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New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020 中国乙型肝炎病毒(HBV)控制的新进展和乙型肝炎病毒感染者的逐级医疗保健:来自 2020 年第四次全国血清学调查的证据
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1016/j.lanwpc.2024.101193

Background

Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys.

Methods

Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals.

Findings

HBsAg prevalence in 1–69-year-olds was 5.86%; in children 1–4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals.

Interpretation

The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1–4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets.

Funding

The study was funded by the Major Science and Technology Special Project of China’s 13th 5-Year Plan (grant no. 2017ZX10105015); Central finance-operation of public health emergency response mechanism of Chinese Center for Disease Control and Prevention (131031001000200001, 102393220020010000017).

背景自1992年中国引进重组乙型肝炎疫苗以来,政府卫生官员一直使用具有全国代表性的血清学调查来监测乙型肝炎防控工作的进展。2020年,我们开展了第四次血清流行病学调查,其中首次纳入了对15岁以上HBsAg阳性受试者的临床状态及其医疗管理的医学评估。与前三次调查相比,我们报告了调查结果。方法与前几次全国调查一样,2020 年的调查采用了分层三阶段整群随机抽样方法,在 120 个全国疾病监测点抽取 1-69 岁的人群进行评估。血样在中国疾病预防控制中心病毒病预防控制所肝炎国家实验室进行HBsAg、抗-HBV表面抗原(抗-HBs)和抗-HBV核心抗原(抗-HBc)检测。研究结果1-69岁人群HBsAg感染率为5.86%,1-4岁儿童血清阳性率为0.30%,全国HBV感染者达7500万人。在 15 岁及以上的 HBsAg 阳性者中,专家体检发现,78.03% 的 HBsAg 携带者无肝脏损伤迹象,19.63% 的 HBsAg 携带者为慢性 HBV 并伴有肝酶异常,0.84% 的 HBsAg 携带者有肝硬化迹象,0.15% 的 HBsAg 携带者有肝癌迹象。59.78% 的 HBsAg + 患者在调查前知道自己呈阳性,3000 万人不知道;在知道自己呈阳性的患者中,38.25% 的患者(1700 万人)有抗病毒治疗的医学指征,其中 17.33% 的患者(300 万人)正在接受抗病毒治疗。解读普通人群中的 HBsAg 感染率从 1992 年的 9.72% 下降到 2020 年的 5.86%,1-4 岁儿童中的 HBsAg 感染率从 1992 年的 9.67% 下降到 2020 年的 0.30%,这表明在实现世界卫生组织预防新感染的目标方面继续取得进展。实施可接受的策略来识别感染者并提供长期的医疗监测和管理,对于预防乙型肝炎感染并发症和实现世卫组织的级联护理目标非常重要。 基金项目 本研究得到了中国 "十三五 "科技重大专项(批准号:2017ZX10105015)、中国疾病预防控制中心公共卫生应急机制中央财政业务费(131031001000200001、102393220020010000017)的资助。
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引用次数: 0
Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic 心脏代谢多发病和抑郁症对认知功能的独立和联合关联:多地区队列的研究结果以及从社区到临床的普遍性
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-12 DOI: 10.1016/j.lanwpc.2024.101198
<div><h3>Background</h3><p>Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.</p></div><div><h3>Methods</h3><p>Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.</p></div><div><h3>Findings</h3><p>Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (<em>P</em>s > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and
背景心血管代谢多病症(CMM)和抑郁症经常同时出现在老年人中,并与神经退行性疾病相关。本研究旨在估算CMM和抑郁症在多地区队列中对认知功能的独立和联合关联,并在包括临床在内的更多环境中验证研究结果的普适性。方法在国际队列记忆研究(COSMIC)小组的14项纵向队列研究中进行数据协调,这些研究横跨北美、南美、欧洲、非洲、亚洲和澳大利亚。此外,还采用了三项不同背景的外部验证研究来进行推广。如果参与者有 CMM 数据,并且基线时没有痴呆症,则有资格被纳入研究。基线CMM定义为1) CMM 5,在高血压、高脂血症、糖尿病、中风和心脏病中≥2;2) CMM 3(与之前的研究一致),在糖尿病、中风和心脏病中≥2。基线抑郁的主要特征是采用老年抑郁量表和流行病学研究中心抑郁量表对抑郁症状进行二元分类测量。通过协调多种认知测量方法,将总体认知标准化为z分数。纵向认知度按总体认知度 z 值的变化计算。在COSMIC研究中,利用汇集的个体参与者数据(IPD)分析来估计CMM和抑郁对认知结果的独立和联合关联,包括横向和纵向关联。在14个COSMIC队列的32931名老年人中,我们纳入了30382名有完整基线CMM、抑郁和认知评估数据的参与者,进行横断面分析。其中,22,599 名参与者至少接受了一次随访认知评估,被纳入纵向分析。三项外部验证研究的1964名参与者来自三个不同环境(社区、记忆诊所和中风后研究)的多种族亚洲老年人队列。在COSMIC研究中,CMM和抑郁各自与横断面和纵向认知功能独立相关,两者之间没有显著的交互作用(Ps > 0.05)。同时患有CMM和抑郁症的参与者的横断面认知能力较低(例如,CMM5 (+)/ 抑郁症(+) β = -0.207,95% CI = (-0.255, -0.159)),认知能力下降速度较快(例如,CMM5 (+)/ 抑郁症(+) β = -0.040,95% CI = (-0.047, -0.034))。在对 APOE 基因型进行额外调整后,这些关联仍保持一致,并且在两步随机效应 IPD 分析中也很稳健。有关 CMM 和抑郁症对认知功能的共同影响的研究结果在三项外部验证研究中得到了重复。我们的研究结果强调了从多维角度研究与年龄相关的合并疾病的重要性,同时针对心脏代谢和心理状况来预防认知功能衰退可以提高有效性。
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引用次数: 0
Invasive fungal disease and antifungal prophylaxis in children with acute leukaemia: a multicentre retrospective Australian cohort study 急性白血病患儿的侵袭性真菌病和抗真菌预防:澳大利亚多中心回顾性队列研究
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-12 DOI: 10.1016/j.lanwpc.2024.101201

Background

Invasive fungal disease (IFD) is a significant complication for children receiving treatment for leukaemia, contributing to morbidity and mortality. Recent regional paediatric epidemiological IFD data are lacking. Additionally uncertainty remains regarding the optimal prophylactic approach in this context.

Methods

In a multi-centre Australian cohort study of children diagnosed with de novo acute leukaemia between 1st January 2017 and 30th June 2020, we characterised antifungal prophylaxis prescribing and IFD prevalence. Impact of antifungal prophylaxis was assessed using Kaplan Meier curves and Cox-proportional hazards regression adjusting for known IFD risk factors.

Findings

A total of 434 children were included (47.2% female; median age 5.0 years, median follow-up 240 days). This cohort included 351 children with ALL (214 high-risk [HR-ALL]; 137 standard-risk [SR-ALL]), and 73 with AML. The prevalence of proven/probable IFD was 6.8% for AML, 14.0% for HR-ALL and 4.4% for SR-ALL. A mould was implicated as the causative pathogen in almost two thirds of cases. Antifungal prophylaxis was prescribed in 98.7% of chemotherapy cycles for AML, 56.7% for HR-ALL and 14.9% for SR-ALL. A mould-active agent was used in 77.4% of AML cycles and 21.2% of HR-ALL cycles. Mould-active prophylaxis was associated with a lower risk of IFD overall and increased IFD-free survival in AML.

Interpretation

These data demonstrate the persistent high regional burden of IFD in children with HR-ALL, and the potential for mould-active prophylaxis to ameliorate this. Strategies to increase uptake of appropriate prophylaxis are required in this cohort.

Funding

This study was supported by a Perth Children’s Hospital Foundation grant (PCHF9973).

背景侵袭性真菌病(IFD)是接受白血病治疗的儿童的一个重要并发症,可导致发病率和死亡率。目前缺乏最新的地区性儿科 IFD 流行病学数据。方法 在一项澳大利亚多中心队列研究中,我们对 2017 年 1 月 1 日至 2020 年 6 月 30 日期间诊断为新发急性白血病的儿童进行了调查,了解了抗真菌预防处方的特点和 IFD 的流行情况。采用卡普兰-梅耶尔曲线和Cox比例危害回归评估了抗真菌预防的影响,并对已知的IFD风险因素进行了调整。研究结果共纳入434名儿童(47.2%为女性;中位年龄5.0岁,中位随访240天)。该队列包括351名ALL患儿(214名高风险[HR-ALL];137名标准风险[SR-ALL])和73名AML患儿。经证实/可能的IFD发病率分别为:AML 6.8%、HR-ALL 14.0%、SR-ALL 4.4%。近三分之二的病例的致病菌为霉菌。98.7%的AML化疗周期、56.7%的HR-ALL化疗周期和14.9%的SR-ALL化疗周期使用了抗真菌预防药物。77.4%的AML周期和21.2%的HR-ALL周期使用了霉菌活性药物。这些数据表明,在HR-ALL患儿中,IFD的区域性负担持续较高,而霉菌活性预防剂则有可能改善这一状况。这项研究得到了珀斯儿童医院基金会的资助(PCHF9973)。
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引用次数: 0
Readmission destination following cardiac surgery and its association with mortality outcomes: a population-based retrospective study 心脏手术后再次入院的目的地及其与死亡率结果的关系:一项基于人群的回顾性研究
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-04 DOI: 10.1016/j.lanwpc.2024.101189

Background

It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality.

Methods

We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003–2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer.

Findings

Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75–1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75–1.52; transfer: aOR = 0.88, 95% CI 0.45–1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50–2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33–1.48).

Interpretation

Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality.

Funding

This study was funded by a National Health and Medical Research Foundation of Australia (NHMRC) Project Grant (#1162833).

背景目前还不清楚手术前转院与心脏手术患者再入院目的地之间的关系,也不清楚再入院到手术医院以外的医院是否与死亡率升高有关。方法我们分析了澳大利亚新南威尔士州居民的关联医院和死亡记录,这些居民年龄≥18岁,在2003-2022年期间接受冠状动脉旁路移植术(CABG)或主动脉瓣置换术(SAVR)后30天内急诊再入院。在接受心脏手术的 102,540 名患者中(孤立 CABG = 63,000 人,SAVR = 27,482 人,合并 = 12,058 人),28.7%(n = 29,398 人)在手术前转院,而 30 天内再入院率为 14.7%(n = 14,708 人)。在再入院期间,35.7%(3499/9795)没有手术前转院的患者和12.0%(590/4913)有手术前转院的患者返回了手术医院。在再次入院的患者中,再次入院到非指标医院的患者的 30 天死亡率没有显著差异,无论是总体上(调整后的几率比 [aOR] = 1.03 95% CI 0.75-1.41),还是按手术前转院进行的分层分析(未转院:aOR = 1.07,95% CI 0.75-1.52;转院:aOR = 0.88,95% CI 0.45-1.72)。在手术前转院的患者中,再次入住手术医院(参考)、最初入院医院(aOR = 1.00,95% CI 0.50-2.00)或第三家不同医院(aOR = 0.70,95% CI 0.33-1.48)的患者的 30 天死亡率相似。释义尽管许多澳大利亚患者在心脏手术后再次入院时,入院医院与手术医院或最初入院医院不同,但这种再次入院与死亡率增加无关。
{"title":"Readmission destination following cardiac surgery and its association with mortality outcomes: a population-based retrospective study","authors":"","doi":"10.1016/j.lanwpc.2024.101189","DOIUrl":"10.1016/j.lanwpc.2024.101189","url":null,"abstract":"<div><h3>Background</h3><p>It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality.</p></div><div><h3>Methods</h3><p>We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003–2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer.</p></div><div><h3>Findings</h3><p>Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75–1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75–1.52; transfer: aOR = 0.88, 95% CI 0.45–1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50–2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33–1.48).</p></div><div><h3>Interpretation</h3><p>Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality.</p></div><div><h3>Funding</h3><p>This study was funded by a <span>National Health and Medical Research Foundation</span> of Australia (NHMRC) Project Grant (<span><span>#1162833</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001834/pdfft?md5=5411c0f6f61f7aa07ead12847456584c&pid=1-s2.0-S2666606524001834-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acceptability of a nationwide scabies mass drug administration (MDA) program in Fiji: a qualitative interview-based study 斐济全国疥疮大规模药物管理 (MDA) 计划的可接受性:基于访谈的定性研究
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-04 DOI: 10.1016/j.lanwpc.2024.101194

Background

Fiji has among the highest global reported prevalence of scabies. Mass drug administration (MDA) has been identified as a potentially effective strategy to control scabies, but acceptability of MDA from the perspectives of people receiving and delivering scabies MDA programs remains underexplored in Fiji and globally.

Methods

A qualitative study was conducted after completion of the national MDA campaign. Participants included 44 community members and 12 key informants across the Central and Western Divisions of Fiji. Semi-structured face-to-face and virtual interviews were conducted in August and September 2023. An interpretive research approach was adopted, and data were analysed using deductive and inductive techniques.

Findings

We identified several barriers and facilitators to scabies MDA acceptability. Facilitators included prior experiences of scabies and knowledge of the potential health benefit of MDA, community attitudes to MDA and neighbours’ adherence practices, endorsement of MDA by community leaders, community consultation and exposure to community sensitisation, and involvement of local key informants during planning and implementation. Barriers included a lack of trust in MDA campaigns, religious beliefs, limited reach of community sensitisation, and challenges to implementing MDA in urban locations.

Interpretation

This is the first qualitative study documenting acceptability of a nationwide scabies-MDA globally. It identified diverse socio-structural factors that influenced MDA implementation and acceptability. Future MDA programs could benefit from widespread community sensitisation, tailored approaches to urban and rural MDA design and delivery, and the inclusion of communities in the co-design and implementation of MDA programs.

Funding

The National Health and Medical Research Council (NHMRC) investigator grant—LR and the Macquarie Group Foundation 50th Celebration Awards–AS.

背景斐济是全球报告疥疮发病率最高的国家之一。大规模用药(MDA)被认为是控制疥疮的潜在有效策略,但从接受和实施疥疮 MDA 计划的人的角度来看,斐济和全球对 MDA 的可接受性仍未进行充分的探讨。参与者包括斐济中部和西部分区的 44 名社区成员和 12 名关键信息提供者。2023 年 8 月和 9 月进行了半结构化面对面访谈和虚拟访谈。我们采用了解释性研究方法,并使用演绎和归纳技术对数据进行了分析。促进因素包括先前的疥疮经历和对 MDA 潜在健康益处的了解、社区对 MDA 的态度和邻居的坚持做法、社区领袖对 MDA 的认可、社区咨询和社区宣传,以及当地主要信息提供者在规划和实施过程中的参与。障碍包括对 MDA 运动缺乏信任、宗教信仰、社区宣传的范围有限,以及在城市地区实施 MDA 所面临的挑战。研究发现了影响 MDA 实施和可接受性的各种社会结构因素。未来的MDA项目将受益于广泛的社区宣传、量身定制的城市和农村MDA设计和实施方法,以及社区参与MDA项目的共同设计和实施。
{"title":"Acceptability of a nationwide scabies mass drug administration (MDA) program in Fiji: a qualitative interview-based study","authors":"","doi":"10.1016/j.lanwpc.2024.101194","DOIUrl":"10.1016/j.lanwpc.2024.101194","url":null,"abstract":"<div><h3>Background</h3><p>Fiji has among the highest global reported prevalence of scabies. Mass drug administration (MDA) has been identified as a potentially effective strategy to control scabies, but acceptability of MDA from the perspectives of people receiving and delivering scabies MDA programs remains underexplored in Fiji and globally.</p></div><div><h3>Methods</h3><p>A qualitative study was conducted after completion of the national MDA campaign. Participants included 44 community members and 12 key informants across the Central and Western Divisions of Fiji. Semi-structured face-to-face and virtual interviews were conducted in August and September 2023. An interpretive research approach was adopted, and data were analysed using deductive and inductive techniques.</p></div><div><h3>Findings</h3><p>We identified several barriers and facilitators to scabies MDA acceptability. Facilitators included prior experiences of scabies and knowledge of the potential health benefit of MDA, community attitudes to MDA and neighbours’ adherence practices, endorsement of MDA by community leaders, community consultation and exposure to community sensitisation, and involvement of local key informants during planning and implementation. Barriers included a lack of trust in MDA campaigns, religious beliefs, limited reach of community sensitisation, and challenges to implementing MDA in urban locations.</p></div><div><h3>Interpretation</h3><p>This is the first qualitative study documenting acceptability of a nationwide scabies-MDA globally. It identified diverse socio-structural factors that influenced MDA implementation and acceptability. Future MDA programs could benefit from widespread community sensitisation, tailored approaches to urban and rural MDA design and delivery, and the inclusion of communities in the co-design and implementation of MDA programs.</p></div><div><h3>Funding</h3><p>The <span>National Health</span> and <span>Medical Research Council</span> (NHMRC) investigator grant—LR and the <span>Macquarie Group Foundation</span> 50th Celebration Awards–AS.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001883/pdfft?md5=303e22bedb7e223428e87bd210877d60&pid=1-s2.0-S2666606524001883-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990–2021: a systematic analysis of the Global Burden of Disease Study 2021 1990-2021 年西太平洋地区心血管疾病负担及其与卫生人力资源的关系:对 2021 年全球疾病负担研究的系统分析
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-03 DOI: 10.1016/j.lanwpc.2024.101195

Background

A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden.

Methods

Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density.

Findings

In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (rs = −0.74) and DALYs (rs = −0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians.

Interpretation

CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden.

Funding

National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).

背景世界卫生组织西太平洋地区心血管疾病(CVD)负担和卫生人力资源(HRH)分布的综合概况尚未公布。有关该地区卫生人力资源与心血管疾病之间关系的研究十分有限。我们旨在描述西太平洋地区心血管疾病的趋势和卫生人力资源的密度,并探讨卫生人力资源与心血管疾病负担之间的关系。方法心血管疾病死亡人数和残疾调整生命年(DALYs)的估计值来自《全球疾病负担研究》(GBD)2021,卫生人力资源的年度密度来自《全球疾病负担研究》2019。我们介绍了 31 个西太平洋国家心血管疾病负担和人力资源密度的趋势。研究结果2021年,心血管疾病在西太平洋地区造成600万人死亡和1.25亿人残疾调整寿命年数,分别占全因死亡和残疾调整寿命年数的39.4%和22.5%。从 1990 年到 2021 年,该地区的心血管疾病死亡人数和残疾调整寿命年数分别增加了 94.9% 和 57.3%,而所有国家的心血管疾病死亡人数和残疾调整寿命年数的年龄标准化比率均有所下降。2021 年,中风和缺血性心脏病是西太平洋地区的主要病因,主动脉瘤、下肢外周动脉疾病、心内膜炎以及心房颤动和扑动是心血管疾病负担增加 32 年的主要原因。2019年,31个国家的人力资源密度相差约20倍,从最低的巴布亚新几内亚到最高的澳大利亚。人力资源密度与心血管疾病年龄标准化死亡率(rs = -0.74)和残疾调整寿命年数(DALYs)(rs = -0.73)呈负相关,尤其是心血管疾病负担与牙科人员、助产士、急诊医务人员和医学实验室技术人员的密度之间的关联性更强。心血管疾病负担与医护人员密度之间的负相关表明,医护人员,尤其是牙科人员、助理及急诊医护人员和医学实验室技术人员值得更多投资,以减轻心血管疾病负担。
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引用次数: 0
Understanding dementia in the Western Pacific: a region-specific approach to prevention 了解西太平洋地区的痴呆症:针对具体地区的预防方法
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lanwpc.2024.101202
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引用次数: 0
Regional health priorities for dementia: a roadmap for the Western Pacific 痴呆症的区域保健优先事项:西太平洋路线图
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lanwpc.2024.101179
In the Western Pacific Region, the prevalence of dementia is expected to increase, however, the diversity of the region is expected to present unique challenges. The region has varying levels of preparedness, with a limited number of countries having a specific national dementia plan and awareness campaigns. Diversity of risk and healthcare services within the region is exerting impact on diagnosis, treatment, care, and support, with most countries being under resourced. Similarly, the ability to monitor dementia-related indicators and progress research, particularly relating to treatment and clinical trial access needs to be addressed. Countries require comprehensive national plans that lay out how resources will be allocated to improve dementia literacy, train, and support carers, mobilise resources to reduce risk factors and improve research capabilities. These plans need to be informed by consumers and tailored to the region to develop an inclusive society for people living with dementia and their families.
在西太平洋地区,痴呆症的发病率预计会增加,但该地区的多样性预计会带来独特的挑战。该地区的准备程度各不相同,只有少数国家制定了专门的国家痴呆症计划并开展了宣传活动。该地区风险和医疗服务的多样性对诊断、治疗、护理和支持产生了影响,大多数国家资源不足。同样,监测痴呆症相关指标和研究进展的能力,尤其是与治疗和临床试验相关的指标和进展,也需要加以解决。各国需要制定全面的国家计划,规定如何分配资源以提高对痴呆症的认识、培训和支持照护者、调动资源以减少风险因素并提高研究能力。这些计划需要参考消费者的意见,并根据本地区的具体情况制定,以便为痴呆症患者及其家人建立一个包容性的社会。
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引用次数: 0
Post-diagnosis dementia care in the Western Pacific region: assessment of needs and pathways to optimal care 西太平洋地区诊断后痴呆症护理:需求评估和最佳护理途径
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lanwpc.2024.101182
The Western Pacific region is home to approximately 25% of the world's population. In the absence of cures for dementia, it is essential to focus on appropriate and accessible care pathways for people living with dementia and their families. This approach will ultimately result in timely diagnosis and improved care and support.
Ensuring adequate dementia care and support pathways has been a longstanding issue in many developed countries and is becoming a more prominent issue in countries with rising dementia prevalence rates but comparatively limited health resources.
This Viewpoint provides an overview of system-level post-diagnosis dementia care, from diagnosis to rehabilitation, across some of the region's lower (Laos, Solomon Islands, Philippines) and upper (China) middle income and high income (South Korea, Australia) countries. Gaps and challenges in post-diagnosis dementia care, as well as suggestions for optimal care, are discussed. This Viewpoint highlights highly variable system level post-diagnosis dementia care in the region.
西太平洋地区的人口约占世界总人口的 25%。在无法治愈痴呆症的情况下,必须把重点放在为痴呆症患者及其家人提供适当和方便的护理途径上。本视点概述了该地区一些中低收入国家(老挝、所罗门群岛、菲律宾)和中高收入国家(中国)以及高收入国家(韩国、澳大利亚)从诊断到康复的系统级痴呆症诊断后护理。文中讨论了痴呆症诊断后护理方面的差距和挑战,以及优化护理的建议。本视点强调了该地区在痴呆症诊断后护理方面存在的巨大系统差异。
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引用次数: 0
Missed opportunities for hypertension screening of older people in the Philippines: cross-sectional analysis of nationally representative individual-level data 菲律宾老年人高血压筛查机会的错失:对具有全国代表性的个人层面数据的横截面分析
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-01 DOI: 10.1016/j.lanwpc.2024.101188

Background

Guidelines recommend routine blood pressure measurement at health facilities. We estimated the potential for opportunistic screening for hypertension at health facilities to change the level and distribution of diagnosed hypertension in the older population of the Philippines.

Methods

We used a representative, nationwide sample of Filipinos aged 60 years and older and classified respondents as a) hypertensive if they had high (≥140/90 mm Hg) blood pressure (BP) or were taking BP medication, b) diagnosed if told have high BP by a doctor, and c) a missed opportunity for diagnosis if they were hypertensive, undiagnosed and had an outpatient visit to a health facility in the past 12 months. We assumed c) would be diagnosed if health facilities operated opportunistic screening. We estimated percentages of hypertensives diagnosed and with a missed opportunity overall, by wealth quintile and covariates, with age-sex and, then, full adjustment.

Findings

We estimated that opportunistic screening at health facilities would increase the percentage of hypertensives diagnosed from 62.7% (95% CI: 58.2, 67.0) to 74.4% (95% CI: 70.9, 77.6). The increase would be larger in richer groups due to lower (private) healthcare utilization by poorer, undiagnosed hypertensives.

Interpretation

Opportunistic screening for hypertension, if effectively implemented at health facilities, would substantially increase diagnosis but exacerbate inequality unless barriers discouraging poorer, older Filipinos from accessing outpatient and primary care were lowered.

Funding

Economic Research Institute for ASEAN and East Asia, Swiss Agency for Development and Cooperation/Swiss National Science Foundation grant 400640_160374.

背景指南建议在医疗机构进行常规血压测量。我们估算了在医疗机构进行高血压机会性筛查对改变菲律宾老年人口中确诊高血压的水平和分布的可能性。方法 我们对 60 岁及以上的菲律宾人进行了具有代表性的全国性抽样调查,并将受访者划分为:a)血压高(≥140/90 mm Hg)或正在服用降压药的高血压患者;b)被医生告知血压高而确诊的高血压患者;c)在过去 12 个月内曾在医疗机构门诊就诊但未确诊的高血压患者。我们假定,如果医疗机构开展机会性筛查,c) 会被确诊。我们估算了已确诊和错过机会的高血压患者的总体百分比,并按财富五分位数和协变量进行了年龄-性别调整,然后进行了全面调整。结果我们估计,在医疗机构进行机会性筛查将使高血压患者的确诊百分比从 62.7% (95% CI: 58.2, 67.0) 提高到 74.4% (95% CI: 70.9, 77.6)。如果在医疗机构有效实施高血压机会性筛查,将大大提高诊断率,但会加剧不平等现象,除非降低阻碍较贫穷的菲律宾老年人获得门诊和初级保健服务的障碍。
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引用次数: 0
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The Lancet Regional Health: Western Pacific
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