Pub Date : 2025-02-01DOI: 10.1016/j.lanepe.2024.101155
Joan Prades , Olga Kozhaeva , Maria Otth , Pamela Kearns , Ruth Ladenstein , Carmelo Rizzari , Delphine Heenen , Uta Dirksen , Cormac Owens , Deyan Lazarov , Ciara Sheehan , Josep M. Borras , Gilles Vassal
Paediatric cancers, although rare, are the leading cause of disease-related mortality in European children above one year. A key pillar of the European Health Union, Europe's Beating Cancer Plan (EBCP) puts a spotlight on childhood cancer. National Cancer Control Plans (NCCPs) have a key role but did not address childhood cancers sufficiently previously. This study considered the NCCPs of 41 European countries in relation to children and adolescents and young adults (AYAs). Twenty two NCCPs informed a structured narrative analysis. Four NCCPs were categorised as having comprehensive paediatric oncology content. Findings emphasise access to care through centralisation combined with local delivery of low-risk interventions and the role of multidisciplinary teams. Survivorship, AYA care, registries, and voluntary associations were addressed to varying degrees. Supportive care was among the weakest areas in the 22 NCCPs. Recommendations were presented to strengthen paediatric oncology in NCCPs and enrich the EBCP vision towards improved survival and reduced inequalities across Europe.
{"title":"Do national cancer control plans address care and research for children, adolescents, and young adults? A review of status, priorities, and recommendations across 41 European countries","authors":"Joan Prades , Olga Kozhaeva , Maria Otth , Pamela Kearns , Ruth Ladenstein , Carmelo Rizzari , Delphine Heenen , Uta Dirksen , Cormac Owens , Deyan Lazarov , Ciara Sheehan , Josep M. Borras , Gilles Vassal","doi":"10.1016/j.lanepe.2024.101155","DOIUrl":"10.1016/j.lanepe.2024.101155","url":null,"abstract":"<div><div>Paediatric cancers, although rare, are the leading cause of disease-related mortality in European children above one year. A key pillar of the European Health Union, Europe's Beating Cancer Plan (EBCP) puts a spotlight on childhood cancer. National Cancer Control Plans (NCCPs) have a key role but did not address childhood cancers sufficiently previously. This study considered the NCCPs of 41 European countries in relation to children and adolescents and young adults (AYAs). Twenty two NCCPs informed a structured narrative analysis. Four NCCPs were categorised as having comprehensive paediatric oncology content. Findings emphasise access to care through centralisation combined with local delivery of low-risk interventions and the role of multidisciplinary teams. Survivorship, AYA care, registries, and voluntary associations were addressed to varying degrees. Supportive care was among the weakest areas in the 22 NCCPs. Recommendations were presented to strengthen paediatric oncology in NCCPs and enrich the EBCP vision towards improved survival and reduced inequalities across Europe.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101155"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980673","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 : 2025-02-01DOI: 10.1016/j.lanepe.2024.101181
Olav Erich Yri , Guro Lindviksmoen Astrup , Astrid Telhaug Karlsson , Rene van Helvoirt , Marianne Jensen Hjermstad , Kristin Moksnes Husby , Jon Håvard Loge , Jo-Åsmund Lund , Tonje Lundeby , Ørnulf Paulsen , Eva Skovlund , Marius-Ioan Taran , Rebecca Rootwelt Winther , Nina Aass , Stein Kaasa
Background
A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions.
Methods
This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox’ proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups.
Findings
For the total cohort (N = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2–6.7). ECOG 2–4, uncontrolled extracranial metastases, and ≥5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3–4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3–3.5]; ECOG 3–4: 2.1 [1.5–2.7]). Patients surviving <6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving >6 months reported stable scores over time.
Interpretation
Patients with ECOG 2–4, especially those with uncontrolled extracranial metastases and ≥5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival <6 months and specifically advise against WBRT.
Funding
The South-Eastern Norway Regional Health Authority; The Norwegian Cancer Society.
{"title":"Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study","authors":"Olav Erich Yri , Guro Lindviksmoen Astrup , Astrid Telhaug Karlsson , Rene van Helvoirt , Marianne Jensen Hjermstad , Kristin Moksnes Husby , Jon Håvard Loge , Jo-Åsmund Lund , Tonje Lundeby , Ørnulf Paulsen , Eva Skovlund , Marius-Ioan Taran , Rebecca Rootwelt Winther , Nina Aass , Stein Kaasa","doi":"10.1016/j.lanepe.2024.101181","DOIUrl":"10.1016/j.lanepe.2024.101181","url":null,"abstract":"<div><h3>Background</h3><div>A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions.</div></div><div><h3>Methods</h3><div>This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox’ proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups.</div></div><div><h3>Findings</h3><div>For the total cohort (<em>N</em> = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2–6.7). ECOG 2–4, uncontrolled extracranial metastases, and ≥5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3–4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3–3.5]; ECOG 3–4: 2.1 [1.5–2.7]). Patients surviving <6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving >6 months reported stable scores over time.</div></div><div><h3>Interpretation</h3><div>Patients with ECOG 2–4, especially those with uncontrolled extracranial metastases and ≥5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival <6 months and specifically advise against WBRT.</div></div><div><h3>Funding</h3><div>The <span>South-Eastern Norway Regional Health Authority</span>; The <span>Norwegian Cancer Society</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101181"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980674","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 : 2025-02-01DOI: 10.1016/j.lanepe.2025.101212
Matteo Lambertini , Bo Nordenskjold
{"title":"Dose-dense anthracycline- and taxane-based chemotherapy remains the preferred treatment for selected patients with high-risk early breast cancer","authors":"Matteo Lambertini , Bo Nordenskjold","doi":"10.1016/j.lanepe.2025.101212","DOIUrl":"10.1016/j.lanepe.2025.101212","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101212"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143133957","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 : 2025-02-01DOI: 10.1016/j.lanepe.2024.101163
Siri L. van der Meijden , Anna M. van Boekel , Laurens J. Schinkelshoek , Harry van Goor , Ewout W. Steyerberg , Rob G.H.H. Nelissen , Dieter Mesotten , Bart F. Geerts , Mark G.J. de Boer , M. Sesmu Arbous
Background
Postoperative infections significantly impact patient outcomes and costs, exacerbated by late diagnoses, yet early reliable predictors are scarce. Existing artificial intelligence (AI) models for postoperative infection prediction often lack external validation or perform poorly in local settings when validated. We aimed to develop locally valid models as part of the PERISCOPE AI system to enable early detection, safer discharge, and more timely treatment of patients.
Methods
We developed and validated XGBoost models to predict postoperative infections within 7 and 30 days of surgery. Using retrospective pre-operative and intra-operative electronic health record data from 2014 to 2023 across various surgical specialities, the models were developed at Hospital A and validated and updated at Hospitals B and C in the Netherlands and Belgium. Model performance was evaluated before and after updating using the two most recent years of data as temporal validation datasets. Main outcome measures were model discrimination (area under the receiver operating characteristic curve (AUROC)), calibration (slope, intercept, and plots), and clinical utility (decision curve analysis with net benefit).
Findings
The study included 253,010 surgical procedures with 23,903 infections within 30-days. Discriminative performance, calibration properties, and clinical utility significantly improved after updating. Final AUROCs after updating for Hospitals A, B, and C were 0.82 (95% confidence interval (CI) 0.81–0.83), 0.82 (95% CI 0.81–0.83), and 0.91 (95% CI 0.90–0.91) respectively for 30-day predictions on the temporal validation datasets (2022–2023). Calibration plots demonstrated adequate correspondence between observed outcomes and predicted risk. All local models were deemed clinically useful as the net benefit was higher than default strategies (treat all and treat none) over a wide range of clinically relevant decision thresholds.
Interpretation
PERISCOPE can accurately predict overall postoperative infections within 7- and 30-days post-surgery. The robust performance implies potential for improving clinical care in diverse clinical target populations. This study supports the need for approaches to local updating of AI models to account for domain shifts in patient populations and data distributions across different clinical settings.
Funding
This study was funded by a REACT EU grant from European Regional Development Fund (ERDF) and Kansen voor West.
背景：术后感染显著影响患者预后和成本，晚期诊断加剧了感染，但早期可靠的预测因素很少。用于术后感染预测的现有人工智能（AI）模型往往缺乏外部验证，或者在验证后在本地环境中表现不佳。我们的目标是开发本地有效的模型，作为PERISCOPE人工智能系统的一部分，以实现早期发现，更安全的出院，更及时的治疗患者。方法：我们建立并验证了XGBoost模型来预测术后7天和30天的感染。利用2014年至2023年各外科专科的回顾性术前和术中电子健康记录数据，这些模型由A医院开发，并在荷兰和比利时的B医院和C医院进行验证和更新。使用最近两年的数据作为时间验证数据集，在更新前后评估模型性能。主要结果测量是模型判别（受试者工作特征曲线下面积（AUROC））、校准（斜率、截距和图）和临床效用（具有净效益的决策曲线分析）。研究结果：该研究包括253,010例手术，其中23,903例在30天内感染。更新后的判别性能、校准性能和临床实用性显著提高。对于时间验证数据集（2022-2023）的30天预测，A、B和C医院更新后的最终auroc分别为0.82（95%可信区间（CI） 0.81-0.83）、0.82 （95% CI 0.81-0.83）和0.91 （95% CI 0.90-0.91）。校准图显示观察结果和预测风险之间有足够的对应关系。在广泛的临床相关决策阈值范围内，所有局部模型都被认为是临床有用的，因为净收益高于默认策略（全部治疗和不治疗）。PERISCOPE可以在术后7天和30天内准确预测整体术后感染。稳健的表现意味着潜在的改善临床护理在不同的临床目标人群。该研究支持了人工智能模型局部更新方法的需求，以考虑患者群体的领域变化和不同临床环境下的数据分布。经费：本研究由欧洲区域发展基金（ERDF）和Kansen voor West的REACT EU资助。
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Pub Date : 2025-02-01DOI: 10.1016/j.lanepe.2024.101160
Anders W. Mølby Nielsen , Lise B.J. Thorsen , Demet Özcan , Louise W. Matthiessen , Else Maae , Marie L.H. Milo , Mette H. Nielsen , Trine Tramm , Jens Overgaard , Birgitte V. Offersen , DBCG RT Committee
Background
Internal mammary node irradiation (IMNI) improves overall survival (OS) in node-positive breast cancer patients. However, the effect is not documented in breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (RT). Therefore, the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate the effect of IMNI in node-positive breast cancer patients treated with newer systemic therapies and 3D-based RT.
Methods
DBCG IMN2 was a nationwide population-based cohort study prospectively allocating node-positive breast cancer patients with right-sided tumours to IMNI and patients with left-sided tumours to no IMNI in six RT centres. Exclusion criteria were prior malignancies, bilateral breast cancer, neoadjuvant systemic therapy, recurrence before RT, or non-standard RT. Systemic treatment included taxane-based chemotherapy, aromatase inhibitors, and trastuzumab. The primary end-point was OS. Secondary endpoints were breast cancer mortality and distant metastasis. Cox regression analyses were used for adjusted hazard ratios (HR). Clinicaltrial.gov ID: NCT06549920.
Findings
In the period January 2007–May 2014, a total of 4541 patients were included. Patient characteristics were distributed evenly between right- and left-sided patients. Median follow-up was 13.7 years for OS. Survival rates at 15 years were 65.0% in patients with IMNI and 60.8% without leading to an adjusted HR of 0.85 (95% CI, 0.76–0.94; p = 0.0016) for OS. Corresponding HRs were 0.84 (95% CI, 0.74–0.95; p = 0.0077) for breast cancer mortality and HR 0.87 (95% CI, 0.78–0.98; p = 0.026) for distant metastasis. No subgroups were identified for the omission of IMNI. The 15-year cumulative incidence of death from ischemic or valvular heart disease was 0.2% (95% CI, 0.0–0.5) in right-sided and 0.7% (95% CI, 0.4–1.2) in left-sided patients.
Interpretation
IMNI reduced distant metastasis and breast cancer mortality and improved OS in node-positive breast cancer patients, despite treatment with newer systemic therapies and 3D-based RT.
Funding
This work was supported by the Danish Cancer Society and Department of Clinical Medicine, Aarhus University, Denmark.
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Pub Date : 2025-02-01DOI: 10.1016/j.lanepe.2024.101162
Alexios Matikas , Andri Papakonstantinou , Sibylle Loibl , Günther G. Steger , Michael Untch , Hemming Johansson , Nikos Tsiknakis , Mats Hellström , Richard Greil , Volker Möbus , Michael Gnant , Jonas Bergh , Theodoros Foukakis
Background
It is unclear whether some patients with high-risk breast cancer do not warrant adjuvant dose-dense chemotherapy due to small expected absolute benefit.
Methods
The phase 3 PANTHER trial (NCT00798070) compared adjuvant sequential epirubicin/cyclophosphamide (EC) and docetaxel (D) administered in either tailored dose-dense (tDD EC/D) or standard interval schedule (FEC/D) to patients with high-risk resected early breast cancer (n = 2003). We compared outcomes across key subgroups of interest, evaluated the performance of the online prognostication and treatment benefit estimation tool PREDICT and conducted a subpopulation treatment effect pattern plot (STEPP) analysis. Primary endpoint was breast cancer recurrence free survival (BCRFS).
Findings
Median follow-up was 10.3 years. Treatment with tDD EC/D improved 10-year BCRFS across all subgroups including according to menopausal status, with an absolute benefit of 2% or more, as well as in luminal (Hazard Ratio [HR] = 0.83, 95% Confidence Interval [CI] 0.65–1.05) and Human Epidermal Growth Factor Receptor 2 (HER2) positive (HR = 0.53, 95% CI 0.30–0.93), but not triple negative breast cancer patients (HR = 1.02, 95% CI 0.66–1.57). PREDICT underestimated overall survival in the entire population and across all subgroups. In STEPP analysis, absolute benefit from tDD EC/D in BCRFS was stable across risk-defined subpopulations, from 3.8% in the lowest risk patients to 3.6% in the highest risk ones. There was no differential treatment effect over time.
Interpretation
We could not reliably identify any subgroup not benefiting from dose-dense treatment, which should be considered for patients with primary resected high-risk breast cancer.
{"title":"Benefit from dose-dense adjuvant chemotherapy for breast cancer: subgroup analyses from the randomised phase 3 PANTHER trial","authors":"Alexios Matikas , Andri Papakonstantinou , Sibylle Loibl , Günther G. Steger , Michael Untch , Hemming Johansson , Nikos Tsiknakis , Mats Hellström , Richard Greil , Volker Möbus , Michael Gnant , Jonas Bergh , Theodoros Foukakis","doi":"10.1016/j.lanepe.2024.101162","DOIUrl":"10.1016/j.lanepe.2024.101162","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether some patients with high-risk breast cancer do not warrant adjuvant dose-dense chemotherapy due to small expected absolute benefit.</div></div><div><h3>Methods</h3><div>The phase 3 PANTHER trial (<span><span>NCT00798070</span><svg><path></path></svg></span>) compared adjuvant sequential epirubicin/cyclophosphamide (EC) and docetaxel (D) administered in either tailored dose-dense (tDD EC/D) or standard interval schedule (FEC/D) to patients with high-risk resected early breast cancer (n = 2003). We compared outcomes across key subgroups of interest, evaluated the performance of the online prognostication and treatment benefit estimation tool PREDICT and conducted a subpopulation treatment effect pattern plot (STEPP) analysis. Primary endpoint was breast cancer recurrence free survival (BCRFS).</div></div><div><h3>Findings</h3><div>Median follow-up was 10.3 years. Treatment with tDD EC/D improved 10-year BCRFS across all subgroups including according to menopausal status, with an absolute benefit of 2% or more, as well as in luminal (Hazard Ratio [HR] = 0.83, 95% Confidence Interval [CI] 0.65–1.05) and Human Epidermal Growth Factor Receptor 2 (HER2) positive (HR = 0.53, 95% CI 0.30–0.93), but not triple negative breast cancer patients (HR = 1.02, 95% CI 0.66–1.57). PREDICT underestimated overall survival in the entire population and across all subgroups. In STEPP analysis, absolute benefit from tDD EC/D in BCRFS was stable across risk-defined subpopulations, from 3.8% in the lowest risk patients to 3.6% in the highest risk ones. There was no differential treatment effect over time.</div></div><div><h3>Interpretation</h3><div>We could not reliably identify any subgroup not benefiting from dose-dense treatment, which should be considered for patients with primary resected high-risk breast cancer.</div></div><div><h3>Funding</h3><div><span>Cancerfonden</span>, <span>Bröstcancerförbundet</span>, <span>Radiumhemmets Forskningsfonder</span>, <span>Amgen</span>, <span>Roche</span>, <span>sanofi-aventis</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101162"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866449","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}
Scurvy, historically rare in-high income countries, has re-emerged as an indicator of socioeconomic and dietary disparities. Limited data exist on scurvy trends among European children, particularly following socioeconomic changes since the COVID-19 pandemic. This study analysed scurvy incidence trends among French children over a nine-year period, examining potential post-pandemic increases.
Methods
This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children aged <18 years hospitalized with scurvy and malnutrition from January 2015 to November 2023 were included. The monthly incidence of hospitalized scurvy per 100,000 children was analysed using a segmented linear regression model with autoregressive error. Incidence of hospitalization for malnutrition was analysed as secondary outcome and for urinary tract infection and vitamin D deficiency as control outcomes.
Findings
A total of 888 children were hospitalized with scurvy (median age, 11 years; interquartile range [IQR], 4–15; 431 boys [48.5%]). The COVID-19 pandemic in March 2020 was associated with a significant increase in scurvy incidence (cumulative increase, 34.5%; 95% confidence interval [CI], 12.7–56.3; p = 0.002) and severe malnutrition (cumulative increase, 20.3%; 95% CI, 10.7–29.9; p < 0.001). The increased incidence of scurvy was correlated with the rise in the consumer price index. In contrast, no change was found for the two control outcomes.
Interpretation
This study identifies a significant increase in scurvy and severe malnutrition post-COVID-19, associated with inflation and socioeconomic instability, emphasizing the urgent need for targeted nutritional support for at-risk paediatric populations.
{"title":"Scurvy incidence trend among children hospitalised in France, 2015–2023: a population-based interrupted time-series analysis","authors":"Zein Assad , Maelle Trad , Zaba Valtuille , Cécile Dumaine , Albert Faye , Tania Ikowsky , Florentia Kaguelidou , Lindsay Osei , Naim Ouldali , Ulrich Meinzer","doi":"10.1016/j.lanepe.2024.101159","DOIUrl":"10.1016/j.lanepe.2024.101159","url":null,"abstract":"<div><h3>Background</h3><div>Scurvy, historically rare in-high income countries, has re-emerged as an indicator of socioeconomic and dietary disparities. Limited data exist on scurvy trends among European children, particularly following socioeconomic changes since the COVID-19 pandemic. This study analysed scurvy incidence trends among French children over a nine-year period, examining potential post-pandemic increases.</div></div><div><h3>Methods</h3><div>This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children aged <18 years hospitalized with scurvy and malnutrition from January 2015 to November 2023 were included. The monthly incidence of hospitalized scurvy per 100,000 children was analysed using a segmented linear regression model with autoregressive error. Incidence of hospitalization for malnutrition was analysed as secondary outcome and for urinary tract infection and vitamin D deficiency as control outcomes.</div></div><div><h3>Findings</h3><div>A total of 888 children were hospitalized with scurvy (median age, 11 years; interquartile range [IQR], 4–15; 431 boys [48.5%]). The COVID-19 pandemic in March 2020 was associated with a significant increase in scurvy incidence (cumulative increase, 34.5%; 95% confidence interval [CI], 12.7–56.3; p = 0.002) and severe malnutrition (cumulative increase, 20.3%; 95% CI, 10.7–29.9; p < 0.001). The increased incidence of scurvy was correlated with the rise in the consumer price index. In contrast, no change was found for the two control outcomes.</div></div><div><h3>Interpretation</h3><div>This study identifies a significant increase in scurvy and severe malnutrition post-COVID-19, associated with inflation and socioeconomic instability, emphasizing the urgent need for targeted nutritional support for at-risk paediatric populations.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101159"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886280","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 : 2025-02-01DOI: 10.1016/j.lanepe.2024.101161
Elisa Stein , Cornelia Heindrich , Kirsten Wittke , Claudia Kedor , Rebekka Rust , Helma Freitag , Franziska Sotzny , Anne Krüger , Markus Tölle , Patricia Grabowski , Carmen Scheibenbogen , Laura Kim
Background
Since the pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the leading trigger for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Evidence indicates that autoimmunity plays an important pathophysiological role. We aimed to evaluate the effectiveness of IA treatment in post-COVID ME/CFS patients.
Methods
This pre-post study included 20 post-coronavirus disease 2019 (COVID) ME/CFS patients found to have elevated β2 adrenergic autoantibodies (β2 AR-AB) between October 2022 and October 2023. Patients, with a median disease duration of 22 months (IQR: 15–31), were treated with five immunoadsorption sessions at Charité - Universitätsmedizin Berlin, Germany. Seven were male and 13 female, with a median age of 40 years (IQR: 36–51). The primary end point was the change in the Short Form (36) Health Survey physical functioning domain (SF36 PF) from baseline to four weeks post immunoadsorption. Key symptoms were assessed via questionnaires over six months. Handgrip strength and EndoPAT® measurements were used to evaluate muscle fatigue and vascular dysfunction. Seven patients who worsened after an initial response received a second cycle.
Findings
The treatment was generally well tolerated, reducing total immunoglobulin G by 79% (CI: 73–84%) and β2 AR-AB by 77% (CI: 58–95%). Patients demonstrated a mean increase in the SF36 PF of 17.75 points (CI: 13.41–26.16), with the greatest improvement occurring between months two and three, and significant gains maintained through month six. 14/20 (70%) patients were categorized as responders with an increase in the SF36 PF of ≥ ten points. Further lasting improvements were reported in fatigue, post-exertional malaise, pain, cognitive, autonomic, and immunological symptoms. Female patients had increased repeat handgrip strength at month six.
Interpretation
Immunoadsorption may improve symptoms in post-COVID ME/CFS patients. The beneficial effects of IgG depletion suggest a significant role for autoantibodies and disturbed B-cell function in the condition's pathophysiology.
Funding
Funded by The Federal Ministry of Education and Research and the Weidenhammer Zöbele Research Foundation.
{"title":"Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study","authors":"Elisa Stein , Cornelia Heindrich , Kirsten Wittke , Claudia Kedor , Rebekka Rust , Helma Freitag , Franziska Sotzny , Anne Krüger , Markus Tölle , Patricia Grabowski , Carmen Scheibenbogen , Laura Kim","doi":"10.1016/j.lanepe.2024.101161","DOIUrl":"10.1016/j.lanepe.2024.101161","url":null,"abstract":"<div><h3>Background</h3><div>Since the pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the leading trigger for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Evidence indicates that autoimmunity plays an important pathophysiological role. We aimed to evaluate the effectiveness of IA treatment in post-COVID ME/CFS patients.</div></div><div><h3>Methods</h3><div>This pre-post study included 20 post-coronavirus disease 2019 (COVID) ME/CFS patients found to have elevated β2 adrenergic autoantibodies (β2 AR-AB) between October 2022 and October 2023. Patients, with a median disease duration of 22 months (IQR: 15–31), were treated with five immunoadsorption sessions at Charité - Universitätsmedizin Berlin, Germany. Seven were male and 13 female, with a median age of 40 years (IQR: 36–51). The primary end point was the change in the Short Form (36) Health Survey physical functioning domain (SF36 PF) from baseline to four weeks post immunoadsorption. Key symptoms were assessed via questionnaires over six months. Handgrip strength and EndoPAT® measurements were used to evaluate muscle fatigue and vascular dysfunction. Seven patients who worsened after an initial response received a second cycle.</div></div><div><h3>Findings</h3><div>The treatment was generally well tolerated, reducing total immunoglobulin G by 79% (<em>CI</em>: 73–84%) and β2 AR-AB by 77% (<em>CI</em>: 58–95%). Patients demonstrated a mean increase in the SF36 PF of 17.75 points (<em>CI</em>: 13.41–26.16), with the greatest improvement occurring between months two and three, and significant gains maintained through month six. 14/20 (70%) patients were categorized as responders with an increase in the SF36 PF of ≥ ten points. Further lasting improvements were reported in fatigue, post-exertional malaise, pain, cognitive, autonomic, and immunological symptoms. Female patients had increased repeat handgrip strength at month six.</div></div><div><h3>Interpretation</h3><div>Immunoadsorption may improve symptoms in post-COVID ME/CFS patients. The beneficial effects of IgG depletion suggest a significant role for autoantibodies and disturbed B-cell function in the condition's pathophysiology.</div></div><div><h3>Funding</h3><div>Funded by The <span>Federal Ministry of Education and Research</span> and the <span>Weidenhammer Zöbele Research Foundation</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101161"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933458","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 : 2025-02-01DOI: 10.1016/j.lanepe.2024.101178
Shiqiang Wu , Alexander Ploner , Ana Martina Astorga Alsina , Yunyang Deng , Lina Ask Schollin , Jiayao Lei
Background
One or two-dose schedule for human papillomavirus (HPV) vaccination has been recommended by the World Health Organization and used in many vaccination programs. We aimed to comprehensively evaluate the effectiveness of quadrivalent HPV vaccine against high-grade cervical lesions by age at vaccination and number of doses received.
Methods
This cohort study included 2,200,495 females aged 10–35 years old who were residents of Sweden between 2006 and 2022, with 584,676 (26.6%) receiving at least one dose of quadrivalent HPV vaccine. We used Poisson regression models to estimate the incidence rate ratios (IRR) comparing the incidence rate of high-grade cervical lesions in relation to age at vaccination and doses.
Findings
In girls initiating vaccination before age 15, we observed IRRs of 0.42 (95% CI 0.33–0.52) after one-dose, 0.54 (0.47–0.63) after two-dose, and 0.50 (0.47–0.53) after three-dose. The IRRs were 0.60 (95% CI 0.52–0.70), 0.55 (0.49–0.62), and 0.54 (0.52–0.56) after one, two or three doses for girls who initiated vaccination age 15–17. For women who initiated vaccination after age 20, higher doses may be needed to achieve a statistically significant risk reduction.
Interpretation
Receiving one or two doses of HPV vaccines prior to age 17, especially for those initiating before age 15, has comparable effectiveness against high-grade cervical lesions with those who received three doses.
Funding
Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and Karolinska Institutet.
{"title":"Effectiveness of quadrivalent human papillomavirus vaccination against high-grade cervical lesions by age and doses: a population-based cohort study","authors":"Shiqiang Wu , Alexander Ploner , Ana Martina Astorga Alsina , Yunyang Deng , Lina Ask Schollin , Jiayao Lei","doi":"10.1016/j.lanepe.2024.101178","DOIUrl":"10.1016/j.lanepe.2024.101178","url":null,"abstract":"<div><h3>Background</h3><div>One or two-dose schedule for human papillomavirus (HPV) vaccination has been recommended by the World Health Organization and used in many vaccination programs. We aimed to comprehensively evaluate the effectiveness of quadrivalent HPV vaccine against high-grade cervical lesions by age at vaccination and number of doses received.</div></div><div><h3>Methods</h3><div>This cohort study included 2,200,495 females aged 10–35 years old who were residents of Sweden between 2006 and 2022, with 584,676 (26.6%) receiving at least one dose of quadrivalent HPV vaccine. We used Poisson regression models to estimate the incidence rate ratios (IRR) comparing the incidence rate of high-grade cervical lesions in relation to age at vaccination and doses.</div></div><div><h3>Findings</h3><div>In girls initiating vaccination before age 15, we observed IRRs of 0.42 (95% CI 0.33–0.52) after one-dose, 0.54 (0.47–0.63) after two-dose, and 0.50 (0.47–0.53) after three-dose. The IRRs were 0.60 (95% CI 0.52–0.70), 0.55 (0.49–0.62), and 0.54 (0.52–0.56) after one, two or three doses for girls who initiated vaccination age 15–17. For women who initiated vaccination after age 20, higher doses may be needed to achieve a statistically significant risk reduction.</div></div><div><h3>Interpretation</h3><div>Receiving one or two doses of HPV vaccines prior to age 17, especially for those initiating before age 15, has comparable effectiveness against high-grade cervical lesions with those who received three doses.</div></div><div><h3>Funding</h3><div><span>Swedish Research Council</span>, <span>Swedish Research Council for Health, Working Life and Welfare</span>, and <span>Karolinska Institutet</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101178"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162763","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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