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Heart failure diagnosis: Impacts of atrial fibrillation on the diagnostic marker NT-proBNP. 心力衰竭诊断：心房颤动对诊断标志物NT-proBNP的影响

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-31 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004782

Yang Chen, Garry McDowell, Gregory Y H Lip

A recent PLOS Medicine study shows that atrial fibrillation lowers the specificity of the biomarker NT-proBNP for heart failure. Adjusted thresholds and better echocardiography access are therefore required for NT-proBNP to remain as a high negative predictive value rule-out test in primary care.

最近的一项PLOS医学研究表明，房颤降低了心力衰竭的生物标志物NT-proBNP的特异性。因此，NT-proBNP需要调整阈值和更好的超声心动图访问，以保持其在初级保健中的高阴性预测值排除试验的地位。

引用次数: 0

NT-proBNP testing for heart failure diagnosis in people with atrial fibrillation: A diagnostic accuracy study. NT-proBNP检测对房颤患者心衰诊断的准确性研究

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-30 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004550

Nicholas R Jones, Kathryn S Taylor, José M Ordóñez-Mena, Clare R Goyder, F D Richard Hobbs, Clare J Taylor

Background: N-terminal pro-B-type natriuretic peptides (NT-proBNP) are important in the assessment of suspected heart failure (HF). However, NT-proBNP concentrations are elevated in atrial fibrillation (AF), creating diagnostic uncertainty. The aim of this study was to assess the diagnostic accuracy of NT-proBNP for HF in people with AF, overall and by age, sex and BMI.

Methods and findings: Retrospective study of all patients with a NT-proBNP test in their primary care electronic health record among English GP practices provided through the Clinical Practice Research Datalink (2004-2018) and linked to secondary care data. The accuracy of NT-proBNP for diagnosing HF within six months was assessed for people with and without AF at thresholds of 125, 400, 660 and 2,000 pg/mL, including by age, sex and BMI. Among 155,347 people who had an NT-proBNP test organized in primary care (median age 61 years), 17,403 (11.2%) had pre-existing AF. Of the 155,347 people included, 14,585 (9.4%) were subsequently diagnosed with HF, including 4,168/17,403 (23.9%) people with AF (median NT-proBNP = 1,852 pg/mL, interquartile range (IQR) [974, 3,459] pg/mL) and 10,417/137,944 (7.6%) without AF (1,110 pg/mL, IQR [434, 3,108] pg/mL). NT-proBNP discriminated better overall among people without AF (AUC = 0.877 (95% confidence interval (CI) [0.873, 0.881]) than with AF (AUC = 0.743 (95% CI [0.735, 0.751]). Among people with AF, NT-proBNP sensitivity and specificity at a 125 pg/mL threshold was 98.8% (95% CI [98.5%, 99.1]) and 13.2% (95% CI [12.6%, 13.7]) and at 400 pg/mL 93.2% (95% CI [92.4, 93.9]) and 35.5% (95% CI [34.7, 36.3]). Among people without AF the corresponding results were 92.9% (95% CI [92.4, 93.4]) and 53.8% (95% CI [53.6, 54.1]) at 125 pg/mL and 77.1% (95% CI [76.3, 77.9]) and 84.9% (95% CI [84.7, 85.1]) at 400 pg/mL. NT-proBNP discriminated less well among people with AF aged ≥65 years compared to <65years (e.g., AUC in people aged 65-75 years was 0.725, 95% CI [0.712, 0.739]). Increasing the threshold for a positive test among people with AF from 125 pg/mL to 660 pg/mL would reduce the number of false positive results by 26.0%, whilst retaining a negative predictive value of 91.5 (95% CI [90.8, 92.1]), albeit with a 10.6% increase in the proportion of those tested with AF having a missed or delayed HF diagnosis. The main limitation of the study is that it relies on routinely collected primary care data and people with an NT-proBNP result <400 pg/mL may not have been referred for further assessment, impacting upon the diagnostic accuracy below this threshold.

Conclusions: NT-proBNP discriminates more accurately for HF among people without AF than with AF. A higher referral threshold could be considered in AF to account for higher median NT-proBNP levels but this would also increase missed HF diagnoses.

背景：n端前b型利钠肽（NT-proBNP）在评估疑似心力衰竭（HF）中很重要。然而，NT-proBNP浓度在房颤（AF）中升高，造成诊断的不确定性。本研究的目的是评估NT-proBNP对房颤患者HF的诊断准确性，包括总体、年龄、性别和BMI。方法和研究结果：回顾性研究通过临床实践研究数据链（2004-2018）提供的英国全科医生的初级保健电子健康记录中进行NT-proBNP测试的所有患者，并与二级保健数据相关联。在年龄、性别和BMI等阈值分别为125、400、660和2000 pg/mL时，对有和没有房颤的患者在6个月内诊断HF的NT-proBNP的准确性进行评估。在155347名在初级保健机构接受NT-proBNP检测的患者中（中位年龄61岁），17403人（11.2%）患有房颤。在155347名患者中，14585人（9.4%）随后被诊断为HF，其中包括4168 / 17403人（23.9%）房颤患者（中位NT-proBNP = 1852 pg/mL，四分位间距（IQR） [974, 3459] pg/mL）和10417 / 137944人（7.6%）无房颤（1110 pg/mL, IQR [434, 3108] pg/mL）。NT-proBNP在没有房颤的人群中(AUC = 0.877（95%可信区间（CI）[0.873, 0.881]）比有房颤的人群(AUC = 0.743 （95% CI[0.735, 0.751]）总体上更好。在房事患者中，125 pg/mL时NT-proBNP的敏感性和特异性分别为98.8% （95% CI[98.5%, 99.1]）和13.2% (95% CI [12.6%, 13.7])， 400 pg/mL时NT-proBNP的敏感性和特异性分别为93.2% （95% CI[92.4, 93.9]）和35.5% （95% CI[34.7, 36.3]）。在没有房事的人群中，相应的结果在125 pg/mL时为92.9% （95% CI[92.4, 93.4]）和53.8% (95% CI[53.6, 54.1])，在400 pg/mL时为77.1% （95% CI[76.3, 77.9]）和84.9% （95% CI[84.7, 85.1]）。结论：与房颤患者相比，非房颤患者的NT-proBNP对HF的鉴别更准确。房颤患者可以考虑较高的转诊阈值来解释较高的NT-proBNP中位数水平，但这也会增加房颤漏诊。

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引用次数: 0

Differences in growth trajectories in breastfed HIV-exposed uninfected and HIV-unexposed infants in Kenya: An observational cohort study. 肯尼亚母乳喂养艾滋病毒暴露的未感染和未感染婴儿生长轨迹的差异：一项观察性队列研究。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-27 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004781

Ruchi Tiwari, Benson O Singa, Priscah Lihanda, Mame M Diakhate, Eric Ochola, Lucy Bunyige, Christina Sherry, Barbra A Richardson, Dalton Wamalwa, Donna M Denno, Grace C John-Stewart, Grace M Aldrovandi, Christine J McGrath

Background: Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth compared to children who are HIV-unexposed (CHU). There are limited data on growth among CHEU in the era of preferred dolutegravir-based antiretroviral therapy (ART) for pregnant and breastfeeding women living with HIV (WLWH). We aimed to compare child growth outcomes in the first two years of life between breastfed CHEU and CHU, and to examine maternal HIV factors associated with growth in CHEU.Methods and findings: We enrolled pregnant women in Kenya and followed them with their child to age 24 months. We measured anthropometry within 7 days of birth, at 3 and 6 weeks, and months 3, 6, 9, 12, 18, and 24. We compared length-for-age Z-scores (LAZ), weight-for-age Z-scores (WAZ), weight-for-length Z-scores (WLZ), head circumference-for-age Z-scores (HCZ), and mid-upper arm circumference-for-age Z-scores (MUAC), and stunting (LAZ < -2), underweight (WAZ < -2), and wasting (WLZ < -2) between groups using linear mixed effects or modified Poisson regression models adjusted for maternal age, education, depression, anemia, household wealth index, time-varying breastfeeding, time-varying food insecurity, parity, and child sex. Among 333 mother-child pairs with at least two child visits (CHEU = 171; CHU = 162), mothers of CHEU were older, less educated, and had lower wealth than mothers of CHU. Birth characteristics were similar between groups, with 9% preterm births and 6% low birthweight. All WLWH were on ART, 89.5% on dolutegravir-lamivudine-tenofovir, 76.6% initiating ART preconception, and 91.2% virally suppressed. The duration of breastfeeding was significantly shorter for CHEU than CHU (median 15 versus 17 months). CHEU had significantly lower LAZ at birth, 18- and 24-months than CHU. In multivariable analysis, growth trajectories for WLZ and HCZ were lower among CHEU than CHU in the first 24 months (interaction p = 0.001 and p = 0.009, respectively). There was no difference in trajectory in LAZ, WAZ, and MUACZ between groups. By 24 months, 31.5% of CHEU were stunted, 9.3% underweight, and 2.4% wasted, versus 27.2%, 3.2%, and 0.6% of CHU, respectively; only the difference in underweight prevalence was statistically significant. CHEU had a higher risk of being underweight from 9- to 24 months than CHU (adjusted Relative Risk at 24 months, 2.99 [95% CI: 1.08, 8.30]; p = 0.034). Growth was associated with maternal education, wealth, and breastfeeding and was lower among male infants. Among CHEU, maternal preconception ART was not associated with growth. Important limitations of this study include the possibility of unmeasured confounding and limited generalizability to contexts with differing prevalence of malnutrition, access to and uptake of ART, or breastfeeding practices.Conclusions: Despite breastfeeding and optimal maternal dolutegravir-based ART, CHEU experienced growth deficits

背景：与未感染艾滋病毒（CHU）的儿童相比，暴露于艾滋病毒和未感染艾滋病毒（CHEU）的儿童生长不良的风险增加。在对感染艾滋病毒的孕妇和哺乳期妇女（WLWH）首选以曲地韦为基础的抗逆转录病毒治疗（ART）时代，关于CHEU增长的数据有限。我们的目的是比较母乳喂养的CHEU和CHU出生后头两年的儿童生长结果，并检查与CHEU生长相关的母体艾滋病毒因子。方法和发现：我们招募了肯尼亚的孕妇，并跟踪她们和她们的孩子到24个月大。我们测量了出生后7天、3周和6周以及第3、6、9、12、18和24个月的人体测量值。我们比较了身高年龄z分数（LAZ）、体重年龄z分数（WAZ）、体重身高z分数（WLZ）、头围年龄z分数（HCZ）、中上臂围年龄z分数（MUAC）和发育迟缓（LAZ）。结论：尽管母乳喂养和最优的基于母体妊娠的抗逆转录病毒治疗，与CHU相比，CHEU在出生后的头两年出现了生长缺陷。在指导方针和政策迅速发展的背景下，继续监测不断扩大的非裔美国人至关重要，以优化他们的健康，并确定和预防未来的健康差距和疾病风险。

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引用次数: 0

Effectiveness of a brief intervention and text-based booster in the emergency department to reduce harmful and hazardous alcohol use: A pragmatic randomized adaptive clinical trial in Moshi, Tanzania. 在急诊科，简短的干预和基于文本的助推器减少有害和危险酒精使用的有效性：在坦桑尼亚Moshi进行的一项实用的随机适应性临床试验。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-27 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004548

Catherine A Staton, Linda Minja, Joao Vitor Perez de Souza, John A Gallis, Pollyana Coelho Pessoa Santos, Mia Buono, Francis Sakita, Kennedy Ngowi, Judith Boshe, Ashley J Phillips, Joao Ricardo Nickenig Vissoci, Blandina T Mmbaga

Background: Alcohol use contributes to over 3 million deaths annually. In Tanzania, there are no evidence-based culturally adapted interventions to address harmful alcohol use behaviors. Our hypothesis was that "Punguza Pombe Kwa Afya Yako" (PPKAY, Reduce Alcohol for your Health), a culturally adapted brief intervention with text-based boosters, is superior to usual care in reducing binge drinking at 3 months post discharge.Methods and findings: This manuscript reports. Stage 1 of our adaptive clinical trial which seeks to determine the effectiveness of the PPKAY+ booster to usual care; a subsequent stage will compare the PPKAY only to personalized and standard boosters. Adults who sought care for an acute injury at the Kilimanjaro Christian Medical Centre Emergency Department, self-disclosed alcohol use prior to the injury, scored ≥8 on the Alcohol Use Disorder Identification Test, and/or test positive by alcohol breathalyzer were offered enrollment. Participants were randomly assigned to PPKAY+ boosters (personalized or standard) or usual care at 1:1:1 allocation. Primary analyses followed the intention-to-treat principle. The PPKAY is a 15-min nurse delivered brief intervention using motivational interviewing techniques combined with a standardized or personalized text based reminder sent weekly to participants after hospital discharge and until 1 year post enrollment compared to a usual care arm. Follow-up was performed by blinded outcome assessors. Our pooled intervention arms PPKAY+ boosters were compared to usual care to determine the effectiveness of the intervention in reducing the number of binge drinking days, the trial's primary outcome, in the previous 4 weeks at 3 months after discharge. A total of 1,484 patients were screened for eligibility between October 12th 2020, and on April 14th 2023. 448 patients met inclusion criteria and consented to participate. 148 were randomized to usual care, and 300 to the pooled intervention arm. Reasons for attrition included loss to follow-up (n = 69), withdrawal (n = 6), and deaths (n = 4), with no differences between arms. Most participants were male (94%), from the Chagga tribe (59%) and had an average age of 36.4 years (SD 12.6) at baseline. At the 3-month follow-up, the intervention arm showed a notable reduction in mean predicted binge drinking days by 1.2 days (95% CI: [-2.3, -0.3]; p = 0.002) compared to the usual care group in a difference-in-differences analysis. Importantly, the self-reported nature of our primary outcome introduces the potential for social desirability bias, particularly in the absence of participant blinding, and should be considered a limitation when interpreting the findings.Conclusion: The reduction in binge drinking behavior at 3-month follow-up compared to usual care suggests our culturally adapted intervention is an effective alcohol intervention for patients acutely injured in Tanzania. Accord

背景：酒精使用每年造成300多万人死亡。在坦桑尼亚，没有针对有害酒精使用行为的循证文化干预措施。我们的假设是“为了健康减少酒精”（PPKAY，减少酒精），一种文化适应性的简短干预，以文本为基础的助推器，在减少出院后3个月的酗酒方面优于常规护理。方法和发现：本文报道。我们的适应性临床试验的第一阶段，旨在确定PPKAY+增强剂对常规护理的有效性；后续阶段将只将PPKAY与个性化助推器和标准助推器进行比较。在乞力马扎罗山基督教医疗中心急诊科寻求治疗急性损伤的成年人，在受伤前自我披露饮酒情况，酒精使用障碍识别测试得分≥8分，和/或酒精呼气测试呈阳性。参与者按1:1:1的比例随机分配到PPKAY+增强治疗组（个性化或标准）或常规治疗组。初步分析遵循意向治疗原则。与常规护理组相比，PPKAY是一个15分钟的护士提供的简短干预，使用动机性访谈技术，结合标准化或个性化的文本提醒，每周向出院后的参与者发送，直到入组后1年。随访由盲法结果评估者进行。我们将合并干预组PPKAY+助推器与常规护理进行比较，以确定在出院后3个月前4周内减少酗酒天数（试验的主要结局）的干预效果。在2020年10月12日至2023年4月14日期间，共有1484名患者接受了资格筛查。448例患者符合纳入标准并同意参与。148人被随机分配到常规治疗组，300人被随机分配到联合干预组。损耗的原因包括随访失败（n = 69）、停药（n = 6）和死亡（n = 4），两组间无差异。大多数参与者为男性（94%），来自Chagga部落（59%），基线时平均年龄为36.4岁（SD 12.6）。在3个月的随访中，与常规护理组相比，干预组的平均预测酗酒天数显着减少了1.2天（95% CI: [-2.3, -0.3]; p = 0.002）。重要的是，我们主要结果的自我报告性质引入了社会期望偏差的可能性，特别是在没有参与者盲法的情况下，在解释研究结果时应将其视为局限性。结论：在3个月的随访中，与常规护理相比，酗酒行为的减少表明，我们的文化适应性干预对坦桑尼亚急性受伤患者是一种有效的酒精干预。根据适应性研究设计，试验的下一阶段将继续比较干预组和没有短信促进的配对组。试验注册号：ClinicalTrials.gov NCT04535011。

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引用次数: 0

Correction: Vaccination strategies, public health impact and cost-effectiveness of dengue vaccine TAK-003: A modeling case study in Thailand. 更正：登革热疫苗TAK-003的疫苗接种策略、公共卫生影响和成本效益：泰国的模拟案例研究。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-24 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004789

Jing Shen, Elizaveta Kharitonova, Anna Tytula, Justyna Zawieja, Samuel Aballea, Shibadas Biswal, Mayuri Sharma, Supattra Rungmaitree, Rosarin Sruamsiri, Derek Wallace, Riona Hanley

[This corrects the article DOI: 10.1371/journal.pmed.1004631.].

[更正文章DOI: 10.1371/journal.pmed.1004631.]。

引用次数: 0

Parental opioid prescriptions and the risk of opioid use in adolescents and young adults: The HUNT Study linked with prescription registry data. 父母开具阿片类药物处方和青少年使用阿片类药物的风险：HUNT研究与处方登记数据相关。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-23 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004763

Anna Marcuzzi, Paulo Ferreira, Paul Jarle Mork, Manuela L Ferreira, Karoline Moe, Sigmund Gismervik, Anne Lovise Nordstoga, Tom Ivar Lund Nilsen

Background: Although opioids are usually not recommended for young people they are often prescribed. It is not clear whether family-level factors are related to the risk of opioid use among adolescents and young adults. The aim of this study is to examine the association between parental opioid prescriptions and risk of opioid use in young people.

Methods and findings: A prospective cohort study, including 21,470 adolescents and young adults (13-29 years) participating in the third (2006-2008) or fourth (2017-2019) survey of the population-based Young-HUNT or HUNT Study, Norway, paired with at least one participating parent. Opioid prescriptions were obtained by a linkage to the Norwegian Prescription Database. Parents' opioid prescriptions were defined as '0', '1', and '≥2' prescriptions over a period of 5 years. Analyses were also stratified according to parental chronic musculoskeletal (MSK) pain status (no, yes) assessed by the Standardised Nordic Questionnaire. Two outcomes were assessed: 1) any opioid prescription, and 2) persistent opioid prescriptions (i.e., at least three out of four quarters of the year). Analyses were adjusted for parental age, parental education level, parental body mass index, offspring age, and offspring participation survey. Follow-up started at the date of survey participation and ended at the date of prescription, emigration/death, or 7-year follow-up. If the mother or father had ≥2 opioid prescriptions, the hazard ratios (HR) for persistent opioid prescriptions in offspring were 2.60 (95% CI [1.86, 3.65]) and 2.37 (95% CI [1.56, 3.60]), respectively, compared to offspring whose parents did not receive any opioid prescriptions. There was no clear evidence that parental chronic MSK pain status influenced these associations. Comparing offspring of mothers with ≥2 versus no opioid prescriptions, the HR for any opioid prescription was 1.30 (95% CI [1.15, 1.47]) if the mother reported chronic MSK pain and 1.31 (95% CI [1.06, 1.62]) if she did not. Corresponding HRs associated with fathers' opioid prescription were 1.19 (95% CI [1.01, 1.41]) if the father reported chronic MSK pain and 1.21 (95% CI [0.98, 1.50]) if he did not. Residual confounding due to unmeasured factors cannot be excluded.

Conclusions: Parental opioid prescription is related to an increased risk for opioid initiation and persistent use in offspring, irrespective of parental history of chronic MSK pain. These findings suggest that family-based strategies should be considered when managing pain and opioid use in young people.

背景：虽然阿片类药物通常不推荐给年轻人，但他们经常被开处方。目前尚不清楚家庭因素是否与青少年和年轻人使用阿片类药物的风险有关。本研究的目的是检查父母阿片类药物处方与年轻人使用阿片类药物风险之间的关系。方法和研究结果：一项前瞻性队列研究，包括21,470名青少年和年轻人（13-29岁），他们参加了挪威基于人群的young -HUNT或HUNT研究的第三次（2006-2008）或第四次（2017-2019）调查，至少有一位父母参与。阿片类药物处方通过与挪威处方数据库的链接获得。父母在5年内开具阿片类药物处方的定义为“0”、“1”和“≥2”。根据标准化北欧问卷评估的父母慢性肌肉骨骼（MSK）疼痛状态（否，是），分析也进行了分层。评估了两个结果：1)任何阿片类药物处方，以及2)持续阿片类药物处方（即一年四个季度中至少三个季度）。对父母年龄、父母受教育程度、父母体重指数、子女年龄和子女参与调查进行调整。随访从参加调查之日开始，至开处方、移民/死亡或7年随访之日结束。如果母亲或父亲有≥2种阿片类药物处方，与父母未服用任何阿片类药物的后代相比，后代持续服用阿片类药物的风险比（HR）分别为2.60 （95% CI[1.86, 3.65]）和2.37 （95% CI[1.56, 3.60]）。没有明确的证据表明父母慢性MSK疼痛状态影响这些关联。比较母亲服用阿片类药物≥2种与未服用阿片类药物的后代，如果母亲报告慢性MSK疼痛，任何阿片类药物处方的HR为1.30 (95% CI[1.15, 1.47])，如果母亲没有报告慢性MSK疼痛，HR为1.31 （95% CI[1.06, 1.62]）。如果父亲报告慢性MSK疼痛，与父亲阿片类药物处方相关的hr为1.19 (95% CI[1.01, 1.41])，如果父亲没有报告慢性MSK疼痛，hr为1.21 （95% CI[0.98, 1.50]）。不能排除由未测量因素引起的残留混杂。结论：无论父母是否有慢性MSK疼痛史，父母开具阿片类药物处方与后代阿片类药物起始和持续使用的风险增加有关。这些发现表明，在管理年轻人的疼痛和阿片类药物使用时，应考虑以家庭为基础的策略。

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引用次数: 0

Estimating the effect on obesity of delaying tax-based interventions in Mexico: A modeling study. 估计墨西哥延迟税收干预对肥胖的影响：一项模型研究。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-23 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004769

Martha Carnalla, Francisco Reyes-Sánchez, Alexis Alonso-Bastida, Alan Reyes-García, Alessio Hernández-Rojas, C Gabriela García, Isabel Junquera-Badilla, Ana Basto-Abreu, Boyd Swimburn, Juan A Rivera, Tonatiuh Barrientos-Gutiérrez

Background: The World Health Organization (WHO) launched the Acceleration Plan to STOP Obesity, highlighting the urgent need for timely implementation of proven interventions. Fiscal policies, including taxes on sugar-sweetened beverages (SSB) and non-essential energy-dense foods (NEDF), are among the most cost-effective strategies to reduce obesity rates. Delays in adopting or strengthening these measures can undermine their impact, and the consequences of postponing such policies remain unmeasured. We aimed to estimate the expected impact of delaying doubling the SSB and NEDF tax in Mexico.

Methods and findings: We simulated a closed cohort of Mexican adults aged 20 years and over from 2021 to 2040. The simulated sample corresponded to the combination of the 2020-22 Health and Nutrition Surveys, which contained anthropometric and demographic information representative at a national level. We projected annual average Body Mass Index (BMI), obesity prevalence, deaths averted, and years lived without obesity (YLWO) under four scenarios: status quo and doubling the current tax on SSB and NEDF in 2025, 2030, and 2035. BMI was projected from 2021 to 2040 using Hall's microsimulation weight change model, and a Mexican projection of total energy intake. To simulate deaths, we estimated the probability of all-cause mortality by BMI category from the National Population Council projections of the Mexican population by age and year. By 2040, doubling the taxes in 2025 resulted in an obesity prevalence of 41.6% (95% Uncertainty Interval [40.2,43.1]) in contrast to the status quo scenario (44.5%, 95% Uncertainty Interval [43.2,45.8]), and 170,600 deaths averted (95% Uncertainty Interval [130,900, 210,200]) and 25,031,900 (95% Uncertainty Interval [19,048,500, 31,015,300]) YLWO gained. A delayed intervention in 2035 resulted in an obesity prevalence of 41.7% (95% Uncertainty Interval [40.4,43.1]), 38,900 deaths averted (95% Uncertainty Interval [29,600, 48,200]), and 4,473,700 (95% Uncertainty Interval [3,378,900, 5,568,500]) YLWO gained. Our results apply only to individuals aged 20 years or older in 2021, excluding cohorts reaching age 20 between 2022 and 2040.

Conclusions: Our results emphasize the urgency of advancing WHO's Acceleration Plan to STOP Obesity. Postponing evidence-based interventions is estimated to exacerbate the burden of obesity, mortality, and suffering.

背景：世界卫生组织（世卫组织）启动了“阻止肥胖加速计划”，强调了及时实施经过验证的干预措施的迫切需要。财政政策，包括对含糖饮料（SSB）和非必需能量密集食品（NEDF）征税，是降低肥胖率的最具成本效益的战略之一。延迟采取或加强这些措施可能会破坏其影响，推迟这些政策的后果仍然无法衡量。我们的目的是估计墨西哥推迟将SSB和NEDF税加倍的预期影响。方法和发现：我们模拟了2021年至2040年期间20岁及以上的墨西哥成年人的封闭队列。模拟样本与2020-22年健康和营养调查相对应，其中包含具有国家代表性的人体测量学和人口统计信息。我们预测了四种情况下的年平均身体质量指数（BMI）、肥胖患病率、避免死亡人数和无肥胖生活年数（YLWO）：保持现状，并在2025年、2030年和2035年将SSB和NEDF的现行税收增加一倍。使用Hall的微模拟体重变化模型和墨西哥的总能量摄入预测来预测2021年至2040年的BMI。为了模拟死亡，我们根据国家人口委员会对墨西哥人口按年龄和年份的预测，按BMI类别估计了全因死亡率的概率。到2040年，2025年的税收翻倍导致肥胖患病率为41.6%(95%不确定区间[40.2,43.1])，与现状（44.5%，95%不确定区间[43.2,45.8]）相比，并避免了170,600例死亡（95%不确定区间[130,900,210,200]）和25,031,900例（95%不确定区间[19,048,500,31,015,300]）的YLWO。2035年的延迟干预导致肥胖患病率为41.7%(95%不确定区间[40.4,43.1])，避免了38,900例死亡（95%不确定区间[29,600,48,200]），获得了4,473,700例（95%不确定区间[3,378,900,5,568,500]）的YLWO。我们的结果仅适用于2021年20岁或以上的个体，不包括2022年至2040年期间20岁的队列。结论：我们的研究结果强调了推进世卫组织阻止肥胖加速计划的紧迫性。据估计，推迟循证干预措施会加重肥胖负担、死亡率和痛苦。

{"title":"Estimating the effect on obesity of delaying tax-based interventions in Mexico: A modeling study.","authors":"Martha Carnalla, Francisco Reyes-Sánchez, Alexis Alonso-Bastida, Alan Reyes-García, Alessio Hernández-Rojas, C Gabriela García, Isabel Junquera-Badilla, Ana Basto-Abreu, Boyd Swimburn, Juan A Rivera, Tonatiuh Barrientos-Gutiérrez","doi":"10.1371/journal.pmed.1004769","DOIUrl":"10.1371/journal.pmed.1004769","url":null,"abstract":"Background: The World Health Organization (WHO) launched the Acceleration Plan to STOP Obesity, highlighting the urgent need for timely implementation of proven interventions. Fiscal policies, including taxes on sugar-sweetened beverages (SSB) and non-essential energy-dense foods (NEDF), are among the most cost-effective strategies to reduce obesity rates. Delays in adopting or strengthening these measures can undermine their impact, and the consequences of postponing such policies remain unmeasured. We aimed to estimate the expected impact of delaying doubling the SSB and NEDF tax in Mexico.Methods and findings: We simulated a closed cohort of Mexican adults aged 20 years and over from 2021 to 2040. The simulated sample corresponded to the combination of the 2020-22 Health and Nutrition Surveys, which contained anthropometric and demographic information representative at a national level. We projected annual average Body Mass Index (BMI), obesity prevalence, deaths averted, and years lived without obesity (YLWO) under four scenarios: status quo and doubling the current tax on SSB and NEDF in 2025, 2030, and 2035. BMI was projected from 2021 to 2040 using Hall's microsimulation weight change model, and a Mexican projection of total energy intake. To simulate deaths, we estimated the probability of all-cause mortality by BMI category from the National Population Council projections of the Mexican population by age and year. By 2040, doubling the taxes in 2025 resulted in an obesity prevalence of 41.6% (95% Uncertainty Interval [40.2,43.1]) in contrast to the status quo scenario (44.5%, 95% Uncertainty Interval [43.2,45.8]), and 170,600 deaths averted (95% Uncertainty Interval [130,900, 210,200]) and 25,031,900 (95% Uncertainty Interval [19,048,500, 31,015,300]) YLWO gained. A delayed intervention in 2035 resulted in an obesity prevalence of 41.7% (95% Uncertainty Interval [40.4,43.1]), 38,900 deaths averted (95% Uncertainty Interval [29,600, 48,200]), and 4,473,700 (95% Uncertainty Interval [3,378,900, 5,568,500]) YLWO gained. Our results apply only to individuals aged 20 years or older in 2021, excluding cohorts reaching age 20 between 2022 and 2040.Conclusions: Our results emphasize the urgency of advancing WHO's Acceleration Plan to STOP Obesity. Postponing evidence-based interventions is estimated to exacerbate the burden of obesity, mortality, and suffering.","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"22 10","pages":"e1004769"},"PeriodicalIF":9.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12548904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356712","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}

引用次数: 0

Association between parental psychiatric conditions and offspring psychiatric, behavioral, and psychosocial outcomes: A Swedish population-based children-of-monozygotic twins study. 父母精神状况与后代精神、行为和社会心理结果之间的关系：一项基于瑞典人口的同卵双胞胎儿童研究。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-21 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004784

Mengping Zhou, Henrik Larsson, Brian M D'Onofrio, Mikael Landén, Ralf Kuja-Halkola, Zheng Chang, Isabell Brikell, Paul Lichtenstein, Erik Pettersson

Background: Mental health problems tend to run in families, with studies showing transdiagnostic associations across generations. Nevertheless, if these associations were attributable to unmeasured familial (either environmental or genetic) factors that influence both generations, then treating the parental conditions would not break the intergenerational transmission. This study aims to investigate the associations between parental psychiatric conditions and offspring psychiatric, behavioral, and psychosocial outcomes, after controlling for unmeasured familial factors shared by offspring of monozygotic (MZ) twin parents (i.e., cousins).Methods and findings: We conducted a children-of-MZ twins study that consisted of 15,603 individuals (born to 7,742 MZ twin parents) born in Sweden between 1970 and 2000, and followed them from their date of birth to the date of the outcome or December 31, 2020, when the offspring were between 21 and 51 years old. The exposures were whether the MZ twin parents were diagnosed with any psychiatric condition, any internalizing condition, or any externalizing condition. The outcomes included register-based psychiatric conditions, behavioral problems, suicide, and psychosocial problems in the offspring. We performed stratified Cox regression for time-to-event outcomes and conditional logistic regression for binary outcomes to compare offspring exposed to an MZ twin parent with psychiatric conditions against their unexposed cousins. We adjusted for the highest parental educational level, maternal and paternal age at childbirth, offspring birth year, offspring sex, and psychiatric diagnosis of the nontwin parent. Offspring of parents with any parental psychiatric condition, internalizing condition, or externalizing condition had significantly higher probabilities for all the psychiatric, behavioral, and psychosocial outcomes, with hazard ratios (HRs) ranging from 1.34 (95% confidence interval [CI] [1.21, 1.49]; p < 0.001) to 2.53 (95% CI [1.96, 3.26]; p < 0.001) for time-to-event outcomes and odds ratios ranging from 1.33 (95% CI [1.17, 1.52]; p < 0.001) to 1.87 (95% CI [1.63, 2.14]; p < 0.001) for binary outcomes. Although these associations attenuated when comparing differentially exposed cousins whose parents were MZ twins (20 out of 27 associations were no longer statistically significant within cousin pairs), associations between broad spectra remained statistically significant. Specifically, across the main analysis and several sensitivity analyses, statistically significant within-twin-family associations remained between any parental psychiatric condition and any offspring psychiatric condition (HR = 1.28, 95% CI [1.13, 1.44]; p < 0.001), between parental internalizing conditions and any offspring psychiatric condition (HR = 1.26, 95% CI [1.09, 1.45]; p = 0.002), and between parental externalizing conditions and any offspring psychiatric condition (HR = 1.27, 95% CI [1.

背景：心理健康问题倾向于家族遗传，研究显示跨代的跨诊断关联。然而，如果这些关联可归因于影响两代人的未测量的家族（环境或遗传）因素，那么治疗父母的情况不会破坏代际遗传。本研究旨在探讨父母精神状况与后代精神、行为和社会心理结果之间的关系，在控制了未测量的单卵双胞胎父母（即表兄弟姐妹）后代共有的家族因素后。方法和发现：我们进行了一项MZ双胞胎的孩子研究，该研究包括1970年至2000年间在瑞典出生的15,603名个体（7742名MZ双胞胎父母所生），并从他们的出生日期到结果日期或2020年12月31日，当后代在21至51岁之间时进行跟踪。暴露是MZ双胞胎父母是否被诊断有任何精神疾病，任何内化疾病，或任何外化疾病。结果包括基于登记的精神状况、行为问题、自杀和后代的社会心理问题。我们采用分层Cox回归对事件发生时间进行回归，并对二元结果进行条件逻辑回归，以比较暴露于患有精神疾病的MZ双胞胎父母的后代与未暴露于MZ双胞胎父母的后代。我们调整了父母的最高教育水平、父母分娩时的年龄、子女出生年份、子女性别和非双胞胎父母的精神诊断。父母有任何精神疾病、内化疾病或外化疾病的后代在所有精神、行为和社会心理结局方面的概率显著更高，风险比（hr）范围为1.34(95%可信区间[CI] [1.21, 1.49]；p结论：虽然父母精神状况与后代精神、行为和社会心理结果之间的代际传递似乎部分归因于影响两代人的未测量的家族（环境或遗传）因素，但也有证据表明存在非共享因素或直接因果效应。如果是后者，那么治疗父母的精神疾病会降低后代患精神疾病的风险。

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引用次数: 0

Impact of excessive social media use on adolescent depression and its consequences in France: An individual-based microsimulation model. 过度使用社交媒体对法国青少年抑郁症的影响及其后果：一个基于个人的微观模拟模型。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-21 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004737

Nicolas Hoertel, Mark Olfson, Carlos Blanco, Margot Biscond, Frédéric Limosin, Marina Sánchez-Rico, Martin Blachier, Henri Leleu

Background: Social media (SM) platforms have become increasingly prevalent in adolescents' lives, and concerns have arisen regarding their potential contribution to depression. This study examined whether excessive SM use contributes to rising adolescent depression rates and evaluated potential mitigation strategies.

Methods and findings: We developed an individual-based microsimulation model of 18.6 million French adolescents born 1990-2012, tracking depression outcomes from 2000-2022 (analyses conducted August 2024-July 2025). The model incorporated 95 parameters, including demographics, SM use patterns, and established depression risk factors (childhood adversities, chronic physical conditions, physical inactivity, obesity, substance use). The main outcome was cumulative depression cases, and secondary outcomes were suicide deaths, health-adjusted life expectancy (HALE) loss, and associated costs. The model was well-calibrated and validated adequately against US-specific data. It showed that excessive SM use likely played an important role in the recent increase in rates of adolescent depression. Among French adolescents, simulations indicated that excessive SM use was associated with an additional cumulative lifetime 590,000 depression cases (95%CI [400,000, 760,000]), 799 suicide deaths (95%CI [547, 1,028]), 137,000 (95%CI [94,000, 176,000]) HALE loss years, and 3.94 (95%CI [2.70, 5.07]) billion euros, compared to scenarios without SM platforms. Key limitations are that microsimulation modeling cannot establish causality from observational data and the reliance on duration-based exposure measures without capturing content type or engagement quality.

Conclusions: In this study, we estimated that limiting SM use to 1 h per day for all adolescents, replacing 30 min of SM use with 30 min of physical activity, or stopping its use for adolescents most at-risk for depression, would be associated with a reduction in cumulative lifetime prevalence of depression by 14.7%, 12.9%, and 12.0%, respectively, and diminished associated costs. Targeted SM interventions could potentially reduce adolescent depression burden, though real-world implementation and effectiveness require validation.

背景：社交媒体（SM）平台在青少年的生活中变得越来越普遍，人们开始关注它们对抑郁症的潜在影响。本研究调查了过度使用SM是否会导致青少年抑郁率上升，并评估了潜在的缓解策略。方法和研究结果：我们建立了一个基于个体的微观模拟模型，涉及1960万1990-2012年出生的法国青少年，追踪2000-2022年期间的抑郁结果（分析于2024年8月至2025年7月进行）。该模型纳入了95个参数，包括人口统计、SM使用模式和已确定的抑郁风险因素（童年逆境、慢性身体状况、缺乏运动、肥胖、物质使用）。主要结局是累积抑郁病例，次要结局是自杀死亡、健康调整预期寿命（HALE）损失和相关费用。该模型经过了很好的校准，并针对美国特定数据进行了充分验证。研究表明，过度使用SM可能是近期青少年抑郁症发病率上升的重要原因。在法国青少年中，模拟表明，与没有SM平台的情况相比，过度使用SM与额外的累积寿命相关：590,000例抑郁症病例（95%CI[400,000, 760,000]）， 799例自杀死亡（95%CI [547, 1,028]）， 137,000 (95%CI [94,000, 176,000]) HALE损失年和3.94 （95%CI[2.70, 50.7]）亿欧元。关键的限制是微模拟建模不能从观察数据和基于持续时间的暴露度量中建立因果关系，而不能捕获内容类型或参与质量。结论：在这项研究中，我们估计，将所有青少年的SM使用限制在每天1小时，用30分钟的体育活动代替30分钟的SM使用，或对抑郁症风险最高的青少年停止使用SM，将分别使抑郁症的累积终生患病率降低14.7%，12.9%和12.0%，并降低相关成本。有针对性的SM干预可能会潜在地减轻青少年抑郁负担，尽管现实世界的实施和有效性需要验证。

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引用次数: 0

Improving reporting of observational studies of interventions: The TARGET guideline. 改进干预措施观察性研究的报告：TARGET指南。

IF 9.9 1区医学 Q1 Medicine

PLoS Medicine

Pub Date : 2025-10-15 eCollection Date: 2025-10-01 DOI: 10.1371/journal.pmed.1004787

Harrison J Hansford, James H McAuley, Aidan G Cashin

Emulating a target trial when conducting an observational study of interventions can reduce the likelihood of design-related biases. The TARGET guideline aims to improve the reporting transparency of observational studies emulating a target trial and help readers appraise and apply the results.

在进行干预的观察性研究时模拟目标试验可以减少设计相关偏差的可能性。TARGET指南旨在提高模拟目标试验的观察性研究报告的透明度，并帮助读者评估和应用结果。

引用次数: 0