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Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. 痴呆症患病率和发病率以及痴呆症风险因素的变化:队列研究分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00120-8
Naaheed Mukadam, Frank J Wolters, Sebastian Walsh, Lindsay Wallace, Carol Brayne, Fiona E Matthews, Simona Sacuiu, Ingmar Skoog, Sudha Seshadri, Alexa Beiser, Saptaparni Ghosh, Gill Livingston
<p><strong>Background: </strong>Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs).</p><p><strong>Methods: </strong>We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms "systematic review" AND "dementia" AND ("prevalence" OR "incidence"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors.</p><p><strong>Findings: </strong>We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis.</p><p><strong>Interpretation: </strong>Our findings suggest that lifestyle interventions such as compulsory education and reducin
背景:一些队列研究报告称,随着时间的推移,痴呆症患病率和发病率有所下降,但这些研究结果并不一致。我们利用已发表的基于人群的队列研究,回顾了痴呆症患病率和发病率随时间推移而变化的证据,这些研究在每一波次中都采用了一致的方法,并旨在利用人群可归因分数(PAFs)量化风险因素随时间推移而发生的相关变化:我们搜索了有关研究痴呆症患病率或发病率随时间变化的队列研究的系统综述。我们使用检索词 "系统综述 "和 "痴呆症 "和("患病率 "或 "发病率")检索了 PubMed 上从数据库开始到 2023 年 1 月 12 日的出版物,没有语言限制。我们在 2024 年 3 月 28 日重复了这一搜索。在符合条件的系统综述中,我们检索了参考文献并选择了同行评议出版物中的队列研究,这些研究在同一地理位置、至少两个时间点测量了痴呆症的流行率或发病率,并报告了年龄标准化的痴呆症流行率或发病率。此外,数据必须来自以人口为基础的样本,对参与者的认知状况进行评估,并使用有效的标准来诊断痴呆症。我们从每篇论文中提取了有关痴呆症风险因素的摘要级数据,如果发表的论文中没有此类数据,我们会联系作者,并计算出每个风险因素在所有可用时间点上的 PAFs。在可能的情况下,我们将痴呆症患病率或发病率的变化与风险因素患病率的变化联系起来:我们在初步搜索中发现了 1925 条记录,其中有五篇符合条件的系统综述。在这些系统综述中,我们发现了 71 篇可能符合条件的主要论文,其中 27 篇被纳入我们的分析。27 篇主要论文中有 13 篇(48%)报告了痴呆症患病率的变化,10 篇(37%)报告了痴呆症发病率的变化,4 篇(15%)报告了痴呆症发病率和患病率的变化。欧洲(5 项)和美国(5 项)报告痴呆症发病率随时间变化的研究一致报告痴呆症发病率在下降。日本的一项研究报告痴呆症患病率和发病率均有所上升,尼日利亚的一项研究报告发病率保持稳定。总体而言,在各项研究中,受教育程度较低或吸烟或两者的 PAFs 随时间推移普遍下降,而肥胖、高血压和糖尿病的 PAFs 则普遍上升。在弗雷明汉研究(美国马萨诸塞州弗雷明汉,1997-2013 年)中,教育程度较低和吸烟的 PAFs 下降与痴呆症发病率下降有关,这是唯一一项有足够数据进行分析的研究:我们的研究结果表明,义务教育和通过国家层面的政策变化降低吸烟率等生活方式干预措施可能与观察到的痴呆症发病率下降有关,因此也可能与未来痴呆症发病率下降有关。还需要在中低收入国家开展更多研究,因为这些国家的痴呆症发病率最高,而且还在继续增加:国家健康与护理研究所三校痴呆症研究计划。
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引用次数: 0
Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France. 酒精康复与癌症风险:法国全国医院队列研究。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00107-5
Michaël Schwarzinger, Carina Ferreira-Borges, Maria Neufeld, François Alla, Jürgen Rehm

Background: Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence.

Methods: We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors.

Findings: 10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses.

Interpretation: Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence.

Funding: European Union's EU4Health programme.

背景:尽管饮酒是癌症的既定风险因素,但有关减少或停止饮酒对癌症发病率影响的证据却很少。我们的主要研究目的是评估酒精康复和戒酒对酒精依赖者癌症发病率的影响:我们在全国范围内开展了一项医院回顾性队列研究,研究对象包括居住在法国本土、2018-21年出院的所有成年人。在控制了潜在混杂风险因素的情况下,采用多变量考克斯比例危险模型估算了在医院接受康复治疗或有禁欲史与未接受康复治疗或禁欲的酒精依赖者对不同性别酒精相关癌症发病风险的影响:2018-21年间,10 260 056名男性和13 739 369名女性从法国医院出院。其中645 720名男性(6-3%)和219 323名女性(1-6%)被确认为酒精依赖。酒精依赖与酒精相关的男女癌症部位(肝细胞癌以及口腔癌、咽癌、喉癌、食道癌和结直肠癌)密切相关,但乳腺癌除外。与没有康复或戒酒的酒精依赖者相比,康复治疗或戒酒的风险明显较低(调整后危险比:0-58,99-89%):男性为 0-58,99-89% CI 为 0-56-0-60;女性为 0-62,0-57-0-66)。在男女两性中,与酒精相关的每种癌症部位的相对风险均显著降低,所有亚组分析和敏感性分析均支持这一结果:我们的研究结果表明,酒精康复和戒酒对降低酒精相关癌症风险有明显的益处。由于只有五分之二的酒精依赖症患者有康复治疗或戒酒史,因此在降低癌症发病率方面还有很大的潜力有待挖掘:资金来源:欧盟的 EU4Health 计划。
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引用次数: 0
Changes in opioid prescribing during the COVID-19 pandemic in England: an interrupted time-series analysis in the OpenSAFELY-TTP cohort. 英格兰 COVID-19 大流行期间阿片类药物处方的变化:OpenSAFELY-TTP 队列的间断时间序列分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00100-2
Andrea L Schaffer, Colm D Andrews, Andrew D Brown, Richard Croker, William J Hulme, Linda Nab, Jane Quinlan, Victoria Speed, Christopher Wood, Milan Wiedemann, Jon Massey, Peter Inglesby, Seb C J Bacon, Amir Mehrkar, Chris Bates, Ben Goldacre, Alex J Walker, Brian MacKenna

Background: The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups.

Methods: For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018-February, 2020), during the lockdown (March, 2020-March, 2021), and recovery periods (April, 2021-June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm.

Findings: There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI -14·5 to -6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI -0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9).

Interpretation: Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic.

Funding: The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.

背景:COVID-19 大流行扰乱了医疗保健服务的提供,包括难以获得亲自护理,这可能会增加对强效药物止痛的需求。由于阿片类药物处方过量存在风险,尤其是对弱势群体而言,因此我们旨在量化 COVID-19 大流行期间总体和主要亚群体的措施变化:在这项在英格兰进行的间断时间序列分析研究中,我们使用了 OpenSAFELY-TPP 中 2000 多万名全科成年患者的常规临床数据,OpenSAFELY-TPP 是一个用于分析电子健康记录的安全软件平台。我们将使用 TPP-SystmOne 软件在全科诊所登记的所有成人纳入其中。利用间断时间序列分析法,我们对 COVID-19 大流行之前(2018 年 1 月至 2020 年 2 月)、封锁期间(2020 年 3 月至 2021 年 3 月)和恢复期(2021 年 4 月至 2022 年 6 月)的阿片类药物处方的普遍性和新增处方进行了量化,并按人口统计学(年龄、性别、贫困程度、种族和地理区域)和通过地址匹配算法确定的护理院患者进行了分层:大流行期间,除了 2020 年 3 月出现暂时性增长外,处方的普遍性变化不大。我们观察到,自 2020 年 3 月起,阿片类药物的新处方量减少了 9-8%(95% CI -14-5~-6-5),下降趋势趋于平缓,2021 年 4 月后略有反弹(4-1%,95% CI -0-9~9-4)。阿片类药物的处方率因人口统计学特征而异,但我们发现,除 80 岁或以上的老年人外,所有亚群体的新处方量都有所减少。在 2020 年 4 月的护理院居民中,肠外阿片类药物处方增加了 186-3%(153-1 至 223-9):在老年人和护理院住户中,阿片类药物处方量暂时有所增加,这可能反映了用于治疗临终COVID-19症状的情况。尽管弱势群体受到医疗服务中断的影响更大,但在大流行期间,大多数人口亚群在阿片类药物处方方面的差异并未扩大。需要进一步开展研究,以了解是什么因素导致了阿片类药物新处方的变化,以及这种变化与大流行期间医疗保健服务的变化之间的关系:资助机构:惠康信托基金会、医学研究委员会、英国国家健康与护理研究所、英国研究与创新组织以及英国健康数据研究组织。
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引用次数: 0
The future of public health doctoral education in Africa: transforming higher education institutions to enhance research and practice. 非洲公共卫生博士教育的未来:改革高等教育机构,加强研究与实践。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-05-10 DOI: 10.1016/S2468-2667(24)00056-2
Justine Bukenya, Derege Kebede, Henry Mwambi, Muhammed Pate, Philip Adongo, Yemane Berhane, Chelsey R Canavan, Tobias Chirwa, Olufunmilayo I Fawole, David Guwatudde, Elizabeth Jackson, Isabel Madzorera, Mosa Moshabela, Ayoade M J Oduola, Bruno Sunguya, Amadou Sall, Tajudeen Raji, Wafaie Fawzi

The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions.

非洲联盟和非洲疾病控制和预防中心发出了《2022 年非洲公共卫生新秩序行 动呼吁》,强调必须提高公共卫生工作人员的能力。对公共卫生人员队伍建设进行更多的国内和全球投资,对于实现非洲联盟《2063 年议程》的愿望至关重要,该议程旨在建立和加快实施非洲大陆公平、以人为本的增长和发展框架。认识到高等教育和研究的关键作用,我们从教学、机构和外部三个概念方面评估了非洲公共卫生学校和计划的公共卫生博士培训能力。为提高大学内部和大学之间的博士培训、研究和实践能力,我们提出了六项相互关联的可行建议。这些建议可以通过大学、研究中心以及国家、地区和全球公共卫生机构之间的公平伙伴关系来实现。
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引用次数: 0
National approaches to reduce mortality after prison release. 降低出狱后死亡率的国家方法。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00105-1
Chrianna Bharat, Michael Farrell
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引用次数: 0
Increasing risks of dementia and brain health concerns. 增加患痴呆症和脑健康问题的风险。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00123-3
Abolfazl Avan, Vladimir Hachinski
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引用次数: 0
Correction to Lancet Public Health 2023; 8: e1016-24. 柳叶刀公共卫生》2023;8:e1016-24 更正。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00130-0
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引用次数: 0
Correction to Lancet Public Health 2024; 9: e407-10. 柳叶刀公共卫生》2024;9:e407-10 更正。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-05-31 DOI: 10.1016/S2468-2667(24)00121-X
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引用次数: 0
The 2024 Europe report of the Lancet Countdown on health and climate change: unprecedented warming demands unprecedented action. 柳叶刀健康与气候变化倒计时 2024 欧洲报告:空前的变暖需要空前的行动。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-05-12 DOI: 10.1016/S2468-2667(24)00055-0
Kim R van Daalen, Cathryn Tonne, Jan C Semenza, Joacim Rocklöv, Anil Markandya, Niheer Dasandi, Slava Jankin, Hicham Achebak, Joan Ballester, Hannah Bechara, Thessa M Beck, Max W Callaghan, Bruno M Carvalho, Jonathan Chambers, Marta Cirah Pradas, Orin Courtenay, Shouro Dasgupta, Matthew J Eckelman, Zia Farooq, Peter Fransson, Elisa Gallo, Olga Gasparyan, Nube Gonzalez-Reviriego, Ian Hamilton, Risto Hänninen, Charles Hatfield, Kehan He, Aleksandra Kazmierczak, Vladimir Kendrovski, Harry Kennard, Gregor Kiesewetter, Rostislav Kouznetsov, Hedi Katre Kriit, Alba Llabrés-Brustenga, Simon J Lloyd, Martín Lotto Batista, Carla Maia, Jaime Martinez-Urtaza, Zhifu Mi, Carles Milà, Jan C Minx, Mark Nieuwenhuijsen, Julia Palamarchuk, Dafni Kalatzi Pantera, Marcos Quijal-Zamorano, Peter Rafaj, Elizabeth J Z Robinson, Nacho Sánchez-Valdivia, Daniel Scamman, Oliver Schmoll, Maquins Odhiambo Sewe, Jodi D Sherman, Pratik Singh, Elena Sirotkina, Henrik Sjödin, Mikhail Sofiev, Balakrishnan Solaraju-Murali, Marco Springmann, Marina Treskova, Joaquin Triñanes, Eline Vanuytrecht, Fabian Wagner, Maria Walawender, Laura Warnecke, Ran Zhang, Marina Romanello, Josep M Antó, Maria Nilsson, Rachel Lowe
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引用次数: 0
Smoking prevalence following tobacco tax increases in Australia. 澳大利亚提高烟草税后的吸烟率。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00094-X
Edward Jegasothy, Francis Markham
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引用次数: 0
期刊
Lancet Public Health
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