Lancet Regional Health-Europe最新文献

{"title":"The effect of bivalent HPV vaccination against invasive cervical cancer and cervical intraepithelial neoplasia grade 3 (CIN3+) in the Netherlands: a population-based linkage study","authors":"Marit Middeldorp ,&nbsp;Jesca G.M. Brouwer ,&nbsp;Janneke W. Duijster ,&nbsp;Mirjam J. Knol ,&nbsp;Folkert J. van Kemenade ,&nbsp;Albert G. Siebers ,&nbsp;Johannes Berkhof ,&nbsp;Hester E. de Melker","doi":"10.1016/j.lanepe.2025.101327","DOIUrl":"10.1016/j.lanepe.2025.101327","url":null,"abstract":"<div><h3>Background</h3><div>The protective effect of HPV vaccination against cervical cancer has been demonstrated in registry linkage studies. The start age of screening in those studies was lower than 25 years. We aimed to estimate the effectiveness of bivalent HPV16/18 vaccination against invasive cervical cancer and cervical intraepithelial neoplasia grade 3 (CIN3+) in the Netherlands, where routine screening starts at age 30 years.</div></div><div><h3>Methods</h3><div>We linked the vaccination status of women born in 1993 who were eligible for HPV vaccination at age 16 years with histopathological results recorded until April 1, 2024, in the nationwide pathology databank (Palga). Cumulative risks of invasive cervical cancer and CIN3+ were estimated for fully vaccinated (3 doses or 2 doses ≥150 days apart), partially vaccinated, and unvaccinated women. Cumulative risk ratios (CRRs) were adjusted for differences in screening participation between vaccine groups.</div></div><div><h3>Findings</h3><div>A total of 103,059 women were included, of whom 47,130 were fully vaccinated, 5098 partially vaccinated, and 50,831 unvaccinated. Five cancers (0·011%) were observed in fully vaccinated, two (0·039%) in partially vaccinated, and 42 (0·083%) in unvaccinated women. The CRR for fully vaccinated women compared with unvaccinated women was 0·085 (95% confidence interval 0·025, 0·24) for cancer and 0·19 (0·16, 0·23) for CIN3+. The CRR for partially vaccinated women was 0·52 (0·12, 1·71) for cancer and 0·42 (0·30, 0·57) for CIN3+.</div></div><div><h3>Interpretation</h3><div>The risk of cervical cancer and CIN3+ was strongly reduced in vaccinated women indicating that vaccine protection extends at least until age 30.</div></div><div><h3>Funding</h3><div>The <span>Dutch Ministry of Health, Welfare, and Sport</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101327"},"PeriodicalIF":13.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139609","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":"Correction to “Effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children: a parallel group randomised controlled trial” [The Lancet Regional Health—Europe, Volume 45, October 2024, 101038]","authors":"Abby Dunn ,&nbsp;James Alvarez ,&nbsp;Amy Arbon ,&nbsp;Stephen Bremner ,&nbsp;Chloe Elsby-Pearson ,&nbsp;Richard Emsley ,&nbsp;Christopher Jones ,&nbsp;Peter Lawrence ,&nbsp;Kathryn J. Lester ,&nbsp;Natalie Morson ,&nbsp;Julia Simner ,&nbsp;Abigail Thomson ,&nbsp;Sam Cartwright-Hatton","doi":"10.1016/j.lanepe.2025.101332","DOIUrl":"10.1016/j.lanepe.2025.101332","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101332"},"PeriodicalIF":13.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098893","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":"Text messaging with or without financial incentives versus a waitlist control for weight loss in men: cost-effectiveness analysis of the Game of Stones randomised controlled trial","authors":"Abraham M. Getaneh ,&nbsp;Marjon van der Pol ,&nbsp;Dwayne Boyers ,&nbsp;Alison Avenell ,&nbsp;Seonaidh Cotton ,&nbsp;Stephan U. Dombrowski ,&nbsp;Cindy M. Gray ,&nbsp;Frank Kee ,&nbsp;Lisa Macaulay ,&nbsp;Michelle McKinley ,&nbsp;Catriona O’Dolan ,&nbsp;James Swingler ,&nbsp;Claire Torrens ,&nbsp;Katrina Turner ,&nbsp;Graeme MacLennan ,&nbsp;Pat Hoddinott","doi":"10.1016/j.lanepe.2025.101328","DOIUrl":"10.1016/j.lanepe.2025.101328","url":null,"abstract":"<div><h3>Background</h3><div>Cost-effective weight loss interventions are needed for people with obesity, particularly men, who are less likely to engage with weight loss programmes. This study aimed to investigate the cost-effectiveness of text messaging plus financial incentives and text messaging alone compared to a waitlist control to help men lose weight.</div></div><div><h3>Methods</h3><div>585 men with obesity were recruited to Game of Stones (GoS): a 3-arm randomised controlled trial in 3 UK areas. Text messaging alone participants received daily automated behavioural texts for 12-months (3% weight loss). Text messaging with financial incentives participants also received loss-framed financial incentives linked to achieving weight loss targets at 12-months (5% significant weight loss). A control group received no intervention for 12 months (1.3% weight loss) followed by 3 months of texts. We conducted a 24-month within-trial cost-effectiveness analysis and lifetime decision model from a UK NHS perspective. The PRIMEtime model extrapolated the impact of GoS weight-loss data on lifetime obesity related disease incidence, costs, and QALYs. Weight regain assumptions were explored in scenario analyses.</div></div><div><h3>Findings</h3><div>Text messaging with financial incentives costs £243 and text messaging alone costs £110 per participant to deliver. There were no significant differences between 24-month total costs or QALYs across groups. When modelled over lifetime, the mean discounted QALYs per person were 12.48, 12.49, and 12.46 for text messaging with financial incentives, text messaging alone, and waitlist control, respectively. The corresponding mean discounted total costs per person were £15,277, £15,117, and £15,100. The between group results for text messaging with financial incentives versus control were: QALY difference (95% CI): 0.02 (0.007, 0.029); cost difference: £176 (£43; £311); Incremental cost-effectiveness ratio (ICER): £9748 (£7,705, £11,791). For text messaging alone versus control: QALY difference: 0.03 (0.015, 0.037); cost difference: £16.5 (-£117; £152); ICER: £628 (£-5,914, £5384).</div></div><div><h3>Interpretation</h3><div>Text messaging with financial incentives and text messaging alone are cost-effective compared to waitlist control. Both are relatively low-cost interventions that can be scaled to improve weight loss for men. The optimal strategy between them depends on weight regain assumptions after 12 months.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research</span> (Ref: NIHR <span><span>129703</span></span>). Trial Registration <span><span>isrctn.org</span><svg><path></path></svg></span> Identifier: ISRCTN91974895.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101328"},"PeriodicalIF":13.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107375","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 European Medicines Agency and The Lancet Regional Health—Europe join forces to protect public health","authors":"Juan Garcia Burgos,&nbsp;Steffen Thirstrup,&nbsp;Emer Cooke","doi":"10.1016/j.lanepe.2025.101331","DOIUrl":"10.1016/j.lanepe.2025.101331","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"53 ","pages":"Article 101331"},"PeriodicalIF":13.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115311","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":"Health-related quality of life in patients undergoing laparoscopic versus open hemihepatectomy: a secondary analysis of the ORANGE II PLUS randomised controlled, phase 3, superiority trial","authors":"Bram Olij ,&nbsp;Robert S. Fichtinger ,&nbsp;Luca A. Aldrighetti ,&nbsp;Mohammad Abu Hilal ,&nbsp;Roberto I. Troisi ,&nbsp;Robert P. Sutcliffe ,&nbsp;Marc G. Besselink ,&nbsp;Somaiah Aroori ,&nbsp;Krishna V. Menon ,&nbsp;Bjørn Edwin ,&nbsp;Mathieu D’Hondt ,&nbsp;Valerio Lucidi ,&nbsp;Tom F. Ulmer ,&nbsp;Rafael Díaz-Nieto ,&nbsp;Zahir Soonawalla ,&nbsp;Steve White ,&nbsp;Gregory Sergeant ,&nbsp;Francesca Ratti ,&nbsp;Christoph Kuemmerli ,&nbsp;Vincenzo Scuderi ,&nbsp;Beth Wedge","doi":"10.1016/j.lanepe.2025.101311","DOIUrl":"10.1016/j.lanepe.2025.101311","url":null,"abstract":"<div><h3>Background</h3><div>Health-related quality of life (HRQoL) has become a critical factor in determining the benefits of new surgical approaches on patients. The ORANGE II PLUS randomised trial compared laparoscopic (LH) and open (OH) hemihepatectomy in an international multicentre randomised controlled setting, with HRQoL as a secondary outcome. The aim of this study was to perform an in-depth analysis of the HRQoL outcomes.</div></div><div><h3>Methods</h3><div>Between October 2013 and January 2019, 352 patients scheduled for hemihepatectomy, were randomly assigned to either LH or OH in a 1:1-ratio in 16 European centres. HRQoL was assessed using the EORTC-QLQ-C30 and QLQ-LMC21 modules, at baseline, hospital discharge, and at 10-days, 3-, 6-, and 12-months after discharge. Differences in functioning- and five selected symptom scales were compared between LH and OH over the cumulative periods from discharge to 3 months as well as to 12 months using a multivariable adjusted linear mixed regression model. The study was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT01441856</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>The modified intention-to-treat analysis included 332 patients (166 LH and 166 OH), with 40% female in LH and 42% female in OH. 1546 questionnaires (81% of maximum) were obtained. Cumulatively over the period from discharge to 3 months postoperatively, patients in the laparoscopic group reported better physical (difference 4.20 points; 95% CI 1.07–7.34) and social functioning (5.95 points; 95% CI 1.65–10.26), and lower pain (−6.41 points, 95% CI −10.01 to −2.82) and appetite loss (−7.29 points, 95% CI −11.59 to −2.99), compared to the OH group. Similar clinically relevant, but slightly attenuated, differences were reported over the cumulative period from discharge to 12 months after surgery. The largest difference was observed at 10 days after surgery.</div></div><div><h3>Interpretation</h3><div>In this international randomised trial evaluating HRQoL, LH demonstrated better physical and social functioning, and less pain and appetite loss, compared to OH. These findings support the preferential use of the laparoscopic approach for hemihepatectomy in experienced centres.</div></div><div><h3>Funding</h3><div><span>Maastricht University Medical Centre+</span>, <span>University Hospital RWTH Aachen</span>, <span>Cancer Research UK 12/048</span>, <span>European Association of Endoscopic Surgery</span>, participating centres.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"54 ","pages":"Article 101311"},"PeriodicalIF":13.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089892","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":"Long-term outcomes of depression up to 10-years after stroke in the South London Stroke Register: a population-based study","authors":"Lu Liu ,&nbsp;Iain J. Marshall ,&nbsp;Xianqi Li ,&nbsp;Ajay Bhalla ,&nbsp;Lidan Liu ,&nbsp;Ruonan Pei ,&nbsp;Charles D.A. Wolfe ,&nbsp;Matthew D.L. O'Connell ,&nbsp;Yanzhong Wang","doi":"10.1016/j.lanepe.2025.101324","DOIUrl":"10.1016/j.lanepe.2025.101324","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data were from the South London Stroke Register (1-January-1997–20-April-2023). Depression was defined as a score &gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;","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 ,&nbsp;Hartmut Häntze ,&nbsp;Christian Mertens ,&nbsp;Felix Busch ,&nbsp;Tristan Lemke ,&nbsp;Jakob Nikolas Kather ,&nbsp;Daniel Truhn ,&nbsp;Su Hwan Kim ,&nbsp;Benedikt Wiestler ,&nbsp;Markus Graf ,&nbsp;Avan Kader ,&nbsp;Fabian Bamberg ,&nbsp;Christopher L. Schlett ,&nbsp;Jakob B. Weiss ,&nbsp;Jeanette Schulz-Menger ,&nbsp;Steffen Ringhof ,&nbsp;Elif Can ,&nbsp;Tobias Pischon ,&nbsp;Thoralf Niendorf ,&nbsp;Jacqueline Lammert ,&nbsp;Keno Bressem","doi":"10.1016/j.lanepe.2025.101323","DOIUrl":"10.1016/j.lanepe.2025.101323","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 &gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;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 (&lt;500 MET min/week) or high (&gt;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 &lt; 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13–1.30; p &lt; 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&lt;sup&gt;3&lt;/sup&gt;/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm&lt;sup&gt;3&lt;/sup&gt;/kg/m; InterMAT: 6.96% both p &lt; 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm&lt;sup&gt;3&lt;/sup&gt;/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm&lt;sup&gt;3&lt;/sup&gt;/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 &lt; 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13–1.30; p &lt; 0.0001), independent of physical activity, osteoporosis and osteoarthritis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;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 ,&nbsp;Caroline Stridsman ,&nbsp;Helena Backman ,&nbsp;Sigrid Vikjord ,&nbsp;Anne Lindberg ,&nbsp;Fredrik Nyberg ,&nbsp;Lowie E.G.W. Vanfleteren","doi":"10.1016/j.lanepe.2025.101322","DOIUrl":"10.1016/j.lanepe.2025.101322","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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&lt;sub&gt;1&lt;/sub&gt;) and forced vital capacity (FVC) (index date). Patients with concomitant asthma were excluded. Patients were stratified into dnsCOPD (FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ≥0.7 and FEV&lt;sub&gt;1&lt;/sub&gt; ≥80% predicted), PRISm (FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ≥0.7 and FEV&lt;sub&gt;1&lt;/sub&gt; &lt;80% predicted) and sCOPD (FEV&lt;sub&gt;1&lt;/sub&gt;/FVC &lt;0.7). Further substratification was based on GOLD A/B/E (A: COPD assessment test (CAT) score &lt;10 points and &lt;2 moderate, 0 severe exacerbations within 1 year before the index date, B: CAT-score ≥10 points and &lt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;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}