The Lancet Regional Health: Western Pacific最新文献_第5页

Indigenous people's perspectives on sharing health data for service delivery purposes: an inquiry using Indigenous methodologies 土著人民对为提供服务而共享保健数据的看法：使用土著方法的调查

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 10.1016/j.lanwpc.2025.101753

Kristie Watego , Morgan Brodhurst-Hill , Cherilda Murray , Clare Mangoyana , Alynta Emery , Jayde Woon , Kara Williams , Natasha Reid , Teyl Engstrom , Carmel Nelson , Clair Sullivan , Jenny Setchell

Background

With healthcare's accelerating digital transformation and expanding data-sharing capabilities, it is essential to uphold Indigenous Data Sovereignty (IDSov)—which affirms Indigenous ownership and authority over health data relating to Indigenous communities. Indigenous Data Governance (IDGov) provides the mechanisms through which IDSov is enacted, ensuring Indigenous Peoples lead decisions about how data are collected, accessed, and used. Our research investigates a local enactment of IDGov, discussing how custodial stewardship is enacted in data-sharing arrangements between an Aboriginal and Torres Strait Islander community-controlled health organisation and a government birthing facility. The research aimed to understand Aboriginal and Torres Strait Islander service users' and health workers' perspectives on how/whether to share data between services.

Methods

Led by a community-controlled organisation, the study used Indigenous methodologies, including ‘yarning’—a traditional knowledge-sharing practice. An Aboriginal researcher conducted yarns with Aboriginal and/or Torres Strait Islander staff and perinatal service users. Collaborative analysis was undertaken using an adapted ‘Thought Ritual’, an Indigenous analytical framework.

Findings

Analysis identified four domains: 1) Power and Control in Data Sharing—Data sharing can shift power dynamics, affecting sovereignty and community control, 2) Safety Concerns—Participants cited legal, cultural, and psychosocial risks tied to stigma and systemic racism, 3) Ability to Do My Job—Limited data access can hinder effective service delivery, and 4) Not Everything Should Be Shared—There is a clear preference for consent-based, selective data sharing.

Interpretation

Honouring Indigenous perspectives in data-sharing arrangements is an ethical obligation. In perinatal settings, upholding custodial stewardship helps safeguard sovereignty, safety, and equitable outcomes.

Funding

Funding was received from the Australian Government through the Medical Research Future Fund.

背景：随着医疗保健数字化转型的加速和数据共享能力的扩大，维护土著数据主权（IDSov）至关重要，这确认了土著对与土著社区有关的健康数据的所有权和权威。土著数据治理（IDGov）提供了制定土著数据治理的机制，确保土著人民主导如何收集、访问和使用数据的决策。我们的研究调查了IDGov的地方法规，讨论了如何在土著人和托雷斯海峡岛民社区控制的卫生组织和政府生育设施之间的数据共享安排中实施托管管理。该研究旨在了解土著和托雷斯海峡岛民服务用户和卫生工作者对如何/是否在服务之间共享数据的看法。该研究由一个社区控制的组织领导，使用了土著方法，包括“编织”——一种传统的知识共享实践。一名土著研究人员与土著和/或托雷斯海峡岛民工作人员和围产期服务使用者进行了交谈。协作分析采用了一种改编的“思想仪式”，这是一种本土的分析框架。分析结果确定了四个领域：1)数据共享中的权力和控制——数据共享可以改变权力动态，影响主权和社区控制；2)安全问题——参与者提到了与污名和系统性种族主义相关的法律、文化和心理风险；3)做我的工作的能力——有限的数据访问可能会阻碍有效的服务提供；4)并非所有内容都应该共享——人们明显倾向于基于同意的、有选择性的数据共享。在数据共享安排中尊重土著观点是一项道德义务。在围产期环境中，坚持监护管理有助于维护主权、安全和公平的结果。资金澳大利亚政府通过医学研究未来基金提供资金。

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引用次数: 0

Corrigendum to “Adverse health outcomes among migrant workers and transnational families in the Asia–Pacific: a systematic review and meta-analysis” [The Lancet Regional Health–Western Pacific 2025;64: 101720] “亚太移徙工人和跨国家庭的不良健康后果：系统审查和荟萃分析”的勘误表[《柳叶刀》区域卫生-西太平洋2025；64: 101720)

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 10.1016/j.lanwpc.2025.101774

Rosita Chia-Yin Lin , Karen Lau , Kathryn Mackey , Natasha Roya Matthews , Maushmi Selvamani , Beatriz Morais , Oumnia Bouaddi , Chaelin Kim , Azusa Iwamoto , Masami Fujita , Ursula Trummer , Tran Ngoc Dang , Alena Kamenshchikova , Cathy Zimmerman , Sally Hargreaves

引用次数: 0

Social determinants of low fertility in Asia: a comparative review of trends in East, Southeast and South Asia 亚洲低生育率的社会决定因素：东亚、东南亚和南亚趋势的比较审查

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 10.1016/j.lanwpc.2025.101724

Wei-Jun Jean Yeung , Jeofrey Bautista Abalos

Asia, home to nearly 60% of the world's population, is central to global demographic change. Fertility trajectories shape population growth, aging, and decline, with implications for labor supply, economic development, family structures, and caregiving. Studying these patterns offers critical insights into the future of population size, structure, and human potential both regionally and globally. This paper addresses gaps in the largely snapshot, country-specific literature by providing a six-decade comparative overview of fertility trends in East, Southeast, and South Asia, with emphasis on their social determinants. Fertility is shaped not only by individual choice or biology but also by broader socioeconomic, cultural, and policy contexts that influence proximate factors of fertility such as union patterns, contraception, postpartum infecundability, and abortion. We identify distinct regional trajectories of fertility decline, examine their underlying drivers, assess the applicability of prevailing theories, and propose an Asymmetric Adaptation Framework to explain Asia's fertility transitions. While socioeconomic development and ideational change have shaped fertility behavior, cultural factors—such as religion, colonial legacies, kinship systems, and family policy—are pivotal in Asia. Certain trends cannot be explained by socioeconomic development alone, reflecting deeper historical and cultural roots. The Asian experience highlights the limits of prevailing Eurocentric, unidirectional theories and underscores the need for regionally grounded explanations that account for the interplay of structural forces, cultural norms, historical contexts, and policy in shaping fertility decline.

亚洲拥有世界近60%的人口，是全球人口变化的中心。生育率轨迹决定了人口的增长、老龄化和下降，对劳动力供应、经济发展、家庭结构和护理都有影响。研究这些模式可以为未来的人口规模、结构以及区域和全球的人类潜力提供重要的见解。本文通过对东亚、东南亚和南亚地区60年来的生育趋势进行比较概述，重点介绍了这些地区的社会决定因素，解决了主要是简要的、针对具体国家的文献中的差距。生育不仅受到个人选择或生物学的影响，还受到更广泛的社会经济、文化和政策背景的影响，这些因素会影响生育的直接因素，如结合模式、避孕、产后不孕和堕胎。我们确定了生育率下降的不同区域轨迹，研究了其潜在驱动因素，评估了主流理论的适用性，并提出了一个不对称适应框架来解释亚洲的生育率转变。虽然社会经济发展和观念变化影响了生育行为，但文化因素——如宗教、殖民遗产、亲属制度和家庭政策——在亚洲至关重要。某些趋势不能仅仅用社会经济发展来解释，它反映了更深层次的历史和文化根源。亚洲的经验凸显了流行的以欧洲为中心的单向理论的局限性，并强调需要基于区域的解释，以解释结构力量、文化规范、历史背景和政策在形成生育率下降过程中的相互作用。

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引用次数: 0

Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach 亚太心律学会（APHRS）关于设备检测心房颤动患者卒中预防策略的科学声明：4S-DDAF方法

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 10.1016/j.lanwpc.2025.101770

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

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.

设备检测心房颤动（DDAF），包括在心血管植入式电子设备上记录的心房高发生率发作和可插入心脏监护仪和智能可穿戴设备检测的亚临床心房颤动，对卒中预防提出了越来越大的挑战。尽管口服抗凝剂（OACs）对临床房颤有效，但其在DDAF中的利益-风险平衡仍不确定。为此，亚太心律学会（APHRS）提出了4S-DDAF方法（条带记录和最长AF持续时间、症状、卒中[缺血性]病史和评分）来指导抗凝决策。该方法整合了电图回顾、症状评估、缺血性卒中或短暂性脑缺血发作（TIA）史和CHA2DS2-VASc评分，强调个性化护理。房颤发作≥24小时、既往卒中/TIA、CHA2DS2-VASc评分≥4分或有血管疾病的患者推荐使用OACs。对于未达到这些阈值的患者，建议进行密切监测和风险因素管理。4S-DDAF方法为DDAF管理的临床决策提供了实用和循证的策略。

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引用次数: 0

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] “2010-2023年中国中暑流行病学特征：基于国家中暑监测系统的纵向研究”的勘误表[The Lancet Regional Health - Western Pacific 64C (2025) 101722]

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 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

引用次数: 0

Prevalence, persistence, and severity of 12-month and 30-day DSM-5 disorders in the World Mental Health Hong Kong Study 香港世界精神卫生研究中12个月和30天DSM-5障碍的患病率、持续性和严重程度

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 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.

香港世界精神卫生（WMHHK）研究旨在评估香港人口密集城市中DSM-5焦虑、情绪和外化障碍的12个月和30天患病率、持续性、严重程度及其相关因素，香港是一个连续受到人口水平压力因素影响的城市，包括社会动荡和COVID-19大流行。方法：从2022年11月至2024年3月，对3053名18岁及以上的成年人进行了面对面或在线视频访谈。诊断评估使用了DSM-5的世界精神卫生综合国际诊断访谈（CIDI-5），评估了十种精神障碍：焦虑（恐慌障碍、广泛性焦虑障碍、创伤后应激障碍、强迫症及相关障碍）、情绪（重度抑郁症、持续性抑郁症、双相情感障碍）和外化（间歇性爆炸性障碍、酒精使用障碍、物质使用障碍）障碍。持续性定义为终生病例中12个月的患病率和12个月病例中30天的患病率。使用多变量逻辑回归分析社会人口学相关因素。发现任何DSM-5精神障碍的12个月和30天患病率分别为10.6% （95% CI: 9.5-11.8）和7.8% （95% CI: 6.7-8.9）。焦虑症的12个月患病率最高（8.0%,95% CI: 7.1-8.9），其次是情绪障碍（4.3%,95% CI: 3.4-5.2）和外化障碍（1.7%,95% CI: 0.9-2.4）。终生病例的12个月持续性为49.0%，总体而言，焦虑（55.6%）高于情绪（39.0%）或外化（35.3%）障碍。年轻人和中年人以及目前未婚的人患此病的风险较高，而受教育程度较低的人患此病的严重程度也较高。共病与疾病的持续性和严重程度增加有关。这项研究显示，香港在大流行后的时期，精神健康负担沉重，强调有必要制定有针对性的公共精神健康计划，以应对这一独特背景下的城市压力。fundingwing基金会，香港；香港大学脑与认知科学国家重点实验室，香港特别行政区；香港赛马会慈善信托基金

{"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}

引用次数: 0

From process to publication: the conduct and reporting of co-design in health research in the Western Pacific region 从程序到出版：西太平洋区域卫生研究共同设计的开展和报告

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 10.1016/j.lanwpc.2025.101766

Yaqoot Fatima , Michelle Olaithe , Shannon Edmed , Bushra Nasir

引用次数: 0

Temporal trends in sepsis hospitalisations and mortality in Aotearoa New Zealand, 2000–2019: a population-based study 2000-2019年新西兰奥特罗阿败血症住院和死亡率的时间趋势：一项基于人群的研究

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 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.

Funding

Health Research Council of New Zealand.

在全球范围内，败血症仍然是一个重大的公共卫生问题。为了为新西兰奥特罗阿（奥特罗阿）败血症预防、治疗和监测的政策制定和干预提供信息，我们通过主要的社会人口学特征描述了20年来住院败血症和死亡率的人口水平流行病学趋势。方法采用先前公布的病例识别策略和国际疾病分类第十版（ICD-10）代码，对2000年至2019年期间澳大利亚所有败血症相关住院（SAH）进行了一项回顾性、基于人群的描述性研究，以识别国家最低数据集中的SAH。计算了发病率和死亡率以及病死率风险，并对20年观察期的趋势进行了分析。比率估计是根据2018年新西兰人口普查中确定的总人口年龄结构进行标准化的。研究结果：我们确定了266105例独特的SAH病例和27402例相关死亡，平均年龄标准化发病率（ASIR）为每10万人320.4例入院，年龄标准化死亡率（ASMR）为每10万人34.2例死亡。ASIR平均每年增长4.5%，从2000年的每10万人217.3人增加到2019年的每10万人386.9人。ASMR每年从2000年的每10万人37.1例死亡下降到2019年的每10万人31.3例死亡。病死率风险从2000年的15.9例死亡下降到2019年的8.1例死亡，这主要是由于≥40岁年龄组患者生存率的提高。SAH的发病率和死亡率在患者人群中存在显著差异，特别是在年龄、种族和社会经济剥夺方面。Māori和太平洋民族的SAH发病率分别是NMPA族裔的1.7倍和2.3倍，死亡率是NMPA族裔的1.6倍和1.7倍。同样，生活在社会经济高度贫困地区的人患SAH的可能性是生活在社会经济最贫困地区的人的两倍，他们的SAH死亡率是生活在社会经济最贫困地区的人的两倍。脓毒症在澳大利亚很常见，是造成人口死亡的主要原因。患者群体之间的发病率和死亡率估计值存在显著差异，在1岁和≥70岁、Māori或太平洋族裔以及生活在高度社会经济贫困地区的患者中，发病率较高。我们的研究结果强调了SAH的负担和有针对性的干预措施的必要性，以解决败血症预防、监测和支持败血症幸存者。新西兰卫生研究理事会。

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引用次数: 0

Mapping the landscape of healthcare-associated infections in China, 2015–2019: a nation-wide observational study 绘制2015-2019年中国医疗保健相关感染的景观：一项全国性的观察性研究

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-12-01 DOI: 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)。

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引用次数: 0

Economic evaluation of potential national childhood screening strategies for type 1 diabetes in Australia 澳大利亚1型糖尿病潜在国家儿童筛查策略的经济评价

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-21 DOI: 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.

Funding

JDRF Australia.

背景1型糖尿病（T1D）是一种影响儿童的自身免疫性疾病。我们的目的是调查与不筛查（常规护理）相比，潜在的国家儿童T1D筛查策略的成本和成本效益。方法筛选成本由基于试验的估计得出。建立了一个马尔可夫微观模拟模型，以确定最具成本效益的儿童T1D筛查策略。建模的三种筛查策略为：策略1)新生儿遗传风险分层，采用血点取样，然后对高危儿童进行自身抗体筛查；策略2)利用唾液取样进行婴儿遗传风险分层，然后对高危儿童进行自身抗体筛查；策略3)在两个儿童期进行全人群自身抗体筛查。该模型追踪了10万人从出生到30岁的情况。进行了单向和概率敏感性分析。结果新生儿血斑遗传风险分层筛查（策略1）是最具成本效益的策略。策略1每个质量调整生命年（QALY）增加的增量成本效益比（ICERs）为50,682美元，策略2每个质量调整生命年增加的增量成本效益比为85,440美元，策略3每个质量调整生命年增加的增量成本效益比为133,285美元。在最佳策略（策略1）中，每个筛查检测到的T1D的成本为480,798美元，每个避免糖尿病酮症酸中毒发作的成本为12,183美元。结果对筛选试验的时间范围、贴现率和成本的变化很敏感。在三种模拟的T1D筛查策略中，新生儿血斑遗传风险分层筛查是最具成本效益的。不同的成本投入可能会改变这种层次结构。我们的经济评估将为澳大利亚和其他高收入国家未来的T1D儿童筛查政策提供有用的信息。FundingJDRF澳大利亚。

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