Pub Date : 2025-11-04DOI: 10.1016/S2352-4642(25)00223-8
Winnie Wan-yee Tso MBBS , Prof Melissa M Hudson MD , Chun Sing Lam PhD , Yuliang Wang MPhil , Grace Pui Yung Tong MBBS , Ramandeep Singh Arora MBBS , Ronnie Baticulon MD , Jiaoyang Cai MD PhD , Bow-wen Chen MD , Rashmi Dalvi MD , Sanjeeva Gunasekrea MBBS , Prof Hiroki Hori MD PhD , Muhammad Saghir Khan MD , Joo-Young Kim MD PhD , Shawn Hsien Ren Lee MBBS , Lok Kan Leung MSocSc , Mora Mel MD , Shuichi Ozono MD PhD , Prof Venkatraman Radhakrishnan MD , Sudhir Sapkota MBBS , Yin Ting Cheung
Survival after childhood cancer has markedly improved over the past decades in Asia, leading to a growing number of survivors in the region. However, long-term care for these individuals remains a substantial challenge in Asia due to the insufficient availability of comprehensive childhood cancer survivorship programmes in the region. Many countries and regions of Asia are only beginning to acknowledge the significance of post-treatment care. In this third paper in a Series on childhood cancer control in Asia, we provide an overview of the challenges, disparities, and enablers in the provision of long-term follow-up care in Asia. These challenges include deficiencies in comprehensive care models that incorporate multidisciplinary approaches and insufficient support for school and social reintegration for childhood cancer survivors. To address these gaps, collaborative initiatives, such as twinning programmes and regional partnerships, can strengthen capacity and improve care delivery for low-income and lower-middle-income countries. Specific to some Asian cultures, the use of traditional complementary medicine underscores the need for further research to evaluate its efficacy in survivors. Leveraging existing networks and fostering regional collaboration will be pivotal in advancing equitable and sustainable survivorship care across the region.
{"title":"Navigating the challenges in and identifying the priorities for childhood cancer survivorship in Asia","authors":"Winnie Wan-yee Tso MBBS , Prof Melissa M Hudson MD , Chun Sing Lam PhD , Yuliang Wang MPhil , Grace Pui Yung Tong MBBS , Ramandeep Singh Arora MBBS , Ronnie Baticulon MD , Jiaoyang Cai MD PhD , Bow-wen Chen MD , Rashmi Dalvi MD , Sanjeeva Gunasekrea MBBS , Prof Hiroki Hori MD PhD , Muhammad Saghir Khan MD , Joo-Young Kim MD PhD , Shawn Hsien Ren Lee MBBS , Lok Kan Leung MSocSc , Mora Mel MD , Shuichi Ozono MD PhD , Prof Venkatraman Radhakrishnan MD , Sudhir Sapkota MBBS , Yin Ting Cheung","doi":"10.1016/S2352-4642(25)00223-8","DOIUrl":"10.1016/S2352-4642(25)00223-8","url":null,"abstract":"<div><div>Survival after childhood cancer has markedly improved over the past decades in Asia, leading to a growing number of survivors in the region. However, long-term care for these individuals remains a substantial challenge in Asia due to the insufficient availability of comprehensive childhood cancer survivorship programmes in the region. Many countries and regions of Asia are only beginning to acknowledge the significance of post-treatment care. In this third paper in a Series on childhood cancer control in Asia, we provide an overview of the challenges, disparities, and enablers in the provision of long-term follow-up care in Asia. These challenges include deficiencies in comprehensive care models that incorporate multidisciplinary approaches and insufficient support for school and social reintegration for childhood cancer survivors. To address these gaps, collaborative initiatives, such as twinning programmes and regional partnerships, can strengthen capacity and improve care delivery for low-income and lower-middle-income countries. Specific to some Asian cultures, the use of traditional complementary medicine underscores the need for further research to evaluate its efficacy in survivors. Leveraging existing networks and fostering regional collaboration will be pivotal in advancing equitable and sustainable survivorship care across the region.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 12","pages":"Pages 880-890"},"PeriodicalIF":15.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/S2352-4642(25)00305-0
Jordan Ramnarine
{"title":"Biopolitical fractures, chronicity, and the epistemic potential of the spectral body","authors":"Jordan Ramnarine","doi":"10.1016/S2352-4642(25)00305-0","DOIUrl":"10.1016/S2352-4642(25)00305-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 12","pages":"Pages 825-826"},"PeriodicalIF":15.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/S2352-4642(25)00247-0
Alexia Sampri PhD , Wen Shi PhD , Thomas Bolton PhD , Samantha Ip PhD , Rochelle Knight MSci , Venexia Walker PhD , Rachel Denholm PhD , Elena Raffetti PhD , Spencer Keene PhD , Elias Allara MD , Xiyun Jiang MSc , Prof Evangelos Kontopantelis PhD , Prof Spiros Denaxas PhD , Prof Kamlesh Khunti FRCP , Nathalie Conrad DPhil , Christina Pagel PhD , Prof Pia Hardelid PhD , Prof Jonathan A C Sterne PhD , Prof Katherine L Brown MD , Prof William N Whiteley PhD , Prof Angela M Wood PhD
Background
The rarity of severe diseases following COVID-19 infection balanced against rare COVID-19 vaccination-related adverse effects is an important consideration for vaccination policies. We aimed to assess the short-term and long-term risks of vascular and inflammatory diseases following first COVID-19 diagnosis and vaccination in children and young people.
Methods
In this retrospective, population-based cohort study, we analysed whole-population linked electronic health records for all individuals in England aged younger than 18 years, registered with a general practitioner, and with known age, sex, and region of residence, between Jan 1, 2020, and Dec 31, 2022. Outcomes were arterial thrombotic events, venous thrombotic events, thrombocytopenia, myocarditis or pericarditis, and inflammatory conditions. COVID-19 diagnosis was defined as the earliest record of a positive SARS-CoV-2 PCR or antigen test, or a COVID-19 diagnosis code in primary-care or secondary-care records; COVID-19 vaccination was defined as the earliest documented receipt of the BNT162b2 vaccine (the predominant vaccine during the study period). Adjusted hazard ratios (aHRs) for all outcomes were estimated by time since a first COVID-19 diagnosis during Jan 1, 2020–March 31, 2022 and by time since a first COVID-19 vaccination during Aug 6, 2021–Dec 31, 2022, adjusting for age, sex, ethnicity, region, deprivation, general practitioner contact frequency, and medication use.
Findings
Of 13 896 125 individuals younger than 18 years (6 784 260 [48·8%] female and 7 111 865 [51·2%] male; 9 979 420 [71·7%] White), 3 903 410 (28·1%) had a COVID-19 diagnosis. COVID-19 diagnosis (compared with no or before diagnosis) was associated with higher risk of arterial thromboembolism (aHR 2·33 [95% CI 1·20–4·51]), venous thromboembolism (4·90 [3·66–6·55]), thrombocytopenia (3·64 [2·21–6·00]), myocarditis or pericarditis (3·46 [2·06–5·80]), and inflammatory conditions (14·84 [11·01–19·99]) in the first week after diagnosis. Incidence declined in weeks 2–4, but remained elevated to beyond 12 months for venous thromboembolism (1·39 [1·14 –1·69]), thrombocytopenia (1·42 [1·01–2·00]), and myocarditis or pericarditis (1·42 [1·05–1·91]). Among 9 245 395 individuals aged between 5 and younger than 18 years who were eligible for vaccination (4 510 490 [48·8%] female and 4 734 905 [51·2%] male; 6 684 140 [72·3%] White), 3 407 560 (36·9%) received a first vaccine. COVID-19 vaccination (compared with no or before vaccination) was associated with elevated risk of myocarditis or pericarditis within the first 4 weeks after vaccination (1·84 [1·25–2·72]). The 6-month absolute excess risks for myocarditis or pericarditis were 2·24 (1·11–3·80) per 100 000 individuals after diagnosis versus before diagnosis or undiagnosed, and 0·85 (0·07–1·91) after vaccination versus before vaccination or unvaccinated.
{"title":"Vascular and inflammatory diseases after COVID-19 infection and vaccination in children and young people in England: a retrospective, population-based cohort study using linked electronic health records","authors":"Alexia Sampri PhD , Wen Shi PhD , Thomas Bolton PhD , Samantha Ip PhD , Rochelle Knight MSci , Venexia Walker PhD , Rachel Denholm PhD , Elena Raffetti PhD , Spencer Keene PhD , Elias Allara MD , Xiyun Jiang MSc , Prof Evangelos Kontopantelis PhD , Prof Spiros Denaxas PhD , Prof Kamlesh Khunti FRCP , Nathalie Conrad DPhil , Christina Pagel PhD , Prof Pia Hardelid PhD , Prof Jonathan A C Sterne PhD , Prof Katherine L Brown MD , Prof William N Whiteley PhD , Prof Angela M Wood PhD","doi":"10.1016/S2352-4642(25)00247-0","DOIUrl":"10.1016/S2352-4642(25)00247-0","url":null,"abstract":"<div><h3>Background</h3><div>The rarity of severe diseases following COVID-19 infection balanced against rare COVID-19 vaccination-related adverse effects is an important consideration for vaccination policies. We aimed to assess the short-term and long-term risks of vascular and inflammatory diseases following first COVID-19 diagnosis and vaccination in children and young people.</div></div><div><h3>Methods</h3><div>In this retrospective, population-based cohort study, we analysed whole-population linked electronic health records for all individuals in England aged younger than 18 years, registered with a general practitioner, and with known age, sex, and region of residence, between Jan 1, 2020, and Dec 31, 2022. Outcomes were arterial thrombotic events, venous thrombotic events, thrombocytopenia, myocarditis or pericarditis, and inflammatory conditions. COVID-19 diagnosis was defined as the earliest record of a positive SARS-CoV-2 PCR or antigen test, or a COVID-19 diagnosis code in primary-care or secondary-care records; COVID-19 vaccination was defined as the earliest documented receipt of the BNT162b2 vaccine (the predominant vaccine during the study period). Adjusted hazard ratios (aHRs) for all outcomes were estimated by time since a first COVID-19 diagnosis during Jan 1, 2020–March 31, 2022 and by time since a first COVID-19 vaccination during Aug 6, 2021–Dec 31, 2022, adjusting for age, sex, ethnicity, region, deprivation, general practitioner contact frequency, and medication use.</div></div><div><h3>Findings</h3><div>Of 13 896 125 individuals younger than 18 years (6 784 260 [48·8%] female and 7 111 865 [51·2%] male; 9 979 420 [71·7%] White), 3 903 410 (28·1%) had a COVID-19 diagnosis. COVID-19 diagnosis (compared with no or before diagnosis) was associated with higher risk of arterial thromboembolism (aHR 2·33 [95% CI 1·20–4·51]), venous thromboembolism (4·90 [3·66–6·55]), thrombocytopenia (3·64 [2·21–6·00]), myocarditis or pericarditis (3·46 [2·06–5·80]), and inflammatory conditions (14·84 [11·01–19·99]) in the first week after diagnosis. Incidence declined in weeks 2–4, but remained elevated to beyond 12 months for venous thromboembolism (1·39 [1·14 –1·69]), thrombocytopenia (1·42 [1·01–2·00]), and myocarditis or pericarditis (1·42 [1·05–1·91]). Among 9 245 395 individuals aged between 5 and younger than 18 years who were eligible for vaccination (4 510 490 [48·8%] female and 4 734 905 [51·2%] male; 6 684 140 [72·3%] White), 3 407 560 (36·9%) received a first vaccine. COVID-19 vaccination (compared with no or before vaccination) was associated with elevated risk of myocarditis or pericarditis within the first 4 weeks after vaccination (1·84 [1·25–2·72]). The 6-month absolute excess risks for myocarditis or pericarditis were 2·24 (1·11–3·80) per 100 000 individuals after diagnosis versus before diagnosis or undiagnosed, and 0·85 (0·07–1·91) after vaccination versus before vaccination or unvaccinated.</div></div><div><h3>Interpretati","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 12","pages":"Pages 837-847"},"PeriodicalIF":15.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/S2352-4642(25)00243-3
Samira Saberian MSc , Prof Chris Gale MBBS PhD , Nimish Subhedar MD FRCPCH , Natalie Gallagher MBChB , Oluwaseun B Esan DPhil , Prof Ian Sinha MBBS PhD , Kelly Harvey MSc , Daniela K Schlüter PhD , Prof David Taylor-Robinson MBChBPhD
Background
Babies born to mothers living in more deprived areas and from ethnic minority groups are at a higher risk of dying during the neonatal period. Preterm and unwell term babies are cared for in neonatal units, and this population contributes substantially to the child mortality rate. The extent of and reasons for socioeconomic and ethnic inequalities in neonatal unit outcomes are unclear. We aimed to evaluate socioeconomic and ethnic inequalities in characteristics and mortality of babies admitted to National Health Service (NHS) neonatal units in England and Wales.
Methods
In this retrospective cohort study, any baby that was born at or after 22 weeks’ gestation and admitted to an NHS neonatal unit in England and Wales, received neonatal care, and had clinical data registered in the National Neonatal Research Database was eligible for inclusion. Our primary exposures of interest were index of multiple deprivation (IMD) and maternal ethnicity. We assessed inequalities in in-unit mortality before discharge using nested logistic regression models, estimating crude, confounder-adjusted, and case-mix adjusted odds of mortality. Case-mix variables on admission were gestational age, birthweight, sex, maternal age, smoking during pregnancy, the presence of any congenital anomaly, obstetric problem, and previous medical problem in the mother.
Findings
Between Jan 1, 2012, and Dec 31, 2022, 709 569 babies were included in the analysis and there were 11 257 (1·6%) neonatal unit deaths. Of the 678 550 babies with complete IMD information, 649 180 (95·7%) babies were born to mothers living in England and 29 308 (4·3%) to mothers living in Wales. 561 621 (79·1%) babies had complete information on exposures and case-mix variables on admission used for logistic regression. More babies in neonatal units were born to women from the most deprived decile (102 419 [15·1%]) compared with the least deprived decile (43 882 [6·5%]). Babies born to women from the most deprived decile were at increased risk of mortality (odds ratio [OR] 1·63 [95% CI 1·48–1·81]) than babies born to women from the least deprived decile. After adjusting for ethnicity, the OR was 1·52 (1·38–1·69), and after adjusting for case-mix, the OR was 1·23 (1·10–1·37). Babies born to mothers who were Black had an OR for mortality of 1·81 (1·67–1·95) compared with mothers who were White, attenuated to 1·68 (1·55–1·81) after adjusting for deprivation, and 1·14 (1·05–1·24) in the case-mix adjusted model. Babies born to mothers who were Asian had an OR for mortality of 1·48 (1·39–1·57) compared with mothers who were White, attenuated to 1·40 (1·32–1·49) after adjusting for deprivation, and 1·36 (1·27–1·45) in the case-mix adjusted model.
Interpretation
There are stark socioeconomic and ethnic inequalities in babies admitted to and who die in neonatal units in England and Wales. Mortality inequal
{"title":"Inequalities in neonatal unit mortality in England and Wales between 2012 and 2022: a retrospective cohort study","authors":"Samira Saberian MSc , Prof Chris Gale MBBS PhD , Nimish Subhedar MD FRCPCH , Natalie Gallagher MBChB , Oluwaseun B Esan DPhil , Prof Ian Sinha MBBS PhD , Kelly Harvey MSc , Daniela K Schlüter PhD , Prof David Taylor-Robinson MBChBPhD","doi":"10.1016/S2352-4642(25)00243-3","DOIUrl":"10.1016/S2352-4642(25)00243-3","url":null,"abstract":"<div><h3>Background</h3><div>Babies born to mothers living in more deprived areas and from ethnic minority groups are at a higher risk of dying during the neonatal period. Preterm and unwell term babies are cared for in neonatal units, and this population contributes substantially to the child mortality rate. The extent of and reasons for socioeconomic and ethnic inequalities in neonatal unit outcomes are unclear. We aimed to evaluate socioeconomic and ethnic inequalities in characteristics and mortality of babies admitted to National Health Service (NHS) neonatal units in England and Wales.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, any baby that was born at or after 22 weeks’ gestation and admitted to an NHS neonatal unit in England and Wales, received neonatal care, and had clinical data registered in the National Neonatal Research Database was eligible for inclusion. Our primary exposures of interest were index of multiple deprivation (IMD) and maternal ethnicity. We assessed inequalities in in-unit mortality before discharge using nested logistic regression models, estimating crude, confounder-adjusted, and case-mix adjusted odds of mortality. Case-mix variables on admission were gestational age, birthweight, sex, maternal age, smoking during pregnancy, the presence of any congenital anomaly, obstetric problem, and previous medical problem in the mother.</div></div><div><h3>Findings</h3><div>Between Jan 1, 2012, and Dec 31, 2022, 709 569 babies were included in the analysis and there were 11 257 (1·6%) neonatal unit deaths. Of the 678 550 babies with complete IMD information, 649 180 (95·7%) babies were born to mothers living in England and 29 308 (4·3%) to mothers living in Wales. 561 621 (79·1%) babies had complete information on exposures and case-mix variables on admission used for logistic regression. More babies in neonatal units were born to women from the most deprived decile (102 419 [15·1%]) compared with the least deprived decile (43 882 [6·5%]). Babies born to women from the most deprived decile were at increased risk of mortality (odds ratio [OR] 1·63 [95% CI 1·48–1·81]) than babies born to women from the least deprived decile. After adjusting for ethnicity, the OR was 1·52 (1·38–1·69), and after adjusting for case-mix, the OR was 1·23 (1·10–1·37). Babies born to mothers who were Black had an OR for mortality of 1·81 (1·67–1·95) compared with mothers who were White, attenuated to 1·68 (1·55–1·81) after adjusting for deprivation, and 1·14 (1·05–1·24) in the case-mix adjusted model. Babies born to mothers who were Asian had an OR for mortality of 1·48 (1·39–1·57) compared with mothers who were White, attenuated to 1·40 (1·32–1·49) after adjusting for deprivation, and 1·36 (1·27–1·45) in the case-mix adjusted model.</div></div><div><h3>Interpretation</h3><div>There are stark socioeconomic and ethnic inequalities in babies admitted to and who die in neonatal units in England and Wales. Mortality inequal","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 12","pages":"Pages 857-867"},"PeriodicalIF":15.5,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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