Pub Date : 2026-03-01Epub Date: 2026-01-05DOI: 10.1016/j.lanepe.2025.101569
Walter Pirker , Joaquim J. Ferreira , Olivier Rascol , Werner Poewe
Hallucinations and delusions are among the most disabling long-term complications of Parkinson's disease (PD). Their pathogenesis is based on a complex interaction of neurodegeneration in critical areas for visual and cognitive processing and PD medication effects. Management rests on the identification and treatment of acute triggers, simplification of PD medication and treatment with antipsychotics. Despite the high prevalence of psychosis in advanced PD there is still a lack of familiarity with its manifestations and therapeutic approaches. This gap is further enhanced by recent developments in drug availability and therapeutic monitoring. Pimavanserin is the only approved drug for the treatment of PD psychosis in the U.S., but currently not marketed elsewhere. The aim of this review is to provide an update on the management options for PD psychosis in other regions of the world with a focus on clinical practice in Europe. Quetiapine and clozapine remain cornerstones of treatment of PD psychosis in Europe. Despite limited evidence for efficacy, quetiapine is often used as first-line therapy, whereas severe PD psychosis usually requires treatment with clozapine, with clozapine demonstrating efficacy without worsening of motor symptoms in randomised, controlled trials. Other antipsychotics should be avoided in PD psychosis due to their ineffectiveness or high potential for worsening parkinsonian motor symptoms. Novel drugs with a better risk-benefit ratio in the treatment of PD psychosis are needed. Non-pharmacological treatments should be explored in relation to their potential to prevent or mitigate psychotic reactions in prospective studies.
{"title":"Management of Parkinson's disease psychosis—a European perspective","authors":"Walter Pirker , Joaquim J. Ferreira , Olivier Rascol , Werner Poewe","doi":"10.1016/j.lanepe.2025.101569","DOIUrl":"10.1016/j.lanepe.2025.101569","url":null,"abstract":"<div><div>Hallucinations and delusions are among the most disabling long-term complications of Parkinson's disease (PD). Their pathogenesis is based on a complex interaction of neurodegeneration in critical areas for visual and cognitive processing and PD medication effects. Management rests on the identification and treatment of acute triggers, simplification of PD medication and treatment with antipsychotics. Despite the high prevalence of psychosis in advanced PD there is still a lack of familiarity with its manifestations and therapeutic approaches. This gap is further enhanced by recent developments in drug availability and therapeutic monitoring. Pimavanserin is the only approved drug for the treatment of PD psychosis in the U.S., but currently not marketed elsewhere. The aim of this review is to provide an update on the management options for PD psychosis in other regions of the world with a focus on clinical practice in Europe. Quetiapine and clozapine remain cornerstones of treatment of PD psychosis in Europe. Despite limited evidence for efficacy, quetiapine is often used as first-line therapy, whereas severe PD psychosis usually requires treatment with clozapine, with clozapine demonstrating efficacy without worsening of motor symptoms in randomised, controlled trials. Other antipsychotics should be avoided in PD psychosis due to their ineffectiveness or high potential for worsening parkinsonian motor symptoms. Novel drugs with a better risk-benefit ratio in the treatment of PD psychosis are needed. Non-pharmacological treatments should be explored in relation to their potential to prevent or mitigate psychotic reactions in prospective studies.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101569"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-11DOI: 10.1016/j.lanepe.2025.101562
Juliette Brenner , Anna E.M. Bastiaansen , Mar Guasp , Sergio Muñiz-Castrillo , Takahiro Iizuka , Marienke A.A.M. de Bruijn , Amaia Muñoz-Lopetegi , Eugenia Martínez-Hernández , Géraldine Picard , Alberto Vogrig , Mathilde Millot , Carsten Finke , Christian Geis , Jan Lewerenz , Nico Melzer , Harald Prüss , Saskia Räuber , Marius Ringelstein , Kevin Rostàsy , Kurt-Wolfram Sühs , Maarten J. Titulaer
<div><h3>Background</h3><div>Anti-N-methyl-<span>d</span>-aspartate receptor (anti-NMDAR) encephalitis is a severe disease that primarily affects young people and can improve with adequate treatment. We aimed to refine the anti-NMDAR Encephalitis One-year functional Status (NEOS) score by developing NEOS2, an updated model using readily available data at the time of diagnosis. We assessed the predictive value of the NEOS2-score for (1) improvement following first-line treatment, (2) functional outcome at one-year follow-up, and (3) resumption of school or work within three years.</div></div><div><h3>Methods</h3><div>In this international (France, Germany, Japan, the Netherlands and Spain) cohort study in patients with a definite anti-NMDAR encephalitis diagnosis (according to the clinical criteria plus antibody testing in CSF), we performed logistic regression analyses to develop and validate multivariable models to predict -based upon variables available at diagnosis- short (ΔmRS two weeks after first-line treatment), middle (modified Rankin Scale [mRS] at one year), and long-term (return to school or work within three years) outcomes. We included clinical variables and biomarkers available at diagnosis.</div></div><div><h3>Findings</h3><div>We included 702 patients (mean age 23 years, 95%-CI 2–69; 79% female, 21% male) diagnosed between the discovery of the disease in 2007 and 2022. Most patients (96%; 672/702) had received first-line immunotherapy, and 38% (233/615) showed improvement within two weeks. One year after diagnosis, 80% (517/644) had a favourable functional outcome (mRS≤2). At three years, 73% (203/278) had resumed work/school. In multivariable analysis, higher age (odds ratio [OR] 0·35, 95%-CI 0·29–0·43, p < 0·0001), treatment delay (OR 0·49, 95%-CI 0·41–0·58, p < 0·0001), movement disorders (OR 0·32, 95%-CI 0·24–0·41, p < 0·0001), ICU-requirement (OR 0·34, 95%-CI 0·26–0·44, p < 0·0001) and increased CSF leucocyte count (OR 0·65, 95%-CI 0·60–0·71, p < 0·0001) independently predicted poorer outcomes (NEOS2, accuracy AUC 80%, 95%-CI 75–86%). The same variables, excluding age, were relevant in predicting improvement following first-line immunotherapy (NEOS2-T AUC 81–84%, 95%-CI 77–86%). Return-to-work or -school served as a useful measure of longer-term outcomes, predicted with equal accuracy as one-year functional outcome (NEOS2-W AUC 80%, 95%-CI 75–85%). The NEOS2-score, applied as an ordinal measure, enabled nuanced predictions of outcome probabilities across the score spectrum, ranging from a high (80%; n = 20/25) likelihood of improving after first-line immunotherapy and achieving a good outcome (100%; n = 32/32) to a high risk of first-line treatment failure (97%; n = 77/79) and no return to school/work (94%; n = 15/16).</div></div><div><h3>Interpretation</h3><div>The NEOS2-score, readily available at diagnosis and easy to apply, can identify patients with either a favourable or poor prognosis, and those who may
{"title":"Development and validation of the NEOS2 score for prediction of long-term outcomes and improvement after first-line immunotherapy in patients with anti-NMDAR encephalitis: an international cohort study","authors":"Juliette Brenner , Anna E.M. Bastiaansen , Mar Guasp , Sergio Muñiz-Castrillo , Takahiro Iizuka , Marienke A.A.M. de Bruijn , Amaia Muñoz-Lopetegi , Eugenia Martínez-Hernández , Géraldine Picard , Alberto Vogrig , Mathilde Millot , Carsten Finke , Christian Geis , Jan Lewerenz , Nico Melzer , Harald Prüss , Saskia Räuber , Marius Ringelstein , Kevin Rostàsy , Kurt-Wolfram Sühs , Maarten J. Titulaer","doi":"10.1016/j.lanepe.2025.101562","DOIUrl":"10.1016/j.lanepe.2025.101562","url":null,"abstract":"<div><h3>Background</h3><div>Anti-N-methyl-<span>d</span>-aspartate receptor (anti-NMDAR) encephalitis is a severe disease that primarily affects young people and can improve with adequate treatment. We aimed to refine the anti-NMDAR Encephalitis One-year functional Status (NEOS) score by developing NEOS2, an updated model using readily available data at the time of diagnosis. We assessed the predictive value of the NEOS2-score for (1) improvement following first-line treatment, (2) functional outcome at one-year follow-up, and (3) resumption of school or work within three years.</div></div><div><h3>Methods</h3><div>In this international (France, Germany, Japan, the Netherlands and Spain) cohort study in patients with a definite anti-NMDAR encephalitis diagnosis (according to the clinical criteria plus antibody testing in CSF), we performed logistic regression analyses to develop and validate multivariable models to predict -based upon variables available at diagnosis- short (ΔmRS two weeks after first-line treatment), middle (modified Rankin Scale [mRS] at one year), and long-term (return to school or work within three years) outcomes. We included clinical variables and biomarkers available at diagnosis.</div></div><div><h3>Findings</h3><div>We included 702 patients (mean age 23 years, 95%-CI 2–69; 79% female, 21% male) diagnosed between the discovery of the disease in 2007 and 2022. Most patients (96%; 672/702) had received first-line immunotherapy, and 38% (233/615) showed improvement within two weeks. One year after diagnosis, 80% (517/644) had a favourable functional outcome (mRS≤2). At three years, 73% (203/278) had resumed work/school. In multivariable analysis, higher age (odds ratio [OR] 0·35, 95%-CI 0·29–0·43, p < 0·0001), treatment delay (OR 0·49, 95%-CI 0·41–0·58, p < 0·0001), movement disorders (OR 0·32, 95%-CI 0·24–0·41, p < 0·0001), ICU-requirement (OR 0·34, 95%-CI 0·26–0·44, p < 0·0001) and increased CSF leucocyte count (OR 0·65, 95%-CI 0·60–0·71, p < 0·0001) independently predicted poorer outcomes (NEOS2, accuracy AUC 80%, 95%-CI 75–86%). The same variables, excluding age, were relevant in predicting improvement following first-line immunotherapy (NEOS2-T AUC 81–84%, 95%-CI 77–86%). Return-to-work or -school served as a useful measure of longer-term outcomes, predicted with equal accuracy as one-year functional outcome (NEOS2-W AUC 80%, 95%-CI 75–85%). The NEOS2-score, applied as an ordinal measure, enabled nuanced predictions of outcome probabilities across the score spectrum, ranging from a high (80%; n = 20/25) likelihood of improving after first-line immunotherapy and achieving a good outcome (100%; n = 32/32) to a high risk of first-line treatment failure (97%; n = 77/79) and no return to school/work (94%; n = 15/16).</div></div><div><h3>Interpretation</h3><div>The NEOS2-score, readily available at diagnosis and easy to apply, can identify patients with either a favourable or poor prognosis, and those who may ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101562"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-19DOI: 10.1016/j.lanepe.2025.101568
Søren K. Martiny , Morten Schmidt , Jonas A. Povlsen , Kirstine K. Søgaard , Hans E. Bøtker , Henrik T. Sørensen
Background
Socioeconomic position (SEP) influences several determinants of infective endocarditis (IE) progression. Whether IE mortality differs by SEP remains unclear. We examined 5-year mortality after IE by individual-level SEP.
Methods
Using nationwide Danish registries, we identified patients with first-time IE (2010–2022). SEP was assessed by educational and affluence level, categorised as low, medium, and high. The Kaplan–Meier estimator provided 30-day, 1-, 3-, and 5-year mortality risks, risk differences, and risk ratios. Time-varying hazard ratios were derived from flexible parametric models. We estimated attendance at outpatient and dental follow-up visits (indicating adherence to follow-up) using the Aalen-Johansen estimator and modelled hospitalisation rate during follow-up (indicating comorbid disease burden) using a joint frailty model, treating death as a competing event in all models.
Findings
The 5-year mortality by educational level was 63.1% (95% CI: 60.8%–65.2%) for low, 53.1% (95% CI: 51.3%–54.9%) for medium, and 45.8% (95% CI: 42.5%–48.8%) for high education. The excess mortality was particularly pronounced within the first 2 years. Within one year after discharge, 65.2% (95% CI: 62.9%–67.4%) of low, 73.6% (95% CI: 72.0%–75.2%) of medium, and 74.5% (95% CI: 71.8%–77.2%) of high-education patients had an outpatient contact. The corresponding five year dental visit proportions were 44.0% (95% CI: 41.6%–46.5%), 64.0% (95% CI: 62.2%–65.9%), and 74.0% (95% CI: 71.2%–76.9%), respectively. The hazard ratio for hospitalisations was 1.35 (95% CI: 1.25–1.49) when comparing low vs. high education and 1.19 (95% CI: 1.10–1.27) for low vs. medium. Estimates and time-dependent patterns were similar for affluence level.
Interpretation
Patients with low SEP had higher IE mortality, particularly within the first 2 years. Reduced adherence to follow-up care and comorbid diseases may contribute to this. Determining how the excess mortality is directly linked to the IE episode warrants further investigation.
Funding
Independent Research Fund Denmark (grant no. 3101-00102B) and Center for Population Medicine, Department of Clinical Epidemiology, Aarhus University.
{"title":"Socioeconomic disparities in long-term mortality after infective endocarditis in Denmark: a nationwide cohort study","authors":"Søren K. Martiny , Morten Schmidt , Jonas A. Povlsen , Kirstine K. Søgaard , Hans E. Bøtker , Henrik T. Sørensen","doi":"10.1016/j.lanepe.2025.101568","DOIUrl":"10.1016/j.lanepe.2025.101568","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic position (SEP) influences several determinants of infective endocarditis (IE) progression. Whether IE mortality differs by SEP remains unclear. We examined 5-year mortality after IE by individual-level SEP.</div></div><div><h3>Methods</h3><div>Using nationwide Danish registries, we identified patients with first-time IE (2010–2022). SEP was assessed by educational and affluence level, categorised as low, medium, and high. The Kaplan–Meier estimator provided 30-day, 1-, 3-, and 5-year mortality risks, risk differences, and risk ratios. Time-varying hazard ratios were derived from flexible parametric models. We estimated attendance at outpatient and dental follow-up visits (indicating adherence to follow-up) using the Aalen-Johansen estimator and modelled hospitalisation rate during follow-up (indicating comorbid disease burden) using a joint frailty model, treating death as a competing event in all models.</div></div><div><h3>Findings</h3><div>The 5-year mortality by educational level was 63.1% (95% CI: 60.8%–65.2%) for low, 53.1% (95% CI: 51.3%–54.9%) for medium, and 45.8% (95% CI: 42.5%–48.8%) for high education. The excess mortality was particularly pronounced within the first 2 years. Within one year after discharge, 65.2% (95% CI: 62.9%–67.4%) of low, 73.6% (95% CI: 72.0%–75.2%) of medium, and 74.5% (95% CI: 71.8%–77.2%) of high-education patients had an outpatient contact. The corresponding five year dental visit proportions were 44.0% (95% CI: 41.6%–46.5%), 64.0% (95% CI: 62.2%–65.9%), and 74.0% (95% CI: 71.2%–76.9%), respectively. The hazard ratio for hospitalisations was 1.35 (95% CI: 1.25–1.49) when comparing low <em>vs.</em> high education and 1.19 (95% CI: 1.10–1.27) for low <em>vs.</em> medium. Estimates and time-dependent patterns were similar for affluence level.</div></div><div><h3>Interpretation</h3><div>Patients with low SEP had higher IE mortality, particularly within the first 2 years. Reduced adherence to follow-up care and comorbid diseases may contribute to this. Determining how the excess mortality is directly linked to the IE episode warrants further investigation.</div></div><div><h3>Funding</h3><div><span>Independent Research Fund</span> Denmark (grant no. 3101-00102B) and Center for Population Medicine, <span>Department of Clinical Epidemiology</span>, <span>Aarhus University</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101568"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.lanepe.2025.101554
Kerstin K. Rauwolf , Teresa de Rojas , Miguel Martins , Maria Otth , Uta Dirksen , Delphine Heenen , Lejla Kameric , Pamela Kearns , Ruth Ladenstein , Cormac Owens , Caroline Queiroz , Richard Sullivan , Carmelo Rizzari , Gilles Vassal , European Society for Paediatric Oncology (SIOPE)
There are pronounced inequalities in outcomes of children, adolescents, and young adults (AYA) with cancer across Europe. The OCEAN project aimed at describing the availability of clinical trials for this population, the inequalities between countries, and propose solutions to reduce these disparities. The ClinicalTrials.gov database was searched to identify all European cancer clinical interventional studies including patients <18 years with a start date between 2010 and 2022. The study included 436 cancer-directed trials in 38 European countries. More than half were academic-sponsored (55%), and 49% included exclusively pediatric/AYA patients. Important differences in available trial numbers per country were identified, with more trials observed in Northern and Western Europe as compared to Eastern Europe. There is an urgent need to address differences in clinical trials availability both at European and national levels to advance equity and improve care, research and access to innovation for all pediatric/AYA patients with cancer in Europe.
Funding
This work has been performed as part of WP6 on inequalities in cancer research of the 4.UNCAN.eu Coordination and Support Action (#101069496) funded by the European Union and has been supported by Zoé4Life (MO).
{"title":"Inequalities in availability of clinical trials for pediatric, adolescent, and young adult patients with cancer in Europe: results from the SIOPE OCEAN project","authors":"Kerstin K. Rauwolf , Teresa de Rojas , Miguel Martins , Maria Otth , Uta Dirksen , Delphine Heenen , Lejla Kameric , Pamela Kearns , Ruth Ladenstein , Cormac Owens , Caroline Queiroz , Richard Sullivan , Carmelo Rizzari , Gilles Vassal , European Society for Paediatric Oncology (SIOPE)","doi":"10.1016/j.lanepe.2025.101554","DOIUrl":"10.1016/j.lanepe.2025.101554","url":null,"abstract":"<div><div>There are pronounced inequalities in outcomes of children, adolescents, and young adults (AYA) with cancer across Europe. The OCEAN project aimed at describing the availability of clinical trials for this population, the inequalities between countries, and propose solutions to reduce these disparities. The <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> database was searched to identify all European cancer clinical interventional studies including patients <18 years with a start date between 2010 and 2022. The study included 436 cancer-directed trials in 38 European countries. More than half were academic-sponsored (55%), and 49% included exclusively pediatric/AYA patients. Important differences in available trial numbers per country were identified, with more trials observed in Northern and Western Europe as compared to Eastern Europe. There is an urgent need to address differences in clinical trials availability both at European and national levels to advance equity and improve care, research and access to innovation for all pediatric/AYA patients with cancer in Europe.</div></div><div><h3>Funding</h3><div>This work has been performed as part of WP6 on inequalities in cancer research of the 4.UNCAN.eu Coordination and Support Action (#101069496) funded by the <span>European Union</span> and has been supported by <span>Zoé4Life</span> (MO).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101554"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-12DOI: 10.1016/j.lanepe.2026.101625
Jonathan Cylus , Martin McKee
The 2025 U.S. National Security Strategy marks a major shift toward a narrowly defined “America First” agenda with significant implications for Europe and its health systems. It reframes global public goods, including disease surveillance, migration governance, and climate action, as burdens rather than shared responsibilities, while prioritising hard power, economic nationalism, strict border control, and fossil fuel expansion. Europe is urged to increase defence spending to 5% of GDP and reduce regulatory and welfare commitments, thereby creating fiscal pressures that risk crowding out investment in health and social care. Its rhetoric on migration, culture, and declining birth rates aligns with and empowers far-right movements, potentially accelerating welfare retrenchment and undermining access to care for migrant and marginalised populations. This Viewpoint analyses the implications of the 2025 U.S. National Security Strategy for public health and health systems in Europe, with particular attention to welfare, migration, climate, and multilateral cooperation. A weakened WHO, reduced U.S. multilateral engagement, and more transactional transatlantic relations threaten global health security. Europe must safeguard health systems, equity, and the multilateral global order.
{"title":"Geopolitics and public health: Europe under the shadow of the U.S. National Security Strategy","authors":"Jonathan Cylus , Martin McKee","doi":"10.1016/j.lanepe.2026.101625","DOIUrl":"10.1016/j.lanepe.2026.101625","url":null,"abstract":"<div><div>The 2025 U.S. National Security Strategy marks a major shift toward a narrowly defined “America First” agenda with significant implications for Europe and its health systems. It reframes global public goods, including disease surveillance, migration governance, and climate action, as burdens rather than shared responsibilities, while prioritising hard power, economic nationalism, strict border control, and fossil fuel expansion. Europe is urged to increase defence spending to 5% of GDP and reduce regulatory and welfare commitments, thereby creating fiscal pressures that risk crowding out investment in health and social care. Its rhetoric on migration, culture, and declining birth rates aligns with and empowers far-right movements, potentially accelerating welfare retrenchment and undermining access to care for migrant and marginalised populations. This Viewpoint analyses the implications of the 2025 U.S. National Security Strategy for public health and health systems in Europe, with particular attention to welfare, migration, climate, and multilateral cooperation. A weakened WHO, reduced U.S. multilateral engagement, and more transactional transatlantic relations threaten global health security. Europe must safeguard health systems, equity, and the multilateral global order.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101625"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-22DOI: 10.1016/j.lanepe.2025.101571
Alice Aveline , Lisa Szatkowski , Janet Berrington , Kate Costeloe , Shalini Ojha , Paul Fleming , Cheryl Battersby
Background
Necrotising enterocolitis (NEC) remains an important cause of morbidity and mortality in preterm infants. This study aimed to examine whether probiotics reduce the risk of severe NEC and other key neonatal morbidities including late onset sepsis and mortality.
Methods
Retrospective study using the United Kingdom National Neonatal Research Database. Infants <32 weeks gestation in England and Wales (01/01/2016–31/12/2022) were included if alive on day four, without major congenital anomaly. A propensity score matched approach was applied matching for gestational age cohorts, birth year epochs and 17 further items. Comparators were infants who were exposed or not to probiotics within 14 days. Primary outcome was severe NEC (confirmed at laparotomy or postmortem or listed primary cause of death). Parent focus groups and former NICU patients supported this study but did not contribute to design or writing.
Findings
48,048 infants (45.2% (21,695/48,048) female), median gestational age 29.4 weeks (IQR 27.4–30.9) were included; 25.3% (12,161/48,048) were exposed to at least one of five available probiotics. 3.6% (1728/48,048) had severe NEC. Of 16,586 infants (8293 exposed and 8293 unexposed) in the propensity-matched analysis, incidence and odds ratios (OR) (95% CI) for exposed versus unexposed for severe NEC was 3.3% versus 4.2%, OR 0.80 (0.72–0.89); other definitions of NEC yielded similar results. Incidence for late onset sepsis (10.8% versus 11.5%, OR 0.94 (0.90–0.97)) and survival to discharge (96.6% versus 94.2%, OR 1.76 (1.65–1.88)). In infants <28 weeks gestation, severe NEC (8.7% versus 9.8%, OR 0.88 (0.82–0.93) and for ≥28 weeks (1.0% versus 1.7%, OR 0.59 (0.47–0.73).
Interpretation
Probiotics were associated with a reduction in severe NEC including in those <28 weeks gestation. We currently recommend neonatal units not already using probiotics, to consider the introduction of products meeting appropriate recommendations, in the context of their local morbidity rates.
Funding
NIHR Advanced Fellowship (CB reference: NIHR300617), Imperial College PhD studentship (AA), NIHR RfPB grant (NIHR203590, SO), Imperial NIHR Biomedical Research Centre.
{"title":"Evaluating the effect of probiotics on severe necrotising enterocolitis in preterm infants born before 32 weeks gestation in England and Wales: a propensity-matched population study","authors":"Alice Aveline , Lisa Szatkowski , Janet Berrington , Kate Costeloe , Shalini Ojha , Paul Fleming , Cheryl Battersby","doi":"10.1016/j.lanepe.2025.101571","DOIUrl":"10.1016/j.lanepe.2025.101571","url":null,"abstract":"<div><h3>Background</h3><div>Necrotising enterocolitis (NEC) remains an important cause of morbidity and mortality in preterm infants. This study aimed to examine whether probiotics reduce the risk of severe NEC and other key neonatal morbidities including late onset sepsis and mortality.</div></div><div><h3>Methods</h3><div>Retrospective study using the United Kingdom National Neonatal Research Database. Infants <32 weeks gestation in England and Wales (01/01/2016–31/12/2022) were included if alive on day four, without major congenital anomaly. A propensity score matched approach was applied matching for gestational age cohorts, birth year epochs and 17 further items. Comparators were infants who were exposed or not to probiotics within 14 days. Primary outcome was severe NEC (confirmed at laparotomy or postmortem or listed primary cause of death). Parent focus groups and former NICU patients supported this study but did not contribute to design or writing.</div></div><div><h3>Findings</h3><div>48,048 infants (45.2% (21,695/48,048) female), median gestational age 29.4 weeks (IQR 27.4–30.9) were included; 25.3% (12,161/48,048) were exposed to at least one of five available probiotics. 3.6% (1728/48,048) had severe NEC. Of 16,586 infants (8293 exposed and 8293 unexposed) in the propensity-matched analysis, incidence and odds ratios (OR) (95% CI) for exposed versus unexposed for severe NEC was 3.3% versus 4.2%, OR 0.80 (0.72–0.89); <em>other definitions of NEC yielded similar results.</em> Incidence for late onset sepsis (10.8% versus 11.5%, OR 0.94 (0.90–0.97)) and survival to discharge (96.6% versus 94.2%, OR 1.76 (1.65–1.88)). In infants <28 weeks gestation, severe NEC (8.7% versus 9.8%, OR 0.88 (0.82–0.93) and for ≥28 weeks (1.0% versus 1.7%, OR 0.59 (0.47–0.73).</div></div><div><h3>Interpretation</h3><div>Probiotics were associated with a reduction in severe NEC including in those <28 weeks gestation. We currently recommend neonatal units not already using probiotics, to consider the introduction of products meeting appropriate recommendations, in the context of their local morbidity rates.</div></div><div><h3>Funding</h3><div><span>NIHR Advanced Fellowship</span> (CB reference: NIHR300617), <span>Imperial College PhD studentship</span> (AA), <span>NIHR RfPB</span> grant (NIHR203590, SO), <span>Imperial NIHR Biomedical Research Centre</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101571"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.lanepe.2026.101626
Esperanza Diaz , Ietza Bojorquez , Rosemary Jouhaud , Gabriel Fabreau , Karl Blanchet
{"title":"Impact of a changing political environment on research on migration and health","authors":"Esperanza Diaz , Ietza Bojorquez , Rosemary Jouhaud , Gabriel Fabreau , Karl Blanchet","doi":"10.1016/j.lanepe.2026.101626","DOIUrl":"10.1016/j.lanepe.2026.101626","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101626"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-09DOI: 10.1016/j.lanepe.2025.101555
Anastasia Chatzilena , Catherine Hyams , Robert Challen , Elizabeth Begier , Jo Southern , Maria Lahuerta , Serena McGuinness , Madeleine Clout , James Campling , Jennifer Oliver , Andrew Vyse , Gillian Ellsbury , Nick Maskell , Bradford Gessner , Adam Finn , Leon Danon
<div><h3>Background</h3><div>Surveillance of acute lower respiratory tract disease (aLRTD) is fundamental for understanding population health burden and healthcare needs. COVID-19 altered respiratory infection epidemiology, but the post-pandemic baseline incidence and severity of aLRTD remain underexplored. We describe the incidence and clinical outcomes of acute lower respiratory tract disease (aLRTD) hospitalisations in adults, stratified by clinical presentation and SARS-CoV-2 status.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of adults (≥18 years) admitted with signs/symptoms or diagnoses of aLRTD to two Bristol acute-care hospitals (1 August 2020–31 July 2024). Patients were classified as having pneumonia (radiological changes or clinician diagnosis, in line with the British Thoracic Society (BTS) and National Institute for Health and Care Excellence (NICE) guidance), non-pneumonic lower respiratory tract infection (NP-LRTI; signs and symptoms of infection without radiological change or pneumonia diagnosis), or no evidence of LRTI (principally chronic respiratory disease exacerbations and heart failure). The primary outcome was incidence of aLRTD, stratified by clinical presentation, age, and SARS-CoV-2 status. Secondary outcomes included 30-day mortality, hospital discharge within 30 days, hospital length of stay, Intensive Care Unit (ICU) admission, ICU length of stay, and 1-year mortality. Population denominators were calculated using General Practitioner (GP) registration data linked to hospital admission patterns.</div></div><div><h3>Findings</h3><div>Among 457,112 hospitalisations, 44,766 were attributed to aLRTD (96% with consented data available): 20,639 pneumonia (48.2%), 15,061 NP-LRTI (35.2%), and 7134 no evidence of LRTI (16.7%). Overall, aLRTD incidence peaked in Year 2 (Aug 2021–Jul 2022) at 14.4/1000 person-years, driven primarily by COVID-19 cases, before stabilising around 13.6/1000 in Year 4 (Aug 2023–Jul 2024). SARS-CoV-2 pneumonia decreased from 2.6 in Year 2 to 0.9/1000 in Year 4, while non-COVID pneumonia remained stable (3.6–5.5/1000) between Year 2 and 4. Compared to pneumonia, NP-LRTI (HR 0.32, 95% CI: 0.29–0.35) and no evidence of LRTI (HR 0.43, 95% CI: 0.19–0.97) had lower mortality risk. Age ≥85 years (HR 5.1, 95% CI: 2.8–9.5, compared with 18–64 years) and severe comorbidities (HR 3.4, 95% CI: 2.8–4.1, compared with none) were associated with increased risk of 30-day mortality.</div></div><div><h3>Interpretation</h3><div>XXaLRTD incidence and severity remained substantial throughout and after COVID-19, with non-COVID infections maintaining consistent rates despite public health measures. These findings highlight the persistent burden of hospitalisations for aLRTD, measured in incidence and adverse outcomes and the importance of comprehensive aLRTD surveillance for public health planning.</div></div><div><h3>Funding</h3><div>AvonCAP is an investigator-led project funded under a co
{"title":"Incidence of community acquired lower respiratory tract disease in Bristol, UK, in 2020–2024: a prospective cohort study","authors":"Anastasia Chatzilena , Catherine Hyams , Robert Challen , Elizabeth Begier , Jo Southern , Maria Lahuerta , Serena McGuinness , Madeleine Clout , James Campling , Jennifer Oliver , Andrew Vyse , Gillian Ellsbury , Nick Maskell , Bradford Gessner , Adam Finn , Leon Danon","doi":"10.1016/j.lanepe.2025.101555","DOIUrl":"10.1016/j.lanepe.2025.101555","url":null,"abstract":"<div><h3>Background</h3><div>Surveillance of acute lower respiratory tract disease (aLRTD) is fundamental for understanding population health burden and healthcare needs. COVID-19 altered respiratory infection epidemiology, but the post-pandemic baseline incidence and severity of aLRTD remain underexplored. We describe the incidence and clinical outcomes of acute lower respiratory tract disease (aLRTD) hospitalisations in adults, stratified by clinical presentation and SARS-CoV-2 status.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of adults (≥18 years) admitted with signs/symptoms or diagnoses of aLRTD to two Bristol acute-care hospitals (1 August 2020–31 July 2024). Patients were classified as having pneumonia (radiological changes or clinician diagnosis, in line with the British Thoracic Society (BTS) and National Institute for Health and Care Excellence (NICE) guidance), non-pneumonic lower respiratory tract infection (NP-LRTI; signs and symptoms of infection without radiological change or pneumonia diagnosis), or no evidence of LRTI (principally chronic respiratory disease exacerbations and heart failure). The primary outcome was incidence of aLRTD, stratified by clinical presentation, age, and SARS-CoV-2 status. Secondary outcomes included 30-day mortality, hospital discharge within 30 days, hospital length of stay, Intensive Care Unit (ICU) admission, ICU length of stay, and 1-year mortality. Population denominators were calculated using General Practitioner (GP) registration data linked to hospital admission patterns.</div></div><div><h3>Findings</h3><div>Among 457,112 hospitalisations, 44,766 were attributed to aLRTD (96% with consented data available): 20,639 pneumonia (48.2%), 15,061 NP-LRTI (35.2%), and 7134 no evidence of LRTI (16.7%). Overall, aLRTD incidence peaked in Year 2 (Aug 2021–Jul 2022) at 14.4/1000 person-years, driven primarily by COVID-19 cases, before stabilising around 13.6/1000 in Year 4 (Aug 2023–Jul 2024). SARS-CoV-2 pneumonia decreased from 2.6 in Year 2 to 0.9/1000 in Year 4, while non-COVID pneumonia remained stable (3.6–5.5/1000) between Year 2 and 4. Compared to pneumonia, NP-LRTI (HR 0.32, 95% CI: 0.29–0.35) and no evidence of LRTI (HR 0.43, 95% CI: 0.19–0.97) had lower mortality risk. Age ≥85 years (HR 5.1, 95% CI: 2.8–9.5, compared with 18–64 years) and severe comorbidities (HR 3.4, 95% CI: 2.8–4.1, compared with none) were associated with increased risk of 30-day mortality.</div></div><div><h3>Interpretation</h3><div>XXaLRTD incidence and severity remained substantial throughout and after COVID-19, with non-COVID infections maintaining consistent rates despite public health measures. These findings highlight the persistent burden of hospitalisations for aLRTD, measured in incidence and adverse outcomes and the importance of comprehensive aLRTD surveillance for public health planning.</div></div><div><h3>Funding</h3><div>AvonCAP is an investigator-led project funded under a co","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101555"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.lanepe.2026.101596
Xingzuo Zhou , Ana Correa , Tom Palmer , Mingze Sun , Elena Pizzo , Pedro Gomes , Jolene Skordis
{"title":"Earned settlement: the value of international health and care workers in the UK","authors":"Xingzuo Zhou , Ana Correa , Tom Palmer , Mingze Sun , Elena Pizzo , Pedro Gomes , Jolene Skordis","doi":"10.1016/j.lanepe.2026.101596","DOIUrl":"10.1016/j.lanepe.2026.101596","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101596"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-13DOI: 10.1016/j.lanepe.2025.101557
Huei-Tyng Huang, Michael Hewitt, Wenhao Li, William Alazawi
Real-world evidence (RWE), derived from real-world data, offers key insights into metabolic dysfunction-associated steatotic liver disease (MASLD). RWE complements traditional randomised controlled trials by capturing large-scale, diverse patient populations and long-term outcomes. This review interrogates the role of RWE in understanding MASLD epidemiology, natural history, hepatic and extra-hepatic endpoints, including its co-morbid association with cardiovascular and chronic kidney disease, and its use in pharmacovigilance and precision medicine. RWE highlights large regional variations and is increasingly leveraged to advance drug development through target discovery and patient stratification. However, challenges such as data quality and confounding factors persist. In this review, key methodological gaps and future research priorities are identified and highlighted. The potential of artificial intelligence with multi-modal data linkage is considerable but requires rigorous methodologies and collaboration to fully realise the potential of RWE in MASLD research.
{"title":"Real-world evidence in metabolic dysfunction-associated steatotic liver disease (MASLD): insights, challenges, and future directions","authors":"Huei-Tyng Huang, Michael Hewitt, Wenhao Li, William Alazawi","doi":"10.1016/j.lanepe.2025.101557","DOIUrl":"10.1016/j.lanepe.2025.101557","url":null,"abstract":"<div><div>Real-world evidence (RWE), derived from real-world data, offers key insights into metabolic dysfunction-associated steatotic liver disease (MASLD). RWE complements traditional randomised controlled trials by capturing large-scale, diverse patient populations and long-term outcomes. This review interrogates the role of RWE in understanding MASLD epidemiology, natural history, hepatic and extra-hepatic endpoints, including its co-morbid association with cardiovascular and chronic kidney disease, and its use in pharmacovigilance and precision medicine. RWE highlights large regional variations and is increasingly leveraged to advance drug development through target discovery and patient stratification. However, challenges such as data quality and confounding factors persist. In this review, key methodological gaps and future research priorities are identified and highlighted. The potential of artificial intelligence with multi-modal data linkage is considerable but requires rigorous methodologies and collaboration to fully realise the potential of RWE in MASLD research.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"62 ","pages":"Article 101557"},"PeriodicalIF":13.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","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