BMC Medicine最新文献

{"title":"Modifiable risk factors of vaccine hesitancy: insights from a mixed methods multiple population study combining machine learning and thematic analysis during the COVID-19 pandemic.","authors":"Omid V Ebrahimi, Ella Marie Sandbakken, Sigrun Marie Moss, Sverre Urnes Johnson, Asle Hoffart, Sarah Bauermeister, Ole André Solbakken, Lars T Westlye, Esten H Leonardsen","doi":"10.1186/s12916-025-03953-y","DOIUrl":"10.1186/s12916-025-03953-y","url":null,"abstract":"<p><strong>Background: </strong>Vaccine hesitancy, the delay in acceptance or reluctance to vaccinate, ranks among the top threats to global health. Identifying modifiable factors contributing to vaccine hesitancy is crucial for developing targeted interventions to increase vaccination uptake.</p><p><strong>Methods: </strong>This mixed-methods multiple population study utilized gradient boosting machines and thematic analysis to identify modifiable predictors of vaccine hesitancy during the COVID-19 pandemic. Predictors of vaccine hesitancy were investigated in 2926 Norwegian adults (M_age = 37.91, 79.69% female), before the predictive utility of these variables was investigated in an independent sample of 734 adults in the UK (M_age = 40.34, 57.08% female). Two independent teams of authors conducted the machine learning and thematic analyses, blind to each other's analytic procedures and results.</p><p><strong>Results: </strong>The machine learning model performed well in discerning vaccine hesitant (n = 248, 8.48% and n = 109, 14.85%, Norway and UK, respectively) from vaccine uptaking individuals (n = 2678, 91.52% and n = 625, 85.15%), achieving an AUC of 0.94 (AUPRC: 0.72; balanced accuracy: 86%; sensitivity = 0.81; specificity = 0.98) in the Norwegian sample, and an AUC of 0.98 (AUPRC: 0.89; balanced accuracy: 89%; sensitivity = 0.83; specificity = 0.97) in the out-of-sample replication in the UK. The mixed methods investigation identified five categories of modifiable risk tied to vaccine hesitancy, including illusion of invulnerability, doubts about vaccine efficacy, mistrust in official entities, minimization of the societal impact of COVID-19, and health-related fears tied to vaccination. The portrayal of rare incidents across alternative media platforms as fear amplifiers, and the mainstream media's stigmatizing presentation of unvaccinated individuals, were provided as additional motives underlying vaccine reluctance and polarization. The thematic analysis further revealed information overload, fear of needles, previous negative vaccination experiences, fear of not getting healthcare follow-up after vaccination if needed, and vaccine aversion due to underlying (psychiatric) illness (e.g., eating disorders) as motives underlying vaccine hesitance.</p><p><strong>Conclusions: </strong>The identified influential predictors were consistent across two European samples, highlighting their generalizability across European populations. These predictors offer insights about modifiable factors that could be adapted by public health campaigns in mitigating misconceptions and fears related to vaccination toward increasing vaccine uptake. Moreover, the results highlight the media's responsibility, as mediators of the public perception of vaccines, to minimize polarization and provide accurate portrayals of rare vaccine-related incidents, reducing the risk aggravating fear and reactance to vaccination.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"155"},"PeriodicalIF":7.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613315","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":"Long-term cost-effectiveness of health behaviour intervention to manage type 2 diabetes in Nepal.","authors":"Padam Kanta Dahal, Corneel Vandelanotte, Lal Rawal, Rashidul Alam Mahumud, Grish Paudel, Melanie Lloyd, Yeji Baek, Biraj Karmacharya, Tomohiko Sugishita, Zanfina Ademi","doi":"10.1186/s12916-025-03981-8","DOIUrl":"10.1186/s12916-025-03981-8","url":null,"abstract":"<p><strong>Background: </strong>Long-term cost-effectiveness analyses of health behaviour interventions to effectively manage type 2 diabetes mellitus (T2DM) in low-income countries are crucial for minimising economic burden and optimising resource allocation. Therefore, this study aimed to estimate the long-term cost-effectiveness of implementing a health behaviour intervention to manage T2DM in Nepal.</p><p><strong>Methods: </strong>A Markov model in combination with a decision tree was developed to compare the costs and outcomes of the health behaviour intervention against usual care among 481 (238-intervention and 243-control) participants from healthcare system and societal perspectives. The model integrates empirical trial data, with published data to inform parameters not collected during the trial. The model estimated costs, quality-adjusted life years (QALYs) and cost-effectiveness over 5 years, 10 years, 20 years, 30 years and a lifetime time horizons with 3% annual discounting. Sub-group, scenarios, both one-way and two-way analyses and probabilistic sensitivity analyses (PSA) were performed to assess the impact of uncertainty in the model under the threshold of 3 times gross domestic product (GDP) per capita (i.e., US $4140) for Nepal.</p><p><strong>Results: </strong>Base-case analysis with lifetime horizon showed that the health behaviour intervention compared to usual care improved QALYs by 3.88 and increased costs by US $4293 per patient, with an incremental cost-effectiveness ratio (ICER) of US $1106 per QALY gained from a healthcare system perspective. From a societal perspective, QALYs also improved by 3.88 and costs increased by US $4550, with an ICER of US $1173 per QALY gained. Furthermore, the intervention demonstrated ICERs of US $636, US $678, US $637, and US $632 per QALY gained over 5-, 10-, 20-, and 30-year time horizons, respectively, from a healthcare system perspective, and US $719, US $766, US $659, and US $716 per QALY gained from a societal perspective. In the PSA, the probability of the health behaviour intervention being cost-effective was over 57%.</p><p><strong>Conclusions: </strong>The health behaviour intervention for managing T2DM was cost-effective over a lifetime horizon compared to usual care. To maximise its impact, this intervention should be scaled up nationwide, and future research is warranted to assess the long-term cost-effectiveness across diverse settings in low-income countries.</p><p><strong>Trial registration: </strong>Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"153"},"PeriodicalIF":7.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603502","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":"Can (dynamic) social norms encourage plant-based food purchases? a quasi-experimental study in real-world Dutch supermarkets.","authors":"Sofia M M Wolfswinkel, Sanne Raghoebar, Josine M Stuber, Emely de Vet, Maartje P Poelman","doi":"10.1186/s12916-025-03986-3","DOIUrl":"10.1186/s12916-025-03986-3","url":null,"abstract":"<p><strong>Background: </strong>Communicating (dynamic) social norms is considered a promising tool to stimulate healthy and sustainable food choices. The aim of the present study was to evaluate to what extent a (dynamic) social norm intervention in real-world supermarkets could increase sales (grams per week) of meat alternatives (i.e. meat substitutes and legumes).</p><p><strong>Methods: </strong>A quasi-experimental study, including three intervention and three control supermarkets, was conducted during a 12-week period. The intervention supermarkets communicated dynamic norms textually on stickers and banners at different in-store locations (e.g. at the entrance, meat aisles). Moreover, the prominence of meat substitutes was (optically) increased and legumes were conveniently placed near the meat and meat substitutes section. Weekly sales data over a period of 75 weeks were obtained, 62 pre-intervention and 13 during intervention. Comparative interrupted time series analyses were conducted to analyse changes in meat alternative sales (in grams) during the intervention period in the intervention supermarkets compared to pre-intervention sales trends and to control supermarkets. Secondary outcomes included meat sales in grams per week and the ratio of protein content of meat alternatives to protein content of meat sales.</p><p><strong>Results: </strong>Average meat alternative sales in weekly grams before the intervention were M = 371,931.2 (SD = 113,055.3) in the control supermarkets and M = 299,012.5 (SD = 91,722.8) in the intervention supermarkets. The intervention did not change meat alternative sales in intervention supermarkets compared to pre-implementation sales trends and to control supermarkets (B = - 685.92, 95% CI [- 9904.8; 8525.7]). Sales of meats were also unaffected (B = - 130.91, 95% CI [- 27,127.50; 26,858.33]), as well as the ratio of protein content of meat alternatives to protein content of meat in grams sold per week (B = - 670.54, 95% CI [- 8990.6; 7644.4]).</p><p><strong>Conclusions: </strong>Communicating (dynamic) social norms via textual and environmental cues (i.e. increasing the prominence of meat alternatives in supermarkets) did not increase meat alternative sales nor reduce meat sales. With supermarkets playing an important role in modulating sustainable food choices, more substantial effort or changes are needed to increase plant-based food purchases and lower meat purchases.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"150"},"PeriodicalIF":7.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603100","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":"International evidence-based recommendations for polycystic ovary syndrome in adolescents.","authors":"Alexia S Peña, Selma Feldman Witchel, Jacky Boivin, Tania S Burgert, Carolyn Ee, Kathleen M Hoeger, Marla E Lujan, Aya Mousa, Sharon Oberfield, Chau Thien Tay, Helena Teede","doi":"10.1186/s12916-025-03901-w","DOIUrl":"10.1186/s12916-025-03901-w","url":null,"abstract":"<p><strong>Background: </strong>During adolescence, accurate diagnostic criteria and/or identification of adolescents \"at risk\" of polycystic ovary syndrome (PCOS) are critical to establish appropriate screening, treatment, and lifelong health plans. The 2023 International Evidence-Based Guideline for PCOS aimed to provide the most up-to-date evidence-based recommendations to improve health outcomes for individuals with PCOS, emphasizing accurate and timely diagnosis of PCOS from adolescence.</p><p><strong>Methods: </strong>The best practice methods following the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria were applied. Healthcare professionals and patients/consumers reviewed extensive evidence synthesis/meta-analysis for 55 prioritized clinical questions. Databases (OVID MEDLINE, All EBM, PsycInfo, EMBASE, CINAHL) were searched until August 2022 as part of the 2023 update of the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework guided experts on evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength.</p><p><strong>Results: </strong>This manuscript focuses on the adolescent-specific recommendations of the 2023 Guideline. The diagnosis is based on the presence of both irregular menstrual cycles (defined according to the time postmenarche) and clinical/biochemical hyperandrogenism following the exclusion of other disorders that mimic PCOS. Adolescents with only one of these features can be considered \"at risk\" of PCOS requiring the management of symptoms and ongoing follow-up. Polycystic ovarian morphology on pelvic ultrasonography or anti-Müllerian hormone levels should not be used for diagnosis during adolescence. Lifelong health planning is recommended to include healthy lifestyles, screening for depression and metabolic features and the transition to adult care, all underpinned by shared decision-making. Healthcare professionals should explain weight-related health risks to adolescents, while minimizing weight stigma. In adolescents with PCOS or \"at risk\" of PCOS, combined oral contraceptive pills are indicated for menstrual irregularity and clinical hyperandrogenism, focusing on low dose preparations, and metformin could be considered for metabolic features and cycle regulation. Overall, the evidence is limited in adolescents with PCOS, and recommendations are based on low to moderate certainty evidence.</p><p><strong>Conclusions: </strong>Extensive international engagement and rigorous processes generated International Guideline diagnostic criteria for adolescents that differ from adult criteria and clarified appropriate screening and management strategies for PCOS during adolescence.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"151"},"PeriodicalIF":7.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603496","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":"Modifications to the National Early Warning Score 2: a Scoping Review.","authors":"Victoria Riccalton, Lynsey Threlfall, Ananya Ananthakrishnan, Cen Cong, Madison Milne-Ives, Peta Le Roux, Chris Plummer, Edward Meinert","doi":"10.1186/s12916-025-03943-0","DOIUrl":"10.1186/s12916-025-03943-0","url":null,"abstract":"<p><strong>Background: </strong>The National Early Warning Score 2 (NEWS2) has been adopted as the standard approach for early detection of deterioration in clinical settings in the UK, and is also used in many non-UK settings. Limitations have been identified, including a reliance on 'normal' physiological parameters without accounting for individual variation.</p><p><strong>Objective: </strong>This review aimed to map how the NEWS2 has been modified to improve its predictive accuracy while placing minimal additional burden on clinical teams.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were followed to structure the review. Six databases (CINAHL, PubMed, Embase, ScienceDirect, Cochrane Library and Web of Science) were searched for studies which reported the predictive accuracy of a modified version of NEWS2. The references were screened based on keywords using EndNote 21. Title, abstract and full-text screening were performed by 2 reviewers independently in Rayyan. Data was extracted into a pre-established form and synthesised in a descriptive analysis.</p><p><strong>Results: </strong>Twelve studies were included from 12,867 references. In 11 cases, modified versions of NEWS2 demonstrated higher predictive accuracy for at least one outcome. Modifications that incorporated demographic variables, trend data and adjustments to the weighting of the score's components were found to be particularly conducive to enhancing the predictive accuracy of NEWS2.</p><p><strong>Conclusions: </strong>Three key modifications to NEWS2-incorporating age, nuanced treatment of FiO₂ data and trend analysis-have the potential to improve predictive accuracy without adding to clinician burden. Future research should validate these modifications and explore their composite impact to enable substantial improvements to the performance of NEWS2.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"154"},"PeriodicalIF":7.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603519","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 cadonilimab (PD-1/CTLA-4 bispecific) in combination with chemotherapy in anti-PD-1-resistant recurrent or metastatic nasopharyngeal carcinoma: a single-arm, open-label, phase 2 trial.","authors":"Yaofei Jiang, Weixin Bei, Lin Wang, Nian Lu, Cheng Xu, Hu Liang, Liangru Ke, Yanfang Ye, Shuiqing He, Shuhui Dong, Qin Liu, Chuanrun Zhang, Xuguang Wang, Weixiong Xia, Chong Zhao, Ying Huang, Yanqun Xiang, Guoying Liu","doi":"10.1186/s12916-025-03985-4","DOIUrl":"10.1186/s12916-025-03985-4","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the efficacy and safety of cadonilimab (anti-PD-1 and CTLA-4 bispecific antibody) plus TPC chemotherapy (NAB-paclitaxel, cisplatin or lobaplatin, and capecitabine) in patients with recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) who failed to PD-1 inhibitor-containing regimens.</p><p><strong>Methods: </strong>In this single-arm, open-label, phase 2 study, RM-NPC patients who failed to at least one line of systemic chemotherapy and anti-PD-1 immunotherapy were enrolled and received cadonilimab plus TPC chemotherapy every 3 weeks for up to 6 cycles, followed by cadonilimab plus capecitabine every 3 weeks for a maximum of 2 years. The primary endpoint was the objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of response (DoR), and safety.</p><p><strong>Results: </strong>Twenty-five patients were enrolled (84% male; median age 44 years (range, 24-60)), with a median follow-up of 10.2 months. The ORR was 68%, with 3 complete responses, 14 partial responses, and 6 stable diseases. The median DoR was 9.1 months (95% CI, 3.8-14.5 months). The median PFS was 10.6 months (95% CI, 5.2-16.0 months). The 12-month OS was 75.6%. Treatment was well tolerated. Grade 3 or 4 treatment-related adverse events occurred in 12 (48%) patients. Fourteen patients (56%) experienced potentially immune-related adverse events (irAEs). One patient experienced a grade 3 immune-related rash and another patient had grade 3 immune-related lipase increased. No treatment-related death occurred.</p><p><strong>Conclusions: </strong>Cadonilimab in combination with TPC chemotherapy demonstrated promising antitumoral efficacy and manageable toxicities in patients with RM-NPC who failed frontline immunotherapy. Further trials are warranted to confirm and expand these findings.</p><p><strong>Trial registration: </strong>This trial was registered at chictr.org.cn (ChiCTR2200067057).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"152"},"PeriodicalIF":7.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603436","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":"Research prioritisation in preparedness for and response to outbreaks of high-consequence pathogens: a scoping review.","authors":"Emilia Antonio, Nicolas Pulik, Susan Khader Ibrahim, Adebisi Adenipekun, Shanthi Levanita, Isabel Foster, Dorothy Chepkirui, Eli Harriss, Louise Sigfrid, Alice Norton","doi":"10.1186/s12916-025-03973-8","DOIUrl":"10.1186/s12916-025-03973-8","url":null,"abstract":"<p><strong>Background: </strong>Priority setting for research on epidemic/pandemic-prone pathogens is essential for the allocation of limited resources to optimise impact. It involves the identification of gaps in knowledge crucial to effective preparedness and response to outbreaks. This review maps priority-setting exercises, reviews their approaches to research prioritisation and describes associated monitoring and evaluation processes for research priorities on high-consequence pathogens.</p><p><strong>Methods: </strong>Using search terms associated with high-consequence pathogens, as defined by the WHO (2020), EMERGE (2019), European CDC (2022) and the Association of Southeast Asian Nations (2021), and research prioritisation, we searched WHO Global Index Medicus; Ovid Medline; Ovid Embase; Ovid Global Health; and Scopus. Grey literature sources were Google Scholar and the WHO websites, complemented by recommendations from stakeholder consultation. Two independent reviewers screened abstracts and full-texts including documents describing research prioritisation activities. Results were analysed using descriptive statistics and narrative synthesis.</p><p><strong>Results: </strong>We identified 125 publications presenting priority setting activities on 17 high-consequence pathogens published between 1975 and 2022. Most (62%) were related to SARS-CoV-2, 5.6% to Ebola virus and 5% to Zika virus. Three different broad approaches to setting priorities were identified, most (53%) involved external consultations with experts. Few (6%) indicated plans to monitor progress against set priorities.</p><p><strong>Conclusions: </strong>Our results highlight the diversity in research prioritisation practice in the context of high-consequence pathogens and a limited application of the existing standards in health research prioritisation. An increased uptake of these standards and harmonisation of practice may improve quality and confidence and ultimately improve alignment of funded research with the resulting priorities.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"147"},"PeriodicalIF":7.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584791","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":"Socioeconomic variations in the proportions of stroke attributable to reproductive profiles among postmenopausal women in China.","authors":"Weidi Sun, Jing Wu, Shiyi Shan, Leying Hou, Zeyu Luo, Jiali Zhou, Peige Song","doi":"10.1186/s12916-025-03976-5","DOIUrl":"10.1186/s12916-025-03976-5","url":null,"abstract":"<p><strong>Background: </strong>This prospective study aimed to examine the individual and combined population attributable fractions (PAFs) of stroke and its subtypes associated with reproductive factors among Chinese postmenopausal women, highlighting variations across socioeconomic status (SES) stratas.</p><p><strong>Methods: </strong>Data were from 138,873 Chinese postmenopausal women enrolled in the China Kadoorie Biobank. Reproductive factors evaluated in this study included early age at menarche, early age at menopause, advanced age at first live birth, high parity, history of stillbirth, history of miscarriage or termination, and non-lactation. PAFs were calculated using hazard ratios, estimated using Cox proportional hazard regression, and prevalence of the seven reproductive factors. PAF for each reproductive risk factor and combined PAFs for all factors were estimated in total population and across SES classes.</p><p><strong>Results: </strong>Of the 138,873 included participants, 17,042 developed strokes during a median follow-up period of 8.9 years. Across SES classes, the greatest attributable fractions of total stroke cases were observed for high parity among low-SES women (PAF 17.2%, 95% confidence interval [CI] 13.7%, 20.6%), history of miscarriage or termination among medium-SES women (PAF 11.4%, 95% CI 8.2%, 14.5%), and no history of lactation among high-SES women (PAF 3.1%, 95% CI 1.7%, 4.9%). A multiplicatively estimated 20.5% (95% CI 20.4%, 20.5%) and 3.1% (95% CI 1.7%, 4.9%) of stroke cases were attributable to the seven reproductive risk factors in low-SES and high-SES women, respectively.</p><p><strong>Conclusions: </strong>A large fraction of stroke cases among Chinese postmenopausal women were associated with reproductive factors. Targeted cardiovascular prevention strategies are warranted among women with different SES to mitigate risks associated with different reproductive profiles.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"149"},"PeriodicalIF":7.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584794","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":"Distinct airway mycobiome signature in patients with pulmonary hypertension and subgroups.","authors":"Chenting Zhang, Bihua Zhong, Qian Jiang, Wenju Lu, Hongkai Wu, Yue Xing, Xuefen Wu, Zizhou Zhang, Yulin Zheng, Peiwen Li, Zhenxiang Li, Ziying Lin, Yuqin Chen, Cheng Hong, Zhuxiang Zhao, Tingting Zhang, Weiquan Liang, Yi Zhang, Caojin Zhang, Jason X-J Yuan, Chunli Liu, Jian Wang, Kai Yang","doi":"10.1186/s12916-025-03982-7","DOIUrl":"10.1186/s12916-025-03982-7","url":null,"abstract":"<p><strong>Background: </strong>The association between lung microbiome and pulmonary hypertension (PH) remain unknown. This study aims to define the airway mycobiome signature and its potential correlation with clinical parameters of PH.</p><p><strong>Methods: </strong>Overall, 244 patients with PH and 120 healthy controls (CON) were recruited from three independent centers. The PH group was divided into subgroups not using antibiotics or corticosteroids (non-ANT/CORT), and those using ANT, CORT, or ANT + CORT within 1 month, and clinical classification (Groups 1, 3, and 4), World Health Organization functional class (I-IV), and disease severity based on mean pulmonary artery pressure or pulmonary vascular resistance levels for in-depth comparison.</p><p><strong>Results: </strong>Distinct airway mycobiome profiles were observed in PH, CON, and PH subgroups. Linear discriminant analysis effect size analysis showed increased Purpureocillium, Issatchenkia, and Cyberlindnera and decreased Peroneutypa, Simplicillium, and Metarhizium in patients with PH (non-ANT/CORT, ANT, CORT, and ANT + CORT) than in CON. Receiver operating characteristic analysis indicated a strong prediction of the two fungal genera sets in distinguishing PH and its subgroups from CON. The two major fungal phyla, Ascomycota and Basidiomycota, correlated differently with major clinical factors. Increased connections among the top fungal phyla or genera were observed in the PH than in the CON group. Dominant enrichment (Purpureocillium, Issatchenkia, and Cyberlindnera) and diminishment (Peroneutypa, Simplicillium, and Metarhizium) of fungal genera consistently and strongly predicted PH without being influenced by different PH subgroups.</p><p><strong>Conclusions: </strong>This study provides the first description of the unique airway mycobiome signature in PH and among different PH subgroups.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"148"},"PeriodicalIF":7.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584780","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":"Smoking-related gut microbiota alteration is associated with obesity and obesity-related diseases: results from two cohorts with sibling comparison analyses.","authors":"Yiting Duan, Chengquan Xu, Wenjie Wang, Xiaoyan Wang, Nuo Xu, Jieming Zhong, Weiwei Gong, Weifang Zheng, Yi-Hsuan Wu, April Myers, Lisa Chu, Ying Lu, Elizabeth Delzell, Ann W Hsing, Min Yu, Wei He, Shankuan Zhu","doi":"10.1186/s12916-025-03969-4","DOIUrl":"10.1186/s12916-025-03969-4","url":null,"abstract":"<p><strong>Background: </strong>Individuals who smoke tend to have a lower body mass index (BMI) but face an increased risk of obesity-related diseases. This study investigates this paradox from the perspective of gut microbiota.</p><p><strong>Methods: </strong>We conducted microbiome analyses to identify smoking-related microbial genera and created a smoking-related microbiota index (SMI) using 16S rRNA sequencing data from 4000 male participants in WELL-China cohort and Lanxi cohort. We employed logistic regression to explore the association between SMI and obesity indices derived from dual-energy X-ray absorptiometry. Cox regression analyses were conducted to explore the association of SMI with incident of obesity-related diseases. To further control for unmeasured familial confounders, sibling comparison analyses were conducted using between-within (BW) model.</p><p><strong>Results: </strong>The smoking-related microbiota index (SMI) showed a positive association with BMI and other obesity indices. Further analyses revealed that SMI is linked to obesity-related diseases, with hazard ratios (95% confidence intervals) of 1.97 (1.41-2.75) for incident diabetes, 1.31 (1.01-1.71) for major adverse cardiovascular events, and 1.70 (1.05-2.75) for obesity-related cancers. Results from sibling comparison analyses reinforced these findings.</p><p><strong>Conclusions: </strong>While smoking may reduce weight through various mechanisms, alterations in gut microbiota related to smoking are associated with weight gain. Further research is required to determine if changes in the smoking-related microbiome contribute to weight gain following smoking cessation.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"146"},"PeriodicalIF":7.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584792","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}