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Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020 越南女性青少年微量营养素缺乏和营养不良的双重负担:2020 年全国横断面研究
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-07 DOI: 10.1016/j.lanwpc.2024.101164

Background

Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents.

Methods

Data from 10- to 18-year-old female participants (n = 1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes.

Findings

Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16–18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p < 0.01), as was thinness (12.25 [3.47, 43.33], p < 0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p < 0.01).

Interpretation

More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam.

Funding

UK BBSRC BB/T008989/1.

背景越南正面临着营养不良的双重负担,超重与营养不良(发育迟缓和/或消瘦)和微量营养素缺乏(MNDs)并存的情况日益普遍。虽然女性青春期营养不良会导致不良的健康后果,并对后代产生潜在的代际影响,但目前还没有研究对当代越南女性青少年的微量营养素缺乏症和营养状况进行全面调查。收集了血液营养生物标志物、人体测量数据和社会人口学数据,并分析了营养状况与多发性营养不良之间的关联;贫血、缺铁(ID)、缺铁性贫血、血清锌过低、血清视黄醇过低和任何多发性营养不良均为特定结果。研究结果超重、发育迟缓和消瘦的发生率分别为 27.2%、14.3% 和 6.9%。血清锌含量低(39.8%)和 ID(13.4%)也很常见。二元分析显示,年龄较大(16-18 岁)、少数民族身份、财富指数较低和炎症与 MNDs 相关。在调整后的逻辑回归中,发育迟缓与血清视黄醇低的几率和[95%置信区间]增加有关(8.92 [2.26, 35.15],p < 0.01),瘦弱也与之有关(12.25 [3.47, 43.33],p < 0.01)。发育迟缓也与患有任何 MND 的几率增加有关(2.06 [1.31, 3.25],p < 0.01)。然而,营养不良、血清锌不足和智障仍然普遍存在。应考虑采用食品系统方法来阻止越南青少年营养不良双重负担的急剧增加。
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引用次数: 0
Multiple-component interventions to increase rotavirus vaccine uptake in children: a randomised controlled trial 提高儿童轮状病毒疫苗接种率的多成分干预措施:随机对照试验
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-05 DOI: 10.1016/j.lanwpc.2024.101153

Background

Rotavirus vaccine has not been included in the Hong Kong Government's Childhood Immunisation Programme. This randomised controlled trial examined whether a simple intervention package can increase rotavirus vaccine uptake in Hong Kong children.

Methods

Postpartum mothers were recruited from two public hospitals in Hong Kong and randomly allocated into three groups using block randomisation, with block sizes kept unknown to investigators and research staff. Control-subjects received public rotavirus information. Subjects in intervention group 1 additionally received: key rotavirus information with a hyperlink to a webpage showing private clinics providing rotavirus vaccines and guidance on searching the clinics, and vaccination reminders. Subjects in intervention group 2 received the same intervention as group 1, plus tokens to receive free rotavirus vaccines at specific health centres. Rotavirus vaccination status was collected when children were approximately 8 months old. Maternal attitudes towards rotavirus vaccine were assessed at enrolment and at the end of the study. This trial has been registered in the Chinese Clinical Trial Register (Ref.:ChiCTR2000039791).

Findings

From 16 February to 30 July 2021, 788 eligible mothers were recruited and randomly allocated to control group (n = 263), intervention group 1 (n = 263), and intervention group 2 (n = 262). The full intervention package (intervention group 2 relative to control group) increased rotavirus vaccine uptake by 1.7 times (95% confidence interval [CI] = 1.49–1.97) or by 33 percent-points (from 48% to 81% uptake). Provision of key rotavirus information with vaccination reminders (intervention group 1 relative to control group) and removal of financial barrier (intervention group 2 relative to intervention group 1) increased uptake by 1.17 times (95% CI = 0.99–1.38) or 8 percent-points, and by 1.46 times (95% CI = 1.29–1.66) or 25 percent-points, respectively.

Interpretation

A multiple-component intervention package, and in particular providing free vaccine, could increase the uptake of rotavirus vaccine in Hong Kong children. The impact of the intervention package was greatest in low-income families, emphasising the importance of removing financial barriers to vaccination to promote equity. Incorporating rotavirus vaccine into the routine CIP could further protect more young children from rotavirus infection and improve equity.

Funding

This work was supported by the Health and Medical Research Fund by the Health Bureau, Government of Hong Kong SAR [Ref.: 19180202].

背景轮状病毒疫苗尚未纳入香港政府的儿童免疫接种计划。这项随机对照试验研究了一个简单的干预方案能否提高香港儿童对轮状病毒疫苗的接种率。方法 从香港两家公立医院招募产后母亲,采用组块随机法将她们随机分配到三个组别,调查人员和研究人员不知道组块大小。对照组受试者获得了轮状病毒的公共信息。干预组 1 的受试者会额外收到:主要轮状病毒信息,以及显示提供轮状病毒疫苗的私人诊所和搜索诊所指南的网页超链接,以及疫苗接种提醒。干预组 2 的受试者除了接受与干预组 1 相同的干预措施外,还获得了在特定医疗中心免费接种轮状病毒疫苗的代金券。轮状病毒疫苗接种情况在儿童约 8 个月大时进行收集。母亲对轮状病毒疫苗的态度在报名时和研究结束时进行评估。研究结果从2021年2月16日至7月30日,共招募了788名符合条件的母亲,并随机分配到对照组(263人)、干预组1(263人)和干预组2(262人)。全套干预措施(干预组 2 相对于对照组)将轮状病毒疫苗接种率提高了 1.7 倍(95% 置信区间 [CI] = 1.49-1.97)或 33 个百分点(从 48% 提高到 81%)。提供主要轮状病毒信息和疫苗接种提醒(干预组 1 相对于对照组)以及消除经济障碍(干预组 2 相对于干预组 1)可使接种率分别提高 1.17 倍(95% CI = 0.99-1.38)或 8 个百分点,以及 1.46 倍(95% CI = 1.29-1.66)或 25 个百分点。干预方案对低收入家庭的影响最大,强调了消除接种疫苗的经济障碍以促进公平的重要性。将轮状病毒疫苗纳入常规儿童免疫接种计划可进一步保护更多幼儿免受轮状病毒感染,并改善公平性。
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引用次数: 0
Establish a noninvasive model to screen metabolic dysfunction-associated steatotic liver disease in children aged 6–14 years in China and its applications in high-obesity-risk countries and regions 建立中国 6-14 岁儿童代谢功能障碍相关性脂肪性肝病的无创筛查模型及其在高肥胖风险国家和地区的应用
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101150

Background

The prevalence of metabolic-associated steatotic liver disease (MASLD) is rising precipitously among children, particularly in regions or countries burdened with high prevalence of obesity. However, identifying those at high risk remains a significant challenge, as the majority do not exhibit distinct symptoms of MASLD. There is an urgent need for a widely accepted non-invasive predictor to facilitate early disease diagnosis and management of the disease. Our study aims to 1) evaluate and compare existing predictors of MASLD, and 2) develop a practical screening strategy for children, tailored to local prevalence of obesity.

Methods

We utilized a school-based cross-sectional survey in Beijing as the training dataset to establish predictive models for screening MASLD in children. An independent school-based study in Ningbo was used to validate the models. We selected the optimal non-invasive MASLD predictor by comparing logistic regression model, random forest model, decision tree model, and support vector machine model using both the Beijing and Ningbo datasets. This was followed by serial testing using the best performance index we identified and indices from previous studies. Finally, we calculated the potential MASLD screening recommendation categories and corresponding profits based on national and subnational obesity prevalence, and applied those three categories to 200 countries according to their obesity prevalence from 1990 to 2022.

Findings

A total of 1018 children were included (NBeijing = 596, NNingbo = 422). The logistic regression model demonstrated the best performance, identifying the waist-to-height ratio (WHtR, cutoff value ≥0.48) as the optimal noninvasive index for predicting MASLD, with strong performance in both training and validation set. Additionally, the combination of WHtR and lipid accumulation product (LAP) was selected as an optimal serial test to improve the positive predictive value, with a LAP cutoff value of ≥668.22 cm × mg/dL. Based on the obesity prevalence among 30 provinces, three MASLD screening recommendations were proposed: 1) “Population-screening-recommended”: For regions with an obesity prevalence ≥12.0%, where MASLD prevalence ranged from 5.0% to 21.5%; 2) “Resources-permitted”: For regions with an obesity prevalence between 8.4% and 12.0%, where MASLD prevalence ranged from 2.3% to 4.4%; 3) “Population-screening-not-recommended”: For regions with an obesity prevalence <8.4%, where MASLD prevalence is difficult to detect using our tool. Using our proposed cutoff for screening MASLD, the number of countries classified into the “Population-screening-recommended” and “Resources-permitted” categories increased from one and 11 in 1990 to 95 and 28 in 2022, respectively.

Interpretation

WHtR might serve as a practical and accessible index for predicting pediatric MASLD. A WHtR value ≥0

背景代谢相关性脂肪性肝病(MASLD)在儿童中的发病率急剧上升,尤其是在肥胖症高发的地区或国家。然而,由于大多数儿童并没有表现出代谢相关性脂肪肝的明显症状,因此识别高危人群仍是一项重大挑战。目前迫切需要一种被广泛接受的非侵入性预测指标,以促进疾病的早期诊断和管理。我们的研究旨在:1)评估和比较现有的 MASLD 预测指标;2)根据当地肥胖症的流行情况,制定切实可行的儿童筛查策略。在宁波进行的一项独立校本研究对模型进行了验证。我们利用北京和宁波的数据集,通过比较逻辑回归模型、随机森林模型、决策树模型和支持向量机模型,选出了最佳的无创 MASLD 预测模型。随后,我们使用我们确定的最佳性能指标和先前研究中的指标进行了连续测试。最后,我们根据国家和次国家的肥胖患病率计算出潜在的MASLD筛查推荐类别和相应的利润,并根据200个国家从1990年到2022年的肥胖患病率将这三个类别应用于这些国家。Logistic回归模型表现最佳,确定腰围身高比(WHtR,临界值≥0.48)为预测MASLD的最佳无创指标,在训练集和验证集中都有很好的表现。此外,WHtR 和脂质累积乘积(LAP)的组合被选为提高阳性预测值的最佳序列测试,LAP 临界值≥668.22 cm × mg/dL。根据 30 个省的肥胖患病率,提出了三项 MASLD 筛查建议:1) "推荐人群筛查":针对肥胖率≥12.0%的地区,其中MASLD患病率在5.0%至21.5%之间;2)"资源允许":肥胖症发病率介于 8.4% 与 12.0% 之间的地区,其中 MASLD 发病率介于 2.3% 与 4.4% 之间;3)"不建议人群筛查":肥胖症患病率为 8.4%的地区,在这些地区,使用我们的工具很难检测到 MASLD 的患病率。使用我们提出的MASLD筛查临界值,被归入 "建议进行人口筛查 "和 "资源允许 "类别的国家数量分别从1990年的1个和11个增加到2022年的95个和28个。在肥胖率≥12.0%的地区,WHtR值≥0.48有助于早期识别和管理MASLD。此外,建议将 WHtR ≥0.48 与 LAP ≥668.22 cm × mg/dL 结合起来进行个体 MASLD 筛查。此外,将这些指标与人口肥胖患病率联系起来,不仅有助于估算MASLD的患病率,还能指出不同肥胖风险水平地区的潜在筛查利润。2022-1G-4251)、国家自然科学基金(批准号:82273654)、浙江省卫生重大科技专项(批准号:WKJ-ZJ-2216)、唐骏2022青年学者基金(2022-B126)和中德人员流动项目(M-0015)的资助。
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引用次数: 0
Advancing social prescribing in Singapore: an update on progress 推进新加坡的社会处方:最新进展情况
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101159

In 2019, SingHealth Community Hospitals (SCH) introduced Social Prescribing (SP) program to support patients in transitioning back to the community after hospitalization, which involves personalized care plans developed by Wellbeing Coordinators (WBCs) to connect patients with relevant community resources. With the recent launch of the nation-wide ‘Healthier SG’ initiative, a population health strategy in Singapore aimed at enabling individuals to prevent and manage chronic diseases, it is important to provide an update on our program's recent developments. This includes creating a living asset map, updating outcome assessment tools, organizing training sessions to enhance the skills SP practitioners, and establishing the Singapore Community of Practice in Social Prescribing (SCOMP).

2019年,新加坡保健集团社区医院(SCH)推出了 "社会处方"(Social Prescribing,简称SP)计划,为住院后重返社区的患者提供支持,其中包括由福利协调员(Wellbeing Coordinator,简称WBC)制定个性化护理计划,为患者联系相关社区资源。新加坡最近在全国范围内发起了 "健康新加坡"(Healthier SG)倡议,这是新加坡的一项人口健康战略,旨在帮助个人预防和管理慢性疾病。这包括创建生活资产地图、更新成果评估工具、组织培训课程以提高社会处方从业人员的技能,以及建立新加坡社会处方实践社区(SCOMP)。
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引用次数: 0
Corrigendum to “Global epidemiology of severe fever with thrombocytopenia syndrome virus in human and animals: a systematic review and meta-analysis” [The Lancet Regional Health - Western Pacific, Volume: 48 (2024) 101133] 对 "严重发热伴血小板减少综合征病毒在人类和动物中的全球流行病学:系统回顾和荟萃分析 "的更正[《柳叶刀区域健康--西太平洋》,第 48 (2024) 101133 卷]
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101174
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引用次数: 0
Context matters: physical activity in the Western Pacific region 背景很重要:西太平洋地区的体育活动
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101190
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引用次数: 0
Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial 远程在线生活方式疗法与心理疗法在减少抑郁方面的临床和成本效益对比:CALM 非劣效性随机试验的结果
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101142
<div><h3>Background</h3><p>We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing.</p></div><div><h3>Methods</h3><p>An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021–April 2022, 182 adults with a Distress Questionnaire-5 score = ≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n = 91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n = 91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs).</p></div><div><h3>Findings</h3><p>The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n = 132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n = 70) mean difference:−3.97, 95% CIs:−5.10, −2.84; and Psychotherapy (n = 62): mean difference:−3.74, 95% CIs:−5.12, −2.37; ITT: Lifestyle (n = 91) mean difference:−4.42, 95% CIs: −4.59, −4.25; Psychotherapy (n = 91) mean difference:−3.82, 95% CIs:−4.05, −3.69) with evidence of non-inferiority (PP GEE β:−0.59; 95% CIs:−1.87, 0.70, n = 132; ITT GEE β:−0.49, 95% CIs:−1.73, 0.75, n = 182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs −$182, $611, ITT AUD$190 [95% CIs −$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:−$222, $1152] ITT AUD$ 408 [95% CIs −$139, $1157].</p></div><div><h3>Interpretation</h3><p>Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists.</p></div><div><h3>Funding</h3><p>This trial was funded by the <span>Australian Medical Research Future Fund</span> (<span><span>GA133346</span></span>) under its Covid-19 Mental Health Research Grant Sche
背景我们开展了首个非劣效性随机对照试验,以确定通过在线视频会议提供的生活方式疗法在心理健康结果和成本方面是否不逊于心理疗法。2021年5月至2022年4月期间,从澳大利亚维多利亚州及其周边地区的一家三级心理健康服务机构招募了182名压力问卷-5得分=≥8(指示性抑郁)的成年人。参与者被分配到为期 8 周的 6 次 90 分钟疗程中,疗程采用基于小组的在线视频会议方式,包括:(1)由营养师和运动生理学家提供的生活方式疗法(针对营养和体育锻炼)(n = 91)或(2)由心理学家提供的心理疗法(认知行为疗法)(n = 91)。采用广义估计方程 (GEE),主要结果为 8 周时的患者健康问卷-9 (PHQ-9) 抑郁度(非劣效差≤2)。成本最小化分析从卫生部门和社会角度估算了总成本的平均差异。结果由盲人研究助理通过计算机辅助电话访谈进行评估。研究结果采用贝塔系数和 95% 置信区间 (CIs) 显示按方案 (PP) 和意向治疗 (ITT) 结果:45岁[SD:13.4],PHQ-9平均值:10.5[SD:5.7]。在 6 个疗程中,平均完成了 4.2 个疗程,有 132 人获得了完整的数据。在 8 周内,两组患者的抑郁程度均有所减轻(PP:生活方式(n = 70)平均差异:-3.97,95% CIs:-5.10,-2.84;心理疗法(n = 62):平均差异:-3.74,95% CIs:-5.12,-2.37;ITT:生活方式(n = 91)平均差异:-4.42,95% CIs:-4.59,-4.37):-4.59,-4.25;心理疗法(n = 91)平均差异:-3.82,95% CIs:-4.05,-3.69),有证据表明非劣效(PP GEE β:-0.59;95% CIs:-1.87,0.70,n = 132;ITT GEE β:-0.49,95% CIs:-1.73,0.75,n = 182)。共记录到三起严重不良事件。虽然生活方式疗法的成本较低,但总成本并无差异(卫生部门调整后的平均差异:PP 156 澳元 [95 CI:-0.49]):PP为156澳元[95% CIs为-182澳元,611澳元,ITT为190澳元[95% CIs为-155澳元,651澳元]];社会调整后的平均差异为350澳元[95% CIs为-182澳元,651澳元]:PP为350澳元[95% CIs:-222澳元,1152澳元] ITT为408澳元[95% CIs:-139澳元,1157澳元]。如果在完全有效的 RCT 中推广,这种方法可以增加专职医疗人员的使用机会,这些人员经过适当的培训和指导,可以以与心理学家相当的成本提供心理保健服务。
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引用次数: 0
Response to advocating for rigorous and multifactorial analyses in post-COVID cognitive research 对倡导在后 COVID 认知研究中进行严格的多因素分析的回应
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101165
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引用次数: 0
Variations in suicide rates among Australian male construction workers by country of birth 按出生国划分的澳大利亚男性建筑工人自杀率差异
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101155
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引用次数: 0
Advocating for rigorous and multifactorial analyses in post-COVID cognitive research 倡导在后 COVID 认知研究中进行严格的多因素分析
IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1016/j.lanwpc.2024.101166
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引用次数: 0
期刊
The Lancet Regional Health: Western Pacific
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