BMC Medicine最新文献

{"title":"Changes in the healthfulness of food and beverage purchases from 2006 to 2022 by outlet type in Mexico.","authors":"Ana Paula Domínguez-Barreto, Irene Farah, Nancy López-Olmedo, Carolina Pérez-Ferrer, Yenisei Ramírez-Toscano, Brent A Langellier, M Arantxa Colchero, Juan A Rivera-Dommarco, Tonatiuh Barrientos-Gutiérrez, Dalia Stern","doi":"10.1186/s12916-025-04036-8","DOIUrl":"10.1186/s12916-025-04036-8","url":null,"abstract":"<p><strong>Background: </strong>To better inform retail food environment policies in the global south, it is necessary to further understand the healthfulness of food and beverages purchased by type of food outlet over time.</p><p><strong>Methods: </strong>Using repeated cross-sectional data from the National Income and Expenditure Survey (ENIGH) in Mexico (2006 to 2022), we estimate the percentage of food and beverage purchases by processing level for each food outlet for the overall population and stratify by education (proxy of socioeconomic status) and urbanicity levels.</p><p><strong>Results: </strong>In 2006, the food outlets with the largest proportions of ultra-processed foods purchases were chain convenience stores (49%), small neighborhood stores (37%), and supermarkets (35%). In contrast, the outlets with the highest proportions of minimally processed food purchases were street markets (83%), public markets (81%), and specialty stores (75%). Over time, households increased the proportion of expenditure in minimally processed foods in supermarkets and slightly in small neighborhood stores (49 to 54% and 46 to 47%, respectively). Conversely, the proportion of expenditures in minimally processed foods decreased from 70 to 62% in street vendors. Households without formal education and residing in rural areas increased their minimally processed food purchases in specialty stores, but decreased in street vendors, acquaintances, and public markets. Households with higher education and residing in more urbanized areas increased their purchases of minimally processed foods in supermarkets and small neighborhood stores and decreased in street vendors. These households also increased their purchases in ultra-processed foods in chain convenience stores.</p><p><strong>Conclusions: </strong>There is a wide range of food outlets in Mexico, each with varying levels of healthfulness. While purchases in supermarkets have become healthier, particularly among higher socioeconomic households and in larger cities, small neighborhood stores have also shown improvements, especially in lower-income households and smaller cities. Since no outlet exclusively sells healthy or unhealthy foods, policies should focus on where people make the majority of their purchases and address healthfulness variations based on education level education and urbanization.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"205"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing healthcare payment reforms' effects on economic inequities and catastrophic expenditures among cancer patients in ethnic minority regions of China.","authors":"Xin Xiang, Yu Li, Ning Liang, Bangqin Wang, Hongzhi Wang","doi":"10.1186/s12916-025-04040-y","DOIUrl":"10.1186/s12916-025-04040-y","url":null,"abstract":"<p><strong>Background: </strong>Ethnic minority groups are particularly vulnerable to healthcare inequities, with catastrophic medical expenditures often pushing them into poverty. However, empirical research on the impact of healthcare reforms on these populations remains limited. This study aims to address this gap by exploring the effects of healthcare payment reforms on healthcare outcomes and financial protection during serious illnesses among ethnic minority populations.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using data from three major ethnic minority groups in China: the Zhuang, Hui, and Manchu. The analysis is based on hospitalization data from 59,622 ethnic minority cancer patients spanning from 2013 to 2024. Ordinary least squares (OLS) linear regression was employed to assess the effects of healthcare payment reforms on healthcare expenses and cost-sharing.</p><p><strong>Results: </strong>The findings indicate that, compared to traditional payment methods, the implementation of diagnosis-related group (DRG) payment reforms led to reductions in hospitalization, drug, and treatment expenses for ethnic minority patients. However, a closer examination of the cost structure reveals that while DRG payment systems have reduced expenditures for public health insurance fund, they have simultaneously increased out-of-pocket costs for minority patients.</p><p><strong>Conclusions: </strong>Given that many ethnic minority patients belong to economically disadvantaged groups with limited financial resources, the rise in out-of-pocket costs exacerbates their economic burden, making them more vulnerable to catastrophic medical expenditures. This situation poses a severe challenge to minority patients already in precarious financial circumstances. This study offers insights and lessons from China that may guide governments worldwide in mitigating healthcare inequities faced by vulnerable populations.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"208"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Global distribution, risk factors, and temporal trends of COPD incidence and mortality (1990-2021): ecological analysis.","authors":"Shafaq Naeem, Fang Wang, Rabia Mubarak, Hui Shen, Xuechun Li, Irene Mommers, Syeda Rija Hussain, Saima Shakil Malik, Chuanhua Yu, Eelko Hak, Xiaolin Xu, Muhammad Fawad, Sumaira Mubarik","doi":"10.1186/s12916-025-04014-0","DOIUrl":"10.1186/s12916-025-04014-0","url":null,"abstract":"<p><strong>Background: </strong>Chronic Obstructive Pulmonary Disease (COPD) remains a significant global public health challenge, contributing to substantial morbidity and mortality worldwide. This study aims to analyze global trends in COPD from 1990 to 2021, with a focus on age, sex, and regional variations. By assessing the global burden of COPD and its association with key risk factors, this research provides critical insights into progress toward health-related Sustainable Development Goals (SDGs) and underscores the urgent need to prioritize COPD in public health agendas.</p><p><strong>Methods: </strong>Utilizing data from the Global Burden of Disease (GBD) study, this research conducted a comprehensive ecological analysis of COPD epidemiology from 1990 to 2021. Key measures included incidence, mortality, and age-standardized rates, alongside an examination of risk factors such as smoking and ambient particulate matter pollution, quantified using country-level summary exposure values (SEV). Statistical analyses, including descriptive analysis, annual rate of change (ARC), and correlation analysis, were applied to assess the burden of COPD and investigate its ecological associations with major risk factors.</p><p><strong>Results: </strong>In 2021, COPD accounted for 16.90 million new cases and 3.70 million deaths globally. The age-standardized incidence rate was 197.37 (95% UI: 181.6-213.42) per 100,000 person-years, while the age-standardized mortality rate was 45.22 (95% UI: 40.61-49.70) per 100,000 person-years. Although global COPD incidence rates declined by 2% from 1990 to 2021, the pace and extent of this decline varied, with some age groups, sexes, and regions experiencing slower reductions or even increases. Higher COPD burden was observed in areas with elevated smoking prevalence, air pollution and greater socioeconomic development.</p><p><strong>Conclusions: </strong>This study highlights the ongoing global burden of COPD and its varying trends from 1990 to 2021 across age groups, sexes, and regions. While incidence and mortality rates have slightly declined, disparities persist, particularly among older adults, men, and regions with higher smoking prevalence and air pollution. These findings emphasize the urgent need to integrate COPD into public health priorities, focusing on targeted interventions to reduce key risk factors. Sustained efforts are essential to achieving health-related Sustainable Development Goals (SDGs) and improving global COPD outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"210"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of invasive versus conservative strategy in stable coronary artery disease patients: a risk-stratification-based hypothesis-generative study.","authors":"Zizhao Qi, Miaohan Qiu, Ying Xu, Kai Xu, Haiwei Liu, Xiaozeng Wang, Jing Li, Bin Liu, Shaoliang Chen, Jiyan Chen, Yaling Han, Yi Li","doi":"10.1186/s12916-025-04020-2","DOIUrl":"10.1186/s12916-025-04020-2","url":null,"abstract":"<p><strong>Background: </strong>Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores.</p><p><strong>Methods: </strong>This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding.</p><p><strong>Results: </strong>The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13-2.26; P = 0.009). Similar results were observed in the low-risk patient subset (N = 2030). While in the moderate-to-high-risk subset (N = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48-0.95; P = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51-1.03; P = 0.07), and with no excessive risk of bleeding.</p><p><strong>Conclusions: </strong>Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. The OPT-CAD risk score may be valuable to the guidance of optimal treatment strategy in SCAD patients.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"199"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased vision impairment reports linked to semaglutide: analysis of FDA adverse event data.","authors":"Marine Massy, Stefanie Marti, Helly Hammer, Robert Hoepner","doi":"10.1186/s12916-025-04031-z","DOIUrl":"10.1186/s12916-025-04031-z","url":null,"abstract":"<p><strong>Background: </strong>Semaglutide, a GLP-1 receptor agonist widely prescribed for type 2 diabetes and obesity, has recently raised concerns about its ocular safety. This study aimed to investigate the association between semaglutide use and vision impairment using data from the FDA Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>We conducted an analysis of FAERS data, comparing reports of vision impairment associated with semaglutide to those associated with other antidiabetic and weight loss medications. The main outcome measure was the reporting odds ratio (rOR) for vision impairment linked to semaglutide use compared to other medications.</p><p><strong>Results: </strong>Semaglutide showed significantly higher reporting of vision impairment compared to other GLP-1 receptor agonists (rOR 1.95, 95% CI 1.75-2.17, p < 0.0001), DPP-4 inhibitors (rOR 2.46, 95% CI 2.12-2.86, p < 0.0001), SGLT2 inhibitors (rOR 3.89, 95% CI 3.35-4.51, p < 0.0001), and metformin (rOR 2.23, 95% CI 1.90-2.62, p < 0.0001). Similar findings were observed when compared to phentermine (rOR 1.57, 95% CI 1.07-2.31, p = 0.026) and orlistat (rOR 3.77, 95% CI 2.96-4.81, p < 0.0001). Topiramate was the sole exception, showing higher vision impairment reporting than semaglutide (rOR 0.30, 95% CI 0.20-0.45, p < 0.0001).</p><p><strong>Conclusions: </strong>These findings suggest a potentially elevated risk of vision impairment with semaglutide use compared to other diabetes and weight loss medications, warranting further investigation and vigilant post-marketing surveillance. Future studies should assess the clinical impact of this potential increased risk on an absolute scale to better inform treatment decisions.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"203"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of photobiomodulation combined with oral cryotherapy on oral mucosa pain in patients with burning mouth syndrome: a multi-institutional, randomized, controlled trial.","authors":"Chenghui Lu, Xuan Zhou, Chenglong Yang, Xinxiang Jiang, Xin Li, Zefan Huang, Qing Du, Guoyao Tang","doi":"10.1186/s12916-025-04015-z","DOIUrl":"10.1186/s12916-025-04015-z","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of burning mouth syndrome (BMS) is approximately 8% in clinical patients; thus, BMS remains a therapeutic challenge. Photobiomodulation (PBM) and oral cryotherapy (OCT) have been evaluated for the treatment of burning pain, but no confirmatory trials have been performed. To evaluate the comparative effectiveness of PBM combined with OCT at reducing pain and psychological distress compared with PBM alone, OCT alone, or drug therapy (DT) alone in a cohort of patients with BMS.</p><p><strong>Methods: </strong>This multi-institutional, single-blinded (assessor-blinded), randomized controlled trial with 4 treatment groups was conducted at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine and Affiliated Stomatology Hospital of Guilin Medical University from December 12, 2022, to January 24, 2024. Among the 156 patients assessed for eligibility, 28 were excluded, and 128 patients with a BMS qualified for randomization to 1 of the 4 treatment groups. The participants received 7 treatment sessions of (1) PBM combined with OCT, (2) PBM, (3) OCT, or (4) DT during a 7-week period. The coprimary outcome measures were changes in visual analogue scale (VAS) scores and the overall response rate between baseline and 7 weeks of treatment.</p><p><strong>Results: </strong>After 7 weeks of treatment, the PBM + OCT group achieved a high overall response rate for pain reduction (81.25%). This difference in pain reduction trends between the groups resulted in a nearly fivefold greater mean change in the VAS score at the 12-week assessment for the PBM + OCT group than for the DT group (p < 0.0083). Furthermore, anxiety symptoms were also significantly alleviated by PBM combined with OCT, resulting in a nearly tenfold greater mean change in the GAD-7 score at the 7-week assessment in the PBM + OCT group than in the DT group (p < 0.0083). No severe adverse events were reported during the study period.</p><p><strong>Conclusions: </strong>PBM and OCT combination therapy reduces oral mucosa pain and alleviates anxiety symptoms in patients with BMS; thus, this combination therapy is expected to become a promising pain management option for patients with BMS.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2300074518.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"196"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between education and ideal cardiovascular health metrics across 36 low- and middle-income countries.","authors":"Yi Zhang, Guangyu Tong, Ning Ma, Shaoru Chen, Yuhao Kong, Lhuri Dwianti Rahmartani, Justice Moses K Aheto, Andrew Marvin Kanyike, Pengyang Fan, Md Ashfikur Rahman, Abdallah Mkopi, Rockli Kim, Peter Karoli, John Lapah Niyi, Melkamu Aderajew Zemene, Lin Zhang, Feng Cheng, Chunling Lu, S V Subramanian, Pascal Geldsetzer, Yue Qiu, Zhihui Li","doi":"10.1186/s12916-025-04032-y","DOIUrl":"10.1186/s12916-025-04032-y","url":null,"abstract":"<p><strong>Background: </strong>The relationship between education and cardiovascular health (CVH) metrics in low- and middle-income countries (LMICs) remains unclear. This study explores the associations between education and ideal cardiovascular health score (CVHS), as well as seven CVH metrics.</p><p><strong>Methods: </strong>This cross-sectional study extracted data from the STEPwise approach to surveillance surveys in 36 LMICs between 2010 and 2020. We assessed CVHS using the sum score in seven metrics defined by American Heart Association: (1) ≥ 150 min/week of moderate, or 75 min/week of vigorous activity, or an equivalent combination; (2) BMI < 25 kg/m² for non-Asians (< 23 kg/m² for Asians); (3) fruit and vegetable intake ≥ 4.5 servings per day; (4) nonsmoking; (5) blood pressure < 120/80 mmHg (untreated); (6) total cholesterol < 200 mg/dL (untreated); and (7) fasting blood glucose < 100 mg/dL (untreated). The ideal CVHS score ranged from 5 to 7. We disaggregated prevalence of ideal CVHS and seven metrics by education, and constructed Poisson regression models to adjust for other socioeconomic factors.</p><p><strong>Results: </strong>Among 81,327 adult participants, the overall ideal CVHS prevalence for the studied countries was highest among individuals with primary education (52.9%, 95% CI: 51.0-54.9), surpassing those of other education levels - 48.0% (95% CI: 44.6-51.3, P = 0.003) for those with no education and 39.1% (95% CI: 36.5-41.8, P < 0.001) for those with tertiary education. Five (ideal physical activity, BMI, blood pressure, total cholesterol, and blood glucose) in seven CVH metrics peaked among participants with primary or secondary education. For instance, the prevalence of ideal blood pressure among individuals with primary education was 34.4% (95% CI: 32.7-36.1), higher than the prevalence in other education levels, ranging from 28.6% to 32.3%. These patterns were concentrated in low-income countries and lower-middle-income countries, while in upper-middle-income countries, the prevalence of ideal CVHS increased with higher education levels, ranging from 15.4% for individuals with no education to 33.1% for those with tertiary education.</p><p><strong>Conclusions: </strong>In LMICs, the association between education and ideal CVHS, along with several CVH metrics, exhibited un inverted U-shape, which may be closely related to the different stages of epidemiologic transition.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"204"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pharmacodynamics-based prophylactic benefits of GLP-1 receptor agonists and SGLT2 inhibitors on neurodegenerative diseases: evidence from a network meta-analysis.","authors":"Ping-Tao Tseng, Bing-Yan Zeng, Chih-Wei Hsu, Chao-Ming Hung, Andre F Carvalho, Brendon Stubbs, Yen-Wen Chen, Tien-Yu Chen, Wei-Te Lei, Jiann-Jy Chen, Kuan-Pin Su, Yow-Ling Shiue, Chih-Sung Liang","doi":"10.1186/s12916-025-04018-w","DOIUrl":"10.1186/s12916-025-04018-w","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a new generation of antihyperglycemic agents that operate through mechanisms distinct from conventional diabetes treatments. Beyond their metabolic effects, these medications have demonstrated neuroprotective properties in preclinical studies. While clinical trials have explored their therapeutic potential in established neurodegenerative conditions, their role in disease prevention remains unclear. We conducted a network meta-analysis (NMA) to comprehensively evaluate the prophylactic benefits of these agents across multiple neurodegenerative diseases and identify the most promising preventive strategies.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov through October 24th, 2024, for randomized controlled trials (RCTs) of GLP-1 receptor agonists or SGLT2 inhibitors. Our primary outcome was the incidence of seven major neurodegenerative diseases: Parkinson's disease, Alzheimer's disease, Lewy body dementia, multiple sclerosis, amyotrophic lateral sclerosis, frontotemporal dementia, and Huntington's disease. Secondary outcomes included safety profiles assessed through dropout rates. We performed a frequentist-based NMA and evaluated risk of bias with Risk of Bias tool. The main result of the primary outcome in the current study would be re-affirmed via sensitivity test with Bayesian-based NMA.</p><p><strong>Results: </strong>Our analysis encompassed 22 RCTs involving 138,282 participants (mean age 64.8 years, 36.4% female). Among all investigated medications, only dapagliflozin demonstrated significant prophylactic benefits, specifically in preventing Parkinson's disease (odds ratio = 0.28, 95% confidence intervals = 0.09 to 0.93) compared to controls. Neither GLP-1 receptor agonists nor other SGLT2 inhibitors showed significant preventive effects for any of the investigated neurodegenerative conditions. Drop-out rates were comparable across all treatments.</p><p><strong>Conclusions: </strong>This comprehensive NMA reveals a novel and specific prophylactic effect of dapagliflozin against Parkinson's disease, representing a potential breakthrough in preventive neurology. The specificity of dapagliflozin's protective effect to Parkinson's disease might rely on its highly selective inhibition to SGLT2. These findings provide important direction for future research and could inform preventive strategies for populations at risk of Parkinson's disease.</p><p><strong>Trial registration: </strong>PROSPERO CRD42021252381.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"197"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting health facilities on the map: a renewed call to create geolocated, comprehensive, updated, openly licensed dataset of health facilities in sub-Saharan African countries.","authors":"Peter M Macharia, Lenka Beňová, Nicolas Ray, Aline Semaan, Moses M Musau, John Kapoi Kipterer, Mark Herringer, Robert W Snow, Emelda A Okiro","doi":"10.1186/s12916-025-04023-z","DOIUrl":"10.1186/s12916-025-04023-z","url":null,"abstract":"<p><strong>Background: </strong>Healthcare service provision, planning, and management depend on the availability of a geolocated, up-to-date, comprehensive health facility database (HFDB) to adequately meet a population's healthcare needs. HFDBs are an integral component of national health system infrastructure forming the basis of efficient health service delivery, planning, surveillance, and ensuring equitable resource distribution, response to epidemics and outbreaks, as well as for research. Despite the value of HFDBs, their availability remains a challenge in sub-Saharan Africa (SSA). Many SSA countries face challenges in creating a HFDB; existing facility lists are incomplete, lack geographical coordinates, or contain outdated information on facility designation, service availability, or capacity. Even in countries with a HFDB, it is often not available open-access to health system stakeholders. Consequently, multiple national and subnational parallel efforts attempt to construct HFDBs, resulting in duplication and lack of governmental input, use, and validation.</p><p><strong>Main body: </strong>In this paper, we advocate for a harmonized SSA-wide HFDB. To achieve this, we elaborate on the steps required and challenges to overcome. We provide an overview of the minimum attributes of a HFDB and discuss past and current efforts to collate HFDBs at the country and regional (SSA) levels. We contend that a complete HFDB should include administrative units, geographic coordinates of facilities, attributes of service availability and capacity, facilities from both public and private sectors, be updated regularly, and be available to health system stakeholders through an open access policy. We provide historical and recent examples while looking at key issues and challenges, such as privacy, legitimacy, resources, and leadership, which must be considered to achieve such HFDBs.</p><p><strong>Conclusion: </strong>A harmonized HFDB for all SSA countries will facilitate efficient healthcare planning and service provision. A continental, cross-border effort will further support planning during natural disasters, conflicts, and migration. This is only achievable if there is a regional commitment from countries and health system stakeholders to open data sharing. This SSA-wide HFDB should be a government-led initiative with contributions from all stakeholders, ensuring no one is left behind in the pursuit of improved health service provision and universal health coverage.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"211"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11978184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating SinergiAPS, an intervention based on patient feedback to improve patient safety in primary care: a cluster randomized trial.","authors":"Maria Antònia Fiol-deRoque, José María Valderas, María Jesús Serrano-Ripoll, Montserrat Gens-Barbarà, Francisco Martín-Luján, Encarna Sánchez-Freire, Juan José Montaño, Sofía Mira-Martínez, Guadalupe Pastor-Moreno, Rocío Zamanillo-Campos, Pau Riera-Serra, Ignacio Ricci-Cabello","doi":"10.1186/s12916-025-04029-7","DOIUrl":"10.1186/s12916-025-04029-7","url":null,"abstract":"<p><strong>Background: </strong>Patient safety, defined by the WHO as the absence of preventable harm, is a critical component of healthcare quality and poses a significant challenge globally. This study aimed to evaluate the effectiveness of SinergiAPS, a patient-centred audit and feedback intervention, in improving patient safety in primary healthcare (PHC) centres.</p><p><strong>Methods: </strong>We conducted a 12-month cluster randomized controlled, multicentre trial. Fifty-nine PHC centres (1053 PHC professionals) in Spain were recruited and randomly allocated (1:1) to usual care or SinergiAPS intervention. The SinergiAPS intervention comprised: a bespoke feedback report with results from audits of patient safety based on the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire, administered to 75 patients/centre; a set of educational materials, and a structured template to record safety improvement plans. The primary outcome (at the PHC professional level) was patient safety culture (Medical Office Survey on Patient Safety Culture (MOSPSC) questionnaire). Secondary outcomes (at the centre level) were patient-reported safety (six PREOS-PC scales), and rate of avoidable hospital admissions. After a 12-month follow-up, we conducted 15 semi-structured interviews with PHC professionals to explore their perceptions of the intervention.</p><p><strong>Results: </strong>During the 12-month follow-up, 10 of the 30 centres in the intervention group held action plan team meetings and eight registered 57 safety improvement action plans. The plans aimed to improve patient activation, address treatment-related incidents, enhance communication between patients and providers, and strengthen patient safety culture. At 12 months, no significant differences were observed in MOSPSC mean score (intervention: 3.60 [95% CI 3.55 to 3.64] vs. control: 3.64 [3.60 to 3.68]). Similarly, no differences were observed in the secondary outcomes, with both groups experiencing a decline in patient-reported safety and avoidable hospital admissions. The qualitative interviews evidenced that the onset of the COVID-19 pandemic 6-9 weeks after initiating the follow-up period severely limited PHC's capacity of developing and implementing safety improvement action plans, despite high levels of acceptability and perceived utility of the SinergiAPS intervention.</p><p><strong>Conclusions: </strong>In the context of the health emergency caused by the COVID-19 pandemic, SinergiAPS did not improve patient safety in Spanish PHC centres.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03837912).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"202"},"PeriodicalIF":7.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}