Lancet Regional Health-Europe最新文献

{"title":"Frequency and survival of delayed breast cancer diagnosis in women participating at screening mammography in the Netherlands: a population-based study","authors":"Lucien E.M. Duijm ,&nbsp;Eline L. van der Veer ,&nbsp;Hermen C. van Beek ,&nbsp;Wikke Setz-Pels ,&nbsp;Vivian van Breest Smallenburg ,&nbsp;Rob M.G. van Bommel ,&nbsp;Clemence L. op de Coul-Froger ,&nbsp;Maaike Gielens ,&nbsp;Dominique J.P. van Uden ,&nbsp;Adri C. Voogd","doi":"10.1016/j.lanepe.2025.101526","DOIUrl":"10.1016/j.lanepe.2025.101526","url":null,"abstract":"<div><h3>Background</h3><div>Although breast cancer screening programmes aim to enable early breast cancer detection, diagnostic delays still occur among participants. Limited information is available on the frequency and survival of women with a delay in breast cancer diagnosis within the screening population. We determined the frequency of various types of delay in breast cancer diagnosis at screening mammography and specified the tumour characteristics, surgical therapy and survival rates of women with these delayed diagnoses, as well as variations in their proportions over time.</div></div><div><h3>Methods</h3><div>We included 901,133 screening examinations obtained in the southern Netherlands between 1999 and 2019. Screening mammograms of women with interval cancers (ICs) and breast cancers detected at subsequent screening were reviewed to determine whether the cancer had been missed.</div></div><div><h3>Findings</h3><div>Of the 7129 women with breast cancers, 5419 (76.0%) were diagnosed without delay after recall and 1101 (15.4%) had a true IC (i.e., not detectable at the previous screen). In total, 1601 women experienced a delay in breast cancer diagnosis, comprising the following three study groups: (i) recalled women with a delay in diagnostic work-up (n = 264), (ii) recalled women with screen-detected cancers (SDCs) at subsequent screening and without a delay in diagnostic work-up, that had been missed at the previous screening round (n = 992), and (iii) women with ICs missed at the latest screening round (n = 345). Overall, 26.6% of cancers were associated with a delay (1601/6028), primarily due to SDCs missed at the previous screen (62.0%, 992/1601), followed by missed ICs (21.5%, 345/1601) and misdiagnosis after recall (16.5%, 264/1601). Compared to SDCs missed at the previous screen and misdiagnosis after recall, missed ICs demonstrated the poorest tumour characteristics, highest mastectomy rate (42.6% vs 20.1% and 19.3%, p &lt; 0.0001) and poorest overall survival (5-year rate 86.9% vs 93.8% and 93.8%, p = 0.0017). Temporal trends in tumour characteristics were mainly observed in SDCs missed at the previous screen.</div></div><div><h3>Interpretation</h3><div>Delayed breast cancer diagnosis at screening mammography or after recall remains a serious point of concern. Most delays are related to SDCs missed at a previous screen, whereas missed ICs show the worst survival.</div></div><div><h3>Funding</h3><div>This research did not receive any funding.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101526"},"PeriodicalIF":13.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499918","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}

{"title":"A multimodal individualized long-term intervention to prevent functional decline after stroke (LAST-long): a single blinded randomised controlled trial","authors":"Torunn Askim ,&nbsp;Sara Rise Langlo ,&nbsp;Elin Bergh ,&nbsp;Øystein Døhl ,&nbsp;Hanne Ellekjær ,&nbsp;Anne Hokstad ,&nbsp;Håkon Ihle-Hansen ,&nbsp;Bent Indredavik ,&nbsp;Stian Lydersen ,&nbsp;Geske Luzum ,&nbsp;Yngve Seljeseth ,&nbsp;Toril Skandsen ,&nbsp;Ingvild Saltvedt ,&nbsp;Bente Thommessen","doi":"10.1016/j.lanepe.2025.101531","DOIUrl":"10.1016/j.lanepe.2025.101531","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Despite the lack of evidence, the Stroke Action Plan for Europe recommends coordinated support after initial rehabilitation. This trial investigated if a coordinator-led multimodal intervention was superior to standard care in preventing dependency and functional decline after stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this single blinded randomised controlled multi-centre trial, patients were consecutively screened, included and randomised (1:1) by a web-based randomization system to an intervention or a control group at the out-patient clinics at four Norwegian hospitals three months post-stroke. Blinded assessments were performed at inclusion and at 6-, 12-, and 18-month follow-up. The inclusion criteria were; age ≥18 years, life expectancy ≥12 months (assessed by the physician), modified Rankin Scale (mRS) score &lt;5, vulnerable to functional decline (defined by other measures). The control group received standard care, while the intervention group additionally received monthly follow-up by a community-based stroke coordinator who applied a study specific checklist to identify the patients’ risk profile within multiple domains. Individual goals and action points were defined accordingly. The intervention lasted for 18 months. Mixed models were used to evaluate differences between the groups for the primary endpoint (mRS at 18-month follow-up) and secondary endpoints (activities of daily living, cognitive function, physical function, patient reported outcomes, physical activity, blood pressure, body mass index and blood tests) at 6-, 12-, and 18-month follow-up. The trial was registered at ClinicalTrials.gov identifier: NCT03859063. The trial has been completed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The LAST-long trial was conducted from April 11, 2019 to August 28, 2024. In total, 301 participants (48% women); mean age 71·3 (SD 12·3) years, National Institute of Health Stroke Scale admission score 3·38 (SD 4·21), and mRS at inclusion 1·6 (SD 0·9), were randomised to the intervention (n = 152) or control (n = 149) group 108.0 (SD 18·5) days post stroke. The number of serious adverse events (deaths, hospitalisation due to cardiovascular events, cerebrovascular events or fall with or without fracture) was 32 (21·1%) in the intervention group and 33 (22·1%) in the control group. At 18 months, the estimated difference between the groups was 0·03 (95% CI: −0·16 to 0·22), p = 0·79 for mRS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The 18-month multimodal intervention was not superior to standard care received by the control group in people with mild stroke. An even longer follow-up period might be needed to investigate the effect of the intervention on hard outcomes like death or recurrent vascular events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;The Research Council of Norway, The Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU (FFU), Foundation Dam.&lt;/div&gt;&lt;/d","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101531"},"PeriodicalIF":13.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499917","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}

{"title":"Ethnic inequalities in all-cause mortality in the UK: the importance of evidence in shaping health policy","authors":"Peter Goldblatt ,&nbsp;Veena Raleigh","doi":"10.1016/j.lanepe.2025.101530","DOIUrl":"10.1016/j.lanepe.2025.101530","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101530"},"PeriodicalIF":13.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528709","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}

{"title":"Ending HIV transmission in Europe","authors":"Jan A.C. Hontelez ,&nbsp;Casper Rokx","doi":"10.1016/j.lanepe.2025.101522","DOIUrl":"10.1016/j.lanepe.2025.101522","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101522"},"PeriodicalIF":13.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468506","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}

{"title":"Management and survival of patients with cancer of unknown primary discussed by a French national multidisciplinary tumour board: a retrospective analysis","authors":"Célia Dupain ,&nbsp;Nicolas Jacquin ,&nbsp;Aurélien Latouche ,&nbsp;Zoé Nevière ,&nbsp;Pierre Gestraud ,&nbsp;Abderaouf Hamza ,&nbsp;Kenza Nedara ,&nbsp;Vincent Cockenpot ,&nbsp;Janick Selves ,&nbsp;Yves Allory ,&nbsp;Laëtitia Chanas ,&nbsp;Maud Milder ,&nbsp;Isabelle Soubeyran ,&nbsp;Hélène Blons ,&nbsp;Anna Patrikidou ,&nbsp;Axel de Bernardi ,&nbsp;Julien Masliah-Planchon ,&nbsp;Odette Mariani ,&nbsp;Etienne Rouleau ,&nbsp;Fabienne Escande ,&nbsp;Sarah Watson","doi":"10.1016/j.lanepe.2025.101524","DOIUrl":"10.1016/j.lanepe.2025.101524","url":null,"abstract":"<div><h3>Background</h3><div>Recent clinical trials have shown that molecularly-guided treatments can improve survival in patients with cancers of unknown primary (CUP). However, the feasibility and clinical benefit of these treatments for CUP in a real-life setting remain uncertain. In France, a national multidisciplinary tumour board dedicated to patients with CUP (CUP MTB) was created in 2020, with the aims of coordinating pathological and molecular diagnostic analyses and providing a centralised expertise for therapeutic orientation. This study aimed at evaluating the diagnostic and therapeutic impact of the CUP MTB on patients with CUP in a national real-life setting.</div></div><div><h3>Methods</h3><div>Patient and tumour characteristics, treatments and outcomes are collected prospectively. This study reports the diagnostic and therapeutic impact of all patients discussed in CUP_MTB between July 2020 and December 2023. The diagnostic impact was defined as the identification of a putative tissue of origin, and the initiation of a MTB–oriented treatment. Overall survival was estimated using the Kaplan–Meier method, and hazard ratios were calculated using Cox proportional hazard models.</div></div><div><h3>Findings</h3><div>A total of 246 CUP patients were referred to CUP_MTB (124 females and 122 men); 187 (76%) underwent pathological and molecular characterizations as recommended by the MTB. Tumour profiling enabled the identification of a putative tissue of origin (TOO) in 130/187 (70%) patients. The most frequent TOO were gastrointestinal (n = 29; 22%), lung (n = 22; 17%), breast (n = 21; 16%), and kidney (n = 19; 15%). 149 (61%) patients received a treatment based on MTB recommendation. 111/149 (74.5%) patients received MTB-oriented treatment, including systemic treatment oriented towards the putative TOO (n = 95, 63.8%), or treatment directed towards a targetable molecular alteration (n = 16, 10.7%). 38 (25.5%) patients for whom no MTB-oriented treatment could be recommended were treated with empiric treatment according to international guidelines. The median overall survival of patients treated with MTB-oriented treatment was 18.6 (IQR = 12.0) months, compared to 11.0 (IQR = 10.5) months in patients with empiric treatment (HR = 0.61, 95% CI 0.38–0.98, p = 0.04).</div></div><div><h3>Interpretation</h3><div>Integration of clinical, pathological and molecular data within an expert MTB is feasible in a real-life setting, enables access to molecularly guided treatments and improves survival for a large proportion of CUP patients. Our findings highlight the benefits of dedicated MTB and reference centres to improve the management of CUP.</div></div><div><h3>Funding</h3><div><span>Institut Curie</span> and the 2025 <span>French Genomic Medicine Initiative</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101524"},"PeriodicalIF":13.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468474","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}

{"title":"The estimated impact of mandatory front-of-pack nutrition labelling policies on adult obesity prevalence and obesity-related mortality in England: a modelling study","authors":"Rebecca Evans ,&nbsp;Martin O'Flaherty ,&nbsp;I Gusti Ngurah Edi Putra ,&nbsp;Chris Kypridemos ,&nbsp;Eric Robinson ,&nbsp;Zoé Colombet","doi":"10.1016/j.lanepe.2025.101506","DOIUrl":"10.1016/j.lanepe.2025.101506","url":null,"abstract":"<div><h3>Background</h3><div>Since 2013, front-of-pack traffic light labels have been implemented voluntarily on packaged food in the UK. The UK Government is now considering alternative labelling approaches which may be more effective, such as Chile's mandatory nutrient warning labels. The present study aimed to estimate the impact of mandatorily implementing (i) traffic light labels and (ii) nutrient warning labels on population-level obesity prevalence and mortality in England.</div></div><div><h3>Methods</h3><div>A microsimulation model was built to simulate the effects of implementing mandatory front-of-pack nutrition labels (nutrient warning and traffic light) on assumed changes in daily energy intake from packaged food (due to consumer behaviour change and reformulation), and subsequent population-level obesity prevalence and mortality due to changes in BMI. We modelled the population of England, aged 30–89 years, over 20 years (2024–2043) using a synthetic population stratified by age, sex and Index of Multiple Deprivation. The model simulates individuals' life courses and counterfactuals under different policy scenarios, allowing detailed assessment of policies on exposures, disease risk, and mortality.</div></div><div><h3>Findings</h3><div>Compared to the baseline scenario (current voluntary implementation of traffic light labelling), mandatory implementation of traffic light labelling was estimated to reduce obesity prevalence by 2.34 percentage points (95% UI 0.67–4.31) and prevent or postpone 57,000 (95% UI 13,000–160,000) obesity-related deaths. Mandatory implementation of nutrient warning labelling was estimated to have a larger impact; a 4.44 percentage point (95% UI 0.08–10.76) reduction in obesity prevalence and 110,000 (95% UI 2000–420,000) fewer obesity-related deaths.</div></div><div><h3>Interpretation</h3><div>This work offers the first modelled estimation of the impact of introducing mandatory front-of-pack nutrition labels on obesity prevalence in the adult population in England. Findings suggest that mandatory implementation of nutrient warning labels would reduce prevalence of obesity and related deaths, compared to current voluntary or mandatory implementation of traffic light labelling, and should therefore be considered by the UK Government.</div></div><div><h3>Funding</h3><div>European Research Council.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101506"},"PeriodicalIF":13.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790205","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}

{"title":"Suicide after involuntary psychiatric care: a nationwide cohort study in Sweden","authors":"Leoni Grossmann ,&nbsp;Fred Johansson ,&nbsp;Seena Fazel ,&nbsp;Ralf Kuja-Halkola ,&nbsp;Björn Bråstad ,&nbsp;David Mataix-Cols ,&nbsp;Lorena Fernández de la Cruz ,&nbsp;Bo Runeson ,&nbsp;Paul Lichtenstein ,&nbsp;Zheng Chang ,&nbsp;Henrik Larsson ,&nbsp;Isabell Brikell ,&nbsp;Brian D'Onofrio ,&nbsp;Ronnie Pingel ,&nbsp;Christian Rück ,&nbsp;John Wallert","doi":"10.1016/j.lanepe.2025.101504","DOIUrl":"10.1016/j.lanepe.2025.101504","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about the risk of suicide in individuals treated against their will in involuntary psychiatric care (IPC). This population-based study provides a first comprehensive description of suicide among individuals who experienced IPC.</div></div><div><h3>Methods</h3><div>We studied all individuals discharged from IPC in Sweden from 2010 through 2020. Clinical and sociodemographic characteristics are reported followed by suicide risk for the complete IPC population and stratified by sex, age, IPC history, and diagnostic category. Crude and adjusted relative risks compared to all individuals discharged from psychiatric in- and outpatient care and the general population were estimated using Poisson regression. Suicide methods, seasonal trends, and geographical variance are also reported.</div></div><div><h3>Findings</h3><div>We identified 72 275 patients treated in IPC with a total of 134 514 inpatient care episodes (mean age = 44·8 years, 37 462 [51·8%] males). Of these, 2104 (2·9%) died by suicide over a median follow-up time of 4·4 years (IQR: 1⋅8–7⋅5). Suicide decedents were younger, more often male, single, diagnosed with personality and substance use disorders, and had a history of self-harm and IPC, compared to those who did not die by suicide. The absolute risk (crude incidence rate (IR) per 100 000 person-years) for all IPC patients was highest closest to discharge (IR_1month = 2941 [2538, 3408]) and decreased thereafter (IR_5years = 738 [705, 773]). Suicide risk in IPC patients was elevated relative to psychiatric inpatients (crude IR ratio (IRR)_5years = 1·57 [1·48, 1·65]), psychiatric outpatients (IRR_5years = 3·77 [3·58, 3·97]), and the general population (IRR_5years = 55·52 [52·65, 58·54]).</div></div><div><h3>Interpretation</h3><div>We found substantial risk differences in distinct subgroups of IPC patients and an excess suicide risk among IPC patients compared to other clinical populations. These findings warrant further investigation as they could inform clinicians and policy makers regarding potential risk stratification, monitoring, and care. Preventing suicides after IPC should be a priority.</div></div><div><h3>Funding</h3><div><span>VR</span>, <span>ALF</span> Medicine, <span>CIMED</span>, <span>FORTE,</span> and <span>Söderström König Foundation</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101504"},"PeriodicalIF":13.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468505","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}

{"title":"Percutaneous and surgical management of aortic stenosis in the SWEDEHEART registry (2013–2023): a nationwide observational study","authors":"Johannes Tödt ,&nbsp;Sasha Koul ,&nbsp;Troels Yndigegn ,&nbsp;Oskar Angerås ,&nbsp;Henrik Bjursten ,&nbsp;Shahab Nozohoor ,&nbsp;Örjan Friberg ,&nbsp;Jenny Backes ,&nbsp;Stefan James ,&nbsp;Björn Redfors ,&nbsp;Patrik Gilje ,&nbsp;Ashkan Labaf ,&nbsp;Henrik Hagström ,&nbsp;Andreas Rück ,&nbsp;Matthias Götberg ,&nbsp;Moman Aladdin Mohammad","doi":"10.1016/j.lanepe.2025.101520","DOIUrl":"10.1016/j.lanepe.2025.101520","url":null,"abstract":"<div><h3>Background</h3><div>Management of severe aortic stenosis (AS) has evolved over the past decade, driven by the widespread adoption of transcatheter aortic valve implantation (TAVI). This study aims to assess trends in procedural volumes, patient characteristics, and outcomes for patients undergoing TAVI or surgical aortic valve replacement (SAVR) in Sweden.</div></div><div><h3>Methods</h3><div>This was a descriptive, non-comparative, nationwide cohort study using the SWEDEHEART registry. We included 21,383 patients who underwent TAVI or SAVR between 2013 and 2023 (11,366 TAVI and 10,017 SAVR). Trends in patient characteristics, preoperative risk, complications and mortality were examined.</div></div><div><h3>Findings</h3><div>TAVI procedures increased from 307 (26.1%, n = 307/1174) in 2013 to 1851 (71.2%, n = 1851/2601) in 2023, while SAVR volumes declined from ∼1000 annually before 2018 to roughly 750 procedures annually. Median age of TAVI patients were 81 (IQR 77, 85) years and 71 (IQR 65, 76) years for SAVR patients. The median EuroSCORE II for TAVI decreased from 5.6 (IQR 3.3, 10.2) to 2.7 (IQR 1.7, 4.6) (p = 0.002), and STS-PROM from 3.3 (IQR 1.9, 4.1) to 1.6 (IQR 1.1, 2.8) (p = 0.0021). Among SAVR patients, EuroSCORE II decreased from 1.5 (IQR 1.0, 2.3) to 1.3 (IQR 0.9, 2.1) (p = 0.022) and STS-PROM from 1.8 (IQR 1.2, 3.0) to 1.6 (IQR 1.1, 2.6) (p = 0.0082). Any in-hospital complications declined significantly for TAVI (29.2%, n = 210/719 to 13.2%, n = 244/1851), while SAVR complication rates increased slightly (18.4%, n = 354/1921 to 18.7%, n = 140/750). In-hospital mortality for TAVI declined from 3.6% (n = 26/719) to 1.0% (n = 18/1851), and 1-year mortality from 11.1% to 6.9% (p = 0.019). SAVR in-hospital all-cause death decreased from 1.6% to 0.4% (n = 3/750) and 5.0% to 2.2% for 1-year mortality (p = 0.013).</div></div><div><h3>Interpretation</h3><div>TAVI has become the predominant treatment strategy for AS in Sweden expanding access within the treated cohort. Despite this, current 2023 SAVR results demonstrate similar in-hospital complication rates compared to TAVI (18.7% vs 13.2%), but lower in-hospital (0.4% vs 1.0%) and 1-year mortality rates (2.2% vs 6.9%).</div></div><div><h3>Funding</h3><div>This study was supported by <span>ALF</span> and national research funding bodies.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101520"},"PeriodicalIF":13.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468473","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}

{"title":"Brand-specific influenza vaccine effectiveness in three Nordic countries during the 2024–2025 season: a target trial emulation study based on registry data","authors":"Kristyna Faksova ,&nbsp;Emilia Myrup Thiesson ,&nbsp;Nicklas Pihlström ,&nbsp;Ulrike Baum ,&nbsp;Tor Biering-Sørensen ,&nbsp;Eero Poukka ,&nbsp;Tuija Leino ,&nbsp;Rickard Ljung ,&nbsp;Anders Hviid","doi":"10.1016/j.lanepe.2025.101518","DOIUrl":"10.1016/j.lanepe.2025.101518","url":null,"abstract":"<div><h3>Background</h3><div>Seasonal influenza causes substantial morbidity and mortality in older adults. While vaccination is recommended in Nordic countries for individuals aged ≥65 years, brand-specific effectiveness estimates are scarce but essential for regulatory decision-making. We evaluated brand-specific effectiveness of seasonal influenza vaccines against laboratory-confirmed influenza-related outcomes in Denmark, Finland, and one Swedish region during the 2024/2025 season.</div></div><div><h3>Methods</h3><div>We conducted a nationwide cohort study using target trial emulation and linked health registries. Individuals aged ≥65 years were matched 1:1, comparing seasonal influenza vaccine recipients to non-recipients. Cumulative incidences of laboratory-confirmed influenza A and B, influenza-related hospitalisation, and death were assessed at 18 weeks post-immunisation. Vaccine effectiveness (VE) was calculated as 1 minus the risk ratio.</div></div><div><h3>Findings</h3><div>A total of 1,164,686 matched pairs were included (mean age 75.4 years, standard deviation 7.3). Overall VE against influenza-related hospitalisation was 46.8% (95% CI 40.8–52.9), with risk differences of −21.3 (−28.9 to −13.8) and −99.3 (−119.6 to −79.1) in Finland and Denmark, respectively, per 100,000 vaccinated individuals. Brand-specific VE was 63.4% (38.1–88.7) for Efluelda Tetra (split virion-high dose), 48.2% (40.8–55.6) for Fluad Tetra (subunit standard-dose adjuvanted), 43.6% (23.7–63.6) for Vaxigrip Tetra (split virion standard-dose), and 30.6% (−7.8 to 69.1) for Influvac Tetra (subunit standard-dose). VE waned by −6.5 percentage points (−10.5 to −2.5) every 3 weeks.</div></div><div><h3>Interpretation</h3><div>Seasonal influenza vaccines moderately reduced the risk of severe outcomes in older adults. Efluelda Tetra and Fluad Tetra appeared to offer favourable protection in their respective target groups, supporting their use in the 2025/2026 season. Annual monitoring using Nordic registries is crucial for informing evidence-based vaccination strategies and regulatory decisions.</div></div><div><h3>Funding</h3><div><span>European Medicines Agency</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101518"},"PeriodicalIF":13.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468471","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}

{"title":"Examination of self-harm clustering in adolescent peer networks: a nationwide registry cohort study in Finland","authors":"Jussi Alho ,&nbsp;Roger T. Webb ,&nbsp;Mai Gutvilig ,&nbsp;Ripsa Niemi ,&nbsp;Kaisla Komulainen ,&nbsp;Kimmo Suokas ,&nbsp;Petri Böckerman ,&nbsp;Marko Elovainio ,&nbsp;Nav Kapur ,&nbsp;Christian Hakulinen","doi":"10.1016/j.lanepe.2025.101517","DOIUrl":"10.1016/j.lanepe.2025.101517","url":null,"abstract":"<div><h3>Background</h3><div>Clusters of self-harming behaviour among adolescents have been observed, yet population-based epidemiological evidence is lacking. This study aims to address this lack by examining the clustering of self-harming behaviour within adolescent peer networks at the population level.</div></div><div><h3>Methods</h3><div>We used nationwide registry data on Finnish people born between January 1, 1985, and December 31, 2000, to examine whether having same-grade schoolmates who had self-harmed was associated with greater subsequent self-harm risk. Cohort members were followed up until first recorded self-harm episode, emigration, death, or December 31, 2020, whichever came first. Hazard ratios (HRs) were estimated using mixed-effects Cox proportional hazards models adjusted for a comprehensive set of individual-, parental-, school-, and area-level covariates.</div></div><div><h3>Findings</h3><div>The cohort comprised 913,149 Finnish residents. Having same-grade schoolmates who had self-harmed between school-starting age and finishing ninth grade was associated with a higher, albeit small in magnitude, HR of subsequent self-harm over a median of 11.6 years of follow-up (HR 1.05, [95% CI 1.01–1.09]). HR was not consistently higher over follow-up time but was highest in the beginning of follow-up when the cohort members were around age 16 (1.45 [1.25–1.69]). Limiting exposure to schoolmates’ self-harm episodes to 1 year consistently showed the highest risk around age 16, regardless of whether the exposure occurred in ninth grade (1.49 [1.21–1.82]) or eighth grade (1.36 [1.07–1.74]), with follow-up commencing after the respective grade.</div></div><div><h3>Interpretation</h3><div>While we cannot rule out residual confounding, our findings suggest that self-harm may socially transmit within adolescent peer networks. The observed highest risk around age 16 suggests that external stressors associated with transitioning to new life stages at this age may moderate the impact of peer self-harm exposure. Prevention and intervention measures that consider possible peer influences on adolescents’ self-harming behaviour may help reduce the public health burden of self-harm.</div></div><div><h3>Funding</h3><div><span>European Research Council</span> and <span>Research Council of Finland</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101517"},"PeriodicalIF":13.0,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468472","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}