Pub Date : 2024-05-01DOI: 10.1016/j.eclinm.2024.102615
S. Chadban, Mustafa Arıcı, Albert J. Power, Mai-Szu Wu, F. S. Mennini, José Javier Arango Álvarez, J. G. Garcia Sanchez, Salvatore Barone, J. Card-Gowers, Alexander Martin, L. Retat
{"title":"Projecting the economic burden of chronic kidney disease at the patient level (Inside CKD): a microsimulation modelling study","authors":"S. Chadban, Mustafa Arıcı, Albert J. Power, Mai-Szu Wu, F. S. Mennini, José Javier Arango Álvarez, J. G. Garcia Sanchez, Salvatore Barone, J. Card-Gowers, Alexander Martin, L. Retat","doi":"10.1016/j.eclinm.2024.102615","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102615","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.eclinm.2024.102663
eClinicalMedicine
{"title":"Safeguarding maternal mental health in the perinatal period","authors":"eClinicalMedicine","doi":"10.1016/j.eclinm.2024.102663","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102663","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141036939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.eclinm.2024.102627
A. Di Castelnuovo, M. Bonaccio, S. Costanzo, A. De Curtis, S. Magnacca, M. Persichillo, T. Panzera, F. Bracone, P. Pignatelli, R. Carnevale, C. Cerletti, M. Donati, Giovanni de Gaetano, L. Iacoviello, Francesco Violi, A. Bonanni, A. Di Castelnuovo, A. Gialluisi, F. Gianfagna, Teresa Di Prospero, Jos Vermylen, R. Pegoraro, Antonio Spagnolo, Deodato Assanelli, Livia Rago, Marco Olivieri, S. Orlandi, S. Esposito, A. Ghulam, R. Parisi, Antonietta Pepe, E. Ruggiero, Sukshma Sharma, Concetta Civitillo, Alisia Cretella, F. Noro, Giuseppe Di Costanzo, Sabrina Franciosa, Martina Morelli
{"title":"The association between hypoalbuminemia and risk of death due to cancer and vascular disease in individuals aged 65 years and older: findings from the prospective Moli-sani cohort study","authors":"A. Di Castelnuovo, M. Bonaccio, S. Costanzo, A. De Curtis, S. Magnacca, M. Persichillo, T. Panzera, F. Bracone, P. Pignatelli, R. Carnevale, C. Cerletti, M. Donati, Giovanni de Gaetano, L. Iacoviello, Francesco Violi, A. Bonanni, A. Di Castelnuovo, A. Gialluisi, F. Gianfagna, Teresa Di Prospero, Jos Vermylen, R. Pegoraro, Antonio Spagnolo, Deodato Assanelli, Livia Rago, Marco Olivieri, S. Orlandi, S. Esposito, A. Ghulam, R. Parisi, Antonietta Pepe, E. Ruggiero, Sukshma Sharma, Concetta Civitillo, Alisia Cretella, F. Noro, Giuseppe Di Costanzo, Sabrina Franciosa, Martina Morelli","doi":"10.1016/j.eclinm.2024.102627","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102627","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.eclinm.2024.102614
Glenn M. Chertow, Ricardo Correa-Rotter, K. Eckardt, Eiichiro Kanda, Avraham Karasik, Guisen Li, Christian Fynbo Christiansen, Panos Stafylas, Stephen G. Holt, Ernst C. Hagen, J. G. Garcia Sanchez, Salvatore Barone, Claudia S. Cabrera, S. Nolan, T. Coker, L. Webber, L. Retat
{"title":"Projecting the clinical burden of chronic kidney disease at the patient level (Inside CKD): a microsimulation modelling study","authors":"Glenn M. Chertow, Ricardo Correa-Rotter, K. Eckardt, Eiichiro Kanda, Avraham Karasik, Guisen Li, Christian Fynbo Christiansen, Panos Stafylas, Stephen G. Holt, Ernst C. Hagen, J. G. Garcia Sanchez, Salvatore Barone, Claudia S. Cabrera, S. Nolan, T. Coker, L. Webber, L. Retat","doi":"10.1016/j.eclinm.2024.102614","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102614","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-30eCollection Date: 2024-06-01DOI: 10.1016/j.eclinm.2024.102599
Grace O Dibben, Lucy Gardiner, Hannah M L Young, Valerie Wells, Rachael A Evans, Zahira Ahmed, Shaun Barber, Sarah Dean, Patrick Doherty, Nikki Gardiner, Colin Greaves, Tracy Ibbotson, Bhautesh D Jani, Kate Jolly, Frances S Mair, Emma McIntosh, Paula Ormandy, Sharon A Simpson, Sayem Ahmed, Stefanie J Krauth, Lewis Steell, Sally J Singh, Rod S Taylor
Background: Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management.
Methods: In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214.
Findings: Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%).
Interpretation: Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions.
Funding: This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-NIHR202020).
{"title":"Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews.","authors":"Grace O Dibben, Lucy Gardiner, Hannah M L Young, Valerie Wells, Rachael A Evans, Zahira Ahmed, Shaun Barber, Sarah Dean, Patrick Doherty, Nikki Gardiner, Colin Greaves, Tracy Ibbotson, Bhautesh D Jani, Kate Jolly, Frances S Mair, Emma McIntosh, Paula Ormandy, Sharon A Simpson, Sayem Ahmed, Stefanie J Krauth, Lewis Steell, Sally J Singh, Rod S Taylor","doi":"10.1016/j.eclinm.2024.102599","DOIUrl":"10.1016/j.eclinm.2024.102599","url":null,"abstract":"<p><strong>Background: </strong>Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management.</p><p><strong>Methods: </strong>In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214.</p><p><strong>Findings: </strong>Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%).</p><p><strong>Interpretation: </strong>Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions.</p><p><strong>Funding: </strong>This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-NIHR202020).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619528","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}
Pub Date : 2024-04-30eCollection Date: 2024-05-01DOI: 10.1016/j.eclinm.2024.102635
Hannah Linne
{"title":"Diabetes UK Professional Conference 2024.","authors":"Hannah Linne","doi":"10.1016/j.eclinm.2024.102635","DOIUrl":"https://doi.org/10.1016/j.eclinm.2024.102635","url":null,"abstract":"","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11070686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850985","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}
Pub Date : 2024-04-29eCollection Date: 2024-06-01DOI: 10.1016/j.eclinm.2024.102575
Rachael Maree Hunter, Jennie Huynh, Margreet Lüchtenborg, Jo Armes, Emma Plugge, Rachel M Taylor, Renske Visser, Elizabeth A Davies
Background: People in prison experience poorer mental and physical health compared to their peers in the general population. The causes are multi-dimensional ranging from lifestyle factors to poorer access to healthcare. Little is known about cancer in people in prison or how the cost of their care compares to the general population.
Methods: Data on people diagnosed with cancer while in English prisons were identified in National Cancer Registration dataset and linked to Hospital Episode Statistics (HES) for the years 2012-2017. General population matched patients were identified using a 1-5 ratio, based on age, gender, year of diagnosis, cancer type and disease stage. Outpatient and inpatient HES data up to six-months from diagnosis were costed using NHS Reference costs and inflated to 2017/2018 costs.
Findings: 879 prison and 4326 general population cancer diagnoses were identified in HES. The adjusted six-month cost of cancer care was significantly lower for people in prison (-£1216.95% confidence interval (CI) -1638 to -795), driven by fewer outpatient attendances. However, people diagnosed in prison had higher emergency care costs (£497.95% CI 375-619). Security escorts further increased the total cost of care.
Interpretation: Following a cancer diagnosis, people in English prisons have significantly lower planned care costs, but higher emergency care costs and an overall higher cost due to security escorts. Further work is required to identify ways of improving cancer care for people in prisons to ensure it is equivalent to that received by the general population.
Funding: National Institute for Health and Social Care Research 16/52/53.
{"title":"Does the cost of cancer care for people in prison differ from those in the general population? Analysis of matched English cancer registry and hospital records.","authors":"Rachael Maree Hunter, Jennie Huynh, Margreet Lüchtenborg, Jo Armes, Emma Plugge, Rachel M Taylor, Renske Visser, Elizabeth A Davies","doi":"10.1016/j.eclinm.2024.102575","DOIUrl":"10.1016/j.eclinm.2024.102575","url":null,"abstract":"<p><strong>Background: </strong>People in prison experience poorer mental and physical health compared to their peers in the general population. The causes are multi-dimensional ranging from lifestyle factors to poorer access to healthcare. Little is known about cancer in people in prison or how the cost of their care compares to the general population.</p><p><strong>Methods: </strong>Data on people diagnosed with cancer while in English prisons were identified in National Cancer Registration dataset and linked to Hospital Episode Statistics (HES) for the years 2012-2017. General population matched patients were identified using a 1-5 ratio, based on age, gender, year of diagnosis, cancer type and disease stage. Outpatient and inpatient HES data up to six-months from diagnosis were costed using NHS Reference costs and inflated to 2017/2018 costs.</p><p><strong>Findings: </strong>879 prison and 4326 general population cancer diagnoses were identified in HES. The adjusted six-month cost of cancer care was significantly lower for people in prison (-£1216.95% confidence interval (CI) -1638 to -795), driven by fewer outpatient attendances. However, people diagnosed in prison had higher emergency care costs (£497.95% CI 375-619). Security escorts further increased the total cost of care.</p><p><strong>Interpretation: </strong>Following a cancer diagnosis, people in English prisons have significantly lower planned care costs, but higher emergency care costs and an overall higher cost due to security escorts. Further work is required to identify ways of improving cancer care for people in prisons to ensure it is equivalent to that received by the general population.</p><p><strong>Funding: </strong>National Institute for Health and Social Care Research 16/52/53.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619527","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}
Pub Date : 2024-04-29eCollection Date: 2024-06-01DOI: 10.1016/j.eclinm.2024.102540
Jo Armes, Renske Visser, Margreet Lüchtenborg, Jennie Huynh, Sue Wheatcroft, Anthony X, Alyce-Ellen Barber, Emma Plugge, Rachel M Taylor, Rachael Maree Hunter, Elizabeth Anne Davies
Background: Approximately 82,000 people are in prison annually in England and Wales. Limited research has investigated cancer in this population and none has explored experiences of imprisoned people with cancer. This study aimed to address this gap.
Methods: We conducted 55 semi-structured, qualitative, audio-recorded interviews with: imprisoned people with cancer (n = 24), custodial staff (n = 6), prison healthcare staff (n = 16) and oncology specialists (n = 9). Data were collected 07/10/2019-20/03/2020. Patients were recruited by prison healthcare staff and interviews were conducted face-to-face. Professionals were recruited via professional networks and interviews were conducted face-to-face or via telephone. Transcribed interviews were analysed using reflexive thematic analysis. We also analysed relevant National Cancer Patient Experience Survey (NCPES) questions for those diagnosed in prison (n = 78) and in the general population (n = 390).
Findings: Our findings highlight the complexities of cancer care for imprisoned people. We identified three core themes: control and choice, communication, and care and custody. Whilst people in prison follow a similar diagnostic pathway to those in the community, additional barriers to diagnosis exist including health literacy, the General Practitioner appointment booking system and communication between prison and oncology staff. Tensions between control and choice in prison impacted aspects of cancer care experience such as symptom management and accessing cancer information. NCPES results supported the qualitative findings and showed people in prison reported significantly poorer experiences than in the general population.
Interpretation: Our findings demonstrate the complexity of cancer care in custodial settings, identifying barriers and enablers to equitable cancer care provision and offering insights on how to improve care for this population.
Funding: National Institute for Health and Social Care Research Delivery Research Programme 16/52/53 and Strategic Priorities Fund 2019/20 Research England via University of Surrey.
{"title":"Cancer in prison: barriers and enablers to diagnosis and treatment.","authors":"Jo Armes, Renske Visser, Margreet Lüchtenborg, Jennie Huynh, Sue Wheatcroft, Anthony X, Alyce-Ellen Barber, Emma Plugge, Rachel M Taylor, Rachael Maree Hunter, Elizabeth Anne Davies","doi":"10.1016/j.eclinm.2024.102540","DOIUrl":"10.1016/j.eclinm.2024.102540","url":null,"abstract":"<p><strong>Background: </strong>Approximately 82,000 people are in prison annually in England and Wales. Limited research has investigated cancer in this population and none has explored experiences of imprisoned people with cancer. This study aimed to address this gap.</p><p><strong>Methods: </strong>We conducted 55 semi-structured, qualitative, audio-recorded interviews with: imprisoned people with cancer (n = 24), custodial staff (n = 6), prison healthcare staff (n = 16) and oncology specialists (n = 9). Data were collected 07/10/2019-20/03/2020. Patients were recruited by prison healthcare staff and interviews were conducted face-to-face. Professionals were recruited via professional networks and interviews were conducted face-to-face or via telephone. Transcribed interviews were analysed using reflexive thematic analysis. We also analysed relevant National Cancer Patient Experience Survey (NCPES) questions for those diagnosed in prison (n = 78) and in the general population (n = 390).</p><p><strong>Findings: </strong>Our findings highlight the complexities of cancer care for imprisoned people. We identified three core themes: control and choice, communication, and care and custody. Whilst people in prison follow a similar diagnostic pathway to those in the community, additional barriers to diagnosis exist including health literacy, the General Practitioner appointment booking system and communication between prison and oncology staff. Tensions between control and choice in prison impacted aspects of cancer care experience such as symptom management and accessing cancer information. NCPES results supported the qualitative findings and showed people in prison reported significantly poorer experiences than in the general population.</p><p><strong>Interpretation: </strong>Our findings demonstrate the complexity of cancer care in custodial settings, identifying barriers and enablers to equitable cancer care provision and offering insights on how to improve care for this population.</p><p><strong>Funding: </strong>National Institute for Health and Social Care Research Delivery Research Programme 16/52/53 and Strategic Priorities Fund 2019/20 Research England via University of Surrey.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619526","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}
Pub Date : 2024-04-26eCollection Date: 2024-05-01DOI: 10.1016/j.eclinm.2024.102490
JooHee Choi, Robert Thänert, Kimberly A Reske, Katelin B Nickel, Margaret A Olsen, Tiffany Hink, Anna Thänert, Meghan A Wallace, Bin Wang, Candice Cass, Margaret H Barlet, Emily L Struttmann, Zainab Hassan Iqbal, Steven R Sax, Victoria J Fraser, Arthur W Baker, Katherine R Foy, Brett Williams, Ben Xu, Pam Capocci-Tolomeo, Ebbing Lautenbach, Carey-Ann D Burnham, Erik R Dubberke, Gautam Dantas, Jennie H Kwon
Background: Urinary tract infections (UTI) affect approximately 250 million people annually worldwide. Patients often experience a cycle of antimicrobial treatment and recurrent UTI (rUTI) that is thought to be facilitated by a gut reservoir of uropathogenic Escherichia coli (UPEC).
Methods: 125 patients with UTI caused by an antibiotic-resistant organism (ARO) were enrolled from July 2016 to May 2019 in a longitudinal, multi-center cohort study. Multivariate statistical models were used to assess the relationship between uropathogen colonization and recurrent UTI (rUTI), controlling for clinical characteristics. 644 stool samples and 895 UPEC isolates were interrogated for taxonomic composition, antimicrobial resistance genes, and phenotypic resistance. Cohort UTI gut microbiome profiles were compared against published healthy and UTI reference microbiomes, as well as assessed within-cohort for timepoint- and recurrence-specific differences.
Findings: Risk of rUTI was not independently associated with clinical characteristics. The UTI gut microbiome was distinct from healthy reference microbiomes in both taxonomic composition and antimicrobial resistance gene (ARG) burden, with 11 differentially abundant taxa at the genus level. rUTI and non-rUTI gut microbiomes in the cohort did not generally differ, but gut microbiomes from urinary tract colonized patients were elevated in E. coli abundance 7-14 days post-antimicrobial treatment. Corresponding UPEC gut isolates from urinary tract colonizing lineages showed elevated phenotypic resistance against 11 of 23 tested drugs compared to non-colonizing lineages.
Interpretation: The gut microbiome is implicated in UPEC urinary tract colonization during rUTI, serving as an ARG-enriched reservoir for UPEC. UPEC can asymptomatically colonize the gut and urinary tract, and post-antimicrobial blooms of gut E. coli among urinary tract colonized patients suggest that cross-habitat migration of UPEC is an important mechanism of rUTI. Thus, treatment duration and UPEC populations in both the urinary and gastrointestinal tract should be considered in treating rUTI and developing novel therapeutics.
Funding: This work was supported in part by awards from the U.S. Centers for Disease Control and Prevention Epicenter Prevention Program (grant U54CK000482; principal investigator, V.J.F.); to J.H.K. from the Longer Life Foundation (an RGA/Washington University partnership), the National Center for Advancing Translational Sciences (grants KL2TR002346 and UL1TR002345), and the National Institute of Allergy and Infectious Diseases (NIAID) (grant K23A1137321) of the National Institutes of Health (NIH); and to G.D. from NIAID (grant R01AI123394) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R01HD092414) of NIH. R.T.'s research was funded by the
背景:全世界每年约有 2.5 亿人受到尿路感染(UTI)的影响。方法:2016 年 7 月至 2019 年 5 月期间,一项纵向多中心队列研究招募了 125 例由抗生素耐药菌(ARO)引起的 UTI 患者。在控制临床特征的前提下,采用多变量统计模型评估尿路病原体定植与复发性UTI(rUTI)之间的关系。研究人员对 644 份粪便样本和 895 株 UPEC 分离物进行了分类组成、抗菌药耐药基因和表型耐药性检测。将队列UTI肠道微生物组概况与已发表的健康和UTI参考微生物组进行了比较,并评估了队列内时间点和复发特异性差异:研究结果:尿路感染复发风险与临床特征无关。UTI肠道微生物组在分类组成和抗菌药耐药基因(ARG)负担方面均有别于健康参考微生物组,在属一级有11个不同的丰富分类群。队列中的rUTI和非rUTI肠道微生物组总体上没有差异,但尿路定植患者的肠道微生物组在抗菌药治疗后7-14天大肠杆菌丰富度升高。与非定植菌株相比,来自泌尿道定植菌株的相应 UPEC 肠道分离物对 23 种测试药物中的 11 种表现出更高的表型耐药性:肠道微生物群与尿路感染期间UPEC的尿路定植有关,是UPEC的ARG富集库。UPEC可无症状地在肠道和泌尿道定植,泌尿道定植患者在抗菌后肠道大肠杆菌大量繁殖表明,UPEC的跨生境迁移是急性尿路感染的一个重要机制。因此,在治疗 rUTI 和开发新型疗法时,应考虑治疗持续时间以及泌尿道和胃肠道中的 UPEC 群体:本研究部分得到了美国疾病控制和预防中心震中预防计划(U54CK000482 号基金;主要研究者,V.J.F.)、长寿基金会(Longer Life Foundation)(一项由美国疾病控制和预防中心资助的研究项目)对 J.H.K.的资助。来自美国国立卫生研究院(NIH)的长寿基金会(RGA/华盛顿大学合作项目)、国家转化科学促进中心(KL2TR002346 和 UL1TR002345 号基金)以及国家过敏与传染病研究所(NIAID)(K23A1137321 号基金);G.D.的研究得到了美国国立卫生研究院(NIH)过敏与传染病研究所(NIAID)(R01AI123394 号基金)和尤妮斯-肯尼迪-施莱佛国家儿童健康与人类发展研究所(Eunice Kennedy Shriver National Institute of Child Health and Human Development)(R01HD092414 号基金)的资助。R.T.的研究得到了德国研究基金会(DFG;German Research Foundation;Grant 402733540)的资助。REDCap 由临床和转化科学奖 (CTSA) 补助金 UL1 TR002345 和 Siteman 综合癌症中心及 NCI 癌症中心支持补助金 P30 CA091842 资助。内容仅由作者本人负责,不代表资助机构的官方观点。
{"title":"Gut microbiome correlates of recurrent urinary tract infection: a longitudinal, multi-center study.","authors":"JooHee Choi, Robert Thänert, Kimberly A Reske, Katelin B Nickel, Margaret A Olsen, Tiffany Hink, Anna Thänert, Meghan A Wallace, Bin Wang, Candice Cass, Margaret H Barlet, Emily L Struttmann, Zainab Hassan Iqbal, Steven R Sax, Victoria J Fraser, Arthur W Baker, Katherine R Foy, Brett Williams, Ben Xu, Pam Capocci-Tolomeo, Ebbing Lautenbach, Carey-Ann D Burnham, Erik R Dubberke, Gautam Dantas, Jennie H Kwon","doi":"10.1016/j.eclinm.2024.102490","DOIUrl":"10.1016/j.eclinm.2024.102490","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract infections (UTI) affect approximately 250 million people annually worldwide. Patients often experience a cycle of antimicrobial treatment and recurrent UTI (rUTI) that is thought to be facilitated by a gut reservoir of uropathogenic <i>Escherichia coli</i> (UPEC).</p><p><strong>Methods: </strong>125 patients with UTI caused by an antibiotic-resistant organism (ARO) were enrolled from July 2016 to May 2019 in a longitudinal, multi-center cohort study. Multivariate statistical models were used to assess the relationship between uropathogen colonization and recurrent UTI (rUTI), controlling for clinical characteristics. 644 stool samples and 895 UPEC isolates were interrogated for taxonomic composition, antimicrobial resistance genes, and phenotypic resistance. Cohort UTI gut microbiome profiles were compared against published healthy and UTI reference microbiomes, as well as assessed within-cohort for timepoint- and recurrence-specific differences.</p><p><strong>Findings: </strong>Risk of rUTI was not independently associated with clinical characteristics. The UTI gut microbiome was distinct from healthy reference microbiomes in both taxonomic composition and antimicrobial resistance gene (ARG) burden, with 11 differentially abundant taxa at the genus level. rUTI and non-rUTI gut microbiomes in the cohort did not generally differ, but gut microbiomes from urinary tract colonized patients were elevated in <i>E. coli</i> abundance 7-14 days post-antimicrobial treatment. Corresponding UPEC gut isolates from urinary tract colonizing lineages showed elevated phenotypic resistance against 11 of 23 tested drugs compared to non-colonizing lineages.</p><p><strong>Interpretation: </strong>The gut microbiome is implicated in UPEC urinary tract colonization during rUTI, serving as an ARG-enriched reservoir for UPEC. UPEC can asymptomatically colonize the gut and urinary tract, and post-antimicrobial blooms of gut <i>E. coli</i> among urinary tract colonized patients suggest that cross-habitat migration of UPEC is an important mechanism of rUTI. Thus, treatment duration and UPEC populations in both the urinary and gastrointestinal tract should be considered in treating rUTI and developing novel therapeutics.</p><p><strong>Funding: </strong>This work was supported in part by awards from the U.S. Centers for Disease Control and Prevention Epicenter Prevention Program (grant U54CK000482; principal investigator, V.J.F.); to J.H.K. from the Longer Life Foundation (an RGA/Washington University partnership), the National Center for Advancing Translational Sciences (grants KL2TR002346 and UL1TR002345), and the National Institute of Allergy and Infectious Diseases (NIAID) (grant K23A1137321) of the National Institutes of Health (NIH); and to G.D. from NIAID (grant R01AI123394) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R01HD092414) of NIH. R.T.'s research was funded by the ","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11133793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175100","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}
Pub Date : 2024-04-22eCollection Date: 2024-06-01DOI: 10.1016/j.eclinm.2024.102601
Elysia Poggi Davis, Catherine H Demers, LillyBelle Deer, Robert J Gallop, M Camille Hoffman, Nancy Grote, Benjamin L Hankin
Background: Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT).
Methods: Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801).
Findings: Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97).
Interpretation: We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation.
Funding: This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
背景:妊娠期缩短是导致儿童发病和死亡的主要原因,会对健康造成终身影响。有必要采取公共卫生措施,提高出生时的胎龄。产前孕产妇抑郁症是一个普遍存在的健康问题,通过相关性和流行病学研究,它与妊娠期缩短密切相关。这项概念验证研究通过对随机临床试验(RCT)的分析,检验了减少产前产妇抑郁对胎儿妊娠期的影响:参与者包括 226 名加入 RCT 并被分配接受人际心理治疗(IPT)或增强型常规护理(EUC)的孕妇。招募工作于2017年7月开始,参与者于2017年8月10日至2021年9月8日入选。抑郁症诊断(《精神疾病诊断与统计手册》第五版结构化临床访谈;DSM 5)和症状(爱丁堡产后抑郁量表和症状检查表)在基线和整个妊娠期进行纵向评估,以确定抑郁轨迹的特征。妊娠日期是根据现行指南通过医疗记录收集的。主要结果是二分法测量的出生时胎龄(≥39 孕周),次要结果是连续测量的出生时胎龄。进行了事后分析,以检验减少产前产妇抑郁对胎龄的影响。该试验已在 ClinicalTrials.gov 注册(NCT03011801):结果:妊娠期抑郁轨迹的下降幅度越大,预示着胎龄越晚,特别是≥39 孕周的足月儿出生数量会增加(EPDS 线性斜率:OR = 1.54,95%≥39 孕周的足月儿出生数量):OR = 1.54,95% CI 1.10-2.16;SCL-20 线性斜率:OR = 1.67,95% CI 1.16-2.42)。因果中介分析支持这样的假设,即被分配到 IPT 的参与者抑郁症状轨迹的减少幅度更大,这反过来又有助于延长妊娠期。自然间接效应(NIE)显示,干预导致的抑郁轨迹减少与妊娠周数≥39周的新生儿有关(EPDS,OR = 1.65,95% CI 1.02-2.66;SCL-20,OR = 1.85,95% CI 1.16-2.97),这也支持了中介效应:我们采用了一项 RCT 设计,发现减少孕期抑郁与延长妊娠期有关:本研究得到了美国国立卫生研究院(NIH)的支持(R01 HL155744、R01 MH109662、R21 MH124026、P50 MH096889)。
{"title":"Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial.","authors":"Elysia Poggi Davis, Catherine H Demers, LillyBelle Deer, Robert J Gallop, M Camille Hoffman, Nancy Grote, Benjamin L Hankin","doi":"10.1016/j.eclinm.2024.102601","DOIUrl":"10.1016/j.eclinm.2024.102601","url":null,"abstract":"<p><strong>Background: </strong>Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT).</p><p><strong>Methods: </strong>Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801).</p><p><strong>Findings: </strong>Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97).</p><p><strong>Interpretation: </strong>We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation.</p><p><strong>Funding: </strong>This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11053273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856754","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}