The Lancet Regional Health: Western Pacific最新文献_第8页

Corrigendum to Policies, resource allocation, and interventions for child and adolescent mental health in low- and middle-income countries in the Western Pacific Region: a scoping review [The Lancet Regional Health—Western Pacific, Vol 62 (2025), 101674] 西太平洋区域低收入和中等收入国家儿童和青少年心理健康政策、资源分配和干预措施的勘误表：范围审查[《柳叶刀》区域卫生-西太平洋，第62卷（2025），101674]

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101742

Jiang Long , Stephanie Zhang , Lingjun Chu , Juliet Balkian , Isabel Giovannucci , Cody Mui , Yiqun Luan , Odille Chang , Phetsavanh Chanthavilay , Kartika Goundar , Munkh-Erdene Luvsan , Elissa Kennedy , Dang Nguyen , Picholas Kian Ann Phoa , Caroline Mae Ramirez , Bach Xuan Tran , Siyan Yi , Paula Melizza Valera , Sovanvorleak Tep , Mengieng Ung , Chunling Lu

引用次数: 0

Epidemiological characteristics of heatstroke in China, 2010–2023: a longitudinal study based on a national heatstroke surveillance system 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

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101722

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

Background

Heatstroke causes numerous pathophysiological changes and can lead to death. Extreme heat events have been increasing in frequency, duration, and intensity worldwide in recent decades and are causing growing public health concern. However, epidemiological studies of heatstroke are limited in number and scope, and have had relatively small sample sizes. To better understand the epidemiological characteristics of heatstroke and advance evidence-based prevention and control strategies, we conducted an observational study of reported heatstroke cases in China.

Methods

Cases included in this study were patients clinically diagnosed with heatstroke during the study period of 2010–2023, reported through a dedicated heatstroke surveillance system established by China CDC. We used descriptive statistical methods to determine the epidemiological characteristics of heatstroke in China.

Findings

There were 86,406 heatstroke cases reported during the study period, with an increasing reporting trend (Spearman correlation coefficient r = 0·79). Annual incidence (Spearman r = 0·77) and proportion of severe cases (Pearson r = 0·67) were positively correlated with the number of nationwide average annual high-temperature days. The overall incidence was 44·83 per 10 million person-years, and the mortality rate was 0·89 per 10 million person-years; 32·02% of cases were severe; the overall case fatality rate (CFR) was 1·98%, and the CFR for severe cases was 6·19%. Most cases and deaths were reported in summer, with peaks in late July. The peaks of incidence, duration, and severity varied by region. The mean age was (50·46 ± 18·73) years, with male cases younger than female cases (49·21 ± 17·41 vs 53·60 ± 21·36; t = −28·73, p < 0·0001). For every five-year increase in age, the risks of severe heatstroke and death increased by 14·64% (95% CI: 1·1415–1·1513) and 25·76% (CI: 1·2400–1·2755), respectively. The male:female ratio was 2·49:1; males exhibited a higher risk of suffering from heatstroke and having greater disease severity than females.

Interpretation

Our study provides a clear profile of heatstroke cases, and highlights differences by population, region, and time of year. Results inform formulation of evidence-based strategies for enhanced heatstroke preparedness and response, such as enhancing public health early warning systems, prioritizing protection for vulnerable groups, and advancing localized interventions for risk communication and clinical management.

Funding

Public Health Talent Program of China’s National Disease Control and Prevention Administration.

中暑会引起许多病理生理变化，并可能导致死亡。近几十年来，全球极端高温事件的频率、持续时间和强度都在增加，并引起越来越多的公共卫生关注。然而，对中暑的流行病学研究在数量和范围上都是有限的，而且样本量相对较小。为了更好地了解中暑的流行病学特征，推进循证防控策略，我们对中国报告的中暑病例进行了观察性研究。方法本研究纳入2010-2023年研究期间临床诊断为中暑的患者，这些患者通过中国疾病预防控制中心建立的中暑专用监测系统报告。我们采用描述性统计方法确定中国中暑的流行病学特征。结果研究期间共报告中暑病例86406例，呈上升趋势（Spearman相关系数r = 0.79）。年发病率（Spearman r = 0.77）和重症比例（Pearson r = 0.67）与全国年平均高温日数呈正相关。总发病率为44.83 / 1000万人-年，死亡率为0.89 / 1000万人-年；重症占32.02%；总病死率（CFR）为1.98%，重症病死率为6.19%。大多数病例和死亡报告发生在夏季，高峰出现在7月下旬。发病率、持续时间和严重程度的高峰因地区而异。平均年龄为（50.46±18.73）岁，男性比女性年轻（49.21±17.41 vs 53.60±21.36;t =−28.73,p < 0.0001）。年龄每增加5年，严重中暑和死亡的风险分别增加14.64% （95% CI: 1.1415 - 1.1513）和25.76% （CI: 1.2400 - 1.2755）。男女比例为2·49:1；与女性相比，男性患中暑的风险更高，疾病严重程度也更高。我们的研究提供了中暑病例的清晰概况，并突出了人口、地区和一年中的时间的差异。研究结果为制定加强中暑防范和应对的循证战略提供了信息，如加强公共卫生预警系统，优先保护弱势群体，推进风险沟通和临床管理的本地化干预措施。国家疾病预防控制局公共卫生人才计划资助项目。

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引用次数: 0

Risk-stratified classification of pulmonary nodule malignancy via a machine learning model integrating imaging and cell-free DNA: a model development and validation study (DECIPHER-NODL) 通过整合成像和无细胞DNA的机器学习模型进行肺结节恶性肿瘤的风险分层分类：模型开发和验证研究（DECIPHER-NODL）

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101730

Huiting Wang , Hairong Huang , Feng Li , Ying Deng , Changyong Wang , Wei Wei , Song Wang , Dongqin Zhu , Hao Xu , Hua Bao , Zheng Li , Wenjun Ye , Yuan Zhang , Caichen Li , Bo Cheng , Xiwen Liu , Liping Liu , Zheng Li , Jing Yang , Wei Chen , Wenhua Liang

Background

Accurate risk stratification of pulmonary nodules is critical for early lung cancer detection. This study aimed to improve malignancy classification and invasiveness prediction using machine learning models integrating low-dose computed tomography (LDCT) radiomics and plasma cell-free DNA (cfDNA) fragmentomics.

Methods

This multicenter study enrolled 1356 participants across discovery (n = 1147) and external validation (n = 209) cohorts. A deep learning-based imaging model processed LDCT scans for automated lung nodule detection and malignancy classification. A parallel cfDNA model analyzed four whole-genome fragmentation features: copy number variation, fragment size ratio, fragment-based methylation, and mutation context and signature. The two models were integrated via a stacked ensemble algorithm. An invasion prediction model evaluated tumor aggressiveness.

Findings

The integrated imaging-cfDNA model outperformed individual models, with an AUC of 0.950 (95% CI: 0.926–0.975) in the internal test set and 0.966 (95% CI: 0.940–0.991) in the external validation. The combined model's specificity increased to 0.60 (95% CI: 0.49–0.71) while maintaining 95% sensitivity, compared to specificities of 0.50 (95% CI: 0.41–0.59) and 0.33 (95% CI: 0.23–0.44) at equivalent sensitivity levels for the imaging and cfDNA models, respectively. The combined model consistently outperformed the other two models across nodule characteristics, with particular improvement for 10–20 mm and pure solid nodules. The invasion prediction model stratified lung cancers with an AUC of 0.884 (internal) and 0.880 (external). Prediction scores increased stepwise with tumor aggressiveness, from adenocarcinoma in situ to minimally invasive adenocarcinoma, and were highest for invasive adenocarcinoma.

Interpretation

This multimodal approach enhances pulmonary nodule risk stratification by integrating radiomic and molecular biomarkers. The model significantly improves diagnostic accuracy, potentially reducing unnecessary procedures while minimizing missed diagnoses, supporting its clinical utility in lung cancer screening.

Funding

Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Key Research & Development Programme, China National Science Foundation, the Science and Technology Planning Project of Guangzhou, and Guangzhou National Laboratory.

背景准确的肺结节风险分层对于早期发现肺癌至关重要。本研究旨在通过结合低剂量计算机断层扫描（LDCT）放射组学和无浆细胞DNA （cfDNA）片段组学的机器学习模型来改善恶性肿瘤的分类和侵袭性预测。方法本多中心研究纳入了1356名参与者，包括发现队列（n = 1147）和外部验证队列（n = 209）。基于深度学习的成像模型处理LDCT扫描，用于自动检测肺结节和恶性肿瘤分类。平行cfDNA模型分析了四个全基因组片段化特征：拷贝数变异、片段大小比、基于片段的甲基化以及突变背景和特征。两个模型通过堆叠集成算法进行集成。侵袭预测模型评估肿瘤侵袭性。结果成像- cfdna集成模型优于单个模型，内部测试集的AUC为0.950 (95% CI: 0.926-0.975)，外部验证集的AUC为0.966 （95% CI: 0.940-0.991）。联合模型的特异性增加到0.60 (95% CI: 0.49-0.71)，同时保持95%的灵敏度，而在同等灵敏度水平下，成像和cfDNA模型的特异性分别为0.50 （95% CI: 0.41-0.59）和0.33 （95% CI: 0.23-0.44）。组合模型在结节特征方面始终优于其他两种模型，特别是在10-20 mm和纯固体结节方面有明显改善。侵袭预测模型对肺癌分层的AUC分别为0.884（内部）和0.880（外部）。从原位腺癌到微创腺癌，随着肿瘤的侵袭性，预测评分逐渐增加，浸润性腺癌的预测评分最高。这种多模式方法通过整合放射组学和分子生物标志物来增强肺结节风险分层。该模型显著提高了诊断准确性，潜在地减少了不必要的程序，同时最大限度地减少了漏诊，支持其在肺癌筛查中的临床应用。非传染性慢性病国家科技重大专项、国家重点研究发展计划、国家自然科学基金、广州市科技规划项目、广州国家实验室。

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引用次数: 0

Drug-resistant gram-negative bacterial infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data, and key evidence gaps 大洋洲区域儿童中的耐药革兰氏阴性细菌感染：流行病学、抗微生物药物可及性、治疗、临床试验和药代动力学数据以及关键证据差距的审查

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101735

Daniel K. Yeoh , Alison Boast , Sophie CH. Wen , Phoebe CM. Williams , Lesley Voss , Brett Ritchie , Mona Mostaghim , Flora Lutui , Alice Lei , Tony Lai , Adam D. Irwin , Kiera Harwood , Thomas Ewin , Celia Cooper , Emma Best , Sarah Bannister , Amanda Gwee

Gram-negative bacterial infections remain a major cause of morbidity and mortality in children and neonates globally, compounded by the rise of antimicrobial resistance. Barriers to paediatric antibiotic licencing lead to reduced availability of potentially effective agents for treatment. For children and neonates in the Oceania region, specific challenges remain including a paucity of surveillance data on local rates of antimicrobial resistance, and lack of availability of newer, more costly agents. In this review, we summarise available regional epidemiological data on the WHO priority pathogens: extended spectrum B-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (CRAB). Paediatric clinical trial and pharmakinetic data for the antimicrobials recommended for treatment of these pathogens are reviewed, and paediatric knowledge gaps identified to inform future collaborative research.

革兰氏阴性细菌感染仍然是全球儿童和新生儿发病和死亡的主要原因，加上抗菌素耐药性的上升。儿科抗生素许可的障碍导致潜在有效治疗药物的可得性减少。对于大洋洲区域的儿童和新生儿来说，具体的挑战仍然存在，包括缺乏当地抗菌素耐药性的监测数据，以及缺乏更新、更昂贵的药物。在这篇综述中，我们总结了世卫组织重点病原体的现有区域流行病学数据：产生扩展谱b -内酰胺酶（ESBL）的肠杆菌、耐碳青霉烯的肠杆菌（CRE）、耐碳青霉烯的铜绿假单胞菌和耐碳青霉烯的鲍曼不动杆菌（CRAB）。审查了推荐用于治疗这些病原体的抗菌素的儿科临床试验和药动学数据，并确定了儿科知识空白，以便为未来的合作研究提供信息。

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引用次数: 0

Diabetes stigma and underdiagnosis: time to change the narrative in the Western Pacific region 糖尿病污名化和诊断不足：是时候改变西太平洋地区的叙事了

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101764

The Lancet Regional Health – Western Pacific

引用次数: 0

Surveillance epidemiology of heatstroke in China: when numerators are denominators 中国中暑监测流行病学：当分子为分母时

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101751

John S. Ji

引用次数: 0

Smartphone based cognitive behavioural therapy for adults with no or minimal depressive symptoms in Japan: an exploratory secondary analysis of RESiLIENT trial 基于智能手机的认知行为疗法治疗日本无抑郁症状或轻度抑郁症状的成年人：一项对弹性试验的探索性二次分析

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101741

Rie Toyomoto , Aran Tajika , Yan Luo , Masatsugu Sakata , Tatsuo Akechi , Takeo Nakayama , Naoki Kondo , Shingo Fukuma , Masaru Horikoshi , James M.S. Wason , Hisashi Noma , Toshi A. Furukawa

Background

Although cognitive behavioural therapy (CBT) is a well-established intervention for both the prevention and treatment of depression, its potential role in mentally healthy individuals remains underexplored. We aimed to evaluate the effects of smartphone CBT in mentally healthy adults.

Methods

This exploratory secondary analysis from the RESiLIENT trial (UMIN000047124), a master protocol trial consisting of four 2 × 2 factorial trials, included 1,425 adults with no or very mild depressive symptoms (PHQ-9 ≤4). Participants were recruited nationwide and randomly assigned via a centralized web-based system to one of 12 six-week programs (n = 117 to 120 each): five single-skill CBT interventions (Behavioural Activation [BA], Cognitive Restructuring [CR], Problem Solving [PS], Assertion Training [AT] and Behaviour therapy for Insomnia [BI]), 4 combinations in which BA was paired with another skill, and three control conditions (Health Information [HI], Self-check [SC], Delayed Treatment [DT]). HI, serving as the primary comparator, delivered general health information in a format similar to active interventions. The primary outcome was change in depressive symptoms (PHQ-9) from baseline to weeks 6 and 26. Secondary outcomes included anxiety (GAD-7), insomnia (ISI), and well-being (SWEMWBS).

Findings

The follow-up rate was 96% at week 6 and adherence to the app was 83%. At week 6, all interventions except PS and BA + PS were superior to HI (SMDs −0.62 to −0.22). At week 26, BA, AT and BI or BA + CR appeared to retain moderate efficacy (SMDs −0.30 to −0.27). BA and AT reduced anxiety, and AT and BI improved sleep quality at week 6. In contrast, CR and PS showed limited effects and lower adherence. There was insufficient evidence to show that the interventions improved overall well-being. No serious adverse events were reported.

Interpretation

Single-skill smartphone CBT, especially BA and AT, reduced depressive and anxiety symptoms in healthy adults, supporting its use as a scalable public health prevention tool and suggesting that the efficacy of individual CBT skills may differ based on baseline symptom severity, highlighting the importance of tailored interventions for mental health maintenance.

Funding

This study was supported by AMED (grant no. JP21de0107005) and JSPS KAKENHI (grant no. 22K21171).

虽然认知行为疗法（CBT）是一种公认的预防和治疗抑郁症的干预措施，但其在心理健康个体中的潜在作用仍未得到充分探索。我们的目的是评估智能手机CBT对心理健康成年人的影响。方法本探索性二次分析来自RESiLIENT试验（UMIN000047124），这是一项由4项2 × 2因子试验组成的主方案试验，包括1,425名无或极轻度抑郁症状（PHQ-9≤4）的成年人。参与者在全国范围内招募，并通过一个集中的网络系统随机分配到12个为期6周的项目中（每个项目n = 117至120）：5个单技能CBT干预（行为激活[BA]，认知重构[CR]，问题解决[PS]，主张训练[AT]和失眠行为治疗[BI]）， 4个BA与另一技能配对的组合，以及3个控制条件（健康信息[HI]，自查[SC]，延迟治疗[DT]）。保健协会作为主要比较国，以类似于积极干预的形式提供一般保健信息。主要结局是抑郁症状（PHQ-9）从基线到第6周和第26周的变化。次要结局包括焦虑（GAD-7）、失眠（ISI）和幸福感（SWEMWBS）。研究结果：第6周的随访率为96%，应用程序的依从性为83%。在第6周，除PS和BA + PS外，所有干预措施均优于HI （SMDs为- 0.62至- 0.22）。在第26周，BA、At和BI或BA + CR似乎保持中等疗效（SMDs为- 0.30至- 0.27）。在第6周，BA和AT减少了焦虑，AT和BI改善了睡眠质量。相比之下，CR和PS的效果有限，依从性较低。没有足够的证据表明这些干预措施改善了整体幸福感。无严重不良事件报告。解释：单技能智能手机CBT，特别是BA和AT，减少了健康成年人的抑郁和焦虑症状，支持其作为可扩展的公共卫生预防工具的使用，并表明个体CBT技能的功效可能根据基线症状严重程度而有所不同，强调了定制干预措施对心理健康维持的重要性。本研究由美国医学研究协会（AMED）资助。JP21de0107005)和JSPS KAKENHI(批准号：22 k21171)。

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引用次数: 0

Prioritizing interventions for echinococcosis prevention in China: a population attributable fraction analysis 中国预防棘球蚴病的优先干预措施：人口归因分数分析

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101738

Shuaiming Xu , Quzhen Danzeng , Bing Guo , Peidi Xu , Lingxi Gu , Yajie Zhao , Xiong Guo , Yuling Tang , Yang Chang , Gonghua Wu , Xing Zhao

<div><h3>Background</h3><div>Despite population-level control efforts, human echinococcosis continues to pose a public health challenge in China. Targeting modifiable risk factors at the individual level could be another recipe, but the priority targets for intervention remain unclear. Our aim was to quantify the potential health gains of hypothetical interventions on modifiable risk factors for human echinococcosis, informing effective control strategies.</div></div><div><h3>Methods</h3><div>We collected and aggregated data on the association between modifiable risk factors and human echinococcosis and national total echinococcosis (cystic echinococcosis [CE], alveolar echinococcosis [AE], and other unclassified cases) incidence during 2007–2020 in China. A Bayesian hierarchical model was developed to pool effect estimates for modifiable risk factors associated with total echinococcosis and its subtypes (CE and AE), while accounting for the adequacy of confounding adjustment. Additionally, we evaluated the preventable burden of human echinococcosis via the annual number of total echinococcosis cases attributable to modifiable risk factors deriving from the population attributable fractions (PAFs).</div></div><div><h3>Findings</h3><div>Twelve risk factors for human echinococcosis were identified from 25 studies across nine endemic provinces and autonomous regions in China, with PAFs ranging from 2.2% to 41.2%. The highest PAFs were observed for surface water sources for drinking (PAF: 41.2%; 95% confidence interval [CI]: 18.9–55.9) and the presence of stray dogs around residences (PAF: 34.9%; 15.8–55.1), accounting for 1437 (95% CI: 658–1947) and 1216 (552–1921) preventable annual total echinococcosis cases, respectively. Drinking unboiled water followed, with a PAF of 33.5% (6.2–54.8) and 1167 (217–1910) preventable cases annually. In contrast, the lowest PAF was estimated for exposure to foxes or fox-derived materials (PAF: 2.2%; 0.5–4.3). Surface water sources for drinking and free-roaming owned dogs showed the highest PAFs for CE (42.6%; 19.7–56.5) and AE (49.4%; 34.8–60.2), respectively. Simultaneously eliminating the presence of stray dogs around residences and surface water sources for drinking was the most-effective among available pair-wise combination of risk factors, in which 75.3% (1621/2152) of preventable total echinococcosis cases are concentrated in Xinjiang Uygur Autonomous Region (833; 519–1005), Qinghai Province (396; 247–478), and Sichuan Province (392; 244–473).</div></div><div><h3>Interpretation</h3><div>Interventions targeting drinking water safety and responsible dog management could reduce echinococcosis incidence in China. Public health efforts should prioritize high-prevalence regions such as Xinjiang Uygur Autonomous Region, Qinghai Province, and Sichuan Province to maximize impact.</div></div><div><h3>Funding</h3><div><span>NHC Key Laboratory of Echinococcosis Prevention and Control</span> (no. <span><span>21H1234</sp

尽管在人群层面采取了控制措施，但人类棘球蚴病仍在中国构成公共卫生挑战。针对个人水平上可改变的危险因素可能是另一种方法，但干预的优先目标仍不清楚。我们的目的是量化对人类棘球蚴病可改变危险因素的假设干预措施的潜在健康收益，为有效的控制策略提供信息。方法收集和汇总2007-2020年中国人类棘球蚴病和全国棘球蚴病（囊性棘球蚴病[CE]、肺泡棘球蚴病[AE]和其他未分类病例）总发病率与可变危险因素的相关性数据。建立贝叶斯层次模型，对与总包虫病及其亚型（CE和AE）相关的可修改危险因素进行综合效应估计，同时考虑混杂调整的充分性。此外，我们通过每年由人群归因分数（paf）衍生的可改变危险因素导致的包虫病总病例数，评估了人类包虫病的可预防负担。从中国9个流行省和自治区的25项研究中确定了12个人类棘球蚴病的危险因素，paf从2.2%到41.2%不等。饮用水地表水的PAF最高（PAF: 41.2%， 95%可信区间[CI]: 18.9-55.9），住所周围存在流浪狗（PAF: 34.9%; 15.8-55.1），分别占1437例（95% CI: 658-1947）和1216例（552-1921）可预防的年包虫病总病例。其次是饮用未煮沸的水，PAF为33.5%(6.2-54.8)，每年可预防的病例为1167例（217-1910）。相比之下，估计暴露于狐狸或狐狸衍生材料的PAF最低（PAF: 2.2%; 0.5-4.3）。饮用水和散养狗的地表水水源中，CE（42.6%; 19.7-56.5）和AE（49.4%; 34.8-60.2）的paf值最高。同时，消除住所和地表水饮用水源附近的流浪狗是最有效的危险因素，其中75.3%（1621/2152）的可预防包虫病病例集中在新疆维吾尔自治区（833;519-1005）、青海省（396;247-478）和四川省（392;244-473）。以饮用水安全和负责任的狗管理为目标的干预措施可以减少中国棘球蚴病的发病率。公共卫生工作应优先考虑高流行地区，如新疆维吾尔自治区、青海省和四川省，以最大限度地发挥影响。国家卫生健康委棘球蚴病预防与控制重点实验室；基金资助：21H1234)；GZB20250191)。

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引用次数: 0

Trends in smoking prevalence before and after the emergence of vaping in Aotearoa/New Zealand among 14–15-year-olds identifying as Māori, Pacific, European, or Asian: an interrupted time series analysis of repeated cross-sectional data, 2003–2024 澳大利亚/新西兰14 - 15岁的Māori、太平洋、欧洲或亚洲青少年在电子烟出现前后的吸烟率趋势：2003-2024年重复横断面数据的中断时间序列分析

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101721

Sam Egger , Andrew Waa , Michael David , Judith McCool , Lucy Hardie , Marianne F. Weber , Qingwei Luo , Jamie Egger , Becky Freeman

Background

Ethnic inequities in health and mortality in Aotearoa/New Zealand have been driven in part by historic and ongoing inequities in smoking prevalence, with Māori and Pacific peoples most affected. Although overall smoking rates among year 10 students aged 14–15 years have declined substantially in recent decades, recent analyses suggested that e-cigarette use (vaping) may have slowed the decline in ever- and regular-smoking, while having little or no impact on daily smoking. However, it remains unclear whether these patterns differ for Māori, Pacific, European, or Asian adolescents.

Methods

Interrupted time series analyses of the Snapshot Survey data (2003–2024; n = 588,143) to assess changes in smoking trends before and after the emergence of vaping in Aotearoa among 14–15-year-old Māori, Pacific, European, and Asian adolescents.

Findings

From 2003 to 2024, ever-, regular-, and daily-smoking prevalence declined substantially among Māori, Pacific, European, and Asian adolescents. However, the rates of decline in ever-smoking slowed significantly from 2010 onwards—coinciding with the emergence of vaping in Aotearoa—for Māori (p = 0.025), European (p < 0.001), and Asian (p = 0.018) adolescents. Similarly, declines in regular-smoking slowed significantly for Māori (p = 0.012), Pacific (p = 0.003), and European (p < 0.001) adolescents. A significant change in the rate of decline in daily smoking was observed only for European adolescents, who showed a small slowing (p = 0.004). Findings were robust to different time series interruption-points (change-years) and controlling for cigarette affordability.

Interpretation

We found no evidence that vaping is displacing adolescent smoking among any of the four ethnic groups analysed. On the contrary, our findings suggest that the emergence and rise of vaping in Aotearoa may have undermined progress in reducing regular-smoking among Māori, Pacific, and European adolescents, but with more serious implications for Māori and Pacific youth.

Funding

None.

新西兰在健康和死亡率方面的种族不平等在一定程度上是由吸烟率方面的历史和目前的不平等造成的，Māori和太平洋人民受影响最大。尽管近几十年来，14-15岁的10年级学生的总体吸烟率大幅下降，但最近的分析表明，电子烟的使用（vaping）可能减缓了经常吸烟和经常吸烟的下降，而对日常吸烟的影响很小或没有影响。然而，目前尚不清楚这些模式是否在Māori、太平洋、欧洲或亚洲青少年中有所不同。方法对快照调查数据（2003-2024年；n = 588,143）进行中断时间序列分析，评估美国14 - 15岁Māori、太平洋、欧洲和亚洲青少年出现电子烟前后的吸烟趋势变化。研究结果：从2003年到2024年，在Māori、太平洋、欧洲和亚洲青少年中，曾经吸烟、经常吸烟和每天吸烟的患病率大幅下降。然而，从2010年开始，吸烟人数的下降速度明显放缓，与此同时，美国青少年(Māori （p = 0.025）、欧洲青少年（p < 0.001）和亚洲青少年（p = 0.018）也开始吸电子烟。同样，在Māori （p = 0.012）、太平洋（p = 0.003）和欧洲（p < 0.001）青少年中，经常吸烟的下降速度明显放缓。仅在欧洲青少年中观察到每日吸烟率下降的显著变化，他们表现出轻微的减缓（p = 0.004）。研究结果对不同时间序列中断点（变化年）和控制香烟可负担性具有稳健性。我们没有发现证据表明，在分析的四个种族群体中，电子烟正在取代青少年吸烟。相反，我们的研究结果表明，电子烟在澳大利亚的出现和上升可能破坏了Māori、太平洋地区和欧洲青少年减少经常吸烟的进展，但对Māori和太平洋地区的青少年有更严重的影响。

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引用次数: 0

An evidence-informed Delphi study of ambulatory care sensitive conditions in China: a policy tool to assess primary care performance 基于证据的中国门诊敏感条件德尔菲研究：评估初级保健绩效的政策工具

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2025-11-01 DOI: 10.1016/j.lanwpc.2025.101734

Jianjian Wang , Xiyue Chen , Yan Zhang , Yue Xiao , Dong Roman Xu , Chu Chen , Ke Ju , Sijiu Wang , Lian Yang , Weiyan Jian , Hongqiao Fu , Yanchun Zhang , Winnie Yip , Chunhua Chi , Yaolong Chen , Ruixian Wu , Yaoguang Zhang , Hongyu Lai , the ACSCs China Working Group, Jay Pan

Background

Ambulatory care sensitive conditions (ACSCs) serve as a critical indicator for assessing healthcare system performance globally. However, China lacks a standardized ACSCs list adapted to its unique healthcare context and evolving medical needs.

Methods

This study employed a modified Delphi method combined with evidence-based medicine. First, we systematically reviewed international ACSCs lists and their development methodologies to identify potential diseases. Next, we evaluated the evidence of these potential conditions within China's healthcare system. Finally, a two-round Delphi survey was performed to finalize a consensus-based ACSCs list for China.

Findings

The finalized ACSCs list comprises 14 conditions, categorized into: five core conditions (chronic obstructive pulmonary disease [COPD], bronchial asthma, hypertension, chronic kidney disease [CKD], and diabetes mellitus) and nine general conditions (bronchiectasis, chronic heart failure, atrial fibrillation, chronic hepatitis B, tuberculosis, iron-deficiency anemia, primary osteoporosis, gastroenteritis, and influenza). Based on the prevailing classification framework in academia, the list includes 12 chronic ACSCs, one acute ACSC, and one infectious ACSC. Compared to most international lists (typically covering about 20 ACSCs), China's ACSCs list prioritizes diagnostic specificity over breadth, ensuring practical applicability in China's current healthcare setting.

Interpretation

This study developed the first evidence-based ACSCs list tailored to China, providing a tool for healthcare performance evaluation and policy development. Future studies should validate its real-world applicability and implement mechanisms for dynamic updates.

Funding

This work is supported by National Science and Technology Major Project of China (Grant No. 2024ZD0523902), National Natural Science Foundation of China (Grant No. 72374149), and Institutional Research Fund from Sichuan University (Grant No. 2023SCUH0025).

背景：门诊敏感条件（ACSCs）是评估全球医疗保健系统绩效的关键指标。然而，中国缺乏适应其独特医疗环境和不断变化的医疗需求的标准化ACSCs清单。方法采用改进的德尔菲法与循证医学相结合的方法。首先，我们系统地回顾了国际ACSCs清单及其开发方法，以确定潜在疾病。接下来，我们评估了中国医疗保健系统中这些潜在条件的证据。最后，进行了两轮德尔菲调查，最终确定了基于共识的中国acsc清单。最终的ACSCs清单包括14种疾病，分为：5种核心疾病（慢性阻塞性肺疾病[COPD]、支气管哮喘、高血压、慢性肾病[CKD]和糖尿病）和9种一般疾病（支气管扩张、慢性心力衰竭、心房颤动、慢性乙型肝炎、结核病、缺铁性贫血、原发性骨质疏松症、肠胃炎和流感）。根据学术界流行的分类框架，清单包括12种慢性ACSC， 1种急性ACSC和1种感染性ACSC。与大多数国际清单（通常涵盖约20个ACSCs）相比，中国的ACSCs清单优先考虑诊断特异性而不是广度，确保在中国当前医疗保健环境中的实际适用性。本研究开发了第一个针对中国的循证ACSCs清单，为医疗绩效评估和政策制定提供了一个工具。未来的研究应该验证其在现实世界中的适用性，并实现动态更新的机制。基金资助：国家科技重大专项（批准号：2024ZD0523902）、国家自然科学基金（批准号：72374149）和四川大学科研基金（批准号：2023SCUH0025）。

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