TY - JOUR AB - Background: The joint impact of exposure to multiple urban environmental factors on asthma remains unclear. Methods: We analysed data from 14 European cohorts to assess the impact of the urban exposome on asthma incidence across the life course. We linked three external exposome domains (air pollution, built environment, ambient temperature) to the participants’ home addresses at baseline. We performed k-means clustering within each domain and assessed associations of clusters with asthma adjusting for potentially relevant covariates in cohort-specific analyses, with subsequent separate meta-analyses for birth and adult cohorts. An environmental risk score using a coefficient-weighted sum approach was used to assess the impact of combining the three domains. Findings: A total of 7428 incident asthma cases were identified among 349,037 participants (from birth up to age 70+). Overall, we observed higher risks of asthma for clusters characterized by high particulate matter and nitrogen dioxide exposure in adults (ORmeta = 1.13, 95%CI:1.01–1.25), and clusters characterized by high built-up area and low levels of greenness in both children and adults (ORmeta = 1.36, 95%CI: 1.14–1.64 for birth cohorts and ORmeta = 1.15, 95%CI: 1.03–1.28 for adult cohorts, respectively). The joint exposure using the environment risk score combining the three domains was consistently associated with higher risks of incident asthma (ORmeta = 1.13, 95%CI: 1.07–1.20 for birth cohorts, ORmeta = 1.15, 95%CI: 1.10–1.20 for adult cohorts per 20% increase). On average 11.6% of the incident asthma cases could be attributed to environmental risk score above cohort-specific median levels. Interpretation: Multiple environmental exposures jointly contribute to incident asthma risk across the life course. Urban planning accounting for these factors may help mitigate asthma development. Funding: This study was funded by the European Union's Horizon 2020 research and innovation program under agreement No 874627 (EXPANSE). AU - Yu, Z.* AU - Kress, S.* AU - Blay, N.* AU - Gregor, P.* AU - Kukk, H.M.* AU - Leskien, M. AU - Majewska, R.* AU - Oosterwegel, M.J.* AU - Szabó, D.* AU - ten Have, M.* AU - Klanova, J.* AU - Mikeš, O.* AU - Bergström, A.* AU - Bussalleu, A.* AU - de Cid, R.* AU - Dalecká, A.* AU - Dadvand, P.* AU - van Dorsselaer, S.* AU - Fischer, K.* AU - de Hoogh, K.* AU - Koppelman, G.H.* AU - Kronberg, J.* AU - Metspalu, A.* AU - Milani, L.* AU - Esko, T.* AU - Metspalu, M.* AU - Lakerveld, J.* AU - Ljungman, P.* AU - Merid, S.K.* AU - Macek, P.* AU - Manczuk, M.* AU - Merritt, A.S.* AU - Pac, A.* AU - Palta, P.* AU - Pershagen, G.* AU - Peters, A. AU - Pikhart, H.* AU - Saucy, A.* AU - Schikowski, T.* AU - Shen, Y.* AU - Standl, M. AU - Tonne, C.* AU - Vermeulen, R.* AU - Vlaanderen, J.* AU - Vonk, J.M.* AU - Wolf, K. AU - Ek, C.H.* AU - Gruzieva, O.* AU - Gehring, U.* AU - Melén, E.* C1 - 74889 C2 - 57661 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - External exposome and incident asthma across the life course in 14 European cohorts: A prospective analysis within the EXPANSE project. JO - Lancet Reg. Health-Eur. VL - 54 PB - Elsevier PY - 2025 SN - 2666-7762 ER - TY - JOUR AB - Background: Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI). Methods: This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site. Findings: Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; median age 49 years IQR 41; 57), 21.8% (n = 6003; n = 2999/50.0% female, n = 3004/50% male; median age 53 years IQR 46; 60) reported CBP, compared to 78.2% (n = 21,515; n = 9194/42.7% female, n = 12,321/57.3% male; median age 48 years IQR 39; 56) who did not. CBP prevalence was highest in those with low (<500 MET min/week) or high (>5000 MET min/week) self-reported physical activity levels (24.6% (n = 10,892) and 22.0% (n = 3800), respectively) compared to moderate (500–5000 MET min/week) levels (19.4% (n = 12,826); p < 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13–1.30; p < 0.0001) was associated with an increased likelihood of chronic back pain (CBP), whereas higher lean muscle mass (LMM) (OR 0.87 per 2-unit Z-score; 95% CI 0.79–0.95; p = 0.003) was associated with a reduced likelihood of CBP. Stratified analyses confirmed these associations persisted in individuals with osteoarthritis (OA-CBP LMM: 22.9 cm3/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm3/kg/m; InterMAT: 6.96% both p < 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm3/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm3/kg/m; InterMAT: 7.9% p = 0.16 and p = 0.0019). Higher pain intensity (Pain Intensity Numerical Rating Scale ≥4) correlated with lower LMM (2-unit Z-score deviation = OR, 0.63; 95% CI, 0.57–0.70; p < 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13–1.30; p < 0.0001), independent of physical activity, osteoporosis and osteoarthritis. Interpretation: This large, population-based study highlights the associations of InterMAT and LMM with CBP. Given the limitations of the cross-sectional design, our findings can be seen as an impetus for further causal investigations within a broader, multidisciplinary framework to guide future research toward improved prevention and treatment. Funding: The NAKO is funded by the Federal Ministry of Education and Research(BMBF) [project funding reference numbers: 01ER1301A/B/C, 01ER1511D, 01ER1801A/B/C/D and 01ER2301A/B/C], federal states of Germany and the Helmholtz Association, the participating universities and the institutes of the Leibniz Association. AU - Ziegelmayer, S.* AU - Häntze, H.* AU - Mertens, C.* AU - Busch, F.W.* AU - Lemke, T.* AU - Kather, J.N.* AU - Truhn, D.* AU - Kim, S.H.* AU - Wiestler, B.* AU - Graf, M.* AU - Kader, A.* AU - Bamberg, F.* AU - Schlett, C.L.* AU - Weiss, J.B.* AU - Schulz-Menger, J.* AU - Ringhof, S.* AU - Can, E.* AU - Pischon, T.* AU - Niendorf, T.* AU - Lammert, J.* AU - Schulze, M.* AU - Keil, T.* AU - Peters, A. AU - Hadamitzky, M.* AU - Makowski, M.R.* AU - Adams, L.* AU - Bressem, K.* C1 - 74686 C2 - 57557 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Intermuscular adipose tissue and lean muscle mass assessed with MRI in people with chronic back pain in Germany: A retrospective observational study. JO - Lancet Reg. Health-Eur. VL - 54 PB - Elsevier PY - 2025 SN - 2666-7762 ER - TY - JOUR AB - Pharmacological management of obesity long suffered from a reputation of a 'Mission Impossible,' with inefficient weight loss and/or unacceptable tolerability. However, the tide has turned with recent progress in biochemical engineering and the development of long-acting agonists at the receptor for glucagon-like peptide-1 (GLP-1), and with unimolecular peptides that simultaneously possess activity at the receptors for GLP-1, the glucose-dependent insulinotropic polypeptide (GIP) and glucagon. Some of these novel therapeutics not only improve body weight and glycemic control in individuals with obesity and type 2 diabetes with hitherto unmet efficacy and tolerable safety, but also exhibit potential therapeutic value in diverse areas such as neurodegenerative diseases, fatty liver disease, dyslipidemia, atherosclerosis, and cardiovascular diseases. In this review, we highlight recent advances in incretin-based therapies and discuss their pharmacological potential within and beyond the treatment of obesity and diabetes, as well as their limitations in use, side effects, and underlying molecular mechanisms. AU - Grandl, G. AU - Novikoff, A. AU - Liu, X. AU - Müller, T.D. C1 - 72521 C2 - 56638 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Recent achievements and future directions of anti-obesity medications. JO - Lancet Reg. Health-Eur. VL - 47 PB - Elsevier PY - 2024 SN - 2666-7762 ER - TY - JOUR AB - From the pioneering moment in 1987 when the insulinotropic effect of glucagon-like peptide 1 (GLP-1) was first demonstrated in humans, to today's pharmaceutical gold rush for GLP-1-based treatments of obesity, the journey of GLP-1 pharmacology has been nothing short of extraordinary. The sequential conceptual developments of long-acting GLP-1 receptor (GLP-1R) mono-agonists, GLP-1R/glucose-dependent insulinotropic polypeptide receptor (GIPR) dual-agonists, and GLP-1R/GIPR/glucagon receptor (GcgR) triple agonists, have led to profound body weight-lowering capacities, with benefits that extend past obesity and towards obesity-associated diseases. The GLP-1R/GIPR dual-agonist tirzepatide has demonstrated a remarkable 23% body weight reduction in individuals with obesity over 72 weeks, eclipsing the average result achieved by certain types of bariatric surgery. Meanwhile, the GLP-1R/GIPR/GcgR triple-agonist retatrutide achieves similar body weight loss (∼25%) in just two-thirds of the time, potentially surpassing the efficacy of Roux-en-Y gastric bypass. These remarkable achievements rightfully raise the question whether and why there is still need for novel anti-obesity medications (AOMs) in the future. AU - Novikoff, A. AU - Grandl, G. AU - Liu, X. AU - Müller, T.D. C1 - 72905 C2 - 56800 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Why are we still in need for novel anti-obesity medications? JO - Lancet Reg. Health-Eur. VL - 47 PB - Elsevier PY - 2024 SN - 2666-7762 ER - TY - JOUR AB - Background High temperatures have been associated with increased mortality, with evidence reported predominately in large cities and for total cardiovascular or respiratory deaths. This case-crossover study examined heat-related cause-specific fi c cardiopulmonary mortality and vulnerability factors using small-area data from Germany. Methods We analyzed daily counts of cause-specific fi c cardiopulmonary deaths from 380 German districts (2000-2016) - 2016) and daily mean temperatures estimated by spatial-temporal - temporal models. We applied conditional quasi-Poisson regression using distributed lag nonlinear models to examine heat effects during May-September - September in each district and random- effects meta-analysis to pool the district-specific fi c estimates. Potential individual- and district-level vulnerability factors were examined by subgroup analyses and meta-regressions, respectively. Findings Heat was associated with increased mortality risks for all cardiopulmonary sub-causes. The relative risk (RR) of total cardiovascular and respiratory mortality for a temperature increment from the 75th to the 99th percentile was 1.24 (95% confidence fi dence interval: 1.23, 1.26) and 1.34 (1.30, 1.38), respectively. The RRs of cardiovascular sub-causes ranged from 1.16 (1.13, 1.19) for myocardial infarction to 1.32 (1.29, 1.36) for heart failure. For respiratory sub- causes, the RR was 1.27 (1.22, 1.31) for COPD and 1.49 (1.42, 1.57) for pneumonia. We observed greater susceptibility related to several individual- and district-level characteristics, e.g., among females or in highly urbanized districts. Heat vulnerability factors remained consistent between urban and rural areas. Interpretation Our study highlights heat-related increases in cause-specific fi c cardiopulmonary mortality across Germany and identifies fi es key vulnerability factors, offering insights for improving public health practices to mitigate heat-related health impacts. Funding European Union's ' s Horizon 2020 research and innovation program; Helmholtz Associations Initiative and Networking Fund. Health 2024;46: Published https://doi.org/10. 1016/j.lanepe.2024. 101049 AU - Zhang, S. AU - Breitner-Busch, S. AU - de'Donato, F.* AU - Stafoggia, M.* AU - Nikolaou, N. AU - Aunan, K.* AU - Peters, A. AU - Schneider, A.E. C1 - 71818 C2 - 56162 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Heat and cause-specific cardiopulmonary mortality in Germany: A case-crossover study using small-area assessment. JO - Lancet Reg. Health-Eur. VL - 46 PB - Elsevier PY - 2024 SN - 2666-7762 ER - TY - JOUR AB - BACKGROUND: Fasting indices of glucose-insulin-metabolism are an easy and affordable tool to assess insulin resistance. We aimed to establish reference ranges for fasting insulin indices that reflect age-dependent variation over the entire life span and subsequently test their clinical application regarding the prediction of glycemic deterioration in children. METHODS: We calculated age- and puberty-dependent reference values for HOMA-IR, HOMA2-IR, HOMA-β, McAuley index, fasting insulin, and fasting glucose from 6994 observations of 5512 non-obese healthy subjects aged 5-80 years. Applying those references, we determined the prevalence of insulin resistance among 2538 subjects with obesity. Furthermore, we investigated the intraindividual stability and the predictive values for future dysglycemia of these fasting indices in 516 children and adolescents with obesity up to 19 years of follow-up. We validated the results in three independent cohorts. FINDINGS: There was a strong age-dependent variation of all indices throughout the life span, including prolonged recovery of pubertal insulin resistance and a subsequent continuous increase throughout adulthood. Already from age 5 years onwards, >40% of children with obesity presented with elevated parameters of insulin resistance. Applying newly developed reference ranges, insulin resistance among children with obesity doubled the risk for future glycemic deterioration (HOMA-IR HR 1.88 (95% CI 1.1-3.21)), fasting insulin HR 1.89 (95% CI 1.11-3.23). In contrast, fasting glucose alone was not predictive for emerging dysglycemia in children with obesity (HR 1.03 (95% CI 0.62-1.71)). The new insulin-based thresholds were superior to fasting glucose and HbA1c in detecting children eventually manifesting with dysglycemia in prospective analyses. INTERPRETATION: The variation of fasting glucose-insulin-metabolism across the life span necessitates age-specific reference ranges. The improved prediction of future glycemic deterioration by indices based on fasting insulin beyond simple glucose measures alone could help to stratify risk characteristics of children with obesity in order to guide patient-tailored prevention and intervention approaches. FUNDING: German Research Foundation (DFG)-through SFB 1052, project number 209933838, subproject C5; Federal Ministry of Education and Research, Germany; European Union-European Regional Development Fund; Free State of Saxony. The German Diabetes Association, the CarbHealth consortium (01EA1908B). EU-IMI2-Consortium SOPHIA (grant agreement No 875534), German Center for Diabetes Research (DZD), grant number 82DZD14E03. AU - Hammel, M.C.* AU - Stein, R. AU - Kratzsch, J.* AU - Vogel, M.* AU - Eckert, A.J.* AU - Triatin, R.D.* AU - Colombo, M.* AU - Meigen, C.* AU - Baber, R.* AU - Stanik, J.* AU - Spielau, U.* AU - Stoltze, A.* AU - Wirkner, K.* AU - Tönjes, A.* AU - Snieder, H.* AU - Holl, R.W.* AU - Stumvoll, M.* AU - Blüher, M. AU - Kiess, W.* AU - Körner, A. C1 - 68091 C2 - 54569 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Fasting indices of glucose-insulin-metabolism across life span and prediction of glycemic deterioration in children with obesity from new diagnostic cut-offs. JO - Lancet Reg. Health-Eur. VL - 30 PB - Elsevier PY - 2023 SN - 2666-7762 ER - TY - JOUR AU - Kopasker, D.* AU - Katikireddi, S.V.* AU - Santos, J.V.* AU - Richiardi, M.* AU - Bronka, P.* AU - Rostila, M.* AU - Cecchini, M.* AU - Ali, S.* AU - Emmert-Fees, K. AU - Bambra, C.* AU - Hoven, H.* AU - Backhaus, I.* AU - Balaj, M.* AU - Eikemo, T.A.* C1 - 68699 C2 - 54908 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Microsimulation as a flexible tool to evaluate policies and their impact on socioeconomic inequalities in health. JO - Lancet Reg. Health-Eur. VL - 34 PB - Elsevier PY - 2023 SN - 2666-7762 ER - TY - JOUR AU - Stein, R. AU - Göpel, E.* AU - Weghuber, D.* AU - Hammel, M.C.* AU - Vogel, M.* AU - Kiess, W.* AU - Körner, A. C1 - 68317 C2 - 54706 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Are there relevant thresholds of insulin-independent indices across the lifespan to predict alterations in glycemic control?—Authors’ reply. JO - Lancet Reg. Health-Eur. VL - 33 PB - Elsevier PY - 2023 SN - 2666-7762 ER - TY - JOUR AB - Background: The genetic disease architecture of Inuit includes a large number of common high-impact variants. Identification of such variants contributes to our understanding of the genetic aetiology of diseases and improves global equity in genomic personalised medicine. We aimed to identify and characterise novel variants in genes associated with Maturity Onset Diabetes of the Young (MODY) in the Greenlandic population. Methods: Using combined data from Greenlandic population cohorts of 4497 individuals, including 448 whole genome sequenced individuals, we screened 14 known MODY genes for previously identified and novel variants. We functionally characterised an identified novel variant and assessed its association with diabetes prevalence and cardiometabolic traits and population impact. Findings: We identified a novel variant in the known MODY gene HNF1A with an allele frequency of 1.9% in the Greenlandic Inuit and absent elsewhere. Functional assays indicate that it prevents normal splicing of the gene. The variant caused lower 30-min insulin (β = −232 pmol/L, βSD = −0.695, P = 4.43 × 10−4) and higher 30-min glucose (β = 1.20 mmol/L, βSD = 0.441, P = 0.0271) during an oral glucose tolerance test. Furthermore, the variant was associated with type 2 diabetes (OR 4.35, P = 7.24 × 10−6) and HbA1c (β = 0.113 HbA1c%, βSD = 0.205, P = 7.84 × 10−3). The variant explained 2.5% of diabetes variance in Greenland. Interpretation: The reported variant has the largest population impact of any previously reported variant within a MODY gene. Together with the recessive TBC1D4 variant, we show that close to 1 in 5 cases of diabetes (18%) in Greenland are associated with high-impact genetic variants compared to 1–3% in large populations. Funding: Novo Nordisk Foundation, Independent Research Fund Denmark, and Karen Elise Jensen's Foundation. AU - Thuesen, A.C.B.* AU - Stæger, F.F.* AU - Kaci, A.* AU - Solheim, M.H.* AU - Aukrust, I.* AU - Jørsboe, E.* AU - Santander, C.G.* AU - Andersen, M.K.* AU - Li, Z.* AU - Gilly, A. AU - Stinson, S.E.* AU - Gjesing, A.P.* AU - Bjerregaard, P.* AU - Pedersen, M.L.* AU - Larsen, C.V.L.* AU - Grarup, N.* AU - Jørgensen, M.E.* AU - Zeggini, E. AU - Bjørkhaug, L.* AU - Njølstad, P.R.* AU - Albrechtsen, A.* AU - Moltke, I.* AU - Hansen, T.* C1 - 67160 C2 - 53491 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - A novel splice-affecting HNF1A variant with large population impact on diabetes in Greenland. JO - Lancet Reg. Health-Eur. VL - 24 PB - Elsevier PY - 2023 SN - 2666-7762 ER - TY - JOUR AB - Background: While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults. Methods: We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM2.5, NO2, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age. Findings: Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV1 of −2.08 mL/year (95% confidence interval: −2.79, −1.36) and in FVC of −2.86 mL/year (−3.73, −1.99) mL/year over the study period. Associations were robust after adjusting for PM2.5, NO2, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV1/FVC ratio. Interpretation: Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period. Funding: German Research Foundation. AU - Zhao, T. AU - Markevych, I.* AU - Fuertes, E.* AU - de Hoogh, K.* AU - Accordini, S.* AU - Boudier, A.* AU - Casas, L.* AU - Forsberg, B.* AU - Garcia Aymerich, J.* AU - Gnesi, M.* AU - Holm, M.* AU - Janson, C.* AU - Jarvis, D.* AU - Johannessen, A.* AU - Jörres, R.A.* AU - Karrasch, S. AU - Leynaert, B.* AU - Maldonado Perez, J.A.* AU - Malinovschi, A.* AU - Martinez-Moratalla, J.* AU - Modig, L.* AU - Nowak, D.* AU - Potts, J.* AU - Probst-Hensch, N.* AU - Sánchez-Ramos, J.L.* AU - Siroux, V.* AU - Urrutia Landa, I.* AU - Vienneau, D.* AU - Villani, S.* AU - Jacquemin, B.* AU - Heinrich, J.* C1 - 68334 C2 - 54714 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): A prospective cohort study in adults. JO - Lancet Reg. Health-Eur. VL - 34 PB - Elsevier PY - 2023 SN - 2666-7762 ER - TY - JOUR AB - The COVID-19 pandemic saw a massive investment into collaborative research projects with a focus on producing data to support public health decisions. We relay our direct experience of four projects funded under the Horizon2020 programme, namely ReCoDID, ORCHESTRA, unCoVer and SYNCHROS. The projects provide insight into the complexities of sharing patient level data from observational cohorts. We focus on compliance with the General Data Protection Regulation (GDPR) and ethics approvals when sharing data across national borders. We discuss procedures for data mapping; submission of new international codes to standards organisation; federated approach; and centralised data curation. Finally, we put forward recommendations for the development of guidelines for the application of GDPR in case of major public health threats; mandatory standards for data collection in funding frameworks; training and capacity building for data owners; cataloguing of international use of metadata standards; and dedicated funding for identified critical areas. AU - Tacconelli, E.* AU - Gorska, A.* AU - Carrara, E.* AU - Davis, R.J.* AU - Bonten, M.* AU - Friedrich, A.W.* AU - Glasner, C.* AU - Goossens, H.* AU - Hasenauer, J. AU - Abad, J.M.H.* AU - Peñalvo, J.L.* AU - Sanchez-Niubo, A.* AU - Sialm, A.* AU - Scipione, G.* AU - Soriano, G.* AU - Yazdanpanah, Y.* AU - Vorstenbosch, E.* AU - Jaenisch, T.* C1 - 66021 C2 - 53062 CY - Radarweg 29, 1043 Nx Amsterdam, Netherlands TI - Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response. JO - Lancet Reg. Health-Eur. VL - 21 PB - Elsevier PY - 2022 SN - 2666-7762 ER -