Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and ...Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and healthy lifestyle index (HLI)with BP control among hypertension patients is seldom reported,which needs to provide more evidence by prospective intervention studies.We examined the association of antihypertensive medication use and HLI with BP control among employees with hypertension in China based on a workplace-based multicomponent intervention program.Methods Between January 2013 and December 2014,a cluster randomized clinical trial of a workplace-based multicomponent intervention program was conducted in 60 workplaces across 20 urban areas in China.Workplaces were randomly divided into intervention (n=40) and control (n=20) groups.Basic information on employees at each workplace was collected by trained professionals,including sociodemographic characteristics,medical history,family history,lifestyle behaviors,medication status and physical measurements.After baseline,the intervention group received a 2-year intervention to achieve BP control,which included:(1) a workplace wellness program for all employees;(2) a guidelines-oriented hypertension management protocol.HLI including nonsmoking,nondrinking,adequate physical activity,weight within reference range and balanced diet,were coded on a 5-point scale (range:0-5,with higher score indicating a healthier lifestyle).Antihypertensive medication use was defined as taking drug within the last 2 weeks.Changes in HLI,antihypertensive medication use and BP control from baseline to 24 months were measured after the intervention.Results Overall,4655 employees were included (age:46.3±7.6 years,men:3547 (82.3%)).After 24 months of the intervention,there was a significant improvement in lifestyle[smoking (OR=0.65,95%CI:0.43-0.99;P=0.045),drinking (OR=0.52,95%CI:0.40-0.68;P<0.001),regular exercise (OR=3.10,95%CI:2.53-3.78;P<0.001),excessive intake of fatty food (OR=0.17,95%CI:0.06-0.52;P=0.002),restrictive use of salt (OR=0.26,95%CI:0.12-0.56;P=0.001)].Compare to employees with a deteriorating lifestyle after the intervention,those with an improved lifestyle had a higher BP control.In the intervention group,compared with employees not using antihypertensive medication,those who consistent used (OR=2.34;95%CI:1.16-4.72;P=0.017) or changed from not using to using antihypertensive medication (OR=2.24;95%CI:1.08-4.62;P=0.030) had higher BP control.Compared with those having lower HLI,participants with a same (OR=1.38;95%CI:0.99-1.93;P=0.056) or high (OR=1.79;95%CI:1.27~2.53;P<0.001) HLI had higher BP control.Those who used antihypertensive medication and had a high HLI had the highest BP control (OR=1.88;95%CI:1.32-2.67,P<0.001).Subgroup analysis also showed the consistent effect as the above.Conclusion These findings suggest that adherence to antihypertensive medication treatment and healthy lifestyle were associated with a significant improvement in BP control among employees with hypertension.展开更多
Chronic obstructive pulmonary disease(COPD)is a complex condition marked by considerable interindividual heterogeneity.Comorbidities exacerbate this variability,worsening disease severity and reducing health-related q...Chronic obstructive pulmonary disease(COPD)is a complex condition marked by considerable interindividual heterogeneity.Comorbidities exacerbate this variability,worsening disease severity and reducing health-related quality of life(HRQoL).Despite the high prevalence of COPD in China,COPD patient clusters remain poorly characterized.This study aimed to identify and validate clusters of Chinese patients with COPD,characterized primarily by comorbidity profiles,using cluster analysis.This cross-sectional,multicenter cohort study used data from the Chinese Enjoying Breathing Program(2020–2023).HRQoL was measured using the EuroQol five dimension(EQ-5D).Dimension reduction was performed via multiple correspondence analysis on 31 variables,including indicators of 27 comorbidities and four sociodemographic or health-related characteristics.Unsupervised machine learning algorithms,K-means++,and hierarchical clustering identified distinct clusters.Robustness was assessed using random forest classification.Logistic regression evaluated the association between cluster membership and EQ-5D outcomes.Among 11145 patients,59.4%had comorbidities.Four clusters emerged:young male smokers,biomass-exposed females,respiratory comorbidity,and elderly multimorbid.The last two clusters had notably lower HRQoL.Cluster analysis identified four clinically meaningful COPD patient clusters based on comorbidities and risk profiles,each with distinct HRQoL outcomes.These findings support targeted public health interventions and integrated care strategies for COPD management.展开更多
The public health workforce is a key component of public health system.To articulate the scope of public health workforce,we reviewed the relevant World Health Organization(wHO)guidance and peer-reviewed journal artic...The public health workforce is a key component of public health system.To articulate the scope of public health workforce,we reviewed the relevant World Health Organization(wHO)guidance and peer-reviewed journal articles on this subject.Specifically,we assessed and compared the relevant publications produced by WHO Headquarters and Regional Offices along with other literature on this issue.Our focus was on the“occupation,workplace setting,and employer of public health workforce”.It is noteworthy that WHO has adopted a conceptual framework with an inclusive scope of the public health workforce,while setting out a 5-year vision to strengthen capacity across all WHO Member States for a multidisciplinary workforce to deliver the essential public health functions,including emergency preparedness and response.The importance of public health workforce in global and national responses to the coronavirus disease 2019(COVID-19)pandemic is recognized.We also observed that there were diverse understandings of the scope of public health workforce worldwide,including macro-,meso-and micro-level perspectives.In the post-COVID-19 era,we suggest that policy-makers and practitioners at the national,regional and global level adopt a coordinated approach to expand and strengthen the national workforce as guided by the WHO towards the health-related targets of United Nations Sustainable Development Goals such as health security and Universal Health Coverage.展开更多
Background The impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and decision-making.However,information on mental health-related healthcare service utilisa...Background The impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and decision-making.However,information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is limited.Aims We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia,Canada,during the COVID-19 pandemic compared with the prepandemic period.Methods We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits,emergency department visits,hospital admissions and psychotropic drug dispensations.We examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019(prepandemic period)and January 2020 to December 2021(pandemic period).In addition,we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic,stratified by year,sex,age and condition.Results By late 2020,except for emergency department visits,utilisation of healthcare services recovered to prepandemic levels.Between 2019 and 2021,the monthly average rate for overall mental health-related outpatient physician visits,emergency department visits and psychotropic drug dispensations increased significantly by 24%,5%and 8%,respectively.Notable and statistically significant increases were observed among 10–14 year-olds(44%in outpatient physician visits,30%in emergency department visits,55%in hospital admissions and 35%in psychotropic drug dispensations)and 15–19 year-olds(45%in outpatient physician visits,14%in emergency department visits,18%in hospital admissions and 34%in psychotropic drug dispensations).Additionally,these increases were more prominent among females than males,with some variation for specific mental health-related conditions.Conclusions The increase in mental health-related healthcare service utilisation and psychotropic drug dispensations during the pandemic likely reflects significant societal consequences of both the pandemic and pandemic management measures.Recovery efforts in British Columbia should consider these findings,especially among the most affected subpopulations,such as adolescents.展开更多
The rising demand for child care is putting a strain on parents of children with autism spectrum disorder(ASD),particularly the mothers.This study investigated Chinese mothers of children with ASD and examined the fac...The rising demand for child care is putting a strain on parents of children with autism spectrum disorder(ASD),particularly the mothers.This study investigated Chinese mothers of children with ASD and examined the factors associated with maternal mental health.An online national survey was completed by the parents of 5077 ASD children and adolescents aged 0–17 years.A total of 28.0%of the mothers reported poor mental health status.Mothers with children aged 10–13 years had a lower chance of having poor mental health status than mothers with children aged 0–2 years(odds ratio(OR)0.63,95%confidence interval(CI)0.43–0.91).Mothers of children with high-functioning autism were less likely to have poor mental health status than those of children with low-functioning autism(OR 0.76,95%CI 0.62–0.94).Having children with comorbidities was related with a higher risk of poor mental status(OR 1.56,95%CI 1.35–1.81),as were having conflicts with other family members(OR 1.44,95%CI 1.22–1.70)and providing full-time care(OR 1.22,CI 1.06–1.41).A higher-than-average family income was associated with lower risk of having poor mental health status(OR 0.70,95%CI 0.58–0.82).Factors related to the children and family,and providing full-time care,have a significant effect on mothers’mental health status.Reducing obstacles to work and social interaction,as well as tackling the financial burden of raising an ASD child,may help improve the well-being of mothers.展开更多
With the civilization and modernization of human society,occupational health has emerged as a fundamental goal of social justice,as highlighted in the United Nations'Sustainable Development Goals(SDGs)since 2016.S...With the civilization and modernization of human society,occupational health has emerged as a fundamental goal of social justice,as highlighted in the United Nations'Sustainable Development Goals(SDGs)since 2016.Specifically,"SDG Goal 1:No Poverty","SDG 3:Good Health and Well-being",and"SDG 8:Decent Work and Economic Growth",are interconnected with other SDGs to support the pursuit of occupational health.展开更多
Objectives:To determine whether providing a choice between high-intensity interval training(HIIT)and moderateintensity continuous training(MICT)within a 4-week diabetes prevention program may lead to greater perceived...Objectives:To determine whether providing a choice between high-intensity interval training(HIIT)and moderateintensity continuous training(MICT)within a 4-week diabetes prevention program may lead to greater perceived autonomy support,motivation regulation,free-living physical activity,and cardiorespiratory fitness 6 months postintervention when compared to imposed exercise.Methods:In a preliminary pragmatic randomized trial,77 individuals at risk of type 2 diabetes(Mage=61.5(±9.8)years;Nfemales=58)were randomized to one of three exercise conditions:HIIT,MICT,or the choice thereof(CHOICE).Perceived autonomy supportwas assessed post-intervention.Changes in motivation,physical activity,and cardiorespiratory fitness were assessed 6 months post-intervention.Linear mixed models and Bonferroni-adjusted pairwise comparisons on estimated marginal means were used to derive effect estimates after adjusting for stratified allocation factors.Results:Perceived autonomy support was not different among conditions[F(2,47)=0.068,p=0.934].No effects were detected for motivation regulation,physical activity,or cardiorespiratory fitness(ps>0.05).Participants in the CHOICE condition self-reported significantly more physical activity 6 months post-intervention compared to preintervention[t(31)=2.922,p=0.019].Improvements in cardiorespiratory fitness were seen in CHOICE[t(65)=2.509,p=0.044]and MICT[t(65)=3.492,p=0.003].Conclusions:Providing choice between HIIT and MICT did not significantly affect individuals’perceived autonomy support or motivation regulation compared to imposed exercise.However,physical activity and cardiorespiratory fitness improved over time for the CHOICE condition.Providing choice between HIIT and MICT may be a feasible exercise strategy among this population.展开更多
Objective:To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions,and explore mediating pathways across diagnosis,initial treatment,...Objective:To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions,and explore mediating pathways across diagnosis,initial treatment,radiotherapy/chemotherapy,follow-up,and recurrence/progression/metastasis.Methods:A multicentre,nationwide survey across 5 disease courses was conducted from 26 hospitals in China.Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up,self-paid check-up,and symptom-based detection.Results:Workplace check-up,self-paid check-up,and symptom-based detection were associated with progressively higher costs across diagnosis[β:1.10,95%confidence interval(CI):0.54±1.67;β:1.46,95%CI:1.00±1.92;andβ:1.68,95%CI:1.25±2.11,respectively],initial treatment(β:0.36,95%CI:0.18±0.55;β:0.51,95%CI:0.35±0.66;andβ:0.56,95%CI:0.42±0.70,respectively),and follow-up(β:0.63,95%CI:0.38±0.88;β:0.83,95%CI:0.61±1.04;andβ:0.85,95%CI:0.65±1.06,respectively)compared to government-organized screening(all P<0.05).Earlier clinical staging and greater use of lower-level hospitals mediated 44.74%±54.97%of cost differences in diagnosis,73.27%±85.04%in initial treatment,and 30.38%±54.73%in follow-up.Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions.Conclusions:Government-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis,reduced overtreatment,and decreased reliance on higher-level hospitals,suggesting potential clinical benefits,efficient resource use,and improved equity in cancer care.展开更多
Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rat...Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.展开更多
Diabetes affects an estimated 828 million people globally,with approximately 44%living in China and India.Rural residents with diabetes in these countries face significant challenges in access to care.Although digital...Diabetes affects an estimated 828 million people globally,with approximately 44%living in China and India.Rural residents with diabetes in these countries face significant challenges in access to care.Although digital health interventions are increasingly used to reach underserved populations,considerable knowledge gaps exist.This mini-review presents the first comparative analysis of digital health implementations for diabetes care in rural China and India,comprising clinical decision support tools,telemedicine,and mobile health applications.The review examines how their distinct health system structures influence technology adoption and clinical outcomes.China's hierarchical administrative structure facilitates standardized nationwide platforms with consistent protocols,while India's federal system enables diverse localized innovations that accommodate regional diversity.Cluster-randomized trials for digital health tools in rural China show significant improvements in glycemic control.In India,interventions examined in this review were associated with improved health behaviors and medication adherence.Both countries demonstrate that digital interventions leveraging existing social structures and co-created with stakeholders yield better outcomes than standard care approaches.This analysis provides actionable insights for policymakers globally while identifying valuable opportunities for knowledge exchange between these two nations that together are home to nearly half of all people living with diabetes worldwide.展开更多
A three-year research project based in British Columbia, Canada, is attempting to develop a framework and tools to assist healthcare system decision-makers achieve “high performance” in resource allocation. In pursu...A three-year research project based in British Columbia, Canada, is attempting to develop a framework and tools to assist healthcare system decision-makers achieve “high performance” in resource allocation. In pursuit of this objective, a literature search was conducted and two phases of primary data collection are being undertaken: an online survey of senior healthcare decision-makers, and in-depth case studies of potential “high performing” organizations. This paper addresses the survey phase;our aim is to provide a practical example of the mechanics of survey design, of benefit to those who want to better understand our forthcoming results, but also as an aid to other researchers grappling with the hard choices and trade-offs involved in the survey development process. Survey content is described in light of the existing literature, with discussion of the choices made by the research team to decide what questions and items would be included and excluded. The target population for the survey was senior managers in Canadian regional health authorities (or the closest equivalent organizations) in each of the 10 provinces and 3 territories. The paper dis- cusses how this sample was obtained, and describes the survey implementation process.展开更多
Staphylococcus aureus(S.aureus)is the third most common pathogen causing 10.6%of bacterial foodborne illnesses in China in 2021[1].Heat-stable Staphylococcal Enterotoxins(SEs)produced by S.aureus are the main contribu...Staphylococcus aureus(S.aureus)is the third most common pathogen causing 10.6%of bacterial foodborne illnesses in China in 2021[1].Heat-stable Staphylococcal Enterotoxins(SEs)produced by S.aureus are the main contributors to staphylococcal food poisoning(SFP),causing vomiting,diarrhea,abdominal pain,headache,muscle cramps,and other acute gastroenteritis symptoms.More than 25 SEs and staphylococcal enterotoxin-like toxins(SE/s)have been described and which together comprise a superfamily of pyrogenic toxin superantigens(SAgs)[2].展开更多
Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and...Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.展开更多
The coronavirus disease 2019(COVID-19)pandemic is a global crisis,and medical systems in many countries are overwhelmed with supply shortages and increasing demands to treat patients due to the surge in cases and seve...The coronavirus disease 2019(COVID-19)pandemic is a global crisis,and medical systems in many countries are overwhelmed with supply shortages and increasing demands to treat patients due to the surge in cases and severe illnesses.This study aimed to assess COVID-19-related essential clinical resource demands in China,based on different scenarios involving COVID-19 spreads and interventions.We used a susceptible–exposed–infectious–hospitalized/isolated–removed(SEIHR)transmission dynamics model to estimate the number of COVID-19 infections and hospitalizations with corresponding essential healthcare resources needed.We found that,under strict non-pharmaceutical interventions(NPIs)or mass vaccination of the population,China would be able to contain community transmission and local outbreaks rapidly.However,under scenarios involving a low intensity of implemented NPIs and a small proportion of the population vaccinated,the use of a peacetime–wartime transition model would be needed for medical source stockpiles and preparations to ensure a normal functioning healthcare system.The implementation of COVID-19 vaccines and NPIs in different periods can influence the transmission of COVID-19 and subsequently affect the demand for clinical diagnosis and treatment.An increased proportion of asymptomatic infections in simulations will not reduce the demand for medical resources;however,attention must be paid to the increasing difficulty in containing COVID-19 transmission due to asymptomatic cases.This study provides evidence for emergency preparations and the adjustment of prevention and control strategies during the COVID-19 pandemic.It also provides guidance for essential healthcare investment and resource allocation.展开更多
AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published dur...AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries(i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventionsto change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.展开更多
AIM To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus(HBV) infection in British Columbia(BC).METHODS We used data from the BC Hepatitis Testers Cohort(BCHTC),which includes a...AIM To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus(HBV) infection in British Columbia(BC).METHODS We used data from the BC Hepatitis Testers Cohort(BCHTC),which includes all individuals tested for hepatitis C virus(HCV) or human immunodeficiency virus(HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990.These data were integrated with prescription drug,medical visit,hospitalization and mortality data.HBV cases were classified as acute or chronic according to provincial guidelines.We compared characteristics of individuals by HBV infection group(acute,chronic and negative).Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group.RESULTS46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection.4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections.Problematic alcohol use,injection drug use,and HIV or HCV co-infection were more common among individuals diagnosed with acute HBV compared to those with chronic infections and HBV negative individuals.In multivariable multinomial logistic regression models,we observed significant associations between acute or chronic HBV diagnosis and being male,age at HBV diagnosis or birth cohort,South and East Asian ethnicity,HCV or HIV infection,and injection drug use.The odds of acute HBV decreased with increasing age among people who inject drugs,while the opposite was true for chronic HBV.Persons with acute HBV were predominantly White(78%) while those with chronic HBV were mostly East Asian(60%).Relative to Whites,East Asians had 12 times greater odds of being diagnosed with chronic HBV infection.These odds increased with increasing socioeconomic deprivation.CONCLUSION Differences in the profiles of people diagnosed with acute and chronic HBV infection necessitate differentiated screening,prevention,care and treatment programs.展开更多
Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019(COVID-19)pandemic,but studies are needed to understand their effectiveness across regions and...Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019(COVID-19)pandemic,but studies are needed to understand their effectiveness across regions and time.Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020,we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions.We found that if these interventions had not been deployed,the cumulative number of cases could have shown a 97-fold(interquartile range 79–116)increase,as of May 31,2020.However,their effectiveness depended upon the timing,duration,and intensity of the interventions,with variations in case severity seen across populations,regions,and seasons.Additionally,before effective vaccines are widely available and herd immunity is achieved,our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns.展开更多
BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investiga...BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.展开更多
Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colpos...Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.展开更多
Background Family environments can shape children’s personalities and social networks,rendering distinguishing adverse childhood experiences(ACEs)from family and society essential,but related evidence remains limited...Background Family environments can shape children’s personalities and social networks,rendering distinguishing adverse childhood experiences(ACEs)from family and society essential,but related evidence remains limited.Aims This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs,their associations with depressive symptoms and cognitive impairment and the(education-moderated)mediating role of social ACEs.Methods Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study.Nine intrafamilial(0,1,2,3,and 4 or more)and three social(0,1,and 2 or more)ACEs were identified.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale.Global cognition,including episodic memory and mental intactness,was calculated as z scores.Binary and ordered logistic regressions,generalised linear models with Gaussian family and identity link,and mediation analysis were used.Results 13435 participants aged 59.0(51.0–66.0)were included.Compared with participants with no intrafamilial ACEs,those with 1,2,3,and 4 or more intrafamilial ACEs tended to develop more social ACEs,with odds ratios(ORs)of 1.55(95%confidence interval(CI):1.36 to 1.76),2.36(95%CI:2.08 to 2.68),3.46(95%CI:3.02 to 3.96)and 6.10(95%CI:5.30 to 7.02),respectively.Both intrafamilial and social ACEs were associated with depressive symptoms(OR>3 for four or more intrafamilial ACEs and two or more social ACEs)and global cognition(β=−0.26 for four or more intrafamilial ACEs andβ=−0.29 for two or more social ACEs).Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3%and 13.1%,respectively.Furthermore,as education levels increased,the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs,while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.Conclusions Improving children’s social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.展开更多
基金supported by grant 2011BAI11B01 from the Projects in the Chinese National Science and Technology Pillar Program during the 12th Five-year Plan Periodby grant 2017-I2M-1-004 from the Chinese Academy of Medical Science Innovation Fund for Medical Sciencesby the Major science and technology special plan project of Yunnan Province (202302AA310045)。
文摘Background Both medication and non-medication therapies are effective approaches to control blood pressure (BP) in hypertension patients.However,the association of joint changes in antihypertensive medication use and healthy lifestyle index (HLI)with BP control among hypertension patients is seldom reported,which needs to provide more evidence by prospective intervention studies.We examined the association of antihypertensive medication use and HLI with BP control among employees with hypertension in China based on a workplace-based multicomponent intervention program.Methods Between January 2013 and December 2014,a cluster randomized clinical trial of a workplace-based multicomponent intervention program was conducted in 60 workplaces across 20 urban areas in China.Workplaces were randomly divided into intervention (n=40) and control (n=20) groups.Basic information on employees at each workplace was collected by trained professionals,including sociodemographic characteristics,medical history,family history,lifestyle behaviors,medication status and physical measurements.After baseline,the intervention group received a 2-year intervention to achieve BP control,which included:(1) a workplace wellness program for all employees;(2) a guidelines-oriented hypertension management protocol.HLI including nonsmoking,nondrinking,adequate physical activity,weight within reference range and balanced diet,were coded on a 5-point scale (range:0-5,with higher score indicating a healthier lifestyle).Antihypertensive medication use was defined as taking drug within the last 2 weeks.Changes in HLI,antihypertensive medication use and BP control from baseline to 24 months were measured after the intervention.Results Overall,4655 employees were included (age:46.3±7.6 years,men:3547 (82.3%)).After 24 months of the intervention,there was a significant improvement in lifestyle[smoking (OR=0.65,95%CI:0.43-0.99;P=0.045),drinking (OR=0.52,95%CI:0.40-0.68;P<0.001),regular exercise (OR=3.10,95%CI:2.53-3.78;P<0.001),excessive intake of fatty food (OR=0.17,95%CI:0.06-0.52;P=0.002),restrictive use of salt (OR=0.26,95%CI:0.12-0.56;P=0.001)].Compare to employees with a deteriorating lifestyle after the intervention,those with an improved lifestyle had a higher BP control.In the intervention group,compared with employees not using antihypertensive medication,those who consistent used (OR=2.34;95%CI:1.16-4.72;P=0.017) or changed from not using to using antihypertensive medication (OR=2.24;95%CI:1.08-4.62;P=0.030) had higher BP control.Compared with those having lower HLI,participants with a same (OR=1.38;95%CI:0.99-1.93;P=0.056) or high (OR=1.79;95%CI:1.27~2.53;P<0.001) HLI had higher BP control.Those who used antihypertensive medication and had a high HLI had the highest BP control (OR=1.88;95%CI:1.32-2.67,P<0.001).Subgroup analysis also showed the consistent effect as the above.Conclusion These findings suggest that adherence to antihypertensive medication treatment and healthy lifestyle were associated with a significant improvement in BP control among employees with hypertension.
基金supported by the Ministry of Science and Tech-nology of the People’s Republic of China(2023ZD0506000)the CAMS Innovation Fund for Medical Sciences(ClFMS,2023-I2M-2-001)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2022-ZHCH330-01).The statements made and views expressed are solely the responsibility of the authors.
文摘Chronic obstructive pulmonary disease(COPD)is a complex condition marked by considerable interindividual heterogeneity.Comorbidities exacerbate this variability,worsening disease severity and reducing health-related quality of life(HRQoL).Despite the high prevalence of COPD in China,COPD patient clusters remain poorly characterized.This study aimed to identify and validate clusters of Chinese patients with COPD,characterized primarily by comorbidity profiles,using cluster analysis.This cross-sectional,multicenter cohort study used data from the Chinese Enjoying Breathing Program(2020–2023).HRQoL was measured using the EuroQol five dimension(EQ-5D).Dimension reduction was performed via multiple correspondence analysis on 31 variables,including indicators of 27 comorbidities and four sociodemographic or health-related characteristics.Unsupervised machine learning algorithms,K-means++,and hierarchical clustering identified distinct clusters.Robustness was assessed using random forest classification.Logistic regression evaluated the association between cluster membership and EQ-5D outcomes.Among 11145 patients,59.4%had comorbidities.Four clusters emerged:young male smokers,biomass-exposed females,respiratory comorbidity,and elderly multimorbid.The last two clusters had notably lower HRQoL.Cluster analysis identified four clinically meaningful COPD patient clusters based on comorbidities and risk profiles,each with distinct HRQoL outcomes.These findings support targeted public health interventions and integrated care strategies for COPD management.
文摘The public health workforce is a key component of public health system.To articulate the scope of public health workforce,we reviewed the relevant World Health Organization(wHO)guidance and peer-reviewed journal articles on this subject.Specifically,we assessed and compared the relevant publications produced by WHO Headquarters and Regional Offices along with other literature on this issue.Our focus was on the“occupation,workplace setting,and employer of public health workforce”.It is noteworthy that WHO has adopted a conceptual framework with an inclusive scope of the public health workforce,while setting out a 5-year vision to strengthen capacity across all WHO Member States for a multidisciplinary workforce to deliver the essential public health functions,including emergency preparedness and response.The importance of public health workforce in global and national responses to the coronavirus disease 2019(COVID-19)pandemic is recognized.We also observed that there were diverse understandings of the scope of public health workforce worldwide,including macro-,meso-and micro-level perspectives.In the post-COVID-19 era,we suggest that policy-makers and practitioners at the national,regional and global level adopt a coordinated approach to expand and strengthen the national workforce as guided by the WHO towards the health-related targets of United Nations Sustainable Development Goals such as health security and Universal Health Coverage.
基金The BCC19C was established and maintained through operational support from Data Analytics,Reporting and Evaluation(DARE)BC Centre for Disease Control(BCCDC)at the Provincial Health Services Authority(PHSA).
文摘Background The impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and decision-making.However,information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is limited.Aims We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia,Canada,during the COVID-19 pandemic compared with the prepandemic period.Methods We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits,emergency department visits,hospital admissions and psychotropic drug dispensations.We examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019(prepandemic period)and January 2020 to December 2021(pandemic period).In addition,we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic,stratified by year,sex,age and condition.Results By late 2020,except for emergency department visits,utilisation of healthcare services recovered to prepandemic levels.Between 2019 and 2021,the monthly average rate for overall mental health-related outpatient physician visits,emergency department visits and psychotropic drug dispensations increased significantly by 24%,5%and 8%,respectively.Notable and statistically significant increases were observed among 10–14 year-olds(44%in outpatient physician visits,30%in emergency department visits,55%in hospital admissions and 35%in psychotropic drug dispensations)and 15–19 year-olds(45%in outpatient physician visits,14%in emergency department visits,18%in hospital admissions and 34%in psychotropic drug dispensations).Additionally,these increases were more prominent among females than males,with some variation for specific mental health-related conditions.Conclusions The increase in mental health-related healthcare service utilisation and psychotropic drug dispensations during the pandemic likely reflects significant societal consequences of both the pandemic and pandemic management measures.Recovery efforts in British Columbia should consider these findings,especially among the most affected subpopulations,such as adolescents.
基金supported by the Beijing Natural Science Foundation(No.J230013),China。
文摘The rising demand for child care is putting a strain on parents of children with autism spectrum disorder(ASD),particularly the mothers.This study investigated Chinese mothers of children with ASD and examined the factors associated with maternal mental health.An online national survey was completed by the parents of 5077 ASD children and adolescents aged 0–17 years.A total of 28.0%of the mothers reported poor mental health status.Mothers with children aged 10–13 years had a lower chance of having poor mental health status than mothers with children aged 0–2 years(odds ratio(OR)0.63,95%confidence interval(CI)0.43–0.91).Mothers of children with high-functioning autism were less likely to have poor mental health status than those of children with low-functioning autism(OR 0.76,95%CI 0.62–0.94).Having children with comorbidities was related with a higher risk of poor mental status(OR 1.56,95%CI 1.35–1.81),as were having conflicts with other family members(OR 1.44,95%CI 1.22–1.70)and providing full-time care(OR 1.22,CI 1.06–1.41).A higher-than-average family income was associated with lower risk of having poor mental health status(OR 0.70,95%CI 0.58–0.82).Factors related to the children and family,and providing full-time care,have a significant effect on mothers’mental health status.Reducing obstacles to work and social interaction,as well as tackling the financial burden of raising an ASD child,may help improve the well-being of mothers.
文摘With the civilization and modernization of human society,occupational health has emerged as a fundamental goal of social justice,as highlighted in the United Nations'Sustainable Development Goals(SDGs)since 2016.Specifically,"SDG Goal 1:No Poverty","SDG 3:Good Health and Well-being",and"SDG 8:Decent Work and Economic Growth",are interconnected with other SDGs to support the pursuit of occupational health.
基金funded by a Grant-in-Aid program provided to the corresponding author by the Heart&Stroke Foundation of Canada(G-18-0022225).
文摘Objectives:To determine whether providing a choice between high-intensity interval training(HIIT)and moderateintensity continuous training(MICT)within a 4-week diabetes prevention program may lead to greater perceived autonomy support,motivation regulation,free-living physical activity,and cardiorespiratory fitness 6 months postintervention when compared to imposed exercise.Methods:In a preliminary pragmatic randomized trial,77 individuals at risk of type 2 diabetes(Mage=61.5(±9.8)years;Nfemales=58)were randomized to one of three exercise conditions:HIIT,MICT,or the choice thereof(CHOICE).Perceived autonomy supportwas assessed post-intervention.Changes in motivation,physical activity,and cardiorespiratory fitness were assessed 6 months post-intervention.Linear mixed models and Bonferroni-adjusted pairwise comparisons on estimated marginal means were used to derive effect estimates after adjusting for stratified allocation factors.Results:Perceived autonomy support was not different among conditions[F(2,47)=0.068,p=0.934].No effects were detected for motivation regulation,physical activity,or cardiorespiratory fitness(ps>0.05).Participants in the CHOICE condition self-reported significantly more physical activity 6 months post-intervention compared to preintervention[t(31)=2.922,p=0.019].Improvements in cardiorespiratory fitness were seen in CHOICE[t(65)=2.509,p=0.044]and MICT[t(65)=3.492,p=0.003].Conclusions:Providing choice between HIIT and MICT did not significantly affect individuals’perceived autonomy support or motivation regulation compared to imposed exercise.However,physical activity and cardiorespiratory fitness improved over time for the CHOICE condition.Providing choice between HIIT and MICT may be a feasible exercise strategy among this population.
基金supported by the Bill&Melinda Gates Foundation(Grant no.OPP1216421)CAMS Innovation Fund for Medical Sciences[CIFMS](Grant no.2021-I2M-1-004)。
文摘Objective:To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions,and explore mediating pathways across diagnosis,initial treatment,radiotherapy/chemotherapy,follow-up,and recurrence/progression/metastasis.Methods:A multicentre,nationwide survey across 5 disease courses was conducted from 26 hospitals in China.Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up,self-paid check-up,and symptom-based detection.Results:Workplace check-up,self-paid check-up,and symptom-based detection were associated with progressively higher costs across diagnosis[β:1.10,95%confidence interval(CI):0.54±1.67;β:1.46,95%CI:1.00±1.92;andβ:1.68,95%CI:1.25±2.11,respectively],initial treatment(β:0.36,95%CI:0.18±0.55;β:0.51,95%CI:0.35±0.66;andβ:0.56,95%CI:0.42±0.70,respectively),and follow-up(β:0.63,95%CI:0.38±0.88;β:0.83,95%CI:0.61±1.04;andβ:0.85,95%CI:0.65±1.06,respectively)compared to government-organized screening(all P<0.05).Earlier clinical staging and greater use of lower-level hospitals mediated 44.74%±54.97%of cost differences in diagnosis,73.27%±85.04%in initial treatment,and 30.38%±54.73%in follow-up.Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions.Conclusions:Government-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis,reduced overtreatment,and decreased reliance on higher-level hospitals,suggesting potential clinical benefits,efficient resource use,and improved equity in cancer care.
基金supported by the Chongqing Tencent Sustainable Development Foundation through the project"Comprehensive Prevention and Control Demonstration Project for Eliminating Cervical Cancer and Breast Cancer in Low Health Resource Areas of China"(Project No.SD20240904145730)by the Tencent Sustainable Social Value(SSV)Inclusive Health Lab(Project No.SSVPJ202307060001)。
文摘Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.
文摘Diabetes affects an estimated 828 million people globally,with approximately 44%living in China and India.Rural residents with diabetes in these countries face significant challenges in access to care.Although digital health interventions are increasingly used to reach underserved populations,considerable knowledge gaps exist.This mini-review presents the first comparative analysis of digital health implementations for diabetes care in rural China and India,comprising clinical decision support tools,telemedicine,and mobile health applications.The review examines how their distinct health system structures influence technology adoption and clinical outcomes.China's hierarchical administrative structure facilitates standardized nationwide platforms with consistent protocols,while India's federal system enables diverse localized innovations that accommodate regional diversity.Cluster-randomized trials for digital health tools in rural China show significant improvements in glycemic control.In India,interventions examined in this review were associated with improved health behaviors and medication adherence.Both countries demonstrate that digital interventions leveraging existing social structures and co-created with stakeholders yield better outcomes than standard care approaches.This analysis provides actionable insights for policymakers globally while identifying valuable opportunities for knowledge exchange between these two nations that together are home to nearly half of all people living with diabetes worldwide.
文摘A three-year research project based in British Columbia, Canada, is attempting to develop a framework and tools to assist healthcare system decision-makers achieve “high performance” in resource allocation. In pursuit of this objective, a literature search was conducted and two phases of primary data collection are being undertaken: an online survey of senior healthcare decision-makers, and in-depth case studies of potential “high performing” organizations. This paper addresses the survey phase;our aim is to provide a practical example of the mechanics of survey design, of benefit to those who want to better understand our forthcoming results, but also as an aid to other researchers grappling with the hard choices and trade-offs involved in the survey development process. Survey content is described in light of the existing literature, with discussion of the choices made by the research team to decide what questions and items would be included and excluded. The target population for the survey was senior managers in Canadian regional health authorities (or the closest equivalent organizations) in each of the 10 provinces and 3 territories. The paper dis- cusses how this sample was obtained, and describes the survey implementation process.
基金supported by the Ministry of Science and Technology of the People’s Republic of China(2022YFD1800400).
文摘Staphylococcus aureus(S.aureus)is the third most common pathogen causing 10.6%of bacterial foodborne illnesses in China in 2021[1].Heat-stable Staphylococcal Enterotoxins(SEs)produced by S.aureus are the main contributors to staphylococcal food poisoning(SFP),causing vomiting,diarrhea,abdominal pain,headache,muscle cramps,and other acute gastroenteritis symptoms.More than 25 SEs and staphylococcal enterotoxin-like toxins(SE/s)have been described and which together comprise a superfamily of pyrogenic toxin superantigens(SAgs)[2].
基金supported by the Bill and Melinda Gates Foundation (No. OPP1216421)CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2021-I2M-1004)。
文摘Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.
基金supported by the following fundings:Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2020-I2M-1-001,2020-I2M-2-015,and 2016-I2M-1-014)National Social Science Fund of China(20&ZD201).
文摘The coronavirus disease 2019(COVID-19)pandemic is a global crisis,and medical systems in many countries are overwhelmed with supply shortages and increasing demands to treat patients due to the surge in cases and severe illnesses.This study aimed to assess COVID-19-related essential clinical resource demands in China,based on different scenarios involving COVID-19 spreads and interventions.We used a susceptible–exposed–infectious–hospitalized/isolated–removed(SEIHR)transmission dynamics model to estimate the number of COVID-19 infections and hospitalizations with corresponding essential healthcare resources needed.We found that,under strict non-pharmaceutical interventions(NPIs)or mass vaccination of the population,China would be able to contain community transmission and local outbreaks rapidly.However,under scenarios involving a low intensity of implemented NPIs and a small proportion of the population vaccinated,the use of a peacetime–wartime transition model would be needed for medical source stockpiles and preparations to ensure a normal functioning healthcare system.The implementation of COVID-19 vaccines and NPIs in different periods can influence the transmission of COVID-19 and subsequently affect the demand for clinical diagnosis and treatment.An increased proportion of asymptomatic infections in simulations will not reduce the demand for medical resources;however,attention must be paid to the increasing difficulty in containing COVID-19 transmission due to asymptomatic cases.This study provides evidence for emergency preparations and the adjustment of prevention and control strategies during the COVID-19 pandemic.It also provides guidance for essential healthcare investment and resource allocation.
文摘AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries(i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventionsto change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.
基金Supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research,No.NHC–142832 and No.PHE-141773
文摘AIM To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus(HBV) infection in British Columbia(BC).METHODS We used data from the BC Hepatitis Testers Cohort(BCHTC),which includes all individuals tested for hepatitis C virus(HCV) or human immunodeficiency virus(HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990.These data were integrated with prescription drug,medical visit,hospitalization and mortality data.HBV cases were classified as acute or chronic according to provincial guidelines.We compared characteristics of individuals by HBV infection group(acute,chronic and negative).Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group.RESULTS46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection.4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections.Problematic alcohol use,injection drug use,and HIV or HCV co-infection were more common among individuals diagnosed with acute HBV compared to those with chronic infections and HBV negative individuals.In multivariable multinomial logistic regression models,we observed significant associations between acute or chronic HBV diagnosis and being male,age at HBV diagnosis or birth cohort,South and East Asian ethnicity,HCV or HIV infection,and injection drug use.The odds of acute HBV decreased with increasing age among people who inject drugs,while the opposite was true for chronic HBV.Persons with acute HBV were predominantly White(78%) while those with chronic HBV were mostly East Asian(60%).Relative to Whites,East Asians had 12 times greater odds of being diagnosed with chronic HBV infection.These odds increased with increasing socioeconomic deprivation.CONCLUSION Differences in the profiles of people diagnosed with acute and chronic HBV infection necessitate differentiated screening,prevention,care and treatment programs.
文摘Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019(COVID-19)pandemic,but studies are needed to understand their effectiveness across regions and time.Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020,we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions.We found that if these interventions had not been deployed,the cumulative number of cases could have shown a 97-fold(interquartile range 79–116)increase,as of May 31,2020.However,their effectiveness depended upon the timing,duration,and intensity of the interventions,with variations in case severity seen across populations,regions,and seasons.Additionally,before effective vaccines are widely available and herd immunity is achieved,our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns.
文摘BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.
基金supported by CAMS Innovation Fund for Medical Sciences(No.CAMS 2021-I2M-1-004)。
文摘Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.
基金This study was funded by the Major Project of the National Social Science Fund of China(21ZDA107)the Fundamental Research Funds for the Central Universities(7101303357).
文摘Background Family environments can shape children’s personalities and social networks,rendering distinguishing adverse childhood experiences(ACEs)from family and society essential,but related evidence remains limited.Aims This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs,their associations with depressive symptoms and cognitive impairment and the(education-moderated)mediating role of social ACEs.Methods Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study.Nine intrafamilial(0,1,2,3,and 4 or more)and three social(0,1,and 2 or more)ACEs were identified.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale.Global cognition,including episodic memory and mental intactness,was calculated as z scores.Binary and ordered logistic regressions,generalised linear models with Gaussian family and identity link,and mediation analysis were used.Results 13435 participants aged 59.0(51.0–66.0)were included.Compared with participants with no intrafamilial ACEs,those with 1,2,3,and 4 or more intrafamilial ACEs tended to develop more social ACEs,with odds ratios(ORs)of 1.55(95%confidence interval(CI):1.36 to 1.76),2.36(95%CI:2.08 to 2.68),3.46(95%CI:3.02 to 3.96)and 6.10(95%CI:5.30 to 7.02),respectively.Both intrafamilial and social ACEs were associated with depressive symptoms(OR>3 for four or more intrafamilial ACEs and two or more social ACEs)and global cognition(β=−0.26 for four or more intrafamilial ACEs andβ=−0.29 for two or more social ACEs).Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3%and 13.1%,respectively.Furthermore,as education levels increased,the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs,while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.Conclusions Improving children’s social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.
