首页 > 最新文献

BMC Medicine最新文献

英文 中文
Patterns of pharmacological treatment in patients with atrial fibrillation: an analysis from the prospective GLORIA-AF Registry Phase III. 房颤患者的药物治疗模式:来自前瞻性GLORIA-AF登记III期的分析
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03858-w
Bernadette Corica, Giulio Francesco Romiti, Giuseppe Boriani, Brian Olshansky, Tze-Fan Chao, Menno V Huisman, Marco Proietti, Gregory Y H Lip

Background: Polypharmacy (i.e., treatment with ≥ 5 drugs) is common in patients with atrial fibrillation (AF) and has been associated with suboptimal management and worse outcomes. Little is known about how prescribed drug patterns affect management and prognosis in patients with AF.

Methods: Based on data from the prospective global GLORIA-AF Registry Phase III (recruiting patients with AF and CHA2DS2-VASc score ≥ 1), we performed a latent class analysis to identify treatment patterns based on 14 drug classes including cardiovascular (CV) and non-CV drugs. We analysed associations with oral anticoagulant (OAC) use and risk of a composite primary outcome (all-cause death and major adverse cardiovascular events (MACE)) and secondary outcomes.

Results: Among 21,245 patients (mean age 70.2 ± 10.3 years, 44.9% females), we identified 6 patterns: i) Low Medicated pattern (18.3%); ii) Hypertension pattern (21.1%); iii) Heart Failure pattern (20.0%); iv) CV Prevention pattern (21.0%); v) Mixed Morbidity pattern (4.5%); and vi) High Medicated pattern (15.0%). All groups had higher odds of OAC use vs the Low Medicated pattern, with highest prevalences in the Heart Failure pattern (OR [95%CI]: 2.17 [1.90-2.48]) and the High Medicated pattern (OR [95%CI]: 2.08 [1.77-2.44]). Over 3-year follow-up, Heart Failure, Mixed Morbidity and High Medicated patterns were associated with higher risk of the primary composite outcome (aHR [95%CI]: 1.32 [1.14-1.53]; 1.45 [1.17-1.80] and 1.35 [1.14-1.60], respectively). Similar results were observed for all-cause mortality.

Conclusions: In patients with AF, different treatment patterns can be identified. Each pattern was associated with unique OAC use and long-term clinical outcomes.

背景:多重用药(即使用≥5种药物治疗)在房颤(AF)患者中很常见,并与管理欠佳和预后较差相关。关于处方药物模式如何影响房颤患者的管理和预后,我们知之甚少。方法:基于前瞻性全球GLORIA-AF登记III期(招募房颤且CHA2DS2-VASc评分≥1的患者)的数据,我们进行了潜在类别分析,以确定基于14种药物类别的治疗模式,包括心血管(CV)和非CV药物。我们分析了口服抗凝剂(OAC)使用与复合主要结局(全因死亡和主要不良心血管事件(MACE))和次要结局风险的相关性。结果:在21245例患者中(平均年龄70.2±10.3岁,女性44.9%),我们确定了6种模式:1)低剂量模式(18.3%);ii)高血压型(21.1%);iii)心力衰竭模式(20.0%);iv) CV预防模式(21.0%);v)混合发病率模式(4.5%);高用药模式(15.0%)。与低剂量用药组相比,所有组使用OAC的几率都更高,其中心力衰竭组(OR [95%CI]: 2.17[1.90-2.48])和高剂量用药组(OR [95%CI]: 2.08[1.77-2.44])的患病率最高。在3年的随访中,心力衰竭、混合发病率和高用药模式与主要综合结局的高风险相关(aHR [95%CI]: 1.32 [1.14-1.53];1.45[1.17-1.80]和1.35[1.14-1.60])。在全因死亡率中也观察到类似的结果。结论:房颤患者可采用不同的治疗模式。每种模式都与独特的OAC使用和长期临床结果相关。
{"title":"Patterns of pharmacological treatment in patients with atrial fibrillation: an analysis from the prospective GLORIA-AF Registry Phase III.","authors":"Bernadette Corica, Giulio Francesco Romiti, Giuseppe Boriani, Brian Olshansky, Tze-Fan Chao, Menno V Huisman, Marco Proietti, Gregory Y H Lip","doi":"10.1186/s12916-025-03858-w","DOIUrl":"10.1186/s12916-025-03858-w","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy (i.e., treatment with ≥ 5 drugs) is common in patients with atrial fibrillation (AF) and has been associated with suboptimal management and worse outcomes. Little is known about how prescribed drug patterns affect management and prognosis in patients with AF.</p><p><strong>Methods: </strong>Based on data from the prospective global GLORIA-AF Registry Phase III (recruiting patients with AF and CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥ 1), we performed a latent class analysis to identify treatment patterns based on 14 drug classes including cardiovascular (CV) and non-CV drugs. We analysed associations with oral anticoagulant (OAC) use and risk of a composite primary outcome (all-cause death and major adverse cardiovascular events (MACE)) and secondary outcomes.</p><p><strong>Results: </strong>Among 21,245 patients (mean age 70.2 ± 10.3 years, 44.9% females), we identified 6 patterns: i) Low Medicated pattern (18.3%); ii) Hypertension pattern (21.1%); iii) Heart Failure pattern (20.0%); iv) CV Prevention pattern (21.0%); v) Mixed Morbidity pattern (4.5%); and vi) High Medicated pattern (15.0%). All groups had higher odds of OAC use vs the Low Medicated pattern, with highest prevalences in the Heart Failure pattern (OR [95%CI]: 2.17 [1.90-2.48]) and the High Medicated pattern (OR [95%CI]: 2.08 [1.77-2.44]). Over 3-year follow-up, Heart Failure, Mixed Morbidity and High Medicated patterns were associated with higher risk of the primary composite outcome (aHR [95%CI]: 1.32 [1.14-1.53]; 1.45 [1.17-1.80] and 1.35 [1.14-1.60], respectively). Similar results were observed for all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with AF, different treatment patterns can be identified. Each pattern was associated with unique OAC use and long-term clinical outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"27"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Potential roles of cigarette smoking on gut microbiota profile among Chinese men. 吸烟对中国男性肠道菌群的潜在影响
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03852-2
Jiayao Fan, Fangfang Zeng, Haili Zhong, Jun Cai, Wentao Shen, Chunxiao Cheng, Chunfeng He, Yuanjiao Liu, Yuan Zhou, Shujie Chen, Yimin Zhu, Tao Liu, Ju-Sheng Zheng, Lan Wang, Yu-Ming Chen, Wenjun Ma, Dan Zhou

Background: Cigarette smoking is posited as a potential factor in disrupting the balance of the human gut microbiota. However, existing studies with limited sample size have yielded inconclusive results.

Methods: Here, we assessed the association between cigarette smoking and gut microbial profile among Chinese males from four independent studies (N total = 3308). Both 16S rRNA and shotgun metagenomic sequencing methods were employed, covering 206 genera and 237 species. Microbial diversity and abundance were compared among non-smokers, current smokers, and former smokers.

Results: Actinomyces[g], Atopobium[g], Haemophilus[g], Turicibacter[g], and Lachnospira[g] were found to be associated with smoking status (current smokers vs. non-smokers). Metagenomic data provided a higher resolution at the species level, particularly for the Actinomyces[g] branch. Additionally, serum γ-glutamylcysteine (γ-Glu-Cys) was found to have a potential role in connecting smoking and Actinomyces[g]. Furthermore, we revealed putative mediation roles of the gut microbiome in the associations between smoking and common diseases including cholecystitis and type 2 diabetes.

Conclusions: We characterized the gut microbiota profile in male smokers and further revealed their potential involvement in mediating the impact of smoking on health outcomes. These findings advance our understanding of the intricate association between cigarette smoking and the gut microbiome.

背景:吸烟被认为是破坏人体肠道菌群平衡的潜在因素。然而,现有的样本量有限的研究得出了不确定的结果。方法:通过4项独立研究(共3308例),我们评估了吸烟与中国男性肠道微生物特征之间的关系。采用16S rRNA和霰弹枪宏基因组测序方法,共覆盖206属237种。比较了不吸烟者、当前吸烟者和曾经吸烟者之间的微生物多样性和丰度。结果:发现放线菌[g]、特托霉菌[g]、嗜血杆菌[g]、Turicibacter[g]和毛螺旋体[g]与吸烟状况(当前吸烟者与非吸烟者)有关。宏基因组数据在物种水平上提供了更高的分辨率,特别是对于放线菌[g]分支。此外,血清γ-谷氨酰半胱氨酸(γ-Glu-Cys)被发现在吸烟和放线菌之间具有潜在的联系[g]。此外,我们揭示了肠道微生物群在吸烟和常见疾病(包括胆囊炎和2型糖尿病)之间的关联中的假定中介作用。结论:我们描述了男性吸烟者的肠道微生物群特征,并进一步揭示了它们在吸烟对健康结果的影响中可能参与的调节作用。这些发现促进了我们对吸烟和肠道微生物群之间复杂关系的理解。
{"title":"Potential roles of cigarette smoking on gut microbiota profile among Chinese men.","authors":"Jiayao Fan, Fangfang Zeng, Haili Zhong, Jun Cai, Wentao Shen, Chunxiao Cheng, Chunfeng He, Yuanjiao Liu, Yuan Zhou, Shujie Chen, Yimin Zhu, Tao Liu, Ju-Sheng Zheng, Lan Wang, Yu-Ming Chen, Wenjun Ma, Dan Zhou","doi":"10.1186/s12916-025-03852-2","DOIUrl":"10.1186/s12916-025-03852-2","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking is posited as a potential factor in disrupting the balance of the human gut microbiota. However, existing studies with limited sample size have yielded inconclusive results.</p><p><strong>Methods: </strong>Here, we assessed the association between cigarette smoking and gut microbial profile among Chinese males from four independent studies (N total = 3308). Both 16S rRNA and shotgun metagenomic sequencing methods were employed, covering 206 genera and 237 species. Microbial diversity and abundance were compared among non-smokers, current smokers, and former smokers.</p><p><strong>Results: </strong>Actinomyces[g], Atopobium[g], Haemophilus[g], Turicibacter[g], and Lachnospira[g] were found to be associated with smoking status (current smokers vs. non-smokers). Metagenomic data provided a higher resolution at the species level, particularly for the Actinomyces[g] branch. Additionally, serum γ-glutamylcysteine (γ-Glu-Cys) was found to have a potential role in connecting smoking and Actinomyces[g]. Furthermore, we revealed putative mediation roles of the gut microbiome in the associations between smoking and common diseases including cholecystitis and type 2 diabetes.</p><p><strong>Conclusions: </strong>We characterized the gut microbiota profile in male smokers and further revealed their potential involvement in mediating the impact of smoking on health outcomes. These findings advance our understanding of the intricate association between cigarette smoking and the gut microbiome.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"25"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Global, regional, and national burden of early-onset colorectal cancer from 1990 to 2021: a systematic analysis based on the global burden of disease study 2021. 1990 - 2021年全球、地区和国家早发性结直肠癌负担:基于2021年全球疾病负担研究的系统分析
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03867-9
Yang Meng, Zongbiao Tan, Junhai Zhen, Di Xiao, Liwei Cai, Weiguo Dong, Changzheng Chen

Background: To provide estimates and trends for burdens of early-onset colorectal cancer (EOCRC) from 1990 to 2021 at the global, regional, and national levels, and to provide projections of EOCRC burden through 2030.

Methods: A trend analysis based on the Global Burden of Diseases 2021. The joinpoint regression model was used to analyze the temporal trends on EOCRC burden by calculating the corresponding average annual percent changes (AAPCs). A decomposition analysis was used to understand the drivers of the changes in EOCRC burden. The relationship between socio-demographic index (SDI) and disease burden was assessed by the concentration index of inequality. In addition, we constructed a Bayesian age-period-cohort model to predict the burden of EOCRC worldwide from 2022 to 2030.

Results: Globally, the burden of EOCRC increased significantly between 1990 and 2021, with the incidence rising from 5.43/100000 to 6.13/100000 (AAPC = 0.39), and the prevalence increasing from 29.65/100000 to 38.86/100000 (AAPC = 0.87). Over the same period, the death rate decreased from 2.98/100000 to 2.30/100000 (AAPC = - 0.84), whereas the disability-adjusted life-year (DALY) decreased from 148.46/100000 to 115.42/100000 (AAPC = - 0.82). In 2021, East Asia and China had the highest burden of EOCRC regionally and nationally. Decomposition analysis indicated the increase in EOCRC burden was mainly driven by population growth. The concentration index revealed that high-SDI countries had a greater burden of EOCRC than low-SDI countries. The global incidence and prevalence of EOCRC will rise continuously from 2022 to 2030.

Conclusions: Between 1990 and 2021, the incidence and prevalence of EOCRC have escalated, whereas the death rate and DALY rate have declined. The burden varied with sex, SDI, and geographical locations. Given the rising trend of EOCRC burden, coordinated efforts are needed to reduce the burden posed by this malignancy.

背景:提供1990年至2021年全球、地区和国家层面早发性结直肠癌(EOCRC)负担的估计和趋势,并提供到2030年的EOCRC负担预测。方法:基于2021年全球疾病负担的趋势分析。采用结合点回归模型计算相应的年平均变化百分数,分析了生态环境污染负担的时间变化趋势。通过分解分析,了解了EOCRC负荷变化的驱动因素。用不平等集中指数评价社会人口指数与疾病负担的关系。此外,我们构建了贝叶斯年龄-时期-队列模型来预测2022 - 2030年全球EOCRC负担。结果:1990 - 2021年,全球EOCRC负担显著增加,发病率从5.43/10万上升至6.13/10万(AAPC = 0.39),患病率从29.65/10万上升至38.86/10万(AAPC = 0.87)。同期,死亡率从2.98/100000下降到2.30/100000 (AAPC = - 0.84),伤残调整生命年(DALY)从148.46/100000下降到115.42/100000 (AAPC = - 0.82)。2021年,东亚和中国地区和国家的EOCRC负担最高。分解分析表明,人口增长是导致EOCRC负担增加的主要原因。浓度指数显示,高sdi国家的EOCRC负担高于低sdi国家。从2022年到2030年,EOCRC的全球发病率和患病率将持续上升。结论:1990年至2021年间,EOCRC的发病率和流行率上升,而死亡率和DALY率下降。这种负担因性别、SDI和地理位置而异。鉴于EOCRC负担呈上升趋势,需要采取协调一致的努力来减轻这种恶性肿瘤造成的负担。
{"title":"Global, regional, and national burden of early-onset colorectal cancer from 1990 to 2021: a systematic analysis based on the global burden of disease study 2021.","authors":"Yang Meng, Zongbiao Tan, Junhai Zhen, Di Xiao, Liwei Cai, Weiguo Dong, Changzheng Chen","doi":"10.1186/s12916-025-03867-9","DOIUrl":"10.1186/s12916-025-03867-9","url":null,"abstract":"<p><strong>Background: </strong>To provide estimates and trends for burdens of early-onset colorectal cancer (EOCRC) from 1990 to 2021 at the global, regional, and national levels, and to provide projections of EOCRC burden through 2030.</p><p><strong>Methods: </strong>A trend analysis based on the Global Burden of Diseases 2021. The joinpoint regression model was used to analyze the temporal trends on EOCRC burden by calculating the corresponding average annual percent changes (AAPCs). A decomposition analysis was used to understand the drivers of the changes in EOCRC burden. The relationship between socio-demographic index (SDI) and disease burden was assessed by the concentration index of inequality. In addition, we constructed a Bayesian age-period-cohort model to predict the burden of EOCRC worldwide from 2022 to 2030.</p><p><strong>Results: </strong>Globally, the burden of EOCRC increased significantly between 1990 and 2021, with the incidence rising from 5.43/100000 to 6.13/100000 (AAPC = 0.39), and the prevalence increasing from 29.65/100000 to 38.86/100000 (AAPC = 0.87). Over the same period, the death rate decreased from 2.98/100000 to 2.30/100000 (AAPC = - 0.84), whereas the disability-adjusted life-year (DALY) decreased from 148.46/100000 to 115.42/100000 (AAPC = - 0.82). In 2021, East Asia and China had the highest burden of EOCRC regionally and nationally. Decomposition analysis indicated the increase in EOCRC burden was mainly driven by population growth. The concentration index revealed that high-SDI countries had a greater burden of EOCRC than low-SDI countries. The global incidence and prevalence of EOCRC will rise continuously from 2022 to 2030.</p><p><strong>Conclusions: </strong>Between 1990 and 2021, the incidence and prevalence of EOCRC have escalated, whereas the death rate and DALY rate have declined. The burden varied with sex, SDI, and geographical locations. Given the rising trend of EOCRC burden, coordinated efforts are needed to reduce the burden posed by this malignancy.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"34"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients. 绿色避难所:住宅绿地和花园空间与自然环境降低糖尿病患者精神障碍的风险。
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03864-y
Erxu Xue, Jianhui Zhao, Jingyu Ye, Jingjie Wu, Dandan Chen, Jing Shao, Xue Li, Zhihong Ye

Background: The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.

Methods: We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.

Results: During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.

Conclusions: Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.

背景:糖尿病和精神障碍的共存是一种非常常见的预后不良的合并症。我们的目的是调查绿地、花园空间和自然环境对糖尿病患者精神障碍风险的影响。方法:我们对来自英国生物银行的39,397名糖尿病患者进行了纵向分析。根据土地利用数据和土地覆盖图中的自然环境建模的住宅绿地和花园空间被分配给每个参与者的住宅地址。采用Cox比例风险模型分析自然暴露与糖尿病精神障碍的关系。采用随机中介分析对空气污染的间接影响进行量化。结果:在平均7.55年的随访中,共发现4513例精神障碍,其中抑郁症2952例,焦虑症1209例。与第一分位数相比,第二分位数和第三分位数的自然环境在300 m缓冲区处的受试者发生精神障碍的风险分别降低了7% (HR = 0.93, 95%CI: 0.86-0.99)和12% (HR = 0.88, 95%CI: 0.82-0.94)。当暴露在300 m缓冲区的花园空间的三分之一时,糖尿病患者发生精神障碍的风险将降低13%。自然环境和园林空间分别预防了6.65%和10.18%的糖尿病患者精神障碍的发生。当暴露于1000 m缓冲区的第三分位数绿地时,发生精神障碍的风险在统计学上有所降低(HR = 0.84, 95% CI: 0.78-0.90)。三种自然暴露对糖尿病患者抑郁和焦虑障碍的保护作用也被观察到。空气污染,特别是二氧化氮、氮氧化物和细颗粒物,在自然暴露与精神障碍之间的关联中发挥了重要作用,分别占48.3%、29.2%和62.4%。结论:住宅绿地、园林空间和自然环境可降低糖尿病患者精神障碍风险,其中空气污染在其中起重要作用。这突出表明,地方政府有可能通过战略规划举措,加强以公共卫生和城市规划为基础的此类干预措施的可持续性。
{"title":"Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients.","authors":"Erxu Xue, Jianhui Zhao, Jingyu Ye, Jingjie Wu, Dandan Chen, Jing Shao, Xue Li, Zhihong Ye","doi":"10.1186/s12916-025-03864-y","DOIUrl":"10.1186/s12916-025-03864-y","url":null,"abstract":"<p><strong>Background: </strong>The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.</p><p><strong>Methods: </strong>We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.</p><p><strong>Results: </strong>During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.</p><p><strong>Conclusions: </strong>Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"31"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between adolescent obesity and early adulthood healthcare utilization-a two-cohort prospective study. 青少年肥胖与成年早期医疗保健利用之间的关系——一项双队列前瞻性研究
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03866-w
Emilia Hagman, Vidar Halsteinli, Resthie R Putri, Christina Hansen Edwards, Gudrun Waaler Bjørnelv, Claude Marcus, Rønnaug A Ødegård

Background: Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood.

Methods: This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13-19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries.

Results: A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25-29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs.

Conclusions: Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.

背景:儿童肥胖是一个日益严重的全球健康挑战,对个人和医疗保健系统具有长期影响。现有的关于儿童肥胖与成人医疗保健使用之间关系的研究是有限的,并且往往依赖于数学模拟模型。本研究旨在提供青少年肥胖对成年早期专业医疗保健利用和成本影响的真实数据。方法:本研究分析了来自两个纵向队列的数据:挪威的基于人群的队列(Young-HUNT)和瑞典的临床队列(BORIS),后者具有匹配的一般人群比较者。研究对象出生于1987年至1994年之间,他们在13-19岁时测量BMI,并在20 - 30岁时进行随访。利用国家患者登记处对医疗保健利用和成本进行了评估。结果:共有7592名挪威人(5.7%为青少年肥胖)和1543名瑞典人(5.7%为青少年肥胖)和7330名匹配的一般人群比较者被纳入研究。在女性中,青少年肥胖与青年期更高的专业医疗保健使用率和成本显著相关,例如,在瑞典,25-29岁的青少年肥胖女性每年接受专业医疗保健就诊的概率为57%,而普通人群的这一比例为49%。对来自挪威和瑞典的真实世界数据队列的分析表明,青少年肥胖与青年期医疗保健使用率和成本的增加有关,超出了先前的估计。明显的性别差异很明显,女性比男性承担更高的成本。
{"title":"Association between adolescent obesity and early adulthood healthcare utilization-a two-cohort prospective study.","authors":"Emilia Hagman, Vidar Halsteinli, Resthie R Putri, Christina Hansen Edwards, Gudrun Waaler Bjørnelv, Claude Marcus, Rønnaug A Ødegård","doi":"10.1186/s12916-025-03866-w","DOIUrl":"10.1186/s12916-025-03866-w","url":null,"abstract":"<p><strong>Background: </strong>Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood.</p><p><strong>Methods: </strong>This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13-19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries.</p><p><strong>Results: </strong>A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25-29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs.</p><p><strong>Conclusions: </strong>Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"33"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Regular versus as-needed treatments for mild asthma in children, adolescents, and adults: a systematic review and network meta-analysis. 儿童、青少年和成人轻度哮喘的常规治疗与按需治疗:一项系统综述和网络荟萃分析
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03847-z
Prapaporn Pornsuriyasak, Sunatee Sa-Nguansai, Kunlawat Thadanipon, Pawin Numthavaj, Gareth J McKay, John Attia, Ammarin Thakkinstian

Background: Inhaled corticosteroids (ICS) are recommended treatment for mild asthma. We aimed to update the evidence on the efficacy and safety of ICS-containing regimens, leukotriene receptor antagonists (LTRA), and tiotropium relative to as-needed (AN) short-acting β2-agonists (SABA) in children (aged 6-11 years) and adolescents/adults.

Methods: A systematic review of randomized controlled trials (RCTs) of regular and AN treatment for mild asthma was conducted (CRD42022352384). PubMed, Scopus, and ClinicalTrials.gov were searched up to 31st March 2024. RCTs in children or adolescents/adults with mild asthma were eligible if they compared any of the following treatments: ICS alone or in combination with fast-acting bronchodilators (FABA, i.e., formoterol or SABA) or long-acting β2-agonists (LABA), LTRA, tiotropium, and SABA alone, for the following outcomes: exacerbations, asthma symptoms, forced expiratory volume in 1 s (FEV1), asthma-specific quality-of-life (QoL), or severe adverse events (SAEs). The two-stage network meta-analysis (NMA) was used to pool risk ratios (RR) or mean differences for treatment outcomes. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). This review followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.

Results: Thirteen RCTs in children and 29 in adolescents/adults were included. Regular ICS ranked best for preventing exacerbations and improving FEV1 in children. NMA of RCTs suggested regular ICS were better in preventing exacerbations than LTRA (RR [95% confidence intervals], (0.81 [0.69,0.96]) and AN-SABA (0.61 [0.48,0.78]), and not different from AN-ICS (0.83 [0.62,1.12]). In adolescents/adults, for preventing severe exacerbations, regular ICS outperformed AN-SABA (0.58 [0.46,0.73]), but AN-ICS/FABA (0.73 [0.54,0.97]), and regular ICS/LABA (0.68 [0.48,0.97]) surpassed regular ICS. Symptom relief and improved FEV1 were not different among the ICS-containing regimens. Regular ICS ranked best for improved QoL and least likely for SAEs.

Conclusions: Regular ICS use may be the most effective treatment for preventing exacerbation and increasing FEV1 in children with mild asthma. In adolescents/adults, ICS-containing regimens outperformed AN-SABA for exacerbation prevention. With varying degrees of heterogeneity, severe exacerbation risk in adolescents/adults might be lower with regular ICS/LABA or AN-ICS/FABA than regular ICS, where AN-ICS/FABA may not be suitable for patients with low FEV1. Additionally, regular ICS use may enhance FEV1 and QoL more than AN-SABA and LTRA.

背景:吸入皮质类固醇(ICS)是轻度哮喘的推荐治疗方法。我们旨在更新关于含ics方案、白三烯受体拮抗剂(LTRA)和噻托溴铵相对于按需(AN)短效β2激动剂(SABA)在儿童(6-11岁)和青少年/成人中的有效性和安全性的证据。方法:对常规和AN治疗轻度哮喘的随机对照试验(RCTs)进行系统评价(CRD42022352384)。检索截止到2024年3月31日的PubMed、Scopus和ClinicalTrials.gov。在患有轻度哮喘的儿童或青少年/成人中,如果比较以下治疗中的任何一种,则符合条件:单独使用ICS或联合使用快速支气管扩张剂(FABA,即福莫特罗或SABA)或长效β2激动剂(LABA)、LTRA、噻托品和单独使用SABA,以获得以下结果:恶化、哮喘症状、1 s用力呼气量(FEV1)、哮喘特异性生活质量(QoL)或严重不良事件(SAEs)。两阶段网络荟萃分析(NMA)用于汇总风险比(RR)或治疗结果的平均差异。使用Cochrane随机试验风险-偏倚工具(RoB2)评估偏倚风险。本次审查遵循PRISMA报告指南,PRISMA检查清单见附加文件2。结果:纳入13项儿童随机对照试验和29项青少年/成人随机对照试验。常规ICS在预防急性加重和改善儿童FEV1方面排名最佳。随机对照试验的NMA显示,常规ICS在预防加重方面优于LTRA (RR[95%可信区间],(0.81[0.69,0.96])和AN-SABA(0.61[0.48,0.78]),与AN-ICS(0.83[0.62,1.12])无显著差异。在青少年/成人中,在预防严重恶化方面,常规ICS优于AN-SABA(0.58[0.46,0.73]),但AN-ICS/FABA(0.73[0.54,0.97])和常规ICS/LABA(0.68[0.48,0.97])优于常规ICS。含ics方案的症状缓解和FEV1改善无差异。常规ICS在改善生活质量方面排名最高,而sae的可能性最低。结论:常规使用ICS可能是预防轻度哮喘患儿加重和增加FEV1最有效的治疗方法。在青少年/成人中,含有ics的方案在预防恶化方面优于AN-SABA。在不同程度的异质性下,青少年/成人使用常规ICS/LABA或AN-ICS/FABA的严重恶化风险可能低于常规ICS,其中AN-ICS/FABA可能不适合低FEV1患者。此外,定期使用ICS可能比AN-SABA和LTRA更能提高FEV1和QoL。
{"title":"Regular versus as-needed treatments for mild asthma in children, adolescents, and adults: a systematic review and network meta-analysis.","authors":"Prapaporn Pornsuriyasak, Sunatee Sa-Nguansai, Kunlawat Thadanipon, Pawin Numthavaj, Gareth J McKay, John Attia, Ammarin Thakkinstian","doi":"10.1186/s12916-025-03847-z","DOIUrl":"10.1186/s12916-025-03847-z","url":null,"abstract":"<p><strong>Background: </strong>Inhaled corticosteroids (ICS) are recommended treatment for mild asthma. We aimed to update the evidence on the efficacy and safety of ICS-containing regimens, leukotriene receptor antagonists (LTRA), and tiotropium relative to as-needed (AN) short-acting β2-agonists (SABA) in children (aged 6-11 years) and adolescents/adults.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs) of regular and AN treatment for mild asthma was conducted (CRD42022352384). PubMed, Scopus, and ClinicalTrials.gov were searched up to 31st March 2024. RCTs in children or adolescents/adults with mild asthma were eligible if they compared any of the following treatments: ICS alone or in combination with fast-acting bronchodilators (FABA, i.e., formoterol or SABA) or long-acting β2-agonists (LABA), LTRA, tiotropium, and SABA alone, for the following outcomes: exacerbations, asthma symptoms, forced expiratory volume in 1 s (FEV<sub>1</sub>), asthma-specific quality-of-life (QoL), or severe adverse events (SAEs). The two-stage network meta-analysis (NMA) was used to pool risk ratios (RR) or mean differences for treatment outcomes. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). This review followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.</p><p><strong>Results: </strong>Thirteen RCTs in children and 29 in adolescents/adults were included. Regular ICS ranked best for preventing exacerbations and improving FEV<sub>1</sub> in children. NMA of RCTs suggested regular ICS were better in preventing exacerbations than LTRA (RR [95% confidence intervals], (0.81 [0.69,0.96]) and AN-SABA (0.61 [0.48,0.78]), and not different from AN-ICS (0.83 [0.62,1.12]). In adolescents/adults, for preventing severe exacerbations, regular ICS outperformed AN-SABA (0.58 [0.46,0.73]), but AN-ICS/FABA (0.73 [0.54,0.97]), and regular ICS/LABA (0.68 [0.48,0.97]) surpassed regular ICS. Symptom relief and improved FEV<sub>1</sub> were not different among the ICS-containing regimens. Regular ICS ranked best for improved QoL and least likely for SAEs.</p><p><strong>Conclusions: </strong>Regular ICS use may be the most effective treatment for preventing exacerbation and increasing FEV<sub>1</sub> in children with mild asthma. In adolescents/adults, ICS-containing regimens outperformed AN-SABA for exacerbation prevention. With varying degrees of heterogeneity, severe exacerbation risk in adolescents/adults might be lower with regular ICS/LABA or AN-ICS/FABA than regular ICS, where AN-ICS/FABA may not be suitable for patients with low FEV<sub>1</sub>. Additionally, regular ICS use may enhance FEV<sub>1</sub> and QoL more than AN-SABA and LTRA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"21"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postpartum depression in relation to chronic diseases and multimorbidity in women's mid-late life: a prospective cohort study of UK Biobank. 产后抑郁与女性中老年慢性病和多病的关系:英国生物银行的前瞻性队列研究
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03853-1
Yue Zhang, Yangyang Cheng, Rodrigo M Carrillo-Larco, Yaguan Zhou, Hui Wang, Xiaolin Xu

Background: Maternal short-term outcomes of postpartum depression (PPD) were widely examined, but little is known about its long-term association with multiple chronic diseases (multimorbidity) in women's later life. This study aims to assess the association of PPD with chronic diseases and multimorbidity in women's mid-late life.

Methods: This prospective cohort study included female participants in UK Biobank who attended online follow-up assessment and reported their history of PPD. A total of 36 chronic diseases were assessed and multimorbidity was defined as the co-existence of two or more of these diseases. Participants were followed from the baseline recruitment to the onset of two or more chronic diseases, death, or the end of follow-up (2023). Logistic regression models, Cox proportional hazard models, quasi-Poisson mixed effects models, and linear mixed models were conducted to examine the association of PPD with chronic diseases and multimorbidity at baseline and during follow-up.

Results: Among all 54,885 participants, 5106 (9.3%) participants experienced PPD, 13,928 (25.4%) participants had multimorbidity at baseline, and 14,135 (25.8%) participants developed two or more diseases during a median follow-up of 15 years. Women with a PPD history had higher odds of having multimorbidity at baseline (odds ratio = 1.35, 95% confidence interval [CI] = 1.27-1.44) and higher risk of developing multimorbidity during follow-up (hazard ratio = 1.13, 95% CI = 1.08-1.20). PPD was associated with increased number of chronic diseases, with the relatively new-onset number of diseases during follow-up being 8% higher for those with PPD (relative risk = 1.08, 95% CI = 1.05-1.12). Chronic diseases also accumulated at a faster annual rate for women with a history of PPD (b = 0.009, 95% CI = 0.007-0.011), compared to those without. We observed no interaction or mediation effects of physical activity, smoking, alcohol drinking, and dietary factors on the association between PPD and multimorbidity; however, women's body mass index at baseline contributed to the association, with the mediation proportion of 6.38% (2.56-10.20%).

Conclusions: PPD was associated with higher risks of chronic diseases and multimorbidity in women's mid-late life. This finding supports the importance of perinatal and postpartum mental health care, and its role in the prevention of chronic diseases and multimorbidity throughout women's life course.

背景:产后抑郁症(PPD)的短期预后已被广泛研究,但其与女性晚年多种慢性疾病(多病)的长期关系尚不清楚。本研究旨在评估PPD与女性中老年慢性疾病和多病的关系。方法:这项前瞻性队列研究纳入了英国生物银行的女性参与者,她们参加了在线随访评估并报告了她们的PPD病史。共评估了36种慢性疾病,多病被定义为两种或两种以上慢性疾病的共存。参与者从基线招募到两种或两种以上慢性疾病的发病、死亡或随访结束(2023年)进行随访。采用Logistic回归模型、Cox比例风险模型、准泊松混合效应模型和线性混合模型,在基线和随访期间检验PPD与慢性疾病和多病的关系。结果:在所有54,885名参与者中,5106名(9.3%)参与者经历过PPD, 13,928名(25.4%)参与者在基线时患有多种疾病,14,135名(25.8%)参与者在中位随访15年期间患有两种或两种以上疾病。有PPD病史的女性在基线时多重发病的几率更高(优势比= 1.35,95%可信区间[CI] = 1.27-1.44),在随访期间多重发病的风险更高(风险比= 1.13,95% CI = 1.08-1.20)。PPD与慢性疾病数量增加相关,随访期间PPD患者相对新发疾病数量增加8%(相对风险= 1.08,95% CI = 1.05-1.12)。与没有PPD病史的女性相比,有PPD病史的女性慢性疾病的年累积速度更快(b = 0.009, 95% CI = 0.007-0.011)。我们没有观察到体育活动、吸烟、饮酒和饮食因素在PPD和多病之间的相互作用或中介作用;然而,女性基线体重指数对该关联有贡献,其中介比例为6.38%(2.56-10.20%)。结论:PPD与女性中老年慢性疾病和多病的高风险相关。这一发现支持了围产期和产后心理保健的重要性,以及它在预防妇女一生中慢性病和多种疾病方面的作用。
{"title":"Postpartum depression in relation to chronic diseases and multimorbidity in women's mid-late life: a prospective cohort study of UK Biobank.","authors":"Yue Zhang, Yangyang Cheng, Rodrigo M Carrillo-Larco, Yaguan Zhou, Hui Wang, Xiaolin Xu","doi":"10.1186/s12916-025-03853-1","DOIUrl":"10.1186/s12916-025-03853-1","url":null,"abstract":"<p><strong>Background: </strong>Maternal short-term outcomes of postpartum depression (PPD) were widely examined, but little is known about its long-term association with multiple chronic diseases (multimorbidity) in women's later life. This study aims to assess the association of PPD with chronic diseases and multimorbidity in women's mid-late life.</p><p><strong>Methods: </strong>This prospective cohort study included female participants in UK Biobank who attended online follow-up assessment and reported their history of PPD. A total of 36 chronic diseases were assessed and multimorbidity was defined as the co-existence of two or more of these diseases. Participants were followed from the baseline recruitment to the onset of two or more chronic diseases, death, or the end of follow-up (2023). Logistic regression models, Cox proportional hazard models, quasi-Poisson mixed effects models, and linear mixed models were conducted to examine the association of PPD with chronic diseases and multimorbidity at baseline and during follow-up.</p><p><strong>Results: </strong>Among all 54,885 participants, 5106 (9.3%) participants experienced PPD, 13,928 (25.4%) participants had multimorbidity at baseline, and 14,135 (25.8%) participants developed two or more diseases during a median follow-up of 15 years. Women with a PPD history had higher odds of having multimorbidity at baseline (odds ratio = 1.35, 95% confidence interval [CI] = 1.27-1.44) and higher risk of developing multimorbidity during follow-up (hazard ratio = 1.13, 95% CI = 1.08-1.20). PPD was associated with increased number of chronic diseases, with the relatively new-onset number of diseases during follow-up being 8% higher for those with PPD (relative risk = 1.08, 95% CI = 1.05-1.12). Chronic diseases also accumulated at a faster annual rate for women with a history of PPD (b = 0.009, 95% CI = 0.007-0.011), compared to those without. We observed no interaction or mediation effects of physical activity, smoking, alcohol drinking, and dietary factors on the association between PPD and multimorbidity; however, women's body mass index at baseline contributed to the association, with the mediation proportion of 6.38% (2.56-10.20%).</p><p><strong>Conclusions: </strong>PPD was associated with higher risks of chronic diseases and multimorbidity in women's mid-late life. This finding supports the importance of perinatal and postpartum mental health care, and its role in the prevention of chronic diseases and multimorbidity throughout women's life course.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"24"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A realist evaluation to explain and understand the role of paramedics in primary care. 一个现实的评估来解释和理解护理人员在初级保健中的作用。
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03863-z
Georgette Eaton, Geoff Wong, Stephanie Tierney, Veronika Williams, Kamal R Mahtani

Background: In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce.

Methods: A realist evaluation was undertaken, consisting of three independent but inter-related research studies: In WP1, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS. WP2 involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed to understand paramedics' perceptions of their role. WP3 utilised focused observations and interviews to delve into the impact of paramedics on the primary care workforce. This comparative study collected data from sixty participants across fifteen sites in the UK, and twelve participants across three sites in a specific region in Canada, where Community Paramedicine is well established.

Results: The culmination of findings from each phase led to the development of a final programme theory, comprising of 50 context-mechanism-outcome configurations (CMOCs) encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care.

Conclusions: Our realist evaluation used a mixed-method approach to present empirical evidence of the role of paramedics in primary care. It offers insights into factors relating to their deployment, employment, and how they fit within the wider primary care team. Based on the evidence generated, we produced a series of practice implementation recommendations and highlighted areas for further research.

背景:为了应对初级保健中不可持续的工作量和劳动力危机,护理人员(具有从救护车服务经验获得的通才临床背景)越来越多地在初级保健中使用。然而,护理人员对初级保健工作人员的具体贡献尚未明确概述。我们使用现实主义的方法来理解护理人员影响(或不影响)初级保健工作人员的方式。方法:进行现实主义评估,包括三个独立但相互关联的研究:在WP1中,对英国初级保健护理人员进行了混合方法横断面调查,以了解NHS内护理人员的现有做法。WP2涉及分析自动网络图,观察初级保健护理人员之间的在线对话,以了解护理人员对其角色的看法。WP3利用重点观察和访谈来深入研究护理人员对初级保健工作人员的影响。这项比较研究收集了来自英国15个地点的60名参与者的数据,以及来自加拿大一个特定地区3个地点的12名参与者的数据,在加拿大,社区辅助医疗已经建立得很好。结果:每个阶段的研究结果的高潮导致了最终方案理论的发展,包括50个情境-机制-结果配置(cmoc),其中包括三个概念类别:初级保健护理人员的期望,护理人员向初级保健角色的转变,以及初级保健护理人员的角色和责任。结论:我们的现实主义评估使用混合方法的方法来提出护理人员在初级保健中的作用的经验证据。它提供了与他们的部署、就业以及他们如何适应更广泛的初级保健团队有关的因素的见解。根据所产生的证据,我们提出了一系列实践实施建议,并强调了进一步研究的领域。
{"title":"A realist evaluation to explain and understand the role of paramedics in primary care.","authors":"Georgette Eaton, Geoff Wong, Stephanie Tierney, Veronika Williams, Kamal R Mahtani","doi":"10.1186/s12916-025-03863-z","DOIUrl":"10.1186/s12916-025-03863-z","url":null,"abstract":"<p><strong>Background: </strong>In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce.</p><p><strong>Methods: </strong>A realist evaluation was undertaken, consisting of three independent but inter-related research studies: In WP1, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS. WP2 involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed to understand paramedics' perceptions of their role. WP3 utilised focused observations and interviews to delve into the impact of paramedics on the primary care workforce. This comparative study collected data from sixty participants across fifteen sites in the UK, and twelve participants across three sites in a specific region in Canada, where Community Paramedicine is well established.</p><p><strong>Results: </strong>The culmination of findings from each phase led to the development of a final programme theory, comprising of 50 context-mechanism-outcome configurations (CMOCs) encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care.</p><p><strong>Conclusions: </strong>Our realist evaluation used a mixed-method approach to present empirical evidence of the role of paramedics in primary care. It offers insights into factors relating to their deployment, employment, and how they fit within the wider primary care team. Based on the evidence generated, we produced a series of practice implementation recommendations and highlighted areas for further research.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"30"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adding salt to foods and risk of incident depression and anxiety. 向食物中添加盐与突发抑郁和焦虑的风险。
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03865-x
Weiwei Wang, Xiaotian Chang, Feifei Lin, Lei Feng, Mengying Wang, Jie Huang, Tao Wu

Background: Diet is a well-known determinant of mental health outcomes. However, epidemiologic evidence on salt consumption with the risk of developing depression and anxiety is still very limited. This study aimed to examine the association between adding salt to foods and incident depression and anxiety longitudinally.

Methods: This study used data from 444,787 adults who had never been diagnosed with depression or anxiety at baseline from the UK Biobank, a national community-based cohort from 2006 to 2010. Adding salt to foods was measured using a four-point Likert scale at baseline from a touch-screen questionnaire. The outcomes were incidents of diagnosed depression (F32-F33) and anxiety (F40-F48), defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Cox proportional hazards models were used to investigate the association between the frequency of adding salt to foods and incident depression and anxiety.

Results: During a mean follow-up period of 14.5 years, 16,319 incidents of depression and 18,959 incidents of anxiety were documented. A higher frequency of adding salt to foods was associated with elevated risk for depression and anxiety. Compared with the group of never/rarely adding salt to foods, the adjusted HRs of incident depression were 1.07 (95% CI: 1.02-1.12), 1.18 (95% CI: 1.10-1.26), and 1.29 (95% CI: 1.18-1.41) across the groups of sometimes, usually, and always, respectively (P trend < 0.001). Participants who reported always adding salt to foods had a 1.17-fold higher risk for developing anxiety (95% CI: 1.07-1.28) compared with those who never/rarely added salt to foods.

Conclusions: A higher frequency of adding salt to foods was independently associated with a higher hazard of depression and anxiety. Interventions such as public awareness campaigns promoting reduced salt consumption may be promising preventative measures to reduce the incidence of depression and anxiety.

背景:众所周知,饮食是心理健康结果的决定因素。然而,关于食盐摄入与患抑郁症和焦虑症风险之间关系的流行病学证据仍然非常有限。本研究旨在纵向考察在食物中添加盐与抑郁症和焦虑症之间的关系。方法:本研究使用了来自英国生物银行的444,787名成年人的数据,这些成年人在基线时从未被诊断为抑郁症或焦虑症,这是一个2006年至2010年的全国性社区队列。在触屏调查问卷的基础上,使用李克特四分制来测量食物中的盐添加量。结果是诊断为抑郁症(F32-F33)和焦虑症(F40-F48)的发生率,根据国际疾病和相关健康问题统计分类第10次修订代码定义。采用Cox比例风险模型来研究在食物中添加盐的频率与事件抑郁和焦虑之间的关系。结果:在平均14.5年的随访期间,记录了16,319例抑郁症和18,959例焦虑症。在食物中添加盐的频率越高,患抑郁和焦虑的风险就越高。与从不/很少加盐组相比,有时加盐组、经常加盐组和经常加盐组的抑郁事件调整hr分别为1.07 (95% CI: 1.02-1.12)、1.18 (95% CI: 1.10-1.26)和1.29 (95% CI: 1.18-1.41) (P趋势)。结论:加盐频率越高,抑郁和焦虑的风险越高。诸如提高公众意识的宣传活动等干预措施可能是减少抑郁和焦虑发生率的有希望的预防措施。
{"title":"Adding salt to foods and risk of incident depression and anxiety.","authors":"Weiwei Wang, Xiaotian Chang, Feifei Lin, Lei Feng, Mengying Wang, Jie Huang, Tao Wu","doi":"10.1186/s12916-025-03865-x","DOIUrl":"10.1186/s12916-025-03865-x","url":null,"abstract":"<p><strong>Background: </strong>Diet is a well-known determinant of mental health outcomes. However, epidemiologic evidence on salt consumption with the risk of developing depression and anxiety is still very limited. This study aimed to examine the association between adding salt to foods and incident depression and anxiety longitudinally.</p><p><strong>Methods: </strong>This study used data from 444,787 adults who had never been diagnosed with depression or anxiety at baseline from the UK Biobank, a national community-based cohort from 2006 to 2010. Adding salt to foods was measured using a four-point Likert scale at baseline from a touch-screen questionnaire. The outcomes were incidents of diagnosed depression (F32-F33) and anxiety (F40-F48), defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Cox proportional hazards models were used to investigate the association between the frequency of adding salt to foods and incident depression and anxiety.</p><p><strong>Results: </strong>During a mean follow-up period of 14.5 years, 16,319 incidents of depression and 18,959 incidents of anxiety were documented. A higher frequency of adding salt to foods was associated with elevated risk for depression and anxiety. Compared with the group of never/rarely adding salt to foods, the adjusted HRs of incident depression were 1.07 (95% CI: 1.02-1.12), 1.18 (95% CI: 1.10-1.26), and 1.29 (95% CI: 1.18-1.41) across the groups of sometimes, usually, and always, respectively (P trend < 0.001). Participants who reported always adding salt to foods had a 1.17-fold higher risk for developing anxiety (95% CI: 1.07-1.28) compared with those who never/rarely added salt to foods.</p><p><strong>Conclusions: </strong>A higher frequency of adding salt to foods was independently associated with a higher hazard of depression and anxiety. Interventions such as public awareness campaigns promoting reduced salt consumption may be promising preventative measures to reduce the incidence of depression and anxiety.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"32"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating agreement between individual nutrition randomised controlled trials and cohort studies - a meta-epidemiological study. 评估个体营养随机对照试验和队列研究之间的一致性——一项荟萃流行病学研究。
IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-21 DOI: 10.1186/s12916-025-03860-2
Julia Stadelmaier, Gina Bantle, Lea Gorenflo, Eva Kiesswetter, Adriani Nikolakopoulou, Lukas Schwingshackl

Background: In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement.

Methods: MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD).

Results: We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were "more or less identical", 71.9% "similar but not identical" and 7.8% "broadly similar". Most RCTs were classified as "low risk of bias" (26.6%) or with "some concerns" (65.6%); cohort studies were mostly rated with "some concerns" (46.6%) or "high risk of bias" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than "PI/ECO similarity" degree.

Conclusions: Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.

背景:在营养学研究中,随机对照试验(RCTs)和队列研究提供了补充证据。本荟萃流行病学研究旨在评估个体营养随机对照试验和调查高度相似研究问题的队列研究的效果估计的一致性,并调查不一致的决定因素。方法:检索2010年1月至2021年9月的MEDLINE、Epistemonikos和Cochrane系统评价数据库。我们将个体rct与基于人群、干预/暴露、比较物和结果(PI/ECO)特征的队列研究相匹配。两位审稿人独立提取研究特征和效应估计,并使用RoB2和ROBINS-E评估偏倚风险。通过合并风险比(RRR)和(标准化)平均差异(DSMD)分析匹配的rct /队列研究的一致性。结果:我们纳入64对RCT/队列研究,共4,136,837名参与者。在PI/ECO相似度方面,20.3%的配对“大致相同”,71.9%的配对“相似但不相同”,7.8%的配对“大致相似”。大多数rct被归类为“低偏倚风险”(26.6%)或“有一定顾虑”(65.6%);由于对重要混杂因素的控制不足,队列研究大多被评为“有一些问题”(46.6%)或“高偏倚风险”(47.9%)。rct和队列研究的效应估计高度一致(RRR 1.00 (95% CI 0.91-1.10, n = 54);DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)。在探索分歧决定因素的元回归分析中,偏见风险判断往往比“PI/ECO相似性”程度对效果估计的影响更大。结论:营养随机对照试验和队列研究的效果估计大致相似。仔细考虑和评估PI/ECO特征和偏倚风险对于可靠地利用随机对照试验和队列研究的证据至关重要。
{"title":"Evaluating agreement between individual nutrition randomised controlled trials and cohort studies - a meta-epidemiological study.","authors":"Julia Stadelmaier, Gina Bantle, Lea Gorenflo, Eva Kiesswetter, Adriani Nikolakopoulou, Lukas Schwingshackl","doi":"10.1186/s12916-025-03860-2","DOIUrl":"10.1186/s12916-025-03860-2","url":null,"abstract":"<p><strong>Background: </strong>In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement.</p><p><strong>Methods: </strong>MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD).</p><p><strong>Results: </strong>We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were \"more or less identical\", 71.9% \"similar but not identical\" and 7.8% \"broadly similar\". Most RCTs were classified as \"low risk of bias\" (26.6%) or with \"some concerns\" (65.6%); cohort studies were mostly rated with \"some concerns\" (46.6%) or \"high risk of bias\" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than \"PI/ECO similarity\" degree.</p><p><strong>Conclusions: </strong>Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"36"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
BMC Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1