Device-detected atrial fibrillation (DDAF), including atrial high-rate episodes recorded at a cardiovascular implantable electronic device and subclinical atrial fibrillation detected by insertable cardiac monitor and smart wearables, poses an increasing challenge in stroke prevention. Although oral anticoagulants (OACs) are effective in clinical AF, their benefit-risk balance in DDAF remains uncertain. In response, the Asia Pacific Heart Rhythm Society (APHRS) proposes the 4S-DDAF approach (Strip documentation and longest AF duration, Symptoms, Stroke [ischemic] history, and Score) to guide anticoagulation decisions. This approach integrates electrogram review, symptom assessment, history of ischemic stroke or transient ischemic attack (TIA), and CHA2DS2-VASc scoring, emphasizing individualized care. OACs are recommended for patients with AF episodes ≥24 h, prior stroke/TIA, CHA2DS2-VASc score ≥4, or vascular disease. In patients not meeting these thresholds, close monitoring and risk factor management are advised. The 4S-DDAF approach provides a practical and evidence-informed strategy for clinical decision-making in the management of DDAF.
{"title":"Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach","authors":"Tze-Fan Chao , Chu-Pak Lau , Eue-Keun Choi , Chi-Keong Ching , Ngai-Yin Chan , Chung-Lieh Hung , Boyoung Joung , Rungroj Krittayaphong , Hung-Fat Tse , Gregory Y.H. Lip","doi":"10.1016/j.lanwpc.2025.101770","DOIUrl":"10.1016/j.lanwpc.2025.101770","url":null,"abstract":"<div><div>Device-detected atrial fibrillation (DDAF), including atrial high-rate episodes recorded at a cardiovascular implantable electronic device and subclinical atrial fibrillation detected by insertable cardiac monitor and smart wearables, poses an increasing challenge in stroke prevention. Although oral anticoagulants (OACs) are effective in clinical AF, their benefit-risk balance in DDAF remains uncertain. In response, the Asia Pacific Heart Rhythm Society (APHRS) proposes the 4S-DDAF approach (Strip documentation and longest AF duration, Symptoms, Stroke [ischemic] history, and Score) to guide anticoagulation decisions. This approach integrates electrogram review, symptom assessment, history of ischemic stroke or transient ischemic attack (TIA), and CHA<sub>2</sub>DS<sub>2</sub>-VASc scoring, emphasizing individualized care. OACs are recommended for patients with AF episodes ≥24 h, prior stroke/TIA, CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥4, or vascular disease. In patients not meeting these thresholds, close monitoring and risk factor management are advised. The 4S-DDAF approach provides a practical and evidence-informed strategy for clinical decision-making in the management of DDAF.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101770"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanwpc.2025.101778
Xiaoye Wang , Fan Ding , Xiaoqi Qi , Ziyi Wang , Yingxin Pei , Lijie Zhang , Jinghuan Ren , Yeping Wang , Qing Guo , Biao Zeng , Shiyao Xu , Tian Liu , Rui Wang , Zhifeng Wang , Guoqing Shi
{"title":"Corrigendum to “Epidemiological characteristics of heatstroke in China, 2010–2023: a longitudinal study based on a national heatstroke surveillance system” [The Lancet Regional Health – Western Pacific 64C (2025) 101722]","authors":"Xiaoye Wang , Fan Ding , Xiaoqi Qi , Ziyi Wang , Yingxin Pei , Lijie Zhang , Jinghuan Ren , Yeping Wang , Qing Guo , Biao Zeng , Shiyao Xu , Tian Liu , Rui Wang , Zhifeng Wang , Guoqing Shi","doi":"10.1016/j.lanwpc.2025.101778","DOIUrl":"10.1016/j.lanwpc.2025.101778","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101778"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanwpc.2025.101757
Corine S.M. Wong , Candi M.C. Leung , Shiyi Wu , Francis P. Flores , Yoona Kim , Xiao Xiao , Solomon B.K. Wong , Wing Chung Chang , Wai Chi Chan , Nancy Xiaonan Yu , Calvin P.W. Cheng , Albert K.K. Chung , Edwin H.M. Lee , Wai Tat Chiu , William G. Axinn , Ronald C. Kessler , Michael Y. Ni
Background
The World Mental Health Hong Kong (WMHHK) Study aims to estimate 12-month and 30-day prevalence, persistence, severity, and correlates of DSM-5 anxiety, mood, and externalising disorders in Hong Kong, a densely populated city impacted by consecutive population-level stressors, including social unrest and the COVID-19 pandemic.
Methods
Face-to-face interviews, either in-person or video-based online, were conducted from November 2022 to March 2024 with a population-representative sample of 3053 adults aged 18 years and above. Diagnostic assessment utilised the World Mental Health Composite International Diagnostic Interview for DSM-5 (CIDI-5), evaluating ten mental disorders: anxiety (panic disorder, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive and related disorders), mood (major depressive disorder, persistent depressive disorder, bipolar spectrum disorders), and externalising (intermittent explosive disorder, alcohol use disorder, substance use disorder) disorders. Persistence was defined as 12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases. Sociodemographic correlates were analysed using multivariable logistic regression.
Findings
Twelve-month and 30-day prevalence of any DSM-5 mental disorder were 10.6% (95% CI: 9.5–11.8) and 7.8% (95% CI: 6.7–8.9), respectively. Twelve-month prevalence was highest for anxiety disorders (8.0%, 95% CI: 7.1–8.9), followed by mood (4.3%, 95% CI: 3.4–5.2) and externalising (1.7%, 95% CI: 0.9–2.4) disorders. Twelve-month persistence among lifetime cases was 49.0%, overall and higher for anxiety (55.6%) than mood (39.0%) or externalising (35.3%) disorders. Younger and middle-aged adults, and who were not currently married, had elevated risks, while lower education was associated with greater disorder severity. Comorbidity was associated with increased persistence and severity across disorders.
Interpretation
This study shows a substantial mental health burden in Hong Kong during the post-pandemic period, highlighting the need for tailored public mental health programmes to address urban stressors in this unique context.
Funding
WYNG Foundation, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Jockey Club Charities Trust.
{"title":"Prevalence, persistence, and severity of 12-month and 30-day DSM-5 disorders in the World Mental Health Hong Kong Study","authors":"Corine S.M. Wong , Candi M.C. Leung , Shiyi Wu , Francis P. Flores , Yoona Kim , Xiao Xiao , Solomon B.K. Wong , Wing Chung Chang , Wai Chi Chan , Nancy Xiaonan Yu , Calvin P.W. Cheng , Albert K.K. Chung , Edwin H.M. Lee , Wai Tat Chiu , William G. Axinn , Ronald C. Kessler , Michael Y. Ni","doi":"10.1016/j.lanwpc.2025.101757","DOIUrl":"10.1016/j.lanwpc.2025.101757","url":null,"abstract":"<div><h3>Background</h3><div>The World Mental Health Hong Kong (WMHHK) Study aims to estimate 12-month and 30-day prevalence, persistence, severity, and correlates of DSM-5 anxiety, mood, and externalising disorders in Hong Kong, a densely populated city impacted by consecutive population-level stressors, including social unrest and the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Face-to-face interviews, either in-person or video-based online, were conducted from November 2022 to March 2024 with a population-representative sample of 3053 adults aged 18 years and above. Diagnostic assessment utilised the World Mental Health Composite International Diagnostic Interview for DSM-5 (CIDI-5), evaluating ten mental disorders: anxiety (panic disorder, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive and related disorders), mood (major depressive disorder, persistent depressive disorder, bipolar spectrum disorders), and externalising (intermittent explosive disorder, alcohol use disorder, substance use disorder) disorders. Persistence was defined as 12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases. Sociodemographic correlates were analysed using multivariable logistic regression.</div></div><div><h3>Findings</h3><div>Twelve-month and 30-day prevalence of any DSM-5 mental disorder were 10.6% (95% CI: 9.5–11.8) and 7.8% (95% CI: 6.7–8.9), respectively. Twelve-month prevalence was highest for anxiety disorders (8.0%, 95% CI: 7.1–8.9), followed by mood (4.3%, 95% CI: 3.4–5.2) and externalising (1.7%, 95% CI: 0.9–2.4) disorders. Twelve-month persistence among lifetime cases was 49.0%, overall and higher for anxiety (55.6%) than mood (39.0%) or externalising (35.3%) disorders. Younger and middle-aged adults, and who were not currently married, had elevated risks, while lower education was associated with greater disorder severity. Comorbidity was associated with increased persistence and severity across disorders.</div></div><div><h3>Interpretation</h3><div>This study shows a substantial mental health burden in Hong Kong during the post-pandemic period, highlighting the need for tailored public mental health programmes to address urban stressors in this unique context.</div></div><div><h3>Funding</h3><div><span>WYNG Foundation</span>, Hong Kong; <span>State Key Laboratory of Brain and Cognitive Sciences</span>, The <span>University of Hong Kong</span>, Hong Kong Special Administrative Region, China; <span>Hong Kong Jockey Club Charities Trust</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101757"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From process to publication: the conduct and reporting of co-design in health research in the Western Pacific region","authors":"Yaqoot Fatima , Michelle Olaithe , Shannon Edmed , Bushra Nasir","doi":"10.1016/j.lanwpc.2025.101766","DOIUrl":"10.1016/j.lanwpc.2025.101766","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101766"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanwpc.2025.101767
Sharla McTavish , Jane Zhang , June Atkinson , Amanda Kvalsivg , Alice Hyun Min Kim , Colin McArthur , Paul Huggan , Michael G. Baker
Background
Globally, sepsis remains a substantial public health concern. To inform policy development and interventions for sepsis prevention, treatment, and surveillance in Aotearoa New Zealand (Aotearoa), we describe population-level epidemiological trends in hospitalised sepsis and mortality over two decades by major sociodemographic characteristics.
Methods
We undertook a retrospective, population-based descriptive study of all sepsis-associated hospitalisation (SAH) in Aotearoa between 2000 and 2019 using previously published case identification strategies and International Classification of Diseases, Tenth Revision (ICD-10) codes to identify SAHs in the National Minimum Dataset. Incidence and mortality rates, and case fatality risks were calculated along with analyses of trends over the 20-year observation period. Rate estimates were standardised to the age structure of the total population identified in the 2018 New Zealand Census.
Findings
We identified 266,105 unique SAH cases and 27,402 associated deaths, with an average age-standardised incidence rate (ASIR) of 320.4 admissions per 100,000 population and an age-standardised mortality rate (ASMR) of 34.2 deaths per 100,000 population. An average annual ASIR increase of 4.5% was observed, from 217.3 admissions in 2000 to 386.9 admissions per 100,000 population in 2019. ASMR decreased annually from 37.1 deaths in 2000 to 31.3 deaths per 100,000 population in 2019. Case fatality risk decreased from 15.9 deaths in 2000 to 8.1 deaths per 100 admissions in 2019, primarily driven by improvements in patient survival in ≥40-year age groups. Significant SAH incidence and mortality disparities were observed between patient populations, particularly by age, ethnicity and socioeconomic deprivation. Māori and Pacific Peoples had SAH incidence rates that were 1.7 and 2.3 times, respectively, higher than those of NMPA ethnicity, and had mortality rates that were 1.6 and 1.7 times higher. Similarly, those living in areas of high socioeconomic deprivation were twice as likely to develop SAH, and their SAH mortality rate was twice as high as that of those living in areas of the least socioeconomic deprivation.
Interpretation
Sepsis is common in Aotearoa and makes a substantial contribution to population mortality. Significant variation in incidence and mortality rate estimates was observed between patient populations, with higher rates in those <1 year and ≥70 years, of Māori or Pacific ethnicity, and those living in areas of high socioeconomic deprivation. Our findings highlight the burden of SAH and the need for targeted interventions to address sepsis prevention, surveillance and support for sepsis survivors in Aotearoa.
{"title":"Temporal trends in sepsis hospitalisations and mortality in Aotearoa New Zealand, 2000–2019: a population-based study","authors":"Sharla McTavish , Jane Zhang , June Atkinson , Amanda Kvalsivg , Alice Hyun Min Kim , Colin McArthur , Paul Huggan , Michael G. Baker","doi":"10.1016/j.lanwpc.2025.101767","DOIUrl":"10.1016/j.lanwpc.2025.101767","url":null,"abstract":"<div><h3>Background</h3><div>Globally, sepsis remains a substantial public health concern. To inform policy development and interventions for sepsis prevention, treatment, and surveillance in Aotearoa New Zealand (Aotearoa), we describe population-level epidemiological trends in hospitalised sepsis and mortality over two decades by major sociodemographic characteristics.</div></div><div><h3>Methods</h3><div>We undertook a retrospective, population-based descriptive study of all sepsis-associated hospitalisation (SAH) in Aotearoa between 2000 and 2019 using previously published case identification strategies and <em>International Classification of Diseases, Tenth Revision</em> (ICD-10) codes to identify SAHs in the National Minimum Dataset. Incidence and mortality rates, and case fatality risks were calculated along with analyses of trends over the 20-year observation period. Rate estimates were standardised to the age structure of the total population identified in the 2018 New Zealand Census.</div></div><div><h3>Findings</h3><div>We identified 266,105 unique SAH cases and 27,402 associated deaths, with an average age-standardised incidence rate (ASIR) of 320.4 admissions per 100,000 population and an age-standardised mortality rate (ASMR) of 34.2 deaths per 100,000 population. An average annual ASIR increase of 4.5% was observed, from 217.3 admissions in 2000 to 386.9 admissions per 100,000 population in 2019. ASMR decreased annually from 37.1 deaths in 2000 to 31.3 deaths per 100,000 population in 2019. Case fatality risk decreased from 15.9 deaths in 2000 to 8.1 deaths per 100 admissions in 2019, primarily driven by improvements in patient survival in ≥40-year age groups. Significant SAH incidence and mortality disparities were observed between patient populations, particularly by age, ethnicity and socioeconomic deprivation. Māori and Pacific Peoples had SAH incidence rates that were 1.7 and 2.3 times, respectively, higher than those of NMPA ethnicity, and had mortality rates that were 1.6 and 1.7 times higher. Similarly, those living in areas of high socioeconomic deprivation were twice as likely to develop SAH, and their SAH mortality rate was twice as high as that of those living in areas of the least socioeconomic deprivation.</div></div><div><h3>Interpretation</h3><div>Sepsis is common in Aotearoa and makes a substantial contribution to population mortality. Significant variation in incidence and mortality rate estimates was observed between patient populations, with higher rates in those <1 year and ≥70 years, of Māori or Pacific ethnicity, and those living in areas of high socioeconomic deprivation. Our findings highlight the burden of SAH and the need for targeted interventions to address sepsis prevention, surveillance and support for sepsis survivors in Aotearoa.</div></div><div><h3>Funding</h3><div><span>Health Research Council</span> of New Zealand.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101767"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanwpc.2025.101775
Hong-Wu Yao , Chen-Long Lv , Yao Tian , Yu-Zheng Zhang , Zheng-Hao Yu , Ming-Mei Du , Cheng-Xue Ma , Ji-Jiang Suo , Shuo Zhao , Yu Zhang , Yu-Bin Xing , An-Ran Zhang , Yan-Ling Bai , Bo-Wei Liu , Zhong-Qiang Yan , Ju-Yuan Liu , Meng Cai , Rui Huo , Jian Lin , Chun-Ping Chen , Yun-Xi Liu
Background
Healthcare-associated infections (HAIs), complicated by antimicrobial resistance continue to affect all countries with unprecedented threat, especially for developing countries. Our objective was to explore the epidemiological features, spatiotemporal heterogeneity and associated factors of HAIs and HAI related multi-drug resistant organisms (MDROs) in China.
Methods
We used national surveillance data that were collected from 6867 sampled hospitals during 2015–2019 to determine the annual incidence of HAIs, key HAI-related quality indicators and associated factors.
Findings
During 2015–2019, total of 4,959,230 HAIs were reported in sampled hospitals in China, with the overall incidence and prevalence estimated as 1.1 and 2.3 per 100 inpatients, which showed decline trend over time. Carbapenem-resistant Acinetobacter baumannii (CRAB) had the highest overall detection rate (51.1%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (31.0%), carbapenem-resistant Pseudomonas aeruginosa (CRPA) (22.8%), and carbapenem-resistant Klebsiella pneumonia (CRKP) (12.4%). Detection rates of MRSA, carbapenem-resistant Escherichia coli (CREC), and vancomycin-resistant Enterococcus faecium (VREfm) reduced, in contrast with an increasing trend for CRKP. Higher risk of HAIs was associated with hospitals located in urban areas (incidence rate ratio [IRR]: 1.39, p < 0.001), in regions with higher GDP per capita (IRR: 1.03, p < 0.001), with more beds (IRR: 1.64 and 2.16 for 500−1500 and ≥ 1500 beds respectively, p < 0.001), as well as in south region of China (IRR: 1.23, p < 0.001). The reduced annual rates of HAIs were observed after 2017 (IRR: 0.92, p < 0.001), when 12 new standards targeted for HAIs were implemented.
Interpretation
The study increases the understanding of HAIs and antimicrobial resistance. It highlights high-risk areas of HAIs and MDROs of concern, where targeted measures to continuously enhance management and policies implementation of HAIs are needed.
Funding
The Foundation of State Key Laboratory of Pathogen and Biosecurity of China (Grant No. SKLPBS2443) and Infection Prevention and Control Research Project of “Gan·Dong China” (Grant No. GY2023022-A).
卫生保健相关感染,连同抗菌素耐药性,继续对所有国家造成前所未有的威胁,特别是对发展中国家。目的探讨中国HAI及其相关多重耐药菌(MDROs)的流行病学特征、时空异质性及相关因素。方法利用2015-2019年全国6867家抽样医院的监测数据,确定hai的年发病率、关键质量指标及相关因素。2015-2019年,中国抽样医院共报告HAIs 4,959,230例,总体发病率和患病率分别为1.1 / 100和2.3 / 100,随着时间的推移呈下降趋势。耐碳青霉烯鲍曼不动杆菌(CRAB)总检出率最高(51.1%),其次是耐甲氧西林金黄色葡萄球菌(MRSA)(31.0%)、耐碳青霉烯铜绿假单胞菌(CRPA)(22.8%)和耐碳青霉烯肺炎克雷伯菌(CRKP)(12.4%)。MRSA、耐碳青霉烯类大肠杆菌(CREC)和耐万古霉素类屎肠球菌(VREfm)的检出率下降,而CRKP的检出率呈上升趋势。城市地区(发病率比[IRR]: 1.39, p < 0.001)、人均GDP较高的地区(IRR: 1.03, p < 0.001)、床位较多的地区(500 - 1500和≥1500床位的IRR分别为1.64和2.16,p < 0.001)以及中国南方地区(IRR: 1.23, p < 0.001)的医院发生HAIs的风险较高。2017年实施了12项针对HAIs的新标准后,观察到HAIs的年发生率降低(IRR: 0.92, p < 0.001)。本研究增加了对HAIs与抗菌药物耐药性的认识。报告强调了令人关注的卫生保健机构和卫生保健机构的高风险领域,在这些领域需要采取有针对性的措施,不断加强卫生保健机构的管理和政策执行。病原与生物安全国家重点实验室资助项目(批准号:2018102239902);SKLPBS2443)和“赣·东中国”感染防治研究项目(批准号:GY2023022-A)。
{"title":"Mapping the landscape of healthcare-associated infections in China, 2015–2019: a nation-wide observational study","authors":"Hong-Wu Yao , Chen-Long Lv , Yao Tian , Yu-Zheng Zhang , Zheng-Hao Yu , Ming-Mei Du , Cheng-Xue Ma , Ji-Jiang Suo , Shuo Zhao , Yu Zhang , Yu-Bin Xing , An-Ran Zhang , Yan-Ling Bai , Bo-Wei Liu , Zhong-Qiang Yan , Ju-Yuan Liu , Meng Cai , Rui Huo , Jian Lin , Chun-Ping Chen , Yun-Xi Liu","doi":"10.1016/j.lanwpc.2025.101775","DOIUrl":"10.1016/j.lanwpc.2025.101775","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare-associated infections (HAIs), complicated by antimicrobial resistance continue to affect all countries with unprecedented threat, especially for developing countries. Our objective was to explore the epidemiological features, spatiotemporal heterogeneity and associated factors of HAIs and HAI related multi-drug resistant organisms (MDROs) in China.</div></div><div><h3>Methods</h3><div>We used national surveillance data that were collected from 6867 sampled hospitals during 2015–2019 to determine the annual incidence of HAIs, key HAI-related quality indicators and associated factors.</div></div><div><h3>Findings</h3><div>During 2015–2019, total of 4,959,230 HAIs were reported in sampled hospitals in China, with the overall incidence and prevalence estimated as 1.1 and 2.3 per 100 inpatients, which showed decline trend over time. Carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB) had the highest overall detection rate (51.1%), followed by methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) (31.0%), carbapenem-resistant <em>Pseudomonas aeruginosa</em> (CRPA) (22.8%), and carbapenem-resistant <em>Klebsiella pneumonia</em> (CRKP) (12.4%). Detection rates of MRSA, carbapenem-resistant <em>Escherichia coli</em> (CREC), and vancomycin-resistant <em>Enterococcus faecium</em> (VREfm) reduced, in contrast with an increasing trend for CRKP. Higher risk of HAIs was associated with hospitals located in urban areas (incidence rate ratio [IRR]: 1.39, p < 0.001), in regions with higher GDP per capita (IRR: 1.03, p < 0.001), with more beds (IRR: 1.64 and 2.16 for 500−1500 and ≥ 1500 beds respectively, p < 0.001), as well as in south region of China (IRR: 1.23, p < 0.001). The reduced annual rates of HAIs were observed after 2017 (IRR: 0.92, p < 0.001), when 12 new standards targeted for HAIs were implemented.</div></div><div><h3>Interpretation</h3><div>The study increases the understanding of HAIs and antimicrobial resistance. It highlights high-risk areas of HAIs and MDROs of concern, where targeted measures to continuously enhance management and policies implementation of HAIs are needed.</div></div><div><h3>Funding</h3><div><span>The Foundation of State Key Laboratory of Pathogen and Biosecurity of China</span> (Grant No. <span><span>SKLPBS2443</span></span>) and <span>Infection Prevention and Control Research Project of “Gan·Dong China”</span> (Grant No. <span><span>GY2023022-A</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101775"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.lanwpc.2025.101755
Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell
Background
Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).
Methods
Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.
Findings
Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.
Interpretation
Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.
{"title":"Economic evaluation of potential national childhood screening strategies for type 1 diabetes in Australia","authors":"Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell","doi":"10.1016/j.lanwpc.2025.101755","DOIUrl":"10.1016/j.lanwpc.2025.101755","url":null,"abstract":"<div><h3>Background</h3><div>Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).</div></div><div><h3>Methods</h3><div>Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.</div></div><div><h3>Findings</h3><div>Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.</div></div><div><h3>Interpretation</h3><div>Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.</div></div><div><h3>Funding</h3><div>JDRF Australia.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101755"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.lanwpc.2025.101752
Guiying Cao , Huang Jing , Cai Jie , Min Liu
Syphilis was nearly eliminated from China in the 1960s; however, it has resurgent and continued to spread in the country since the 1980s. Surveillance data from China revealed that the notification rate of syphilis increased 11.88% annually between 2004 and 2019, with an notification rate of 38.37 per 100,000 population in 2019. This paper aims to summarize the national policies and plans for syphilis since the 1980s; the full-cycle management strategy for the publicity and education, screening, diagnosis and treatment, management, and surveillance and monitoring of syphilis; the epidemiology of syphilis; and challenges in the prevention and control in China. Finally, we propose a series of new strategies to better manage syphilis to help eliminate the infection in China.
{"title":"The changing epidemiology of syphilis: new strategies for new challenges in China","authors":"Guiying Cao , Huang Jing , Cai Jie , Min Liu","doi":"10.1016/j.lanwpc.2025.101752","DOIUrl":"10.1016/j.lanwpc.2025.101752","url":null,"abstract":"<div><div>Syphilis was nearly eliminated from China in the 1960s; however, it has resurgent and continued to spread in the country since the 1980s. Surveillance data from China revealed that the notification rate of syphilis increased 11.88% annually between 2004 and 2019, with an notification rate of 38.37 per 100,000 population in 2019. This paper aims to summarize the national policies and plans for syphilis since the 1980s; the full-cycle management strategy for the publicity and education, screening, diagnosis and treatment, management, and surveillance and monitoring of syphilis; the epidemiology of syphilis; and challenges in the prevention and control in China. Finally, we propose a series of new strategies to better manage syphilis to help eliminate the infection in China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101752"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that poses a serious public health challenge in several Asian countries. In this study, we aimed to describe the recent epidemiological characteristics of SFTS in Japan using denominator-based test data.
Methods
We analysed reported SFTS case-patients in Japan using national surveillance data from March 2013 to April 2024. The case-fatality ratio (CFR) was calculated using the National Vital Statistics Surveillance System (NVSSS) for 2013–2022. Trends in test numbers and positivity rates were examined using data from annual reports and public health institute surveys.
Findings
During the study period, 931 case-patients were reported, including 11 veterinary healthcare workers. The annual notification rate rose from 3.12 per ten million in 2013 to 10.46 in 2023, with 30 (64%) estimated infection prefectures, primarily in western and central Japan. The NVSSS CFRs remained high at approximately 20%. Test numbers and positive results increased from 2013 (n = 350, n = 41) to 2022 (n = 923, n = 95); however, positivity decreased from 12% to 10%.
Interpretation
The annual SFTS notification rate increased, and infection regions expanded between 2013 and 2023, with persistently high CFRs and increased testing. Veterinary healthcare workers appear to be a potential high-risk group. These findings highlight that SFTS remains a public health concern in Japan, requiring a comprehensive health strategy.
Funding
This work was supported by the Japan Society for the Promotion of Science Kakenhi Grants-in-Aid for Young Scientists (grant number: 24K19277).
发热伴血小板减少综合征(SFTS)是一种蜱传人畜共患疾病,在一些亚洲国家构成了严重的公共卫生挑战。在本研究中,我们旨在利用基于分母的检测数据描述日本SFTS的最新流行病学特征。方法利用2013年3月至2024年4月日本国家监测数据,对报告的SFTS病例进行分析。使用2013-2022年国家生命统计监测系统(NVSSS)计算病死率(CFR)。使用年度报告和公共卫生研究所调查的数据检查了检测次数和阳性率的趋势。研究期间共报告病例931例,其中兽医卫生工作者11例。年通报率从2013年的每千万人3.12例上升到2023年的每千万人10.46例,估计有30个(64%)感染县,主要在日本西部和中部。NVSSS的cfr仍然很高,约为20%。检测数量和阳性结果从2013年(n = 350, n = 41)增加到2022年(n = 923, n = 95);然而,积极性从12%下降到10%。在2013年至2023年期间,SFTS年度报告率上升,感染区域扩大,持续高CFRs和增加检测。兽医保健工作者似乎是一个潜在的高风险群体。这些发现强调,在日本,SFTS仍然是一个公共卫生问题,需要一个全面的卫生战略。本研究由日本科学促进会Kakenhi青年科学家资助项目(资助号:24K19277)资助。
{"title":"Comprehensive epidemiological analysis of severe fever with thrombocytopenia syndrome in Japan, 2013–2023: descriptive observational study","authors":"Tomohiro Ohno , Hirofumi Kato , Yusuke Kobayashi , Masami Kitaoka , Minako Kanesaki , Shimpei Murai , Masaru Jinushi , Mitsuki Aoki , Takuri Takahashi , Tomoe Shimada , Taro Kamigaki , Tomimasa Sunagawa","doi":"10.1016/j.lanwpc.2025.101747","DOIUrl":"10.1016/j.lanwpc.2025.101747","url":null,"abstract":"<div><h3>Background</h3><div>Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that poses a serious public health challenge in several Asian countries. In this study, we aimed to describe the recent epidemiological characteristics of SFTS in Japan using denominator-based test data.</div></div><div><h3>Methods</h3><div>We analysed reported SFTS case-patients in Japan using national surveillance data from March 2013 to April 2024. The case-fatality ratio (CFR) was calculated using the National Vital Statistics Surveillance System (NVSSS) for 2013–2022. Trends in test numbers and positivity rates were examined using data from annual reports and public health institute surveys.</div></div><div><h3>Findings</h3><div>During the study period, 931 case-patients were reported, including 11 veterinary healthcare workers. The annual notification rate rose from 3.12 per ten million in 2013 to 10.46 in 2023, with 30 (64%) estimated infection prefectures, primarily in western and central Japan. The NVSSS CFRs remained high at approximately 20%. Test numbers and positive results increased from 2013 (n = 350, n = 41) to 2022 (n = 923, n = 95); however, positivity decreased from 12% to 10%.</div></div><div><h3>Interpretation</h3><div>The annual SFTS notification rate increased, and infection regions expanded between 2013 and 2023, with persistently high CFRs and increased testing. Veterinary healthcare workers appear to be a potential high-risk group. These findings highlight that SFTS remains a public health concern in Japan, requiring a comprehensive health strategy.</div></div><div><h3>Funding</h3><div>This work was supported by the Japan Society for the Promotion of <span>Science Kakenhi</span> Grants-in-Aid for Young Scientists (grant number: <span><span>24K19277</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101747"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.lanwpc.2025.101750
Zhi Sheng , Tianhang Zhou , Chunyu Du , Tingfang Wu , Liping Wen , Xianmei Yang , Wencai Chen , Xuehong Ma , Hua Deng , Ling Ge , Changchun Zhang , Xu Hong , Rui He , Xiangdong Du , Lingyan Zhu , Hu Xiang , Sijing Chen , Jiachen Liu , Yongzhuo Ding , Guangming Liang , Xin Yu
Background
Parental schizophrenia confers intergenerational mental health risks. The sex-specific transmission patterns remain poorly quantified. This study examined parent-reported transmission rate and familial risk factors among Chinese offspring of schizophrenia probands.
Methods
In this cross-sectional study, we enrolled 27,315 schizophrenia probands and 35,772 offspring. Psychiatric disorder diagnoses of offspring were parent-reported and subsequently verified via the medical management system. Age- and sex-standardized rate referenced China's 2020 census. Robust Poisson regression generated adjusted rate ratios (aRR). Multivariable logistic models were used to identify risk factors for young offspring. This study was registered with ClinicalTrials (NCT07005245).
Findings
The parent-reported transmission rate in offspring was 2.68% (95% CI, 2.52%–2.85%), dominated by schizophrenia spectrum disorders (1.42%). Standardized rates reached 2.53% (95% CI, 2.01%–3.05%) after demographic standardization. Offspring risk increased by 86.0% when conception occurred post-parental illness onset. Firstborn status (aRR = 1.67), low-income household (aRR = 1.43), and being a male child (aRR = 1.14) were significantly associated with elevated risk. Sex-specific parental age effects were also observed. In the subgroup analysis of underage (<17 years) offspring, maternal transmission was associated with post-parental-onset birth (OR = 2.48, p < 0.001), lower household income (OR = 2.32, p < 0.001), and prenatal antipsychotic exposure (OR = 1.69, p < 0.001). Paternal transmission was related to father-only caregiving (OR = 2.15, p < 0.001), lower household income (OR = 1.97, p < 0.001), and male offspring (OR = 1.79, p = 0.001). Dual-parent care demonstrated a robust protective effect across both maternal and paternal schizophrenia groups (OR = 0.75, 95% CI, 0.51–1.10).
Interpretation
Our findings highlighted critical interactions between familial aggregation, sex-differentiated perinatal exposures, and caregiving environments. Policy priorities should integrate sex-stratified genetic counselling, prenatal medication monitoring, and family support programs targeting caregiving inequalities.
Funding
This study was supported by the National Natural Science Foundation of China (32070589).
父母精神分裂症会带来代际心理健康风险。性别特异性传播模式的量化仍然很差。本研究考察了中国精神分裂症先证者后代中父母报告的传播率和家族危险因素。方法在这项横断面研究中,我们招募了27,315名精神分裂症先证者和35,772名后代。后代的精神障碍诊断由父母报告,随后通过医疗管理系统进行验证。年龄和性别标准化率参考了中国2020年人口普查数据。稳健泊松回归生成调整率比(aRR)。使用多变量逻辑模型来确定年轻后代的危险因素。本研究已在ClinicalTrials注册(NCT07005245)。结果父母报告的后代传播率为2.68% (95% CI, 2.52% ~ 2.85%),以精神分裂症谱系障碍(1.42%)为主。人口统计学标准化后,标准化率达到2.53% (95% CI, 2.01% ~ 3.05%)。当受孕发生在父母发病后,后代风险增加86.0%。长子身份(aRR = 1.67)、低收入家庭(aRR = 1.43)和男孩身份(aRR = 1.14)与风险升高显著相关。性别差异的父母年龄效应也被观察到。在未成年(17岁)后代的亚组分析中,母体传播与父母后发病分娩(OR = 2.48, p < 0.001)、较低的家庭收入(OR = 2.32, p < 0.001)和产前抗精神病药物暴露(OR = 1.69, p < 0.001)有关。父系遗传与仅由父亲照料(OR = 2.15, p < 0.001)、较低的家庭收入(OR = 1.97, p < 0.001)和男性后代(OR = 1.79, p = 0.001)有关。双亲护理在母亲和父亲精神分裂症组中都显示出强大的保护作用(OR = 0.75, 95% CI, 0.51-1.10)。解释:我们的研究结果强调了家族聚集、性别分化的围产期暴露和护理环境之间的关键相互作用。政策重点应包括按性别分层的遗传咨询、产前药物监测和针对照顾不平等的家庭支持计划。本研究由国家自然科学基金(32070589)资助。
{"title":"Sex-differences in the intergenerational transmission of mental disorders among schizophrenia probands: familial risk and protective factors in a population-based study","authors":"Zhi Sheng , Tianhang Zhou , Chunyu Du , Tingfang Wu , Liping Wen , Xianmei Yang , Wencai Chen , Xuehong Ma , Hua Deng , Ling Ge , Changchun Zhang , Xu Hong , Rui He , Xiangdong Du , Lingyan Zhu , Hu Xiang , Sijing Chen , Jiachen Liu , Yongzhuo Ding , Guangming Liang , Xin Yu","doi":"10.1016/j.lanwpc.2025.101750","DOIUrl":"10.1016/j.lanwpc.2025.101750","url":null,"abstract":"<div><h3>Background</h3><div>Parental schizophrenia confers intergenerational mental health risks. The sex-specific transmission patterns remain poorly quantified. This study examined parent-reported transmission rate and familial risk factors among Chinese offspring of schizophrenia probands.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we enrolled 27,315 schizophrenia probands and 35,772 offspring. Psychiatric disorder diagnoses of offspring were parent-reported and subsequently verified via the medical management system. Age- and sex-standardized rate referenced China's 2020 census. Robust Poisson regression generated adjusted rate ratios (aRR). Multivariable logistic models were used to identify risk factors for young offspring. This study was registered with ClinicalTrials (<span><span>NCT07005245</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>The parent-reported transmission rate in offspring was 2.68% (95% CI, 2.52%–2.85%), dominated by schizophrenia spectrum disorders (1.42%). Standardized rates reached 2.53% (95% CI, 2.01%–3.05%) after demographic standardization. Offspring risk increased by 86.0% when conception occurred post-parental illness onset. Firstborn status (aRR = 1.67), low-income household (aRR = 1.43), and being a male child (aRR = 1.14) were significantly associated with elevated risk. Sex-specific parental age effects were also observed. In the subgroup analysis of underage (<17 years) offspring, maternal transmission was associated with post-parental-onset birth (OR = 2.48, <em>p</em> < 0.001), lower household income (OR = 2.32, <em>p</em> < 0.001), and prenatal antipsychotic exposure (OR = 1.69, <em>p</em> < 0.001). Paternal transmission was related to father-only caregiving (OR = 2.15, <em>p</em> < 0.001), lower household income (OR = 1.97, <em>p</em> < 0.001), and male offspring (OR = 1.79, <em>p</em> = 0.001). Dual-parent care demonstrated a robust protective effect across both maternal and paternal schizophrenia groups (OR = 0.75, 95% CI, 0.51–1.10).</div></div><div><h3>Interpretation</h3><div>Our findings highlighted critical interactions between familial aggregation, sex-differentiated perinatal exposures, and caregiving environments. Policy priorities should integrate sex-stratified genetic counselling, prenatal medication monitoring, and family support programs targeting caregiving inequalities.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Natural Science Foundation of China</span> (32070589).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101750"},"PeriodicalIF":8.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}