three rounds of an online survey. We defined consensus as ≥70% agreement or disagreement with each statement after the final round. Consensus was reached on 26/31 statements (participant retention rate 94%). From the statements, we propose a unified definition of child maltreatment to improve measurement and surveillance in Europe. Concerted efforts are now required to test and refine the definition further prior to real-world operationalisation.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101196"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144485","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":"Ensuring equity in access to liver transplant for patients with acute-on-chronic liver failure across the UK","authors":"Oliver D. Tavabie ,&nbsp;Paul N. Brennan","doi":"10.1016/j.lanepe.2024.101193","DOIUrl":"10.1016/j.lanepe.2024.101193","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101193"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985374","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":"Strengthening Romania's health workforce: leading by example","authors":"Rosemary James ,&nbsp;Cris Scotter ,&nbsp;Alexandru Florin Rogobete ,&nbsp;Teodor Cristian Blidaru ,&nbsp;Alexandru Rafila ,&nbsp;Gareth Rees ,&nbsp;Ioana Novac ,&nbsp;Daphne Kaiteladou ,&nbsp;Yanina Andersen ,&nbsp;Khamis Al-alawy ,&nbsp;Olympia Konstantakopoulou ,&nbsp;Natasha Azzopardi Muscat ,&nbsp;Tomas Zapata ,&nbsp;Nicolae Dragoș Garofil","doi":"10.1016/j.lanepe.2024.101191","DOIUrl":"10.1016/j.lanepe.2024.101191","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101191"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933539","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":"Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis","authors":"Axel Wolsink ,&nbsp;Maaike P. Cliteur ,&nbsp;Charlotte J. van Asch ,&nbsp;Hieronymus D. Boogaarts ,&nbsp;Ruben Dammers ,&nbsp;Gerjon Hannink ,&nbsp;Floris H.B.M. Schreuder ,&nbsp;Catharina J.M. Klijn","doi":"10.1016/j.lanepe.2024.101180","DOIUrl":"10.1016/j.lanepe.2024.101180","url":null,"abstract":"<div><h3>Background</h3><div>Intracerebral haemorrhage (ICH) accounts for approximately 28% of all strokes worldwide. ICH has a high case fatality, and only few survivors recover to independent living. Over the past decades, demographic changes, and changes in prevalence and management of risk factors may have influenced incidence. Widespread implementation of stroke units and improved care in general may have affected case fatality and outcome. We aimed to update the evidence on incidence, case fatality, and functional outcome of ICH, according to age, sex, and country income level.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed and Embase from 2008 to April 2023 for prospective population-based studies on incidence, case fatality, or functional outcome of first-ever ICH. We excluded studies in which less than 80% of cases was confirmed with imaging or autopsy. Quality of the studies was assessed based on the used case finding methods. We used inverse variance-based random-effects meta-analyses to pool the crude incidence, case fatality at 1 month, and the percentage of patients with good functional outcome after 3, 6, or 12 months, as defined by the authors of the individual studies. Time trends were assessed using weighted linear meta-regression. Funnel plots were constructed to study publication bias. The review was registered on PROSPERO (CRD42023413314).</div></div><div><h3>Findings</h3><div>We identified 70 eligible studies, describing 19,470 ICH patients from 26 different countries. Of these, 62 studies reported on crude incidence, 41 on case fatality, and 10 on functional outcome. Overall crude incidence was 29.2 per 100,000 person-years (95% CI 23.3–36.4; I² = 100%). Incidence was lower in women than in men and increased with age. Incidence was highest in lower-middle income countries, followed by high and upper-middle income countries. Case fatality at 1 month was 35.5% (95% CI 32.3–38.9; I² = 90%). The percentage of patients with good functional outcome (mRS 0–2 in nine studies, mRS 0–3 in one) after 3–12 months was 31.2% (95% CI 24.7–38.6; I² = 76%). We found no time trends in incidence, case fatality, or functional outcome.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate the persistently high burden and devastating consequences of ICH, stressing the need for better preventive strategies and acute treatments.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101180"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933537","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":"Impact and cost-effectiveness of scaling up HCV testing and treatment strategies for achieving HCV elimination among people who inject drugs in England: a mathematical modelling study","authors":"Zoe Ward ,&nbsp;Ruth Simmons ,&nbsp;Hannah Fraser ,&nbsp;Adam Trickey ,&nbsp;Jo Kesten ,&nbsp;Andy Gibson ,&nbsp;Leila Reid ,&nbsp;Sean Cox ,&nbsp;Fiona Gordon ,&nbsp;Stuart Mc Pherson ,&nbsp;Stephen Ryder ,&nbsp;Javier Vilar ,&nbsp;Alec Miners ,&nbsp;Jack Williams ,&nbsp;Beatrice Emmanouil ,&nbsp;Monica Desai ,&nbsp;Laura Coughlan ,&nbsp;Ross Harris ,&nbsp;Graham R. Foster ,&nbsp;Matthew Hickman ,&nbsp;Peter Vickerman","doi":"10.1016/j.lanepe.2024.101176","DOIUrl":"10.1016/j.lanepe.2024.101176","url":null,"abstract":"<div><h3>Background</h3><div>England aims to reach the World Health Organization (WHO) elimination target of decreasing HCV incidence among people who inject drugs (PWID) to &lt;2 per 100 person-years (/100pyrs) by 2030. We assessed what testing and treatment strategies will achieve this target and whether they are cost-effective.</div></div><div><h3>Methods</h3><div>A dynamic deterministic HCV transmission model among PWID was developed for four England regions, utilising data on the scale-up of HCV treatment among PWID in prisons, drug treatment centres (DTC, where opioid agonist therapy is provided), and any other setting (e.g., primary care). The model projected whether the elimination target will be reached with existing testing and treatment initiatives (‘status quo’ model, SQ), or whether improvements are needed from 2024. Cost data was collated through practitioners' interviews and published literature. The mean incremental cost-effectiveness ratio (ICER per quality adjusted life year (QALY) saved, 50-year time horizon; 3.5% discount rate) of SQ (assumes counterfactual of no treatment scale-up post-2015) and improved model (counterfactual: SQ model) was compared to a willingness-to-pay threshold of £20,000/QALY saved.</div></div><div><h3>Findings</h3><div>The SQ model projects HCV incidence will decrease by 79.7–98.6% (range of medians) over 2015–2030 to 0.2–2.2/100pyrs, with an ICER of £308–1609/QALY saved across the regions. There is &gt;80% probability of achieving the incidence target in three regions, and 40% probability in the other region. If annual testing in DTC increases to 80% (from 27%) or 75% of people get tested during their prison stay (from 55%) from 2024 in the lower impact region, then their probability increases to &gt;65%, with both strategies being highly cost-effective.</div></div><div><h3>Interpretation</h3><div>Many England regions could reach the WHO HCV elimination target by 2030 under existing testing and treatment pathways. Scaling up of testing in DTC or prisons will help achieve this target and is highly cost-effective.</div></div><div><h3>Funding</h3><div><span>NIHR</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101176"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933460","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":"Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005–2022): a nationwide registry study","authors":"Ben Völschow ,&nbsp;Alina Goßling ,&nbsp;Caroline Kellner ,&nbsp;Johannes T. Neumann","doi":"10.1016/j.lanepe.2024.101168","DOIUrl":"10.1016/j.lanepe.2024.101168","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population.</div></div><div><h3>Methods</h3><div>Data for 2005–2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.</div></div><div><h3>Findings</h3><div>Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p &lt; 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p &lt; 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29–3.4]).</div></div><div><h3>Interpretation</h3><div>Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101168"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907948","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":"Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)","authors":"Yang Chen ,&nbsp;Ziyi Zhong ,&nbsp;Ying Gue ,&nbsp;Maciej Banach ,&nbsp;Garry McDowell ,&nbsp;Dimitri P. Mikhailidis ,&nbsp;Peter P. Toth ,&nbsp;Peter E. Penson ,&nbsp;Tomasz Tomasik ,&nbsp;Adam Windak ,&nbsp;Marek Gierlotka ,&nbsp;Tadeusz Osadnik ,&nbsp;Agnieszka Kuras ,&nbsp;Marcin Miga ,&nbsp;Jacek Jozwiak ,&nbsp;Gregory Y.H. Lip","doi":"10.1016/j.lanepe.2024.101182","DOIUrl":"10.1016/j.lanepe.2024.101182","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.</div></div><div><h3>Methods</h3><div>This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL).</div></div><div><h3>Findings</h3><div>We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6–5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07–1.65, Q4: aHR 1.28, 95% CI 1.03–1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14–1.82, Q4: aHR 1.29, 95% CI 1.04–1.59), similar results for premature all-cause mortality. Within age 45–80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively.</div></div><div><h3>Interpretation</h3><div>TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships.</div></div><div><h3>Funding</h3><div><span>Polish Lipid Association</span>, <span>College of Family Physician in Poland</span>, <span>Valeant in Poland</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101182"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933463","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":"A framework for resilient and sustainable health systems in the European Region","authors":"Natasha Azzopardi Muscat,&nbsp;Hans Henri P. Kluge","doi":"10.1016/j.lanepe.2024.101199","DOIUrl":"10.1016/j.lanepe.2024.101199","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101199"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016127","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":"How bureaucracy is bleeding science dry: international observational research under the General Data Protection Regulation","authors":"Derek P. de Winter ,&nbsp;Nina A.M. Houben ,&nbsp;Enrico Lopriore","doi":"10.1016/j.lanepe.2024.101200","DOIUrl":"10.1016/j.lanepe.2024.101200","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101200"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016129","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 paradox of prosperity and poverty: confronting inequality in Norway","authors":"The Lancet Regional Health – Europe","doi":"10.1016/j.lanepe.2025.101225","DOIUrl":"10.1016/j.lanepe.2025.101225","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101225"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128610","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}