Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101141
David Benton, Hayley A. Young
{"title":"There is more to nutrition and cardiovascular disease than ultra-processing","authors":"David Benton, Hayley A. Young","doi":"10.1016/j.lanepe.2024.101141","DOIUrl":"10.1016/j.lanepe.2024.101141","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101141"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101185
Justyna D. Kowalska , Fakhrridin Nizamov , Shaffiq Essajee
{"title":"Lessons learned from the Eastern Europe and central Asia region on the elimination of HIV vertical transmission: insights from United Nations Children’s fund","authors":"Justyna D. Kowalska , Fakhrridin Nizamov , Shaffiq Essajee","doi":"10.1016/j.lanepe.2024.101185","DOIUrl":"10.1016/j.lanepe.2024.101185","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101185"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101206
The Lancet Regional Health – Europe
{"title":"The Italian health data system is broken","authors":"The Lancet Regional Health – Europe","doi":"10.1016/j.lanepe.2024.101206","DOIUrl":"10.1016/j.lanepe.2024.101206","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101206"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101149
Giovenale Moirano , Chloe Fletcher , Jan C. Semenza , Rachel Lowe
Background
In recent years, Europe has experienced several outbreaks of West Nile Virus (WNV), a mosquito-borne pathogen. This study aims to quantify the impact of weekly mean temperature and cumulative precipitation on human cases of West Nile Neuroinvasive Disease (WNND), to assess the feasibility of climate-informed early warning systems for severe forms of WNV infection.
Methods
Using a space-time-stratified case-crossover design, the short-term effects of meteorological factors on WNND cases reported in Europe from 2014 to 2022 were examined. Distributed lag nonlinear models were implemented in conditional logistic regressions to assess the delayed and nonlinear effects of temperature and precipitation on WNND risk as well as to estimate the Attributable Fraction (AF) of cases to extreme values of the two meteorological factors.
Findings
Between 2014 and 2022, Europe reported 3437 WNND cases. Both meteorological factors recorded in the 8 weeks before symptom onset showed positive and delayed effects on WNND risk. The strongest effect was found for weekly mean temperatures at 2 weeks lag (Odds Ratio (OR): 1.15; 95% Confidence Interval (CI) 1.12–1.19) and for weekly cumulative precipitation at 3 weeks lag (OR: 1.12; 95% CI 1.09–1.16). Of all WNND cases analyzed, 36.4% (95% CI, 31.3%–40.3%) could be attributed to weekly mean temperatures exceeding the 25 °C, while 13.1% (95% CI, 9.5%–16.4%) to weekly cumulative precipitations exceeding 40 mm.
Interpretation
These findings emphasize the significance of short-term variations in temperature and precipitation in driving WNND incidence in Europe. Meteorological factors can be used to operationalize early warning systems to reduce the disease burden from WNV infections, which are continually increasing across the continent.
Funding
European Union’s Horizon Europe research and innovation programme.
{"title":"Short-term effect of temperature and precipitation on the incidence of West Nile Neuroinvasive Disease in Europe: a multi-country case-crossover analysis","authors":"Giovenale Moirano , Chloe Fletcher , Jan C. Semenza , Rachel Lowe","doi":"10.1016/j.lanepe.2024.101149","DOIUrl":"10.1016/j.lanepe.2024.101149","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, Europe has experienced several outbreaks of West Nile Virus (WNV), a mosquito-borne pathogen. This study aims to quantify the impact of weekly mean temperature and cumulative precipitation on human cases of West Nile Neuroinvasive Disease (WNND), to assess the feasibility of climate-informed early warning systems for severe forms of WNV infection.</div></div><div><h3>Methods</h3><div>Using a space-time-stratified case-crossover design, the short-term effects of meteorological factors on WNND cases reported in Europe from 2014 to 2022 were examined. Distributed lag nonlinear models were implemented in conditional logistic regressions to assess the delayed and nonlinear effects of temperature and precipitation on WNND risk as well as to estimate the Attributable Fraction (AF) of cases to extreme values of the two meteorological factors.</div></div><div><h3>Findings</h3><div>Between 2014 and 2022, Europe reported 3437 WNND cases. Both meteorological factors recorded in the 8 weeks before symptom onset showed positive and delayed effects on WNND risk. The strongest effect was found for weekly mean temperatures at 2 weeks lag (Odds Ratio (OR): 1.15; 95% Confidence Interval (CI) 1.12–1.19) and for weekly cumulative precipitation at 3 weeks lag (OR: 1.12; 95% CI 1.09–1.16). Of all WNND cases analyzed, 36.4% (95% CI, 31.3%–40.3%) could be attributed to weekly mean temperatures exceeding the 25 °C, while 13.1% (95% CI, 9.5%–16.4%) to weekly cumulative precipitations exceeding 40 mm.</div></div><div><h3>Interpretation</h3><div>These findings emphasize the significance of short-term variations in temperature and precipitation in driving WNND incidence in Europe. Meteorological factors can be used to operationalize early warning systems to reduce the disease burden from WNV infections, which are continually increasing across the continent.</div></div><div><h3>Funding</h3><div><span>European Union’s Horizon Europe</span> research and innovation programme.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101149"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101166
Brenda W.J.H. Penninx , Femke Lamers , Rick Jansen , Michael Berk , Golam M. Khandaker , Livia De Picker , Yuri Milaneschi
Major depressive disorder is a common, disabling mental disorder characterized by extensive etiological and phenotypic heterogeneity. This heterogeneity makes treatment approaches imprecise and often ineffective. Insight into the underlying biological mechanisms underpinning depression and its subtypes may enable more personalized treatments. In this review, we provide an overview of immuno-metabolic depression and illustrate that significant immuno-metabolic dysregulations are present in about 20–30% of people with depression. Such immuno-metabolic depression is characterized by the clustering of 1) atypical, energy-related depressive symptoms such as hypersomnia, fatigue, hyperphagia, and possibly anhedonia, 2) systemic low-grade inflammation with elevated levels of e.g., C-reactive protein, cytokines and glycoprotein acetyls, and 3) metabolic abnormalities involving e.g., obesity, dyslipidaemia, insulin and leptin resistance. Persons with immuno-metabolic depression are at a higher risk for cardiometabolic diseases and seem to respond less well to standard antidepressant treatment. Interventions targeting inflammation, metabolism or lifestyle may be more effective treatment options for individuals with immuno-metabolic depression, in line with principles of precision psychiatry.
{"title":"Immuno-metabolic depression: from concept to implementation","authors":"Brenda W.J.H. Penninx , Femke Lamers , Rick Jansen , Michael Berk , Golam M. Khandaker , Livia De Picker , Yuri Milaneschi","doi":"10.1016/j.lanepe.2024.101166","DOIUrl":"10.1016/j.lanepe.2024.101166","url":null,"abstract":"<div><div>Major depressive disorder is a common, disabling mental disorder characterized by extensive etiological and phenotypic heterogeneity. This heterogeneity makes treatment approaches imprecise and often ineffective. Insight into the underlying biological mechanisms underpinning depression and its subtypes may enable more personalized treatments. In this review, we provide an overview of immuno-metabolic depression and illustrate that significant immuno-metabolic dysregulations are present in about 20–30% of people with depression. Such immuno-metabolic depression is characterized by the clustering of 1) atypical, energy-related depressive symptoms such as hypersomnia, fatigue, hyperphagia, and possibly anhedonia, 2) systemic low-grade inflammation with elevated levels of e.g., C-reactive protein, cytokines and glycoprotein acetyls, and 3) metabolic abnormalities involving e.g., obesity, dyslipidaemia, insulin and leptin resistance. Persons with immuno-metabolic depression are at a higher risk for cardiometabolic diseases and seem to respond less well to standard antidepressant treatment. Interventions targeting inflammation, metabolism or lifestyle may be more effective treatment options for individuals with immuno-metabolic depression, in line with principles of precision psychiatry.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101166"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.lanepe.2024.101135
Vincenzo Oliva , Giovanna Fico , Michele De Prisco , Xenia Gonda , Adriane R. Rosa , Eduard Vieta
Bipolar disorders are chronic psychiatric conditions characterized by recurrent episodes of mania and depression. Affecting over 1% of the global population, these disorders contribute significantly to disability and mortality, often due to suicide and cardiovascular disease. Diagnostic challenges arise from symptom overlap with unipolar depression, frequently leading to delays. Bipolar disorders are driven by complex genetic, neurobiological, and environmental factors and are commonly accompanied by psychiatric and medical comorbidities, further complicating diagnosis and treatment. Standard management strategies include mood stabilizers, antipsychotics, and selective use of antidepressants, complemented by psychosocial interventions like cognitive-behavioral therapy and psychoeducation, which are vital for relapse prevention. Despite recent advancements, the management of bipolar disorders remains challenging, constrained by clinical variability, an absence of specific biomarkers, and differences in approved treatments and treatment guidelines across regions. Emerging research underscores the potential of precision psychiatry and digital health tools to enhance diagnosis and treatment. Nonetheless, critical gaps persist, particularly in implementing equitable care worldwide. This review offers a comprehensive update on bipolar disorders, examining clinical presentation, early diagnosis, pathogenesis, therapeutic strategies, and future perspectives to guide clinicians and researchers in addressing these ongoing challenges in research and clinical practice.
{"title":"Bipolar disorders: an update on critical aspects","authors":"Vincenzo Oliva , Giovanna Fico , Michele De Prisco , Xenia Gonda , Adriane R. Rosa , Eduard Vieta","doi":"10.1016/j.lanepe.2024.101135","DOIUrl":"10.1016/j.lanepe.2024.101135","url":null,"abstract":"<div><div>Bipolar disorders are chronic psychiatric conditions characterized by recurrent episodes of mania and depression. Affecting over 1% of the global population, these disorders contribute significantly to disability and mortality, often due to suicide and cardiovascular disease. Diagnostic challenges arise from symptom overlap with unipolar depression, frequently leading to delays. Bipolar disorders are driven by complex genetic, neurobiological, and environmental factors and are commonly accompanied by psychiatric and medical comorbidities, further complicating diagnosis and treatment. Standard management strategies include mood stabilizers, antipsychotics, and selective use of antidepressants, complemented by psychosocial interventions like cognitive-behavioral therapy and psychoeducation, which are vital for relapse prevention. Despite recent advancements, the management of bipolar disorders remains challenging, constrained by clinical variability, an absence of specific biomarkers, and differences in approved treatments and treatment guidelines across regions. Emerging research underscores the potential of precision psychiatry and digital health tools to enhance diagnosis and treatment. Nonetheless, critical gaps persist, particularly in implementing equitable care worldwide. This review offers a comprehensive update on bipolar disorders, examining clinical presentation, early diagnosis, pathogenesis, therapeutic strategies, and future perspectives to guide clinicians and researchers in addressing these ongoing challenges in research and clinical practice.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101135"},"PeriodicalIF":13.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-30DOI: 10.1016/j.lanepe.2024.101204
Nanna Nørtoft Nielsen , Jonas Faartoft Jensen , Joachim Baech , Trine Trab , Tarec Christoffer El-Galaly , Claudia Schöllkopf , Andreas Due Ørskov , Hans Beier Ommen , Lene Sofie Granfeldt , Daniel Tuyet Kristensen , Marianne Tang Severinsen
Background
Second primary malignancies (SPMs) are a well-known, long-term complication of antineoplastic treatment. This nationwide cohort study examined the risk of non-myeloid SPMs in survivors of adult acute myeloid leukaemia (AML) treated with intensive chemotherapy and, in some cases, allogeneic stem cell transplantation (alloSCT), compared to a matched general population.
Methods
Patients with incident AML between 2000 and 2018, alive and aged 18–70 years two years after start of intensive chemotherapy, were included and matched 1:10 to comparators from the general Danish population on sex, age, and the Nordic Multimorbidity Index. Exclusion criteria were non-myeloid SPMs for both AML survivors and comparators.
Findings
A total of 750 AML survivors and 7500 comparators were followed for a median of 10.6 years. The hazard ratio (HR) of non-myeloid SPMs was 1.55 (95% confidence interval [CI] 1.27–1.89) for AML survivors compared to comparators, driven by non-melanoma skin cancer (HR 2.52, 95% CI 1.90–3.35), not of solid cancer (HR 1.14, 95% CI 0.87–1.49). The 10-year cumulative incidences of any non-myeloid SPM were 13.5% (95% CI 10.6–16.5%) in AML survivors and 11.9% (95% CI 11.1–12.8%) in matched comparators. Additionally, AML survivors consolidated with alloSCT had a higher hazard rate of non-myeloid SPMs compared to non-transplanted AML survivors (adjusted HR 1.50, 95% CI 1.00–2.26).
Interpretation
The increased rate of non-myeloid SPMs observed in this population-based cohort study of AML survivors was almost entirely driven by non-melanoma skin cancer and is thus outweighed by the importance of intensive chemotherapy.
Funding
Svend Andersen, Heinrich Kopps, and Karen Elise Jensen’s Foundation.
{"title":"Second primary non-myeloid malignancies following intensive treatment for adult acute myeloid leukaemia: a Danish population-based cohort study","authors":"Nanna Nørtoft Nielsen , Jonas Faartoft Jensen , Joachim Baech , Trine Trab , Tarec Christoffer El-Galaly , Claudia Schöllkopf , Andreas Due Ørskov , Hans Beier Ommen , Lene Sofie Granfeldt , Daniel Tuyet Kristensen , Marianne Tang Severinsen","doi":"10.1016/j.lanepe.2024.101204","DOIUrl":"10.1016/j.lanepe.2024.101204","url":null,"abstract":"<div><h3>Background</h3><div>Second primary malignancies (SPMs) are a well-known, long-term complication of antineoplastic treatment. This nationwide cohort study examined the risk of non-myeloid SPMs in survivors of adult acute myeloid leukaemia (AML) treated with intensive chemotherapy and, in some cases, allogeneic stem cell transplantation (alloSCT), compared to a matched general population.</div></div><div><h3>Methods</h3><div>Patients with incident AML between 2000 and 2018, alive and aged 18–70 years two years after start of intensive chemotherapy, were included and matched 1:10 to comparators from the general Danish population on sex, age, and the Nordic Multimorbidity Index. Exclusion criteria were non-myeloid SPMs for both AML survivors and comparators.</div></div><div><h3>Findings</h3><div>A total of 750 AML survivors and 7500 comparators were followed for a median of 10.6 years. The hazard ratio (HR) of non-myeloid SPMs was 1.55 (95% confidence interval [CI] 1.27–1.89) for AML survivors compared to comparators, driven by non-melanoma skin cancer (HR 2.52, 95% CI 1.90–3.35), not of solid cancer (HR 1.14, 95% CI 0.87–1.49). The 10-year cumulative incidences of any non-myeloid SPM were 13.5% (95% CI 10.6–16.5%) in AML survivors and 11.9% (95% CI 11.1–12.8%) in matched comparators. Additionally, AML survivors consolidated with alloSCT had a higher hazard rate of non-myeloid SPMs compared to non-transplanted AML survivors (adjusted HR 1.50, 95% CI 1.00–2.26).</div></div><div><h3>Interpretation</h3><div>The increased rate of non-myeloid SPMs observed in this population-based cohort study of AML survivors was almost entirely driven by non-melanoma skin cancer and is thus outweighed by the importance of intensive chemotherapy.</div></div><div><h3>Funding</h3><div><span>Svend Andersen</span>, <span>Heinrich Kopps</span>, and <span>Karen Elise Jensen’s Foundation</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101204"},"PeriodicalIF":13.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-28DOI: 10.1016/j.lanepe.2024.101203
Abyan Irzaldy , Tine Jerman , Inge M.C.M. de Kok , Jan A.C. Hontelez , Harry J. de Koning , Erik E.L. Jansen , Urška Ivanuš
Background
HPV vaccination is most efficacious in preventing cervical cancer and its precursors when administered during preadolescence. Because in Slovenia women are invited for cytology screening from age 20, women targeted for preadolescent HPV vaccination have been screening-eligible since 2018. We aim to assess the impact of preadolescent HPV vaccination programme on cytology screening performance and CIN2+ incidence.
Methods
This is a cohort study using data from Slovenia's cervical screening registry. We compared the incidence of high-grade lesions (CIN2 or worse) between women in the first vaccine-targeted birth cohort (1998–2001) and in the latest non-vaccine-targeted birth cohort (1994–1997). We calculated the Incidence Rate Ratio (IRR) of CIN2+ using Poisson regression. To identify a possible shift in the harms-benefits ratio of screening, we compared the following screening performance indicators using chi-square tests: colposcopy referral rate (CRR), positive predictive value (PPV) of low-grade and high-grade results, and CIN2+ detection rate.
Findings
The annual quadrivalent vaccine coverage in vaccine-targeted cohort was between 48.7% and 55.2%. The CIN2+ incidence was substantially lower in vaccine-targeted cohort (IRR 0.58 95% CI 0.49–0.69). Screening indicators were significantly lower for the vaccine-targeted cohort: direct CRR (0.47% [118/25,185] vs. 0.68% [206/30,181]), PPV (26.8% [30/112] vs. 39.0% [76/195]), and CIN2+ detection rate (0.31% [79/25,185] vs. 0.55% [165/30,181]) (p < 0.05).
Interpretation
Even under imperfect vaccination coverage of around 50%, CIN2+ incidence in the vaccine-targeted cohort was observed to be 42% lower. Furthermore, the harms-benefits ratio of cervical screening deteriorates, marked by lower PPV and detection rate. This warrants an adaptation in screening algorithms in vaccinated cohorts.
Funding
European Union Horizon 2020.
背景：在青春期前接种HPV疫苗对预防宫颈癌及其前体最有效。由于斯洛文尼亚女性从20岁起就被邀请进行细胞学筛查，因此自2018年以来，针对青春期前HPV疫苗接种的女性一直符合筛查条件。我们的目的是评估青春期前HPV疫苗接种计划对细胞学筛查表现和CIN2+发病率的影响。方法：这是一项队列研究，使用斯洛文尼亚宫颈筛查登记处的数据。我们比较了1998-2001年第一个接种疫苗的出生队列和1994-1997年最新的非接种疫苗的出生队列中女性高级别病变（CIN2或更严重）的发生率。我们用泊松回归计算CIN2+的发病率比（IRR）。为了确定筛查的利弊比可能发生的变化，我们使用卡方检验比较了以下筛查绩效指标：阴道镜转诊率（CRR）、低分级和高分级结果的阳性预测值（PPV）以及CIN2+检出率。研究结果：疫苗靶向队列的年四价疫苗覆盖率在48.7%至55.2%之间。在疫苗靶向队列中，CIN2+发生率显著降低（IRR 0.58, 95% CI 0.49-0.69）。疫苗靶向队列的筛查指标明显较低：直接CRR（0.47%[118/25,185]对0.68%[206/30,181]）、PPV（26.8%[30/112]对39.0%[76/195]）和CIN2+检出率（0.31%[79/25,185]对0.55% [165/30,181]）(p解释：即使在疫苗接种覆盖率约为50%的不完善情况下，疫苗靶向队列的CIN2+发病率也低42%。此外，子宫颈筛查的危害效益比恶化，表现为PPV和检出率降低。这就需要在接种疫苗的队列中调整筛选算法。资助：欧盟地平线2020。
{"title":"Impact of a national HPV vaccination programme for preadolescent girls on cytology screening performance and CIN2+ incidence: five-year population-based cervical screening results from Slovenia","authors":"Abyan Irzaldy , Tine Jerman , Inge M.C.M. de Kok , Jan A.C. Hontelez , Harry J. de Koning , Erik E.L. Jansen , Urška Ivanuš","doi":"10.1016/j.lanepe.2024.101203","DOIUrl":"10.1016/j.lanepe.2024.101203","url":null,"abstract":"<div><h3>Background</h3><div>HPV vaccination is most efficacious in preventing cervical cancer and its precursors when administered during preadolescence. Because in Slovenia women are invited for cytology screening from age 20, women targeted for preadolescent HPV vaccination have been screening-eligible since 2018. We aim to assess the impact of preadolescent HPV vaccination programme on cytology screening performance and CIN2+ incidence.</div></div><div><h3>Methods</h3><div>This is a cohort study using data from Slovenia's cervical screening registry. We compared the incidence of high-grade lesions (CIN2 or worse) between women in the first vaccine-targeted birth cohort (1998–2001) and in the latest non-vaccine-targeted birth cohort (1994–1997). We calculated the Incidence Rate Ratio (IRR) of CIN2+ using Poisson regression. To identify a possible shift in the harms-benefits ratio of screening, we compared the following screening performance indicators using chi-square tests: colposcopy referral rate (CRR), positive predictive value (PPV) of low-grade and high-grade results, and CIN2+ detection rate.</div></div><div><h3>Findings</h3><div>The annual quadrivalent vaccine coverage in vaccine-targeted cohort was between 48.7% and 55.2%. The CIN2+ incidence was substantially lower in vaccine-targeted cohort (IRR 0.58 95% CI 0.49–0.69). Screening indicators were significantly lower for the vaccine-targeted cohort: direct CRR (0.47% [118/25,185] vs. 0.68% [206/30,181]), PPV (26.8% [30/112] vs. 39.0% [76/195]), and CIN2+ detection rate (0.31% [79/25,185] vs. 0.55% [165/30,181]) (p < 0.05).</div></div><div><h3>Interpretation</h3><div>Even under imperfect vaccination coverage of around 50%, CIN2+ incidence in the vaccine-targeted cohort was observed to be 42% lower. Furthermore, the harms-benefits ratio of cervical screening deteriorates, marked by lower PPV and detection rate. This warrants an adaptation in screening algorithms in vaccinated cohorts.</div></div><div><h3>Funding</h3><div><span>European Union Horizon 2020</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101203"},"PeriodicalIF":13.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-28DOI: 10.1016/j.lanepe.2024.101195
Ruolin Li , Alexander Kurilshikov , Shuyue Yang , Julie A.E. van Oortmerssen , Arno van Hilten , Fariba Ahmadizar , Gennady Roshchupkin , Robert Kraaij , Liesbeth Duijts , Jingyuan Fu , M. Kamran Ikram , Vincent W.V. Jaddoe , André G. Uitterlinden , Fernando Rivadeneira , Maryam Kavousi , Alexandra Zhernakova , Carolina Medina-Gomez
Background
The human gut microbiome changes considerably over time. Previous studies have shown that gut microbiome profiles correlate with multiple metabolic traits. As disease development is likely a lifelong process, evidence gathered at different life stages would help gain a better understanding of this correlation. Therefore, we aim to investigate how the association of the gut microbiome and metabolic traits change over the lifespan.
Methods
We identified microbiome patterns (clusters) within two population-based cohorts at different life stages, i.e., pre-adolescents of the Generation R Study (mean age 9.8 years; n = 1488) and older adults of the Rotterdam Study (RS, mean age 62.7 years; n = 1265) using K-Means clustering, and surveyed for host metabolic phenotypes, lifestyles and other factors driving these patterns. Analyses were replicated in the Lifelines-DEEP Study (mean age 45.0 years; n = 1117). The association between microbiome clusters and host metabolic health was evaluated as well as the link between microbiome clusters and incident atherosclerotic cardiovascular disease (ASCVD) in RS during follow-up (median 6.5 years).
Findings
We identified two distinct microbiome clusters (U and H) within each study population presenting contrasting metabolic statuses. Cluster U was characterized by lower microbiome diversity, increased Streptococcus, Fusicatenibacter, and decreased Prevotella_9 and Christensenellaceae_R-7_group; wherein individuals showed higher fat percentage, triglycerides, use of medications, and lower socioeconomic status. Individuals in cluster U had increased odds (between 1.10 and 1.65) of being relatively metabolically unhealthy and presented a higher 5-year ASCVD risk (mean risk 0.059 ± 0.071 vs 0.047 ± 0.042, p < 0.001).
Interpretation
We provide evidence of a life–course relationship between gut microbiome profiles and metabolic health.
Funding
R.L is supported by European UnionHorizon 2020 research and innovation program under Marie Skłodowska-Curie grant agreement No 860898 [FIDELIO].
{"title":"Association between gut microbiome profiles and host metabolic health across the life course: a population-based study","authors":"Ruolin Li , Alexander Kurilshikov , Shuyue Yang , Julie A.E. van Oortmerssen , Arno van Hilten , Fariba Ahmadizar , Gennady Roshchupkin , Robert Kraaij , Liesbeth Duijts , Jingyuan Fu , M. Kamran Ikram , Vincent W.V. Jaddoe , André G. Uitterlinden , Fernando Rivadeneira , Maryam Kavousi , Alexandra Zhernakova , Carolina Medina-Gomez","doi":"10.1016/j.lanepe.2024.101195","DOIUrl":"10.1016/j.lanepe.2024.101195","url":null,"abstract":"<div><h3>Background</h3><div>The human gut microbiome changes considerably over time. Previous studies have shown that gut microbiome profiles correlate with multiple metabolic traits. As disease development is likely a lifelong process, evidence gathered at different life stages would help gain a better understanding of this correlation. Therefore, we aim to investigate how the association of the gut microbiome and metabolic traits change over the lifespan.</div></div><div><h3>Methods</h3><div>We identified microbiome patterns (clusters) within two population-based cohorts at different life stages, i.e., pre-adolescents of the Generation R Study (mean age 9.8 years; n = 1488) and older adults of the Rotterdam Study (RS, mean age 62.7 years; n = 1265) using K-Means clustering, and surveyed for host metabolic phenotypes, lifestyles and other factors driving these patterns. Analyses were replicated in the Lifelines-DEEP Study (mean age 45.0 years; n = 1117). The association between microbiome clusters and host metabolic health was evaluated as well as the link between microbiome clusters and incident atherosclerotic cardiovascular disease (ASCVD) in RS during follow-up (median 6.5 years).</div></div><div><h3>Findings</h3><div>We identified two distinct microbiome clusters (U and H) within each study population presenting contrasting metabolic statuses. Cluster U was characterized by lower microbiome diversity, increased <em>Streptococcus</em>, <em>Fusicatenibacter</em>, and decreased <em>Prevotella_9</em> and <em>Christensenellaceae_R-7_group</em>; wherein individuals showed higher fat percentage, triglycerides, use of medications, and lower socioeconomic status. Individuals in cluster U had increased odds (between 1.10 and 1.65) of being relatively metabolically unhealthy and presented a higher 5-year ASCVD risk (mean risk 0.059 ± 0.071 vs 0.047 ± 0.042, p < 0.001).</div></div><div><h3>Interpretation</h3><div>We provide evidence of a life–course relationship between gut microbiome profiles and metabolic health.</div></div><div><h3>Funding</h3><div>R.L is supported by <span>European Union</span> <span>Horizon 2020</span> research and innovation program under <span>Marie Skłodowska-Curie</span> grant agreement No 860898 [FIDELIO].</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101195"},"PeriodicalIF":13.6,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号