PLoS Medicine最新文献

Background: With the healthcare sector contributing nearly 5% of total global greenhouse gas (GHG) emissions globally, a precise assessment of their carbon footprint is crucial for achieving carbon neutrality targets. This study aims to comprehensively assess the carbon footprint of Chinese healthcare service providers, to identify their driving activities and sources across different time periods, and to provide a solid foundation for the development of effective emission reduction policies in healthcare service in China.

Methods and findings: The data on overall national health expenditures for 2012 and 2018, as well as expenditures by different levels of hospitals, various hospital departments, and specific diseases, were sourced from China's Health Statistics Yearbooks and national input-output tables (IOTs). Environmentally extended input-output analysis (EEIOA) and structural path analysis (SPA) were utilized to assess the carbon footprint of healthcare services in China in 2012 and 2018. Overall, the total carbon footprint of Chinese healthcare service providers increased by 51 MtCO2e (15%) in 2018 compared to that in 2012, accounting for about 3.7% of the total domestic GHG emissions. In 2018, public hospitals made the largest contribution to the carbon footprint within the national health expenditure categories, with their carbon emissions increasing by 29 MtCO2e (19%). Among medical institutions, procurement was the largest contributor to the carbon footprint, with emissions increasing by 46 MtCO2e (25%). Within hospital departments, the internal medicine department had the highest carbon footprint, reaching 47.66 MtCO2e (26%) in 2018. When classified by hospital grades, tertiary hospitals contributed the most, emitting 126.50 MtCO2e (70%). When classified by disease category, circulatory system diseases had the largest carbon footprint of 12.68 MtCO2e (19%), while malignant neoplasms were the primary contributor among subcategory diseases, emitting 5.52 MtCO2e (8%). The main limitation of this study lies in the fact that national IOTs are updated approximately every 5 years, and data for methane (CH₄) and nitrous oxide (N₂O) have not been updated since 2018. As a result, the analysis could only be performed for the years 2012 and 2018.

Conclusions: These findings highlighted the substantial GHG emission contributions in China from public hospitals, especially tertiary hospitals, procurement activities, Internal Medicine Departments, and specific diseases in the carbon footprint. The findings provided robust scientific evidence for formulating strategies to reduce carbon emissions within the healthcare service in China and will also have implications for other countries.

Background: It is unknown whether fasting plasma glucose (FPG) level within the normal range as defined by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is associated with perinatal outcomes. This study explored the associations between FPG levels lower than the IADPSG threshold during oral glucose tolerance test (OGTT) and adverse perinatal outcomes in women with or without gestational diabetes mellitus (GDM).

Methods and findings: From January 1, 2017, to May 31, 2022, this single-center retrospective cohort study included 33,417 women with singleton pregnancies at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. All women underwent a 75-g OGTT at 24-28 gestational weeks. The primary endpoint was a composite of adverse outcomes, including gestational hypertension, preeclampsia, fetal death and stillbirth, preterm birth, primary cesarean delivery, and small or large for gestational age. Overall, 3,108 (9.5%) women had IADPSG-defined GDM and of whom 2,426 (76.3%) had FPG levels below the IADPSG threshold. Compared to the GDM population, non-GDM women with borderline-normal FPG levels were at significantly greater risk of adverse outcomes with an adjusted odds ratio (aOR) of 1.62 (95% CI [1.20, 2.19]; p = 0.002) at 4.6 mmol/L, an aOR of 1.50 (95% CI [1.05, 2.13]; p = 0.025) at 4.8 mmol/L, and an aOR of 1.58 (95% CI [1.05, 2.40]; p = 0.030) at 4.9 mmol/L glucose level. Nonetheless, non-GDM women demonstrated significantly lower risk (aOR 0.66, 95% CI [0.44, 0.98]; p = 0.038) compared to GDM counterparts exhibiting low fasting glycemia at 3.9 mmol/L. However, this study was limited by its retrospective design and may lack generalizability to other ethnic groups.

Conclusions: Even at FPG levels lower than the IADPSG threshold, FPG was significantly associated with adverse perinatal outcomes, and the associations presented different patterns in women with and without GDM.

[This corrects the article DOI: 10.1371/journal.pmed.1004541.].

Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a chemoprevention strategy against malaria in pregnancy. A recent PLOS Medicine study highlights the need for better understanding of the mechanism by which IPTp-SP reduces low birthweight, as well as novel measures to prevent malaria earlier in gestation.

Background: Depression and burnout, which are common among healthcare workers, were exacerbated by the COVID-19 pandemic. Mindfulness-Based Stress Reduction (MBSR) and psilocybin have been reported to reduce depressive symptoms, but the efficacy of the combination requires comparison to an active treatment control. We sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR versus MBSR alone for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic. We hypothesized that psilocybin would augment the antidepressant effects of MBSR in this population.

Methods and findings: We conducted a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. (ClinicalTrials.gov Identifier: NCT05557643) Participants were enrolled between January 2nd, 2023 and January 16th, 2024, and randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25 mg psilocybin. Evaluation of safety and feasibility of enrollment and retention was a primary objective of the study. The primary efficacy endpoint was change in depressive symptoms, as measured by the Quick Inventory of Depressive Symptoms (QIDS-SR-16) at 2 weeks post-intervention. Symptoms of depression and burnout were assessed at baseline, and 2 weeks and 6 months post-intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events (AEs) and suicidality were assessed through a 6-month follow-up. Twenty-five participants were enrolled and randomized. Safety was a study outcome and assessed by rate and severity of AEs and any incident suicidality or significant mental health symptoms. Baseline and outcome data were summarized using descriptive statistics, with continuous variables reported as means and standard deviations. We recorded 12 study-related, Grade 1-2 AEs and no serious AEs. In a linear mixed model analysis (LMM), the MBSR + PAP arm evidenced a significantly larger decrease in QIDS-SR-16 score than the MBSR-only arm from baseline to 2-weeks post-intervention (between-groups effect = 4.6, 95% CI [1.51, 7.70]; p = 0.008). This effect waned at the 6-month follow-up. Secondary outcome measures for burnout (subscales of the MBI-HSS-MP), demoralization (DS II), and connectedness (WCS) favored the MBSR + PAP arm; however, these effects did not survive correction for multiple comparisons. A mixed RM-ANCOVA was conducted to control for baseline differences in outcome measures. Sensitivity analyses were conducted, adjusting for baseline differences in gender and clustering

Background: The planetary health diet (PHD) has been proposed as a dietary index with potential co-benefits for human and planetary health. Evidence is limited on its association with type 2 diabetes (T2D) incidence and greenhouse gas (GHG) emissions. Our objective was to assess the associations of adherence to the PHD with incident T2D and GHG emissions.

Methods and findings: We analysed data from 23,722 participants (55% female), with a mean (standard deviation, SD) age of 59.1 (9.3) in the UK-based EPIC-Norfolk prospective cohort study. Dietary intake was assessed across three time points (1993-1997, 1998-2000 and 2004-2011) using a food frequency questionnaire. We assessed adherence to the PHD (theoretical score range 0-140 points) based on the consumption of 13 food groups and two nutrients. Cox proportional hazards regression models, which accounted for time-varying covariates, were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for T2D. Linear regression models were used to analyse the association between the PHD and estimated GHG emissions. During a mean follow-up period of 19.4 (SD 6.8) years, 3,496 cases of incident T2D were recorded over 461,086 person-years. Greater adherence to the PHD was associated with lower T2D incidence; comparing the highest PHD quintile (85.7-117.8 points) to the lowest (33.9-68.4 points), the HR (95% CI) was 0.68 (0.61, 0.76) in the most adjusted model including socio-demographic, behavioural factors, energy intake, adiposity, and prevalent cardiovascular disease or cancer. The estimated population attributable fraction (PAF) for incident T2D due to adherence below the 80th percentile (85.7 points) was 12.3% (95% CI: 9.2%, 15.3%). Those in the highest quintile of the PHD had approximately 18% lower GHG emissions compared to those in the lowest (β5th/1st -18.4% (95% CI: -19.3%, -17.5%)). The main limitation of this research is the possibility of residual confounding due to the observational design of this study.

Conclusions: Our findings of a lower incidence of T2D and reduced GHG emissions among those with higher adherence to the PHD support the promotion of this diet for the population-level prevention of T2D and for planetary sustainability.

Background: Preventing and treating post-acute sequelae of COVID-19 infection (PASC), commonly known as Long COVID, has become a public health priority. This study tests whether Paxlovid treatment in the acute phase of COVID-19 could help prevent the onset of PASC.

Methods and findings: We used electronic health records from the National Clinical Cohort Collaborative to define a cohort of 445,738 patients who had COVID-19 since April 1, 2022, and were eligible for Paxlovid treatment due to risk for progression to severe COVID-19. We used the target trial emulation framework to estimate the effect of Paxlovid treatment on PASC incidence. We emulated a series of six sequential trials: one for each day of a 5-day treatment grace period. For each sequential trial, the treatment group was defined as patients prescribed Paxlovid on the trial start day, and the control group was defined as all patients meeting eligibility criteria who remained untreated on the trial start day. We pooled individual record-level data from the sequential trials for analysis. The follow-up period was 180 days. The primary outcome was overall PASC incidence measured using a computable phenotype. Secondary outcomes were incident cognitive, fatigue, and respiratory symptoms in the post-acute period. We controlled for a wide range of demographic and medical history covariates. Compared to the control group, Paxlovid treatment did not have a significant effect on overall PASC incidence or incident respiratory symptoms. It had a small protective effect against cognitive (relative risk [RR] 0.91; 95% CI [0.84, 0.98]; p = 0.019) and fatigue (RR 0.94; 95% CI [0.90, 0.98]; p = 0.002) symptoms. Finally, we estimated Paxlovid's effect on overall PASC incidence across strata of age, COVID-19 vaccination status, and Charlson Comorbidity Index (CCI) prior to COVID-19. We found small protective effects among patients aged 65 years or more (RR 0.92; 95% CI [0.88, 0.97]; p < 0.001; absolute risk difference [ARD] -0.43%; number needed to treat [NNT] 233) and with a CCI of 3 or 4 (RR 0.83; 95% CI [0.75, 0.92]; p < 0.001; ARD -1.30%; NNT 76). This study's main limitation is that the causal interpretation relies on the assumption that we controlled for all confounding variables.

Conclusions: Although some prior observational studies suggested that Paxlovid held promise as a PASC preventive, this study-with a large, nationally sampled cohort; a contemporary study period; and causal inference methodology-found that Paxlovid treatment during acute COVID-19 had no effect on subsequent PASC incidence. Stratified analyses suggest that Paxlovid may have a small protective effect among higher-risk patients, but the NNT is high. In conclusion, we see Paxlovid as unlikely to become a definitive solution for PASC prevention.