Pub Date : 2025-11-25DOI: 10.1016/j.lanepe.2025.101525
Iain Hardie , Louise Marryat , Aja Murray , Josiah King , Kenneth Okelo , Lynda Fenton , Abigail K. Stevely , James P. Boardman , Michael V. Lombardo , Sarah J. Stock , Rachael Wood , Bonnie Auyeung
Background
COVID-19 public health and social measures (PHSM) may have affected children's development, for example by reducing their interaction with others. We examined associations between PHSM and developmental concerns among young children in Scotland.
Methods
We utilised data from routine 13–15 month and 27–30 month child health reviews, covering all children in Scotland who took part in reviews between January 2019 and August 2023 and had full developmental data. Interrupted time-series analysis assessed slope changes in the weekly proportion of children with health visitor-identified developmental concerns following the March 2020 introduction of, and August 2021 removal of, PHSM. Outcomes were any 13–15 month and 27–30 month developmental concerns, and domain-specific concerns regarding speech-language-communication, problem solving, gross motor, personal-social, emotional-behavioural and fine motor development.
Findings
Weekly proportions were based on 257,532 children, covering 13–15 month review records for 186,265 children (95,506 [51.3%] male and 90,756 [48.7%] female) and 27–30 month review records for 186,766 children (95,209 [51.0%] male and 91,557 [49.0%] female). The March 2020 PHSM introduction was associated with a slope change increase in the proportion of children with any developmental concerns (+0.091 percentage points per week [95% CI: 0.065, 0.116] at 13–15 months and +0.076 percentage points per week [95% CI: 0.048, 0.104] at 27–30 months. The August 2021 PHSM removal was associated with a slope change decrease in the proportion of children with any developmental concerns at 27–30 months (−0.067 percentage points per week [95% CI: −0.088, −0.046]), but not 13–15 months, in the main analysis. Results were broadly consistent across developmental domains.
Interpretation
COVID-19 PHSM were associated with increased developmental concerns among young children in Scotland. While leveraging interrupted time-series analysis yields findings consistent with a causal impact of PHSM, the influence of potential time-varying confounders cannot be ruled out.
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Pub Date : 2025-11-20DOI: 10.1016/j.lanepe.2025.101487
Massimo Agosti
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Pub Date : 2025-11-20DOI: 10.1016/j.lanepe.2025.101535
Donal J. Buggy , Malachy O. Columb , Jeroen Hermanides , Markus W. Hollmann , Mark Coburn , Alexander Zarbock , MOPED Investigators
Background
The prevalence of people with Diabetes Mellitus (DM) presenting for surgery is increasing. Guidelines on perioperative management are based on expert opinion with variability of practice likely. Our objective was to document perioperative management and 30-day outcomes of people with DM across Europe.
Methods
This was a prospective, observational study involving 89 hospitals across 21 European countries, ranging from district general to tertiary referral centres. Between January 2021 and February 2024, 6126 people with confirmed DM (any type except gestational) receiving surgery of any kind requiring anaesthesia were followed for 30 days. Centres were self-selected by anaesthesiology clinicians working there, who enrolled consecutive people with DM to a locally determined target number. There was 5936 (97%) 30-day follow-up completion. The primary outcome was Days at Home at 30 Days (DAH-30). Secondary outcomes included descriptive characteristics of perioperative management, dysglycaemia and incidence of postoperative complications.
Findings
There was significant variation between countries in perioperative DM management and 30-day outcomes, and variance in DAH-30 (median [range]) 26 [23–30] days, P = 0.0001). The proportion of people with DM with increased HbA1c (>69 mmol mol) was higher in T1DM compared with T2DM (n = 51, 18% vs n = 388, 7%; difference 11%, 95% CI 6–17; P = 0.002). In univariate analysis, there was an association between patients with lower HbA1c < 53 mmol mol−1 median (25–75% range) DAH-30 = 27 days (23–29), contrasting with higher HbA1c > 69 mmol mol, median DAH-30 = 25 days (20–28); difference 2.0, 95% CI 1.3–2.7; P < 0.0001). This association was upheld in multivariable analysis only for patients with little blood loss.
Interpretation
There is a need to harmonise international practice to reduce variability in perioperative diabetes management and 30-day outcome.
Funding
The European Society of Anaesthesiology and Intensive Care (ESA-IC) funded administrative staff throughout the conduct of the study. The College of Anaesthesiologists of Ireland (CAI) and British Journal of Anaesthesia (BJA) partially contributed to data collection in Ireland and UK.
背景：糖尿病患者（DM）的手术患病率正在上升。围手术期管理指南基于专家意见，实践可能存在差异。我们的目标是记录整个欧洲糖尿病患者的围手术期管理和30天的结果。方法：这是一项前瞻性观察性研究，涉及21个欧洲国家的89家医院，从地区综合医院到三级转诊中心。在2021年1月至2024年2月期间，6126名确诊的糖尿病患者（除妊娠期外的任何类型）接受任何需要麻醉的手术，随访30天。中心由在那里工作的麻醉临床医生自行选择，他们连续招募DM患者到当地确定的目标数量。30天随访完成5936例（97%）。主要终点为30天在家天数（DAH-30）。次要结局包括围手术期处理、血糖异常和术后并发症发生率的描述性特征。研究结果：各国在围手术期DM管理和30天预后方面存在显著差异，在DAH-30（中位[范围]）26[23-30]天方面存在显著差异，P = 0.0001。糖尿病患者HbA1c升高（69 mmol mol）的比例在T1DM患者中高于T2DM患者（n = 51,18% vs n = 388,7%；差异11%，95% CI 6-17; P = 0.002）。在单因素分析中，HbA1c≤53 mmol mol−1的患者中位（25 - 75%范围）DAH-30 = 27天（23-29），而HbA1c≤69 mmol mol的患者中位DAH-30 = 25天（20-28）；差异2.0,95% CI 1.3 ~ 2.7；P < 0.0001)。在多变量分析中，这种关联仅在少量失血的患者中得到证实。有必要协调国际惯例，以减少围手术期糖尿病管理和30天预后的可变性。欧洲麻醉与重症监护学会（ESA-IC）在整个研究过程中为管理人员提供资金。爱尔兰麻醉师学院（CAI）和英国麻醉学杂志（BJA）为爱尔兰和英国的数据收集做出了部分贡献。
{"title":"Management and Outcomes of Perioperative Care of People with Diabetes across Europe (MOPED): a prospective, observational study","authors":"Donal J. Buggy , Malachy O. Columb , Jeroen Hermanides , Markus W. Hollmann , Mark Coburn , Alexander Zarbock , MOPED Investigators","doi":"10.1016/j.lanepe.2025.101535","DOIUrl":"10.1016/j.lanepe.2025.101535","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of people with Diabetes Mellitus (DM) presenting for surgery is increasing. Guidelines on perioperative management are based on expert opinion with variability of practice likely. Our objective was to document perioperative management and 30-day outcomes of people with DM across Europe.</div></div><div><h3>Methods</h3><div>This was a prospective, observational study involving 89 hospitals across 21 European countries, ranging from district general to tertiary referral centres. Between January 2021 and February 2024, 6126 people with confirmed DM (any type except gestational) receiving surgery of any kind requiring anaesthesia were followed for 30 days. Centres were self-selected by anaesthesiology clinicians working there, who enrolled consecutive people with DM to a locally determined target number. There was 5936 (97%) 30-day follow-up completion. The primary outcome was Days at Home at 30 Days (DAH-30). Secondary outcomes included descriptive characteristics of perioperative management, dysglycaemia and incidence of postoperative complications.</div></div><div><h3>Findings</h3><div>There was significant variation between countries in perioperative DM management and 30-day outcomes, and variance in DAH-30 (median [range]) 26 [23–30] days, P = 0.0001). The proportion of people with DM with increased HbA1c (>69 mmol mol) was higher in T1DM compared with T2DM (n = 51, 18% vs n = 388, 7%; difference 11%, 95% CI 6–17; P = 0.002). In univariate analysis, there was an association between patients with lower HbA1c < 53 mmol mol<sup>−1</sup> median (25–75% range) DAH-30 = 27 days (23–29), contrasting with higher HbA1c > 69 mmol mol, median DAH-30 = 25 days (20–28); difference 2.0, 95% CI 1.3–2.7; P < 0.0001). This association was upheld in multivariable analysis only for patients with little blood loss.</div></div><div><h3>Interpretation</h3><div>There is a need to harmonise international practice to reduce variability in perioperative diabetes management and 30-day outcome.</div></div><div><h3>Funding</h3><div>The <span>European Society of Anaesthesiology and Intensive Care</span> (ESA-IC) funded administrative staff throughout the conduct of the study. The <span>College of Anaesthesiologists of Ireland</span> (CAI) and <span>British Journal of Anaesthesia</span> (BJA) partially contributed to data collection in Ireland and UK.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101535"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580502","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 : 2025-11-20DOI: 10.1016/j.lanepe.2025.101538
Xavier Chapalain , Olivier Huet , Kathryn M. Rowan , Paul R. Mouncey , Olivier Langeron , David K. Menon , David A. Harrison
Background
Recent epidemiological studies reported conflicting results regarding mortality trends for traumatic brain injury (TBI) patients. Mortality trends for the critically ill TBI population, and their drivers of changes, remains understudied. Particularly, withdrawal of life-sustaining therapy (WLST) decisions were rarely evaluated concurrently. In this study, we aimed to describe hospital mortality and WLST trends over the past 15 years in England, Wales and Northern Ireland for TBI patients admitted to an intensive care unit (ICU).
Methods
Observational cohort study, involving 235 adult ICUs participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme (CMP). From April 1, 2009 to March 31, 2024, all TBI patients were included. Comparator cohorts consisted of patients with trauma, sepsis, and vascular brain injury recorded in the CMP. The primary outcome was hospital mortality. The secondary outcome was the incidence of WLST decisions. We also examined the proportion of patients experiencing predefined early secondary brain insults.
Findings
Of the 2,324,961 ICU admissions, we identified 45,684 unique TBI patients. Over the study period, hospital mortality for TBI patients increased from 25.6% (1021/3988) to 35.0% (1306/3727). The proportion of WLST decisions rose from 7.5% (301/4024) to 19.7% (759/3850). After adjustment for main confounders, multivariable analyses confirmed these trends. No similar trends were observed among the comparator cohorts. TBI patients were exposed to hypotension, hypocapnia, hypercapnia and hyperglycaemia in 49.8% (22,559/45,298), 29.9% (12,356/41,262), 33.6% (13,869/41,262) and 29.2% (12,127/41,505) of cases, respectively. Half of patients (50.3%, 20,747/41,265) were exposed to hypoxaemia, and this proportion increased markedly from 36.9% (1359/3684) to 61.2% (2186/3572) over time.
Interpretation
For critically ill TBI patients, hospital mortality and WLST decisions rates increased over time. These findings raise important questions regarding the processes and ethical frameworks underpinning WLST decisions.
Funding
UKRI, NIHR, UK Ministry of Defence, Alzheimer’s Research UK, French Society of Anaesthesiology and Critical Care, Gueules Cassées Foundation, INNOVEO donation fund.
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Pub Date : 2025-11-20DOI: 10.1016/j.lanepe.2025.101508
Vita W. Jongen , Anders Boyd , Patrizia Carrieri , Nina Schat , Selwyn H. Lowe , Rosan van Zoest , Marit G.A. van Vonderen , Jolanda Lammers , Mark Verhagen , Ard van Sighem , Marc van der Valk
Background
To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.
Methods
We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.
Findings
6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17–1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62–1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05–3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80–5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01–1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50–1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15–1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21–2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025–0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011–0.035).
Interpretation
A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.
Funding
Dutch Ministry of Health, Welfare and Sport; TKI Health Holland.
背景：为了进一步减少荷兰的艾滋病毒新诊断，必须解决阻碍预防的个人和结构性障碍。我们的目的是估计新的艾滋病毒诊断的不成比例的负担，并探讨交叉的社会人口、社会经济和健康相关因素如何共同影响新的艾滋病毒诊断的风险。方法：我们将ATHENA队列（一个正在进行的全国性HIV队列）的数据与荷兰统计局的登记数据相结合。我们选择了2012年1月1日至2023年12月31日期间新诊断出艾滋病毒的个体，并将其与一般人群中的个体进行匹配。我们使用多变量广义线性模型评估新HIV诊断的决定因素。我们使用个体异质性和区分精度的多水平分析（MAIHDA）来量化交叉变量的联合和个人贡献。结果发现，6055名男性和1020名女性新诊断为艾滋病毒感染者。具有移民背景和中低收入或低于贫困线的收入与两名男性新诊断艾滋病毒的风险较高相关(低至中：调整奇数比(aOR) = 1.24, 95%置信区间(CI) = 1.17-1.31；低于贫困线：aOR = 1.75, 95% CI = 1.62-1.89)和女性（中低：aOR = 2.49, 95% CI = 2.05-3.01；低于贫困线：aOR = 4.71, 95% CI = 3.80-5.83）。使用精神保健（aOR = 1.14, 95% CI = 1.01-1.27）或抗抑郁药（aOR = 1.66, 95% CI = 1.50-1.84）也增加了男性的风险；接受社会福利（aOR = 1.39, 95% CI = 1.15-1.67）和使用抗精神病药物（aOR = 1.66, 95% CI = 1.21-2.28）增加了女性的风险。在MAIHDA确定的所有交叉点中，第一代移民背景、收入低于贫困线和使用抗抑郁药的男性HIV诊断的预测概率最高（0.036%，95%置信区间(CI) = 0.025-0.052）。第一代家庭背景、收入低于贫困线、接受社会福利和使用抗精神病药物的妇女的预测风险最高（0.019%,95% CI = 0.011-0.035）。对于具有移民背景和经济和心理健康脆弱性的个体，观察到新的艾滋病毒诊断负担不成比例地更高。需要在这些群体中加强艾滋病毒预防和检测。荷兰卫生、福利和体育部；TKI健康荷兰。
{"title":"Risk of new HIV diagnosis by intersecting migration, socioeconomic, and mental health vulnerabilities in the Netherlands: a nationwide analysis of the ATHENA cohort and Statistics Netherlands registry data","authors":"Vita W. Jongen , Anders Boyd , Patrizia Carrieri , Nina Schat , Selwyn H. Lowe , Rosan van Zoest , Marit G.A. van Vonderen , Jolanda Lammers , Mark Verhagen , Ard van Sighem , Marc van der Valk","doi":"10.1016/j.lanepe.2025.101508","DOIUrl":"10.1016/j.lanepe.2025.101508","url":null,"abstract":"<div><h3>Background</h3><div>To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.</div></div><div><h3>Methods</h3><div>We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.</div></div><div><h3>Findings</h3><div>6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17–1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62–1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05–3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80–5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01–1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50–1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15–1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21–2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025–0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011–0.035).</div></div><div><h3>Interpretation</h3><div>A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.</div></div><div><h3>Funding</h3><div><span>Dutch Ministry of Health, Welfare and Sport</span>; <span>TKI Health Holland</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101508"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736732","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 : 2025-11-20DOI: 10.1016/j.lanepe.2025.101536
Tala Ballouz, Philipp Kerksieck, Sarah R. Haile, Holger Dressel, Oliver Hämmig, Georg F. Bauer, Jan S. Fehr, Milo A. Puhan, Dominik Menges
Background
Data on the longer-term impact of post COVID-19 condition (PCC) on work-related functioning is limited, despite evidence on the persistence of PCC for years after infection. This study aimed to describe changes in work ability and sick leave associated with PCC up to three years post-infection.
Methods
We used data from 667 working-age individuals within a prospective population-based cohort following individuals infected with SARS-CoV-2 between August 2020 and January 2021. PCC was determined at 12 months and work ability was assessed biannually. The impact of SARS-CoV-2 on participants’ physical and mental work performance and COVID-19 related sick leave were assessed at three years.
Findings
Participants with protracted COVID-19 related symptoms at 12 months after infection reported persistently lower work ability scores than those without symptoms, with no evidence of a difference in change over time (−0.12 points per year, 95% CI −0.29 to 0.07). Compared to recovered individuals, work ability scores among those with moderate health impairment improved by +0.72 points per year (95% CI −0.04 to 1.46), while trends were similar among those with mild or severe impairment. A higher proportion of participants with PCC reported worsening in physical and mental performance at work than those without PCC. Among those with PCC, 11.5% (9/78) reported taking COVID-19 related sick leave for one month or more, in contrast to 4.0% (13/327) among those without PCC.
Interpretation
The study highlights the prolonged impact of PCC on work-related functioning and underscores the need for targeted occupational, clinical and social measures for those affected.
Funding
Federal Office of Public Health, Department of Health of the Canton of Zurich, University of Zurich Foundation, Switzerland; Horizon Europe.
背景：关于COVID-19后病情（PCC）对工作功能的长期影响的数据有限，尽管有证据表明PCC在感染后持续数年。本研究旨在描述PCC感染后长达三年的工作能力和病假的变化。方法：我们使用了2020年8月至2021年1月期间感染SARS-CoV-2的前瞻性人群队列中的667名工作年龄个体的数据。12个月时测定PCC，每半年评估一次工作能力。每三年评估新冠肺炎对参与者身心工作表现和新冠肺炎相关病假的影响。在感染后12个月，持续出现COVID-19相关症状的参与者报告的工作能力得分持续低于没有症状的参与者，没有证据表明随时间的变化存在差异（每年- 0.12点，95% CI - 0.29至0.07）。与康复个体相比，中度健康障碍患者的工作能力得分每年提高+0.72分（95% CI为- 0.04至1.46），而轻度或重度健康障碍患者的趋势相似。与没有患前列腺癌的人相比，患前列腺癌的人在工作时身心表现恶化的比例更高。在患有PCC的人中，11.5%（9/78）报告请了一个月或更长时间的与COVID-19相关的病假，而在没有PCC的人中，这一比例为4.0%（13/327）。该研究强调了PCC对工作功能的长期影响，并强调了对受影响者采取有针对性的职业、临床和社会措施的必要性。资助：苏黎世州卫生部联邦公共卫生局，苏黎世大学基金会，瑞士；欧洲地平线。
{"title":"Work ability trajectories and sick leave in individuals with post COVID-19 condition: 3-year follow-up of a population-based cohort","authors":"Tala Ballouz, Philipp Kerksieck, Sarah R. Haile, Holger Dressel, Oliver Hämmig, Georg F. Bauer, Jan S. Fehr, Milo A. Puhan, Dominik Menges","doi":"10.1016/j.lanepe.2025.101536","DOIUrl":"10.1016/j.lanepe.2025.101536","url":null,"abstract":"<div><h3>Background</h3><div>Data on the longer-term impact of post COVID-19 condition (PCC) on work-related functioning is limited, despite evidence on the persistence of PCC for years after infection. This study aimed to describe changes in work ability and sick leave associated with PCC up to three years post-infection.</div></div><div><h3>Methods</h3><div>We used data from 667 working-age individuals within a prospective population-based cohort following individuals infected with SARS-CoV-2 between August 2020 and January 2021. PCC was determined at 12 months and work ability was assessed biannually. The impact of SARS-CoV-2 on participants’ physical and mental work performance and COVID-19 related sick leave were assessed at three years.</div></div><div><h3>Findings</h3><div>Participants with protracted COVID-19 related symptoms at 12 months after infection reported persistently lower work ability scores than those without symptoms, with no evidence of a difference in change over time (−0.12 points per year, 95% CI −0.29 to 0.07). Compared to recovered individuals, work ability scores among those with moderate health impairment improved by +0.72 points per year (95% CI −0.04 to 1.46), while trends were similar among those with mild or severe impairment. A higher proportion of participants with PCC reported worsening in physical and mental performance at work than those without PCC. Among those with PCC, 11.5% (9/78) reported taking COVID-19 related sick leave for one month or more, in contrast to 4.0% (13/327) among those without PCC.</div></div><div><h3>Interpretation</h3><div>The study highlights the prolonged impact of PCC on work-related functioning and underscores the need for targeted occupational, clinical and social measures for those affected.</div></div><div><h3>Funding</h3><div><span>Federal Office of Public Health</span>, <span>Department of Health of the Canton of Zurich</span>, <span>University of Zurich Foundation</span>, Switzerland; <span>Horizon Europe</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101536"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580504","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 : 2025-11-20DOI: 10.1016/j.lanepe.2025.101542
Bruno Sepodes , Juan Garcia Burgos , Steffen Thirstrup
{"title":"European Medicines Agency approvals of new medicines in September and October 2025","authors":"Bruno Sepodes , Juan Garcia Burgos , Steffen Thirstrup","doi":"10.1016/j.lanepe.2025.101542","DOIUrl":"10.1016/j.lanepe.2025.101542","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101542"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571262","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 : 2025-11-20DOI: 10.1016/j.lanepe.2025.101537
Santiago Madero , Oscar Soto-Angona , Genis Ona , Jose Sanchez-Moreno , Eduard Vieta
In this viewpoint, we explore the evolving landscape of psychedelic-assisted therapy in Europe, focusing on clinical, regulatory, and therapeutic developments. While access remains limited, recent initiatives in Switzerland, Germany, and the Czech Republic illustrate growing momentum toward regulated use. We examine the debate surrounding psychedelics as pharmacological agents versus psychotherapeutic catalysts and argue for an integrative framework that considers neurobiological mechanisms, subjective experience, and contextual factors. We focus on how their effects, particularly those involving neuroplasticity and critical periods, may interact with psychotherapeutic processes. We highlight the importance of context and psychological support in shaping outcomes and discuss the challenges of implementing scalable care models. Regulatory fragmentation and methodological complexities continue to hinder progress, but publicly funded trials such as EPIsoDE and PsyPal offer promising examples of ethical and effective approaches. In our view, the future of psychedelic therapy lies not in simplifying its complexity, but in embracing it.
{"title":"Current perspectives on psychedelic treatments in Europe","authors":"Santiago Madero , Oscar Soto-Angona , Genis Ona , Jose Sanchez-Moreno , Eduard Vieta","doi":"10.1016/j.lanepe.2025.101537","DOIUrl":"10.1016/j.lanepe.2025.101537","url":null,"abstract":"<div><div>In this viewpoint, we explore the evolving landscape of psychedelic-assisted therapy in Europe, focusing on clinical, regulatory, and therapeutic developments. While access remains limited, recent initiatives in Switzerland, Germany, and the Czech Republic illustrate growing momentum toward regulated use. We examine the debate surrounding psychedelics as pharmacological agents versus psychotherapeutic catalysts and argue for an integrative framework that considers neurobiological mechanisms, subjective experience, and contextual factors. We focus on how their effects, particularly those involving neuroplasticity and critical periods, may interact with psychotherapeutic processes. We highlight the importance of context and psychological support in shaping outcomes and discuss the challenges of implementing scalable care models. Regulatory fragmentation and methodological complexities continue to hinder progress, but publicly funded trials such as EPIsoDE and PsyPal offer promising examples of ethical and effective approaches. In our view, the future of psychedelic therapy lies not in simplifying its complexity, but in embracing it.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101537"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580505","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 : 2025-11-18DOI: 10.1016/j.lanepe.2025.101540
Benjamin Davido , Sofia Ny , Corine van Lingen , Christine Årdal , Laura Alonso Irujo , Sofia Linnros , Lucie Collineau , Nerea Gonzalez Hernandez , Marta Gutierrez Rubio , Giel van de Laar , Lida Politi , Brian Kristensen , Ana Álvarez-Fernández , Yohann Lacotte , Agathe Claude , Marie-Cécile Ploy
Antimicrobial resistance (AMR) causes over 35,000 deaths annually in the EU/EEA and is projected to result in 1.91 million global deaths each year by 2050. The second Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI-2), uniting 128 partners from 30 countries, represents a coordinated EU/EEA effort to curb AMR through a One Health approach. Although nearly all EU/EEA countries have an AMR National Action Plan, our initial assessment revealed that implementation remains constrained by limited resources, weak intersectoral coordination and fragmented leadership. EU-JAMRAI-2 addresses these challenges by promoting harmonized surveillance, strengthening infection prevention and control, applying behaviorally tailored stewardship interventions, ensuring sustainable access to essential antibiotics, and raising awareness among priority target audiences. By analyzing policy gaps and operational barriers, this paper underscores the need for stronger accountability and political commitment to translate strategies into sustainable action. Strengthening AMR governance through a unified European approach is essential to achieve effective, lasting progress against this silent pandemic.
{"title":"Strengthening antimicrobial resistance governance in Europe: a coordinated one health approach","authors":"Benjamin Davido , Sofia Ny , Corine van Lingen , Christine Årdal , Laura Alonso Irujo , Sofia Linnros , Lucie Collineau , Nerea Gonzalez Hernandez , Marta Gutierrez Rubio , Giel van de Laar , Lida Politi , Brian Kristensen , Ana Álvarez-Fernández , Yohann Lacotte , Agathe Claude , Marie-Cécile Ploy","doi":"10.1016/j.lanepe.2025.101540","DOIUrl":"10.1016/j.lanepe.2025.101540","url":null,"abstract":"<div><div>Antimicrobial resistance (AMR) causes over 35,000 deaths annually in the EU/EEA and is projected to result in 1.91 million global deaths each year by 2050. The second Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI-2), uniting 128 partners from 30 countries, represents a coordinated EU/EEA effort to curb AMR through a One Health approach. Although nearly all EU/EEA countries have an AMR National Action Plan, our initial assessment revealed that implementation remains constrained by limited resources, weak intersectoral coordination and fragmented leadership. EU-JAMRAI-2 addresses these challenges by promoting harmonized surveillance, strengthening infection prevention and control, applying behaviorally tailored stewardship interventions, ensuring sustainable access to essential antibiotics, and raising awareness among priority target audiences. By analyzing policy gaps and operational barriers, this paper underscores the need for stronger accountability and political commitment to translate strategies into sustainable action. Strengthening AMR governance through a unified European approach is essential to achieve effective, lasting progress against this silent pandemic.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101540"},"PeriodicalIF":13.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797111","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 : 2025-11-17DOI: 10.1016/j.lanepe.2025.101533
Agata Łaszewska , Timea Helter , Ashley Baldwin , Anthony J. Cleare , Philip J. Cowen , Jonathan Evans , Quentin J.M. Huys , Micheal Kurkar , Alexander C. Lewis , Neil Nixon , Abhinav Rastogi , Stuart Watson , John R. Geddes , Michael Browning , Judit Simon
Background
Pramipexole augmentation of antidepressant treatment for treatment-resistant depression (TRD) has been shown to improve symptom burden over 12 weeks but with some adverse effects compared to placebo augmentation. We aimed to evaluate the cost-effectiveness of pramipexole augmentation for TRD.
Methods
We conducted an economic evaluation as part of the PAX-D trial over 12 and 48 weeks. Two costing perspectives, National Health Service and Personal Social Services (NHS + PSS) and societal, were adopted. The primary outcome was quality-adjusted life year (QALY) based on the EQ-5D-5L. Secondary outcomes included year of full capability (YFC) based on the ICECAP-A, and capability-weighted life year (CWLY) based on the OxCAP-MH. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes and cost-effectiveness acceptability curves were reported alongside sensitivity analyses. The trial was registered with ISCTRN (ISRCTN84666271) and EudraCT (2019-001023-13) and is complete.
Findings
From the NHS + PSS perspective, mean incremental cost of pramipexole was £60 (95% CI: −£55, £176) over 12 weeks and £811 (95% CI: £110, £1513) over 48 weeks. The difference in QALY gained was 0.012 (95% CI: 0.003, 0.021) over 12 weeks and 0.090 (95% CI: 0.036, 0.144) over 48 weeks, equivalent to 4 (95% CI: 1, 8) and 33 (95% CI: 13, 52) days in perfect health. The ICER was £5069/QALY (95% CI: −£3642, £35,608) over 12 weeks and £9007/QALY (95% CI: £2,219, £27,258) over 48 weeks, representing over 90% probability of cost-effectiveness at £20,000/QALY threshold. From the societal perspective, pramipexole was on average cost saving and more effective over 48 weeks. Alternative analyses provided consistent conclusions.
Interpretation
Pramipexole augmentation for TRD has demonstrated both clinical and cost-effectiveness. Further trials, directly comparing pramipexole to other augmentation strategies, will be useful in determining the position of this repurposed medication in the treatment pathway of depression.
Funding
National Institute for Health and Care Research, Efficacy and Mechanism Evaluation Programme.
{"title":"Cost-effectiveness of pramipexole augmentation for acute phase and maintenance therapy of treatment-resistant depression compared to placebo augmentation: economic evaluation of the PAX-D randomised controlled trial","authors":"Agata Łaszewska , Timea Helter , Ashley Baldwin , Anthony J. Cleare , Philip J. Cowen , Jonathan Evans , Quentin J.M. Huys , Micheal Kurkar , Alexander C. Lewis , Neil Nixon , Abhinav Rastogi , Stuart Watson , John R. Geddes , Michael Browning , Judit Simon","doi":"10.1016/j.lanepe.2025.101533","DOIUrl":"10.1016/j.lanepe.2025.101533","url":null,"abstract":"<div><h3>Background</h3><div>Pramipexole augmentation of antidepressant treatment for treatment-resistant depression (TRD) has been shown to improve symptom burden over 12 weeks but with some adverse effects compared to placebo augmentation. We aimed to evaluate the cost-effectiveness of pramipexole augmentation for TRD.</div></div><div><h3>Methods</h3><div>We conducted an economic evaluation as part of the PAX-D trial over 12 and 48 weeks. Two costing perspectives, National Health Service and Personal Social Services (NHS + PSS) and societal, were adopted. The primary outcome was quality-adjusted life year (QALY) based on the EQ-5D-5L. Secondary outcomes included year of full capability (YFC) based on the ICECAP-A, and capability-weighted life year (CWLY) based on the OxCAP-MH. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes and cost-effectiveness acceptability curves were reported alongside sensitivity analyses. The trial was registered with ISCTRN (ISRCTN84666271) and EudraCT (2019-001023-13) and is complete.</div></div><div><h3>Findings</h3><div>From the NHS + PSS perspective, mean incremental cost of pramipexole was £60 (95% CI: −£55, £176) over 12 weeks and £811 (95% CI: £110, £1513) over 48 weeks. The difference in QALY gained was 0.012 (95% CI: 0.003, 0.021) over 12 weeks and 0.090 (95% CI: 0.036, 0.144) over 48 weeks, equivalent to 4 (95% CI: 1, 8) and 33 (95% CI: 13, 52) days in perfect health. The ICER was £5069/QALY (95% CI: −£3642, £35,608) over 12 weeks and £9007/QALY (95% CI: £2,219, £27,258) over 48 weeks, representing over 90% probability of cost-effectiveness at £20,000/QALY threshold. From the societal perspective, pramipexole was on average cost saving and more effective over 48 weeks. Alternative analyses provided consistent conclusions.</div></div><div><h3>Interpretation</h3><div>Pramipexole augmentation for TRD has demonstrated both clinical and cost-effectiveness. Further trials, directly comparing pramipexole to other augmentation strategies, will be useful in determining the position of this repurposed medication in the treatment pathway of depression.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research</span>, <span>Efficacy and Mechanism Evaluation Programme</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101533"},"PeriodicalIF":13.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580503","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}
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