Background: Low birth weight, defined as less than 2.5 kg (5.5 lbs) at birth, remains a critical global public health challenge. It significantly increases the risk of neonatal mortality and immediate complications such as sepsis and hypothermia, along with lifelong consequences including childhood disabilities and adult-onset chronic diseases. However, there was a limited study that described the spatial distribution and predictors of low birth weight in sub-Saharan Africa. The study aimed to assess geospatial variations and predictors of low birth weight in sub-Saharan Africa.
Methods: A community-based cross-sectional study design based on Demographic and Health Survey (2015-2024) data, comprising a weighted sample of 138,164 women aged 15-49 years with live births among 28 sub-Saharan African countries, was included in the study. Global Moran's I was calculated to determine overall clustering of low birth weight. Statistically significant hot spot and cold spot areas of low birth weight were determined by Getis-Ord G∗ statistics. Ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regressions were utilized to determine predictors of low birth weight. The best-fitting models were determined by the highest R2 and the lowest corrected Akaike Information Criterion values. Finally, the statistically significant predictors from the final model were displayed on a map.
Findings: Low birth weight was clustered (Moran's I 0.23, z-score 50.2, p-value <0.01) in the study area. Significant hotspot areas were depicted in Mauritania, Mali, Senegal, Burkina Faso, Nigeria, Gabon, Angola, Madagascar, South Africa, Lesotho, Malawi, and Ethiopia. Conversely, low-risk cold spots were observed in Uganda, Kenya, Rwanda, Burundi, Tanzania, Zambia, Zimbabwe, Cameroon, and Sierra Leone. Short birth interval, no visit to a health facility in the last year, twin birth, no media exposure, and unemployed women were significant predictors of low birth weight.
Interpretation: There is spatial variation of low birth weight across different regions in sub-Saharan Africa. Significant hotspot and cold spot areas along with significant predictors were identified, which is a priority for policy makers. Targeted maternal health interventions, improved healthcare access, health education using mass media, and economic empowerment for women are recommended to reduce low birth weight.
Funding: None.
Background: People with disabilities frequently experience poorer health than others in the population, yet the extent of this health gap is unknown. We undertook an umbrella review of meta-analyses to assess the amount, strength and quality of the evidence of the association between disability and a broad range of health outcomes.
Methods: We searched Cochrane Library, EMBASE, Medline, PsycINFO and Health Evidence to identify meta-analyses of quantitative studies, published January 1, 2000 to February 3, 2025, in any language. We included systematic reviews with meta-analyses that compared health outcomes between people with and without disabilities, across all study settings and geographical locations. Two reviewers assessed study eligibility and extracted data. We assessed risk of bias using the AMSTAR2 tool and evaluated the strength of evidence for each meta-analysis according to the Fusar-Poli and Radua criteria. We narratively described the association between disability and health outcomes, categorised according to ICD-11 categories. This study is registered with PROSPERO, CRD42025645729.
Findings: The search generated 11,221 unique records, of which 58 systematic reviews that included meta-analyses were included. Together, these reviews drew on 1409 primary studies from 77 countries and produced 132 separate meta-analyses that evaluated 16 health outcomes. Overall, most systematic reviews were of moderate to low quality. Intellectual and developmental disabilities accounted for the largest share of the meta-analyses (n = 60, 45%). One-third of associations (n = 45, 34%) showed convincing or highly suggestive evidence linking disability to adverse health outcomes. The majority of meta-analyses (n = 113, 86%) found statistically significant and positive associations. No studies that examined disability in relation to diseases of the blood, diseases of the immune system, diseases of the musculoskeletal system or conditions related to sexual health were identified.
Interpretation: People with disabilities are a diverse group, yet share the common experience of markedly worse health than their peers without disabilities. The evidence base is constrained by limited measurement of subjective health outcomes and definitions of disability that may not capture contextual factors. Consequently, the true association of disability and poor health outcomes may be underestimated. Health inequities experienced by people with disabilities necessitate health system reforms with efforts to embed inclusion and address social determinants of health.
Funding: The National Institute for Health and Care Research, the Programme for Evidence to Inform Disability Action grant from the Foreign, Commonwealth and Development Office, the Conrad N. Hilton Foundation.
Digital health tools improve the efficiency and quality of cancer care and are poised to have an even greater impact in the future. However, the extent to which these tools will enhance both disease-centered and human-centered care depends on which values, outcomes, and processes diverse stakeholders and sectors prioritize. Human-centered care recognizes the uniqueness and inherent value of individuals and values the inimitability of human relationships. In this Viewpoint, we call for prioritization of human-centered care in the design and implementation of digital health tools. After summarizing key ethical frameworks, we provide examples of digital innovations from Brazil, India, and the United States that demonstrate how choices in design, implementation, and evaluation can enhance human-centered care provision. In addition, we provide recommendations to support clinicians, researchers, and health systems in prioritizing human-centered care, including the involvement of patients, caregivers, and communities in all phases of design and implementation.
Funding: No funding was used in the creation of this manuscript. WER, ASE, and JEN are partially supported by the NIH/National Cancer Institute comprehensive cancer center award P30 CA008748. WER is supported by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program.
Background: Renal sarcomas arise rarely in children and adolescents and represent a histologically and biologically diverse disease category. Consequently, standardizing optimal therapies for pediatric renal sarcomas remains challenging. Leveraging a large North American research collaborative, the purposes of this study were to evaluate the current state of patient, disease, and survival characteristics among pediatric renal sarcomas and to expose knowledge gaps that will inform future discovery.
Methods: Patients 21 years or younger and treated for a primary renal sarcoma between January 1st, 2000 and November 30th, 2022 were identified through the Pediatric Surgical Oncology Research Collaborative. Patient (e.g., demographics) and disease (e.g., histology, stage, molecular alterations) characteristics were abstracted from contributing institutions. Descriptive statistics, Pearson-Chi square (categorical variables), Kruskal-Wallis (continuous variables), Cox regression (Hazard ratios), and Kaplan-Meier 4-year event-free and overall survival (OS) analyses were completed.
Findings: Among 158 patients, clear cell sarcoma of the kidney (CCSK; n = 94), Ewing sarcoma (EWS; n = 33), and undifferentiated sarcoma (n = 8) predominated. Sarcoma type correlated significantly with age at diagnosis (p < 0.0001), with infantile fibrosarcoma (IFS) and CCSK occurring in the youngest patients, whereas EWS and synovial sarcoma presented in the oldest. Predisposition syndromes were identified in 11/155 (7.1%) patients, most commonly DICER1 and Li-Fraumeni. Multimodal therapies varied significantly across sarcoma types (p = 0.0008), although nephrectomy was uniform. Tumor thrombectomy was performed in 9 patients (6 with EWS). When tested, somatic molecular alterations were observed principally in CCSK (17/38; 45%) and EWS (26/26; 100%; p = 0.001). At 4 years, OS differed significantly by sarcoma type, ranging from highest to lowest as follows: CCSK 0.927 (95% CI 0.845-0.967), EWS 0.901 (95% CI 0.723-0.967), undifferentiated sarcoma 0.833 (95% CI 0.273-0.975), IFS 0.667 (95% CI 0.054-0.945), and rhabdomyosarcoma 0.500 (95% CI 0.111-0.804; p = 0.036). Hematogenous metastases occurred most in the lungs (n = 19 total; 10 with EWS), followed by bone (n = 12), which occurred only with CCSK (n = 9) and EWS (n = 3). Two patients developed brain metastases (one each with CCSK and rhabdomyosarcoma). At 4 years, OS was 0.957 (95% CI 0.888-0.984) for patients presenting without metastases and 0.717 (95% CI 0.545-0.833) for those with metastases (p = 0.00015).
Interpretation: Renal sarcomas presenting in children and adolescents comprise a heterogeneous disease category with unique patient, clinical, and molecular characteristics that complicate standardizing therapeutic strategies beyond CCSK and EWS.
Funding: None.
Background: Higher pre-pregnancy body mass index (BMI) has been associated with obstetric complications and proposed as a psychosocial risk factor for postpartum depression (PPD). However, its relationship with postpartum post-traumatic stress disorder (PP-PTSD) and perceived obstetric violence has not been sufficiently investigated. We aimed to examine the association between pre-pregnancy BMI and perinatal mental health outcomes.
Methods: We conducted a retrospective cohort study in Spain in 2023 using a self-administered online questionnaire completed by 2363 women between one and six months postpartum. Outcomes included high perception of obstetric violence (CARE-MQ > p90), risk of PP-PTSD (PPQ ≥ p90), and PPD (EPDS ≥12). Pre-pregnancy BMI was categorized according to WHO criteria. Multivariable logistic regression models adjusted for sociodemographic, clinical, and obstetric confounders were used.
Findings: Women with higher pre-pregnancy BMI had a higher frequency of medical interventions (induction of labor, oxytocin, regional analgesia) and more birth complications (aOR 1.69, 95% CI 1.21-2.34). Higher pre-pregnancy BMI was independently associated with increased risk of PPD (aOR 1.44, 95% CI 1.05-1.97), but not with PP-PTSD or perceived obstetric violence. Protective factors included older maternal age, higher income, attendance at childbirth preparation classes, adherence to the birth plan, skin-to-skin contact, and early initiation of breastfeeding. Complicated births and failure to adhere to the birth plan were associated with increased risk of experiencing at least one postpartum mental health problem.
Interpretation: Higher pre-pregnancy BMI may be linked to increased vulnerability to postpartum depression. This relationship appears influenced by obstetric characteristics and care practices, underscoring the need for further research and for preventive strategies to improve respectful, stigma-free perinatal care for women with higher pre-pregnancy BMI.
Funding: This study was funded by Instituto de Salud Carlos III (project PI22/00541) and co-funded by the European Union.
Background: People from socioeconomically deprived backgrounds are at greater risk of developing lung disease and having a higher symptom burden. It remains unclear whether they have equitable access to and experience of palliative care. Therefore, we aimed to synthesise evidence on socioeconomic inequalities in access, receipt of, preference for, and experience of palliative care among people with advanced lung disease.
Methods: Mixed-methods systematic review, searching four databases (MEDLINE, Embase, PsychINFO, CINAHL) from inception to March 28, 2025. We included studies that reported on socioeconomic position and palliative care in advanced lung disease (lung cancer, mesothelioma, chronic obstructive pulmonary disease, interstitial lung disease). Study quality was assessed using the Mixed Methods Appraisal Tool. Both meta-analysis (using a random effects model with I2 to assess heterogeneity, sensitivity analysis and GRADE of evidence) and narrative synthesis were performed. PROSPERO CRD42024546502.
Findings: Of 10,572 records, 54 studies met inclusion criteria (4.2 million participants). Meta-analysis of six studies showed people with lung cancer in the lowest SEP group were 18% less likely to receive palliative care than those in the highest (OR 0.82, 95% CI 0.75-0.90, I2 = 93.9%). GRADE of evidence was assessed as moderate. Qualitative findings identified financial hardship and insurance barriers limited access to pain relief and oxygen. Few studies considered multiple demographic characteristics, but those that did reported worse access among ethnic minorities and rural populations.
Interpretation: This review provides novel evidence of how the inverse care law operates in advanced lung disease. People from lower socioeconomic groups are significantly less likely to access palliative care, despite greater need. There is an urgent need for equity-focused research and policy interventions, co-produced with underserved communities that account for intersecting social disadvantages.
Funding: National Institute for Health and Care Research.
Background: For chronic lymphocytic leukaemia (CLL) and intermediate risk factors (unmutated IGHV and/or 11q deletion and/or complex karyotype; no TP53 alteration), the best first-line treatment is unclear. We compared an MRD-guided, fixed-duration ibrutinib-venetoclax (IV) regimen to fludarabine-cyclophosphamide-rituximab (FCR) in this population.
Methods: The ERADIC randomised, phase 2 trial (NCT04010968), conducted at 35 French hospitals, recruited previously untreated, fit adults with intermediate-risk CLL. Randomisation was 1:1 to: 6x4-weekly cycles of FCR (Months 1-6); or ibrutinib 420 mg/day from Month 1 plus venetoclax (ramp-up to 400 mg/day from Month 4) for a duration depending on the bone marrow measurable residual disease level at Month 9 (if undetectable at a threshold of <0·01% [BM uMRD4] to Month 15; otherwise to Month 27). Primary outcome was the BM uMRD4 rate at Month 27, by assessment oligocentrally (intent-to-treat, worst-case scenario method).
Findings: Between 27 September 2019 and 31 January 2021, 120 patients were enrolled (73% male). At Month 27, the BM uMRD4 rate was 37% (22/59; 95% confidence interval [CI] 25, 51) with IV versus 13% (8/61; 95% CI 6, 24) with FCR. The high amount of missing BM MRD data, along with imbalance in missing data between arms, meant that no confirmatory statistics were performed. Best rate of BM uMRD4 plus peripheral blood uMRD5 was 47% (22/47) with IV versus 19% (8/43) with FCR (p = 0·0090). With median 43 months' follow-up, progression-free survival was longer with IV versus FCR (estimated hazard ratio 0·35, 95% CI 0·16, 0·80, p = 0·012). By Month 27, six deaths had occurred (FCR: acute myeloid leukaemia, septic shock, myelodysplastic syndrome; IV: 2 sudden deaths, COVID-19). By the time of follow-up, the most common serious grade 3/4 events were infections and haematological toxicities with FCR, and infections and cardiovascular/metabolic toxicities with IV.
Interpretation: Due to the high amount of missing BM MRD data at Month 27, the primary outcome statistical analysis was not deemed feasible. The outcomes reported are secondary and exploratory, and were not been powered for in the study design. A patient profile suitable for an MRD-guided, fixed-duration IV regimen requires consideration of potential toxicities.
Funding: Abbvie and Janssen France.
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