Pub Date : 2024-12-04eCollection 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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>European Union's Horizon Europe research and innovation programme.</p>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"101149"},"PeriodicalIF":13.6,"publicationDate":"2024-12-04","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 : 2024-12-03DOI: 10.1016/j.lanepe.2024.101154
Julia Wiersinga , Sofie Jansen , Mike J.L. Peters , Hanneke F.M. Rhodius-Meester , Marijke C. Trappenburg , Jurgen A.H.R. Claassen , Majon Muller
Hypertension and orthostatic hypotension (OH) frequently coexist in the older population, both stemming from impaired blood pressure (BP) regulation. Managing hypertension in patients with OH presents a significant clinical challenge, particularly in frail older adults who are also prone to falls. Hypertension treatment is often suboptimal in this population due to concerns over the potential increased risk of falls associated with treatment. However, current clinical guidelines provide limited guidance on managing this complex issue. This review explores the pathophysiology of hypertension and OH, reviews existing guidelines, and examines the evidence surrounding hypertension management in patients with OH. Additionally, we provide an overview of research focused on frail older adults and offer expert-opinion-based recommendations for the management of hypertension and OH in routine clinical practice.
{"title":"Hypertension and orthostatic hypotension in the elderly: a challenging balance","authors":"Julia Wiersinga , Sofie Jansen , Mike J.L. Peters , Hanneke F.M. Rhodius-Meester , Marijke C. Trappenburg , Jurgen A.H.R. Claassen , Majon Muller","doi":"10.1016/j.lanepe.2024.101154","DOIUrl":"10.1016/j.lanepe.2024.101154","url":null,"abstract":"<div><div>Hypertension and orthostatic hypotension (OH) frequently coexist in the older population, both stemming from impaired blood pressure (BP) regulation. Managing hypertension in patients with OH presents a significant clinical challenge, particularly in frail older adults who are also prone to falls. Hypertension treatment is often suboptimal in this population due to concerns over the potential increased risk of falls associated with treatment. However, current clinical guidelines provide limited guidance on managing this complex issue. This review explores the pathophysiology of hypertension and OH, reviews existing guidelines, and examines the evidence surrounding hypertension management in patients with OH. Additionally, we provide an overview of research focused on frail older adults and offer expert-opinion-based recommendations for the management of hypertension and OH in routine clinical practice.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101154"},"PeriodicalIF":13.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758809","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 : 2024-12-03DOI: 10.1016/j.lanepe.2024.101164
Job F.M. van Boven , Alexandra L. Dima , Björn Wettermark , Ines Potočnjak , Tamás Ágh
{"title":"Leveraging digital medication adherence technologies to enhance sustainability of European health systems: ENABLE’s key recommendations","authors":"Job F.M. van Boven , Alexandra L. Dima , Björn Wettermark , Ines Potočnjak , Tamás Ágh","doi":"10.1016/j.lanepe.2024.101164","DOIUrl":"10.1016/j.lanepe.2024.101164","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101164"},"PeriodicalIF":13.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758808","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}
Background: In recent decades, relapsing remitting multiple sclerosis (MS) became more treatable through new disease-modifying therapies (DMTs). Identifying safe treatments with minimal fetal risks for family planning is needed.
Methods: In this prospective cohort from the German MS and Pregnancy Registry (DMSKW), we analyzed pregnancy and neonatal outcomes in MS-patients using descriptive statistics and logistic/linear regression models to compare DMT-exposed pregnancies to DMT-unexposed pregnancies.
Findings: In 2885 DMT-exposed and 837 DMT-unexposed pregnancies, exposure was not associated with spontaneous abortions, preterm births or major congenital anomalies (MCAs). Severe infections were rare, but more frequent in the Fumarates-group (11/395: 2.8% vs. 8/837 unexposed-group: 1.0%, p-value: 0.03). Antibiotic-use was associated with 2nd-trimester (OR: 2.47, CI: 1.47, 4.05, p-value: <0.001), 3rd-trimester Natalizumab-exposure (OR: 1.75, CI: 1.15, 2.63, p-value: 0.01), and anti-CD20-exposure (OR: 2.16, CI: 1.41, 3.29, p-value: <0.001). Birthweight was significantly reduced in the Sphingosine-1-phosphate-group (β: -132 g, CI: -205, -60, p-value: <0.001), and 3rd-trimester Natalizumab-subgroup (β: -74 g, CI: -138, -9.4, p-value: 0.02). Small for gestational age (SGA) neonates were common in the Sphingosine-1-phospate- (OR: 1.65, CI: 1.07, 2.50, p-value: 0.02) and anti-CD20-group (OR: 1.54, CI: 1.01, 2.32, p-value: 0.04), and also the entire cohort (651/3459: 18.8%), exceeding the general German population rate (10%) (p-value: <0.001).
Interpretation: We observed an increased SGA risk, especially following highly-effective DMTs, although the pathomechanisms remain unclear. More research is needed on infection risks and MCAs, perhaps by linking different registries.
Funding: The DMSKW is partly supported by Almirall, Biogen, Hexal, Merck, Novartis, Roche, Sanofi Genzyme, Teva Pharma and Viatris.
背景：近几十年来，通过新的疾病修饰疗法（dmt），复发缓解型多发性硬化症（MS）变得更容易治疗。为计划生育确定胎儿风险最小的安全治疗方法是必要的。方法：在这个来自德国MS和妊娠登记处（DMSKW）的前瞻性队列中，我们使用描述性统计和logistic/线性回归模型分析MS患者的妊娠和新生儿结局，比较dmt暴露妊娠和未暴露妊娠。结果：在2885例接触dmt和837例未接触dmt的妊娠中，接触dmt与自然流产、早产或重大先天性异常（MCAs）无关。严重感染罕见，但富马酸酯组更常见（11/395:2.8% vs. 8/837未暴露组：1.0%，p值：0.03）。使用抗生素与妊娠中期相关（OR: 2.47, CI: 1.47, 4.05， p值）：解释：我们观察到SGA风险增加，特别是在高效dmt后，尽管病理机制尚不清楚。需要对感染风险和MCAs进行更多的研究，或许可以通过将不同的登记处联系起来。资金：DMSKW部分由Almirall、Biogen、Hexal、Merck、Novartis、Roche、Sanofi Genzyme、Teva Pharma和Viatris提供支持。
{"title":"Impact of disease-modifying therapies on pregnancy outcomes in multiple sclerosis: a prospective cohort study from the German multiple sclerosis and pregnancy registry.","authors":"Nadine Bast, Karen Dost-Kovalsky, Sabrina Haben, Natalia Friedmann, Laura Witt, Theresa Oganowski, Ralf Gold, Sandra Thiel, Kerstin Hellwig","doi":"10.1016/j.lanepe.2024.101137","DOIUrl":"10.1016/j.lanepe.2024.101137","url":null,"abstract":"<p><strong>Background: </strong>In recent decades, relapsing remitting multiple sclerosis (MS) became more treatable through new disease-modifying therapies (DMTs). Identifying safe treatments with minimal fetal risks for family planning is needed.</p><p><strong>Methods: </strong>In this prospective cohort from the German MS and Pregnancy Registry (DMSKW), we analyzed pregnancy and neonatal outcomes in MS-patients using descriptive statistics and logistic/linear regression models to compare DMT-exposed pregnancies to DMT-unexposed pregnancies.</p><p><strong>Findings: </strong>In 2885 DMT-exposed and 837 DMT-unexposed pregnancies, exposure was not associated with spontaneous abortions, preterm births or major congenital anomalies (MCAs). Severe infections were rare, but more frequent in the Fumarates-group (11/395: 2.8% vs. 8/837 unexposed-group: 1.0%, p-value: 0.03). Antibiotic-use was associated with 2nd-trimester (OR: 2.47, CI: 1.47, 4.05, p-value: <0.001), 3rd-trimester Natalizumab-exposure (OR: 1.75, CI: 1.15, 2.63, p-value: 0.01), and anti-CD20-exposure (OR: 2.16, CI: 1.41, 3.29, p-value: <0.001). Birthweight was significantly reduced in the Sphingosine-1-phosphate-group (β: -132 g, CI: -205, -60, p-value: <0.001), and 3rd-trimester Natalizumab-subgroup (β: -74 g, CI: -138, -9.4, p-value: 0.02). Small for gestational age (SGA) neonates were common in the Sphingosine-1-phospate- (OR: 1.65, CI: 1.07, 2.50, p-value: 0.02) and anti-CD20-group (OR: 1.54, CI: 1.01, 2.32, p-value: 0.04), and also the entire cohort (651/3459: 18.8%), exceeding the general German population rate (10%) (p-value: <0.001).</p><p><strong>Interpretation: </strong>We observed an increased SGA risk, especially following highly-effective DMTs, although the pathomechanisms remain unclear. More research is needed on infection risks and MCAs, perhaps by linking different registries.</p><p><strong>Funding: </strong>The DMSKW is partly supported by Almirall, Biogen, Hexal, Merck, Novartis, Roche, Sanofi Genzyme, Teva Pharma and Viatris.</p>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"101137"},"PeriodicalIF":13.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985370","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 : 2024-12-01DOI: 10.1016/j.lanepe.2024.101145
Christoph Wilhelm , Anke Steckelberg , Felix G. Rebitschek
<div><h3>Background</h3><div>Despite notable advancements in artificial intelligence (AI) that enable complex systems to perform certain tasks more accurately than medical experts, the impact on patient-relevant outcomes remains uncertain. To address this gap, this systematic review assesses the benefits and harms associated with AI-related algorithmic decision-making (ADM) systems used by healthcare professionals, compared to standard care.</div></div><div><h3>Methods</h3><div>In accordance with the PRISMA guidelines, we included interventional and observational studies published as peer-reviewed full-text articles that met the following criteria: human patients; interventions involving algorithmic decision-making systems, developed with and/or utilizing machine learning (ML); and outcomes describing patient-relevant benefits and harms that directly affect health and quality of life, such as mortality and morbidity. Studies that did not undergo preregistration, lacked a standard-of-care control, or pertained to systems that assist in the execution of actions (e.g., in robotics) were excluded. We searched MEDLINE, EMBASE, IEEE Xplore, and Google Scholar for studies published in the past decade up to 31 March 2024. We assessed risk of bias using Cochrane's RoB 2 and ROBINS-I tools, and reporting transparency with CONSORT-AI and TRIPOD-AI. Two researchers independently managed the processes and resolved conflicts through discussion. This review has been registered with PROSPERO (CRD42023412156) and the study protocol has been published.</div></div><div><h3>Findings</h3><div>Out of 2,582 records identified after deduplication, 18 randomized controlled trials (RCTs) and one cohort study met the inclusion criteria, covering specialties such as psychiatry, oncology, and internal medicine. Collectively, the studies included a median of 243 patients (IQR 124–828), with a median of 50.5% female participants (range 12.5–79.0, IQR 43.6–53.6) across intervention and control groups. Four studies were classified as having low risk of bias, seven showed some concerns, and another seven were assessed as having high or serious risk of bias. Reporting transparency varied considerably: six studies showed high compliance, four moderate, and five low compliance with CONSORT-AI or TRIPOD-AI. Twelve studies (63%) reported patient-relevant benefits. Of those with low risk of bias, interventions reduced length of stay in hospital and intensive care unit (10.3 vs. 13.0 days, p = 0.042; 6.3 vs. 8.4 days, p = 0.030), in-hospital mortality (9.0% vs. 21.3%, p = 0.018), and depression symptoms in non-complex cases (45.1% vs. 52.3%, p = 0.03). However, harms were frequently underreported, with only eight studies (42%) documenting adverse events. No study reported an increase in adverse events as a result of the interventions.</div></div><div><h3>Interpretation</h3><div>The current evidence on AI-related ADM systems provides limited insights into patient-relevant outcomes. Our f
{"title":"Benefits and harms associated with the use of AI-related algorithmic decision-making systems by healthcare professionals: a systematic review","authors":"Christoph Wilhelm , Anke Steckelberg , Felix G. Rebitschek","doi":"10.1016/j.lanepe.2024.101145","DOIUrl":"10.1016/j.lanepe.2024.101145","url":null,"abstract":"<div><h3>Background</h3><div>Despite notable advancements in artificial intelligence (AI) that enable complex systems to perform certain tasks more accurately than medical experts, the impact on patient-relevant outcomes remains uncertain. To address this gap, this systematic review assesses the benefits and harms associated with AI-related algorithmic decision-making (ADM) systems used by healthcare professionals, compared to standard care.</div></div><div><h3>Methods</h3><div>In accordance with the PRISMA guidelines, we included interventional and observational studies published as peer-reviewed full-text articles that met the following criteria: human patients; interventions involving algorithmic decision-making systems, developed with and/or utilizing machine learning (ML); and outcomes describing patient-relevant benefits and harms that directly affect health and quality of life, such as mortality and morbidity. Studies that did not undergo preregistration, lacked a standard-of-care control, or pertained to systems that assist in the execution of actions (e.g., in robotics) were excluded. We searched MEDLINE, EMBASE, IEEE Xplore, and Google Scholar for studies published in the past decade up to 31 March 2024. We assessed risk of bias using Cochrane's RoB 2 and ROBINS-I tools, and reporting transparency with CONSORT-AI and TRIPOD-AI. Two researchers independently managed the processes and resolved conflicts through discussion. This review has been registered with PROSPERO (CRD42023412156) and the study protocol has been published.</div></div><div><h3>Findings</h3><div>Out of 2,582 records identified after deduplication, 18 randomized controlled trials (RCTs) and one cohort study met the inclusion criteria, covering specialties such as psychiatry, oncology, and internal medicine. Collectively, the studies included a median of 243 patients (IQR 124–828), with a median of 50.5% female participants (range 12.5–79.0, IQR 43.6–53.6) across intervention and control groups. Four studies were classified as having low risk of bias, seven showed some concerns, and another seven were assessed as having high or serious risk of bias. Reporting transparency varied considerably: six studies showed high compliance, four moderate, and five low compliance with CONSORT-AI or TRIPOD-AI. Twelve studies (63%) reported patient-relevant benefits. Of those with low risk of bias, interventions reduced length of stay in hospital and intensive care unit (10.3 vs. 13.0 days, p = 0.042; 6.3 vs. 8.4 days, p = 0.030), in-hospital mortality (9.0% vs. 21.3%, p = 0.018), and depression symptoms in non-complex cases (45.1% vs. 52.3%, p = 0.03). However, harms were frequently underreported, with only eight studies (42%) documenting adverse events. No study reported an increase in adverse events as a result of the interventions.</div></div><div><h3>Interpretation</h3><div>The current evidence on AI-related ADM systems provides limited insights into patient-relevant outcomes. Our f","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101145"},"PeriodicalIF":13.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757803","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 : 2024-11-30DOI: 10.1016/j.lanepe.2024.101153
Joost Boeckmans , Jürgen H. Prochaska , Alexander Gieswinkel , Michael Böhm , Philipp S. Wild , Jörn M. Schattenberg
Background
The liver–heart axis potentially influences the risk of mortality in patients with heart failure. We aimed to identify the clinical utility of the fibrosis-4 (FIB-4) index in patients with heart failure for predicting mortality in the context of metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods
Patients with heart failure and a subsample of healthy participants were enrolled in the MyoVasc study (NCT04064450) and followed for nine years. Participants with excessive alcohol consumption were excluded. The Fatty Liver Index (FLI) and FIB-4 index were used to classify MASLD and hepatic fibrosis, respectively. Data were adjusted for potential confounders. The primary endpoint was all-cause mortality.
Findings
2726 participants, including 172 healthy individuals, were included in the study. The participants had a mean age of 64.4 ± 11.2 years and a median FIB-4 index of 1.59 (interquartile range [1.17; 2.17]). There were 532 deaths. The FIB-4 index was predictive for all-cause mortality (hazard ratio (HR) 1.341, 95% confidence interval (CI) [1.273; 1.412], p < 0.0001). The HRs and 95% CIs for the FIB-4 index in FLI categories were 1.597 [1.256; 2.031] (p = 0.00013, FLI <30), 1.802 [1.519; 2.138] (p < 0.0001, FLI 30–60), and 1.292 [1.215; 1.374] (p < 0.0001, FLI ≥60). The interaction term for the FIB-4 index with FLI ≥60 (reference FLI <30) was HR 0.774 [0.617; 0.972] (p = 0.027), indicating a smaller impact of the FIB-4 index in FLI ≥60 than in FLI <30 (HR 1.664 [1.333; 2.077], p < 0.0001). Multivariable linear regressions revealed relevant independent relationships between the FIB-4 index and N-terminal pro-B-type natriuretic peptide, systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy in participants with a FLI below 60.
Interpretation
In patients with heart failure, the FIB-4 index predicts all-cause mortality and relates to cardiac functional and structural changes, especially in those without MASLD.
{"title":"Clinical utility of the Fibrosis-4 index for predicting mortality in patients with heart failure with or without metabolic dysfunction-associated steatotic liver disease: a prospective cohort study","authors":"Joost Boeckmans , Jürgen H. Prochaska , Alexander Gieswinkel , Michael Böhm , Philipp S. Wild , Jörn M. Schattenberg","doi":"10.1016/j.lanepe.2024.101153","DOIUrl":"10.1016/j.lanepe.2024.101153","url":null,"abstract":"<div><h3>Background</h3><div>The liver–heart axis potentially influences the risk of mortality in patients with heart failure. We aimed to identify the clinical utility of the fibrosis-4 (FIB-4) index in patients with heart failure for predicting mortality in the context of metabolic dysfunction-associated steatotic liver disease (MASLD).</div></div><div><h3>Methods</h3><div>Patients with heart failure and a subsample of healthy participants were enrolled in the MyoVasc study (<span><span>NCT04064450</span><svg><path></path></svg></span>) and followed for nine years. Participants with excessive alcohol consumption were excluded. The Fatty Liver Index (FLI) and FIB-4 index were used to classify MASLD and hepatic fibrosis, respectively. Data were adjusted for potential confounders. The primary endpoint was all-cause mortality.</div></div><div><h3>Findings</h3><div>2726 participants, including 172 healthy individuals, were included in the study. The participants had a mean age of 64.4 ± 11.2 years and a median FIB-4 index of 1.59 (interquartile range [1.17; 2.17]). There were 532 deaths. The FIB-4 index was predictive for all-cause mortality (hazard ratio (HR) 1.341, 95% confidence interval (CI) [1.273; 1.412], p < 0.0001). The HRs and 95% CIs for the FIB-4 index in FLI categories were 1.597 [1.256; 2.031] (p = 0.00013, FLI <30), 1.802 [1.519; 2.138] (p < 0.0001, FLI 30–60), and 1.292 [1.215; 1.374] (p < 0.0001, FLI ≥60). The interaction term for the FIB-4 index with FLI ≥60 (reference FLI <30) was HR 0.774 [0.617; 0.972] (p = 0.027), indicating a smaller impact of the FIB-4 index in FLI ≥60 than in FLI <30 (HR 1.664 [1.333; 2.077], p < 0.0001). Multivariable linear regressions revealed relevant independent relationships between the FIB-4 index and N-terminal pro-B-type natriuretic peptide, systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy in participants with a FLI below 60.</div></div><div><h3>Interpretation</h3><div>In patients with heart failure, the FIB-4 index predicts all-cause mortality and relates to cardiac functional and structural changes, especially in those without MASLD.</div></div><div><h3>Funding</h3><div>Johannes Gutenberg-University Mainz.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101153"},"PeriodicalIF":13.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757802","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}
<div><h3>Background</h3><div>Migrant populations are at increased risk of developing mental health problems. We aimed to compare the efficacy and acceptability of psychosocial interventions in this population.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and network meta-analysis (NMA). Cochrane Central Register of randomised trials (CENTRAL), MEDLINE, PTSDpubs, PsycINFO, PubMed, CINAHL, EMBASE, Web of Science, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> were searched from database inception to October 7, 2024, to identify randomized clinical trials assessing the efficacy of psychosocial interventions for migrant populations in reducing symptoms of post-traumatic stress disorder (PTSD), depression or anxiety. Studies with second-generation migrants were excluded if they comprised over 20% of participants. Two independent researchers screened, reviewed, and extracted data. The primary outcomes were the severity of PTSD, depression, and anxiety symptoms at post-intervention. Secondary outcomes included acceptability. Standardised mean differences (SMDs) and risk ratios (RRs) were pooled using pairwise and NMA. PROSPERO: CRD42023418817.</div></div><div><h3>Findings</h3><div>Of the 103 studies with 19,230 participants included, 96 contributed to the meta-analyses for at least one outcome, with women representing 64% of the participants. Narrative Exposure Therapy (NET), counselling, Eye Movement Desensitization and Reprocessing (EMDR), and creative expressive interventions demonstrated greater efficacy than treatment as usual (TAU) in reducing PTSD symptoms, with SMDs [95% Confidence Intervals (CIs)] ranging from −0.69 [−1.14, −0.24] to −0.60 [−1.20, −0.01], albeit with low confidence in the evidence. For depressive symptoms, Integrative therapy emerged as the top intervention compared to TAU, with moderate confidence (SMD [95% CI] = −0.70 [−1.21, −0.20]). For anxiety symptoms, NET, Integrative therapy, and Problem Management Plus (PM+)/Step-by-Step (SbS) were more effective than TAU, with SMDs [95% CIs] ranging from −1.32 [−2.05, −0.59] to −0.35 [−0.65, −0.05]. Still, the confidence in the evidence was low. Overall, head-to-head comparisons yielded inconclusive results, and the acceptability analysis revealed variations across interventions. 16% of the studies (17 studies) were classified as “high risk” of bias, 68% (70) as having “some concerns”, and 18% (19) as “low risk”. We identified considerable heterogeneity (I<sup>2</sup> of >70%).</div></div><div><h3>Interpretation</h3><div>The analysis revealed no clear differences in the efficacy of psychosocial interventions compared to TAU for reducing symptoms of PTSD, depression, and anxiety. While certain interventions showed potential benefits, confidence in these findings was generally low, limiting the ability to draw definitive conclusions about their comparative effectiveness.</div></div><div><h3>Funding</h3><div>This research rece
{"title":"Comparative efficacy and acceptability of psychosocial interventions for PTSD, depression, and anxiety in asylum seekers, refugees, and other migrant populations: a systematic review and network meta-analysis of randomised controlled studies","authors":"Giulia Turrini , Marianna Purgato , Camilla Cadorin , Monica Bartucz , Doriana Cristofalo , Chiara Gastaldon , Michela Nosè , Giovanni Ostuzzi , Davide Papola , Eleonora Prina , Federico Tedeschi , Anke B. Witteveen , Marit Sijbrandij , Corrado Barbui","doi":"10.1016/j.lanepe.2024.101152","DOIUrl":"10.1016/j.lanepe.2024.101152","url":null,"abstract":"<div><h3>Background</h3><div>Migrant populations are at increased risk of developing mental health problems. We aimed to compare the efficacy and acceptability of psychosocial interventions in this population.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and network meta-analysis (NMA). Cochrane Central Register of randomised trials (CENTRAL), MEDLINE, PTSDpubs, PsycINFO, PubMed, CINAHL, EMBASE, Web of Science, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> were searched from database inception to October 7, 2024, to identify randomized clinical trials assessing the efficacy of psychosocial interventions for migrant populations in reducing symptoms of post-traumatic stress disorder (PTSD), depression or anxiety. Studies with second-generation migrants were excluded if they comprised over 20% of participants. Two independent researchers screened, reviewed, and extracted data. The primary outcomes were the severity of PTSD, depression, and anxiety symptoms at post-intervention. Secondary outcomes included acceptability. Standardised mean differences (SMDs) and risk ratios (RRs) were pooled using pairwise and NMA. PROSPERO: CRD42023418817.</div></div><div><h3>Findings</h3><div>Of the 103 studies with 19,230 participants included, 96 contributed to the meta-analyses for at least one outcome, with women representing 64% of the participants. Narrative Exposure Therapy (NET), counselling, Eye Movement Desensitization and Reprocessing (EMDR), and creative expressive interventions demonstrated greater efficacy than treatment as usual (TAU) in reducing PTSD symptoms, with SMDs [95% Confidence Intervals (CIs)] ranging from −0.69 [−1.14, −0.24] to −0.60 [−1.20, −0.01], albeit with low confidence in the evidence. For depressive symptoms, Integrative therapy emerged as the top intervention compared to TAU, with moderate confidence (SMD [95% CI] = −0.70 [−1.21, −0.20]). For anxiety symptoms, NET, Integrative therapy, and Problem Management Plus (PM+)/Step-by-Step (SbS) were more effective than TAU, with SMDs [95% CIs] ranging from −1.32 [−2.05, −0.59] to −0.35 [−0.65, −0.05]. Still, the confidence in the evidence was low. Overall, head-to-head comparisons yielded inconclusive results, and the acceptability analysis revealed variations across interventions. 16% of the studies (17 studies) were classified as “high risk” of bias, 68% (70) as having “some concerns”, and 18% (19) as “low risk”. We identified considerable heterogeneity (I<sup>2</sup> of >70%).</div></div><div><h3>Interpretation</h3><div>The analysis revealed no clear differences in the efficacy of psychosocial interventions compared to TAU for reducing symptoms of PTSD, depression, and anxiety. While certain interventions showed potential benefits, confidence in these findings was generally low, limiting the ability to draw definitive conclusions about their comparative effectiveness.</div></div><div><h3>Funding</h3><div>This research rece","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101152"},"PeriodicalIF":13.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744150","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 : 2024-11-29eCollection 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":"<p><p>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.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"101135"},"PeriodicalIF":13.6,"publicationDate":"2024-11-29","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 : 2024-11-27DOI: 10.1016/j.lanepe.2024.101147
Iain M. Carey , Julia A. Critchley , Umar A.R. Chaudhry , Stephen DeWilde , Elizabeth S. Limb , Liza Bowen , Selma Audi , Derek G. Cook , Peter H. Whincup , Naveed Sattar , Arshia Panahloo , Tess Harris
Background
While people with type 2 diabetes (T2D) are more susceptible to infections, studies potentially underestimate the true burden of infection-related mortality since they rely on clinical coding systems primarily structured by body system, and by only focusing on underlying cause. This study examined cause-specific mortality in people with T2D compared to the general population during 2015–2019, focusing on infections.
Methods
509,403 people aged 41–90 years with T2D alive on 1/1/2015 in Clinical Practice Research Datalink were matched to 976,431 without diabetes on age, sex, and ethnicity. Recorded underlying cause of death was identified through national linked mortality data; infection-related deaths were counted across all ICD-10 (10th revision of the International Classification of Diseases) chapters, not just infection chapters A00-B99. All-cause and cause-specific hazard ratios (HR) for mortality during 2015–2019 compared people with T2D to people without diabetes and were estimated using Cox models adjusting for region. Additional analyses for sepsis related mortality considered the impact of including any mention of sepsis on the death certificate.
Findings
85,367/509,403 (16.8%) people with T2D died during 2015–2019 compared to 106,824/976,431 (10.9%) of people without diabetes of the same sex, age and ethnicity. All infections (11,128/85,367 = 13.0%) represented the third highest underlying cause of death among people with T2D after cardiovascular disease and cancer; a much higher contribution than counting only from specific infection chapters (1046/85,367 = 1.2%). The HR for people with T2D vs non-diabetes for all infection mortality (1.82, 95% CI 1.78–1.86) was higher than that estimated for all-cause (HR = 1.65, 95% CI 1.64–1.66). The estimated mortality rate associated with sepsis among people with T2D was highly dependent on whether any mention was included (2.2 per 1000 person-years) or only underlying cause (0.2 per 1000 person-years); but the HR for people with T2D vs non-diabetes was similar (any mention HR = 2.26, 95% CI 2.19–2.34 vs underlying cause only HR = 2.52, 95% CI 2.27–2.80).
Interpretation
People with T2D die from infections at a higher rate than similar people without diabetes, and the overall burden is greater than previously reported. Routine statistics concentrating on underlying cause of death may somewhat under-estimate the importance of infections as causes of death among people with T2D. These findings emphasise the potential importance of awareness, earlier diagnosis and treatment of infections to prevent premature deaths.
Funding
National Institute for Health and Care Research.
背景虽然2型糖尿病（T2D）患者更容易受到感染，但由于研究依赖于主要按身体系统划分的临床编码系统，而且只关注潜在病因，因此可能低估了感染相关死亡率的真实负担。本研究调查了 2015-2019 年期间 T2D 患者与普通人群相比的特异性死因，重点关注感染。方法将临床实践研究数据链中 2015 年 1 月 1 日在世的 509,403 名 41-90 岁 T2D 患者与 976,431 名非糖尿病患者进行年龄、性别和种族匹配。记录的基本死因通过国家链接的死亡数据确定；与感染相关的死亡计入 ICD-10（国际疾病分类第 10 次修订版）的所有章节，而不仅仅是感染章节 A00-B99。2015-2019年期间的全因死亡率和特定病因死亡率危险比（HR）将患有T2D的人与未患有糖尿病的人进行了比较，并使用Cox模型进行了估算，同时对地区进行了调整。对脓毒症相关死亡率的附加分析考虑了在死亡证明中提及脓毒症的影响。研究结果2015-2019年间，85,367/509,403（16.8%）名T2D患者死亡，而相同性别、年龄和种族的非糖尿病患者死亡人数为106,824/976,431（10.9%）。所有感染（11,128/85,367 = 13.0%）是继心血管疾病和癌症之后导致 T2D 患者死亡的第三大根本原因；这一比例远高于仅计算特定感染章节（1046/85,367 = 1.2%）的比例。就所有感染死亡率而言，T2D 患者与非糖尿病患者的 HR 值（1.82，95% CI 1.78-1.86）高于全因死亡率的估计值（HR = 1.65，95% CI 1.64-1.66）。T2D患者中与败血症相关的估计死亡率在很大程度上取决于是否包括任何提及（每1000人年2.2例）或仅包括潜在病因（每1000人年0.2例）；但T2D患者与非糖尿病患者的HR相似（任何提及HR = 2.26，95% CI 2.19-2.34 vs 仅包括潜在病因HR = 2.52，95% CI 2.27-2.80）。集中于基本死因的常规统计可能在一定程度上低估了感染作为 T2D 患者死因的重要性。这些发现强调了认识、早期诊断和治疗感染对预防过早死亡的潜在重要性。
{"title":"Contribution of infection to mortality in people with type 2 diabetes: a population-based cohort study using electronic records","authors":"Iain M. Carey , Julia A. Critchley , Umar A.R. Chaudhry , Stephen DeWilde , Elizabeth S. Limb , Liza Bowen , Selma Audi , Derek G. Cook , Peter H. Whincup , Naveed Sattar , Arshia Panahloo , Tess Harris","doi":"10.1016/j.lanepe.2024.101147","DOIUrl":"10.1016/j.lanepe.2024.101147","url":null,"abstract":"<div><h3>Background</h3><div>While people with type 2 diabetes (T2D) are more susceptible to infections, studies potentially underestimate the true burden of infection-related mortality since they rely on clinical coding systems primarily structured by body system, and by only focusing on underlying cause. This study examined cause-specific mortality in people with T2D compared to the general population during 2015–2019, focusing on infections.</div></div><div><h3>Methods</h3><div>509,403 people aged 41–90 years with T2D alive on 1/1/2015 in Clinical Practice Research Datalink were matched to 976,431 without diabetes on age, sex, and ethnicity. Recorded underlying cause of death was identified through national linked mortality data; infection-related deaths were counted across all ICD-10 (10th revision of the International Classification of Diseases) chapters, not just infection chapters A00-B99. All-cause and cause-specific hazard ratios (HR) for mortality during 2015–2019 compared people with T2D to people without diabetes and were estimated using Cox models adjusting for region. Additional analyses for sepsis related mortality considered the impact of including any mention of sepsis on the death certificate.</div></div><div><h3>Findings</h3><div>85,367/509,403 (16.8%) people with T2D died during 2015–2019 compared to 106,824/976,431 (10.9%) of people without diabetes of the same sex, age and ethnicity. All infections (11,128/85,367 = 13.0%) represented the third highest underlying cause of death among people with T2D after cardiovascular disease and cancer; a much higher contribution than counting only from specific infection chapters (1046/85,367 = 1.2%). The HR for people with T2D vs non-diabetes for all infection mortality (1.82, 95% CI 1.78–1.86) was higher than that estimated for all-cause (HR = 1.65, 95% CI 1.64–1.66). The estimated mortality rate associated with sepsis among people with T2D was highly dependent on whether any mention was included (2.2 per 1000 person-years) or only underlying cause (0.2 per 1000 person-years); but the HR for people with T2D vs non-diabetes was similar (any mention HR = 2.26, 95% CI 2.19–2.34 vs underlying cause only HR = 2.52, 95% CI 2.27–2.80).</div></div><div><h3>Interpretation</h3><div>People with T2D die from infections at a higher rate than similar people without diabetes, and the overall burden is greater than previously reported. Routine statistics concentrating on underlying cause of death may somewhat under-estimate the importance of infections as causes of death among people with T2D. These findings emphasise the potential importance of awareness, earlier diagnosis and treatment of infections to prevent premature deaths.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101147"},"PeriodicalIF":13.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723014","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 : 2024-11-27DOI: 10.1016/j.lanepe.2024.101156
Christopher J. Graham
{"title":"Alcohol normalisation in Europe: the role of alcohol sports sponsorship","authors":"Christopher J. Graham","doi":"10.1016/j.lanepe.2024.101156","DOIUrl":"10.1016/j.lanepe.2024.101156","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"48 ","pages":"Article 101156"},"PeriodicalIF":13.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723013","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}
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