Lancet Regional Health-Europe最新文献

{"title":"Estimating incidence rates of primary infection and reinfection with hepatitis C virus among people who inject drugs in Scotland: a model-based analysis of repeated cross-sectional survey data","authors":"Scott A. McDonald ,&nbsp;Norah Palmateer ,&nbsp;Andrew McAuley ,&nbsp;Rory N. Gunson ,&nbsp;Stephen T. Barclay ,&nbsp;John F. Dillon ,&nbsp;Matthew Hickman ,&nbsp;Sharon J. Hutchinson","doi":"10.1016/j.lanepe.2025.101505","DOIUrl":"10.1016/j.lanepe.2025.101505","url":null,"abstract":"<div><h3>Background</h3><div>Reducing the incidence of hepatitis C virus (HCV) infection is a World Health Organization (WHO) elimination goal, but approaches to estimate this from population-level survey data are lacking. We modelled HCV incidence among people who inject drugs (PWID) surveyed over time, to provide evidence on whether Scotland has reached the WHO elimination target of ≤2 per 100 person-years in this population.</div></div><div><h3>Methods</h3><div>A statistical model was fitted using HCV infection data from five sweeps (2013-14, 2015-16, 2017-18, 2019-20, and 2022-23) of a national bio-behavioural survey, involving 11,651 PWID recruited at sites providing injecting equipment. Per-sweep incidence rates of primary chronic HCV infection, reinfection, and combined primary and reinfection (‘total infection’) were inferred within a Bayesian framework. Incidence rates relate to the number of new infections per 100 person-years for the population at risk of (primary, reinfection and total) infection.</div></div><div><h3>Findings</h3><div>In 2022-23, the model-estimated total, re-infection and primary infection incidence rates were 3.4 per 100 person-years (95% credible interval (CrI):2.6–4.3), 1.9 (1.3–2.6), and 4.1 (3.0–5.4), respectively. For total new infections, the model-estimated incidence rate decreased by 51% from 7.0 per 100 person-years in 2015-16 to 3.4 in 2022-23 (relating to an absolute decrease of 3.6 per 100 person-years; 95% CrI: 2.0–5.3). Between 2015-16 and 2022-23, model-estimated re-infection and primary infection incidence rates decreased by 78% and 40%, respectively.</div></div><div><h3>Interpretation</h3><div>Over a period when direct-acting antiviral therapy was scaled-up in Scotland, major reductions in the incidence of primary infection, reinfection, and total HCV infection were evident, indicating that the WHO target is within reach, for a relatively high-risk population of PWID.</div></div><div><h3>Funding</h3><div><span>Public Health Scotland</span> (for NESI); <span>NIHR HPRU in Behavioural Science and Evaluation</span>; <span>NIHR Programme Grants for Applied Research programme</span> (reference number <span><span>RP-PG-0616-20008</span></span>).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101505"},"PeriodicalIF":13.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420065","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":"Long-acting nitrate use before and after revascularization to evaluate angina in chronic coronary syndrome: a case-crossover study from SCAAR","authors":"Sacharias von Koch ,&nbsp;Tania Sharma ,&nbsp;Ramzi Khamis ,&nbsp;Tomas Jernberg ,&nbsp;Stefan James ,&nbsp;Elmir Omerovic ,&nbsp;Sammy Zwackman ,&nbsp;Johan Sjögren ,&nbsp;David Erlinge ,&nbsp;Moman A. Mohammad","doi":"10.1016/j.lanepe.2025.101507","DOIUrl":"10.1016/j.lanepe.2025.101507","url":null,"abstract":"<div><h3>Background</h3><div>The ORBITA and ORBITA-2 trials have provided valuable insights into the effects of coronary revascularization in chronic coronary syndrome (CCS). However, uncertainties remain regarding the efficacy of revascularization on symptoms in large real-world populations. To evaluate the efficacy of revascularization, we used dispensed long-acting nitrates as a proxy for the presence of angina.</div></div><div><h3>Methods</h3><div>The Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients with CCS and at least one stenosis ≥50% undergoing angiography between the 1st of January 2014 and the 16th of January 2020. Four groups were defined based on treatment strategy: coronary artery bypass graft (CABG) surgery, complete revascularization with percutaneous coronary intervention (PCI), incomplete revascularization with PCI, and no revascularization. As patients in these treatment arms are inherently different, we employed a case-crossover design where each patient served as their own control with data collected during two periods: 1 year before up until angiography and 1–2 years after. This study design inherently controls for time-invariant confounding. The primary outcome was the use of long-acting nitrates defined as a dispensed prescription during the studied periods. Conditional Poisson regression was used to analyse the data.</div></div><div><h3>Findings</h3><div>For this study, 15,955 patients were eligible. CABG, complete revascularization with PCI, and incomplete revascularization with PCI were associated with a decrease in dispensed prescriptions of long-acting nitrates (from 989/2218 [30.8%] to 156/3207 [4.9%]; risk-ratio (RR): 0.16 [95% confidence interval (CI): 0.13–0.19]), (from 1676/7525 [22.3%] to 966/7525 [12.8%]; RR: 0.58 [95% CI: 0.53–0.62]), and (from 601/2180 [27.6%] to 495/2180 [22.7%]; RR: 0.82 [95% CI: 0.73–0.93]), respectively. No difference was observed for no revascularization (from 864/3043 [28.4%] to 856/3043 [28.1%]; RR: 0.99 [95% CI: 0.90–1.09]).</div></div><div><h3>Interpretation</h3><div>Revascularization reduces the use of long-acting nitrates in patients with CCS, suggesting angina symptom improvement. CABG appears to provide a more significant effect than PCI, with complete PCI demonstrating greater effectiveness than incomplete revascularization.</div></div><div><h3>Funding</h3><div>This work was supported by The Swedish <span>Heart and Lung Foundation</span>, <span>ALF</span>, <span>Skane University Hospital funds</span>, the <span>Crafoord Foundation</span> and the <span>Swedish Medical Association</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101507"},"PeriodicalIF":13.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420066","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":"Impact of cigarette prices and age-of-sale policies on smoking prevalence among youth in 26 European Member States (2012–2023): a longitudinal ecological study using repeated cross-sectional data","authors":"Ayaka Teshima ,&nbsp;Ariadna Feliu ,&nbsp;Silvano Gallus ,&nbsp;Cristina Martinez ,&nbsp;Esteve Fernandez","doi":"10.1016/j.lanepe.2025.101511","DOIUrl":"10.1016/j.lanepe.2025.101511","url":null,"abstract":"<div><h3>Background</h3><div>Reducing tobacco and nicotine use and preventing smoking initiation among youth are key public health priorities. We evaluated the impact of cigarette prices and age-of-sale laws on youth smoking prevalence in the European Union (EU).</div></div><div><h3>Methods</h3><div>In this ecological study with 26 EU Member States as the unit of analysis, we estimated smoking prevalence among individuals aged 15–24, using five Eurobarometer waves (2012–2023, n = 12,087). We used fixed-effects panel regression models to assess the association between cigarette prices, the introduction of 18+ age-of-sale laws for tobacco products and changes in youth smoking prevalence, controlling for time and tobacco control policy implementation.</div></div><div><h3>Findings</h3><div>Weighted youth smoking prevalence decreased from 28.4% (841/2818) in 2012 to 22.2% (490/2222) in 2023, although the trend was not consistently downward. A €1 increase in inflation-adjusted cigarette prices per pack was associated with a 3.4 percentage point reduction in male youth prevalence (95% CI: −6.40 to −0.45), while there was no significant association for females or at the EU level. Regional variation was observed, with price increases associated with substantial reductions in youth smoking among both sexes in Southern Europe and among males in Northern Europe. In contrast, no such associations were found in Western or Eastern Europe. Age-of-sale laws were not significantly associated with youth smoking prevalence at the EU level.</div></div><div><h3>Interpretation</h3><div>Current taxation and age-of-sale policies remain insufficient, with impacts varying by sex and region. Achieving the tobacco endgame requires harmonised EU-level measures and stronger enforcement, particularly of these two policies, to prevent the ongoing influx of new youth smoking initiates. This study suggests that their potential impact has been constrained by inadequate enforcement to date rather than by policy ineffectiveness.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101511"},"PeriodicalIF":13.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420438","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":"Initiation of SGLT2 inhibitors versus mineralocorticoid receptor antagonists as third-line therapy in heart failure with reduced ejection fraction: a nationwide cohort study","authors":"Henrik Svanström ,&nbsp;George Frederick Mkoma ,&nbsp;Anders Hviid ,&nbsp;Björn Pasternak","doi":"10.1016/j.lanepe.2025.101510","DOIUrl":"10.1016/j.lanepe.2025.101510","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) guidelines recommend early initiation of four foundational therapies—renin-angiotensin system inhibitors (RASI), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT2) inhibitors. In clinical practice, these drugs are usually introduced sequentially, and optimal sequencing remains uncertain. This study investigated the effectiveness of initiating SGLT2 inhibitors versus MRAs as the third foundational therapy following RASI and beta-blockers.</div></div><div><h3>Methods</h3><div>This was a nationwide non-interventional study in Denmark, July 2020–2023. Patients with HFrEF (left ventricular ejection fraction ≤40%) aged ≥45 years on background RASI and beta-blockers were included. An active-comparator new-user design was used to emulate a trial-like comparison. Baseline characteristics were balanced using inverse-probability of treatment weighting based on propensity scores. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death, heart failure hospitalization, and their composite. Weighted hazard ratios (wHRs) were estimated using proportional hazards regression.</div></div><div><h3>Findings</h3><div>The study included 4185 new MRA users (63% spironolactone, 37% eplerenone) and 2565 new SGLT2 inhibitor users (74% dapagliflozin, 26% empagliflozin). All-cause mortality occurred in 423 MRA users (unweighted rate 6.3 per 100 person-years) and 155 SGLT2 inhibitor users (5.8 per 100 person-years). In weighted analysis comparing SGLT2 inhibitors to MRAs, the wHR was 0.70 (95% CI 0.57–0.86; absolute risk difference −2.1 per 100 person-years, 95% CI –0.9 to −3.2). For the composite secondary outcome, the wHR was 0.83 (95% CI 0.71–0.97); for cardiovascular death, 0.65 (95% CI 0.49–0.87); and for heart failure hospitalization, 0.89 (95% CI 0.74–1.07).</div></div><div><h3>Interpretation</h3><div>Initiating SGLT2 inhibitors as the third foundational therapy after RASI and beta-blockers was associated with significantly lower risk of all-cause mortality compared to MRAs. These findings support the prioritization of SGLT2 inhibitors in treatment sequencing for HFrEF.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>Novo Nordisk Foundation</span> and <span>Karolinska Institutet</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101510"},"PeriodicalIF":13.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369815","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":"European Health Forum Gastein (EHFG) 2025","authors":"Ivana Nedic,&nbsp;Rebekka Park","doi":"10.1016/j.lanepe.2025.101521","DOIUrl":"10.1016/j.lanepe.2025.101521","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101521"},"PeriodicalIF":13.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424892","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":"Opt-in and opt-out strategies for HIV testing","authors":"Emilia Miró ,&nbsp;Patricia Trenc ,&nbsp;Begoña Espinosa ,&nbsp;Lourdes Piedrafita ,&nbsp;Nayra Cabrera ,&nbsp;Concepción Abellas Álvarez","doi":"10.1016/j.lanepe.2025.101482","DOIUrl":"10.1016/j.lanepe.2025.101482","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"58 ","pages":"Article 101482"},"PeriodicalIF":13.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361793","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":"Opt-in and opt-out strategies for HIV testing—author's reply","authors":"Miłosz Parczewski","doi":"10.1016/j.lanepe.2025.101500","DOIUrl":"10.1016/j.lanepe.2025.101500","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"58 ","pages":"Article 101500"},"PeriodicalIF":13.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361803","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":"When social inequities dictate outcomes: the multidisciplinary call of cholangiocarcinoma","authors":"Raffaele Brustia ,&nbsp;Vincent Leroy ,&nbsp;Alain Luciani ,&nbsp;Julien Calderaro ,&nbsp;Christophe Tournigand","doi":"10.1016/j.lanepe.2025.101496","DOIUrl":"10.1016/j.lanepe.2025.101496","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"58 ","pages":"Article 101496"},"PeriodicalIF":13.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361792","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":"Paediatric invasive group A streptococcal infections and associations with viral infections in 15 European countries after lifting non-pharmaceutical interventions against SARS-CoV-2: an interrupted time-series analysis","authors":"Léa Lenglart ,&nbsp;Izel Özmen ,&nbsp;David Aguilera-Alonso ,&nbsp;Daniel Blazquez-Gamero ,&nbsp;Navin P. Boeddha ,&nbsp;Emilie Pauline Buddingh ,&nbsp;Danilo Buonsenso ,&nbsp;Cristina Calvo ,&nbsp;Riccardo Castagnoli ,&nbsp;Marta Daina ,&nbsp;Maria-Myrto Dourdouna ,&nbsp;Marieke Emonts ,&nbsp;Carmen Ezinwoke ,&nbsp;Catarina Gouveia ,&nbsp;David Grandioso Vas ,&nbsp;Jeroen Hol ,&nbsp;Mette Holm ,&nbsp;Christian R. Kahlert ,&nbsp;Benno Kohlmaier ,&nbsp;Kamila Ludwikowska ,&nbsp;Ana Friães","doi":"10.1016/j.lanepe.2025.101497","DOIUrl":"10.1016/j.lanepe.2025.101497","url":null,"abstract":"<div><h3>Background</h3><div>After lifting non-pharmaceutical interventions (NPIs) against the transmission of SARS-CoV-2, various countries experienced an increase in invasive Group A Streptococcal (iGAS) infections. We aimed to characterise the paediatric outbreak across Europe and to analyse the influence of viral infections.</div></div><div><h3>Methods</h3><div>We conducted an interrupted time-series analysis based on data from 15 European countries from the PEGASUS consortium. We assessed the evolution of the number of iGAS cases aged 1 month to 18 years between 01/01/2018 and 03/31/2024, comparing the post-NPIs period (01-04-2022 until 31-03-2024) to the baseline period (01-01-2018 until 31-03-2020). Further analyses were performed by country, clinical phenotype, age and severity, including sensitivity analyses. We then explored whether certain iGAS phenotypes correlated with trends in RSV, influenza and VZV across countries over time using Google Trends data.</div></div><div><h3>Findings</h3><div>We included 2091 iGAS cases over the study period; 79 children (3.6%) died and 580 (27.7%) required PICU admission. We estimated an overall increase of +229.8% (95% CI (141.9–341.6)) among iGAS cases from October 2022 to March 2024, compared to the baseline period. The observed increases varied across clinical phenotypes, ranging from +62.7% (95% CI (8.3–157.9)) for osteo-articular infections to +238.7% (95% CI 75.8–464.8) for pneumonia. We observed a strong correlation between the incidence of iGAS pneumonia and RSV (Rho: 0.57, 95% CI [0.11–0.79]) and influenza (Rho 0.69, 95% CI 0.35–0.87); and between skin and soft tissue infections and VZV (Rho: 0.73, 95% CI [0.42–0.89]).</div></div><div><h3>Interpretation</h3><div>The patterns observed across Europe during this outbreak demonstrate an association between respiratory viruses as well as VZV, and iGAS.</div></div><div><h3>Funding</h3><div>This study has received funding from <span>ESPID</span>, INOPSU and the Northwest Clinics. The COPP study group was supported by grants of the Dutch <span>National Health Council</span> (ZonMW) project number 10430072110007 and the Christine Bader Foundation.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101497"},"PeriodicalIF":13.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333709","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":"Are marketing bans on alcoholic beverages a quick buy?—authors’ reply","authors":"Allison Ekberg ,&nbsp;David Stuckler ,&nbsp;Gauden Galea","doi":"10.1016/j.lanepe.2025.101478","DOIUrl":"10.1016/j.lanepe.2025.101478","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"58 ","pages":"Article 101478"},"PeriodicalIF":13.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324592","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}