The Lancet Regional Health: Western Pacific最新文献

{"title":"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","authors":"Daniel K. Yeoh ,&nbsp;Alison Boast ,&nbsp;Sophie CH. Wen ,&nbsp;Phoebe CM. Williams ,&nbsp;Lesley Voss ,&nbsp;Brett Ritchie ,&nbsp;Mona Mostaghim ,&nbsp;Flora Lutui ,&nbsp;Alice Lei ,&nbsp;Tony Lai ,&nbsp;Adam D. Irwin ,&nbsp;Kiera Harwood ,&nbsp;Thomas Ewin ,&nbsp;Celia Cooper ,&nbsp;Emma Best ,&nbsp;Sarah Bannister ,&nbsp;Amanda Gwee","doi":"10.1016/j.lanwpc.2025.101735","DOIUrl":"10.1016/j.lanwpc.2025.101735","url":null,"abstract":"<div><div>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 <em>Pseudomonas aeruginosa</em>, and carbapenem-resistant <em>Acinetobacter baumannii</em> (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.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101735"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466908","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":"Diabetes stigma and underdiagnosis: time to change the narrative in the Western Pacific region","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101764","DOIUrl":"10.1016/j.lanwpc.2025.101764","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101764"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614468","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":"Surveillance epidemiology of heatstroke in China: when numerators are denominators","authors":"John S. Ji","doi":"10.1016/j.lanwpc.2025.101751","DOIUrl":"10.1016/j.lanwpc.2025.101751","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101751"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569017","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":"Smartphone based cognitive behavioural therapy for adults with no or minimal depressive symptoms in Japan: an exploratory secondary analysis of RESiLIENT trial","authors":"Rie Toyomoto ,&nbsp;Aran Tajika ,&nbsp;Yan Luo ,&nbsp;Masatsugu Sakata ,&nbsp;Tatsuo Akechi ,&nbsp;Takeo Nakayama ,&nbsp;Naoki Kondo ,&nbsp;Shingo Fukuma ,&nbsp;Masaru Horikoshi ,&nbsp;James M.S. Wason ,&nbsp;Hisashi Noma ,&nbsp;Toshi A. Furukawa","doi":"10.1016/j.lanwpc.2025.101741","DOIUrl":"10.1016/j.lanwpc.2025.101741","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div>This study was supported by AMED (grant no. JP21de0107005) and JSPS KAKENHI (grant no. 22K21171).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101741"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569018","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":"Prioritizing interventions for echinococcosis prevention in China: a population attributable fraction analysis","authors":"Shuaiming Xu ,&nbsp;Quzhen Danzeng ,&nbsp;Bing Guo ,&nbsp;Peidi Xu ,&nbsp;Lingxi Gu ,&nbsp;Yajie Zhao ,&nbsp;Xiong Guo ,&nbsp;Yuling Tang ,&nbsp;Yang Chang ,&nbsp;Gonghua Wu ,&nbsp;Xing Zhao","doi":"10.1016/j.lanwpc.2025.101738","DOIUrl":"10.1016/j.lanwpc.2025.101738","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;&lt;span&gt;NHC Key Laboratory of Echinococcosis Prevention and Control&lt;/span&gt; (no. &lt;span&gt;&lt;span&gt;21H1234&lt;/sp","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101738"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466903","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":"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","authors":"Sam Egger ,&nbsp;Andrew Waa ,&nbsp;Michael David ,&nbsp;Judith McCool ,&nbsp;Lucy Hardie ,&nbsp;Marianne F. Weber ,&nbsp;Qingwei Luo ,&nbsp;Jamie Egger ,&nbsp;Becky Freeman","doi":"10.1016/j.lanwpc.2025.101721","DOIUrl":"10.1016/j.lanwpc.2025.101721","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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 &lt; 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 &lt; 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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101721"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614467","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":"An evidence-informed Delphi study of ambulatory care sensitive conditions in China: a policy tool to assess primary care performance","authors":"Jianjian Wang ,&nbsp;Xiyue Chen ,&nbsp;Yan Zhang ,&nbsp;Yue Xiao ,&nbsp;Dong Roman Xu ,&nbsp;Chu Chen ,&nbsp;Ke Ju ,&nbsp;Sijiu Wang ,&nbsp;Lian Yang ,&nbsp;Weiyan Jian ,&nbsp;Hongqiao Fu ,&nbsp;Yanchun Zhang ,&nbsp;Winnie Yip ,&nbsp;Chunhua Chi ,&nbsp;Yaolong Chen ,&nbsp;Ruixian Wu ,&nbsp;Yaoguang Zhang ,&nbsp;Hongyu Lai ,&nbsp;the ACSCs China Working Group,&nbsp;Jay Pan","doi":"10.1016/j.lanwpc.2025.101734","DOIUrl":"10.1016/j.lanwpc.2025.101734","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Interpretation</h3><div>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.</div></div><div><h3>Funding</h3><div>This work is supported by <span>National Science and Technology Major Project</span> of China (Grant No. <span><span>2024ZD0523902</span></span>), <span>National Natural Science Foundation of China</span> (Grant No. <span><span>72374149</span></span>), and Institutional Research Fund from <span>Sichuan University</span> (Grant No. <span><span>2023SCUH0025</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101734"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466899","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":"Tracking the course of vaping and cigarette smoking across adolescence: the Child to Adult Transition Study","authors":"Susan M. Sawyer ,&nbsp;Louise Canterford ,&nbsp;Elizabeth Greenhalgh ,&nbsp;Susan Ellul ,&nbsp;Nandita Vijayakumar ,&nbsp;Michelle Scollo ,&nbsp;S. Ghazaleh Dashti","doi":"10.1016/j.lanwpc.2025.101719","DOIUrl":"10.1016/j.lanwpc.2025.101719","url":null,"abstract":"<div><h3>Background</h3><div>Adolescence is characterised by incident substance use which carries risks for lifelong harms. In Australia, public health measures have limited adolescent smoking, but there has been rapid uptake of vaping over the past decade and the natural history of vaping across adolescence is yet unknown.</div></div><div><h3>Methods</h3><div>We used data from 1181 participants from the prospective, longitudinal Child to Adult Transition Study, recruited in 2012 at age nine. We report annual prevalence of vaping, smoking, and dual use, and incidence, age of uptake, and order of first product use from nine annual waves of data spanning ages 12–21. Multiple imputation addressed missing data.</div></div><div><h3>Findings</h3><div>Prevalence of vaping at any frequency (46.9%, 95% CI: 43.6%, 50.3%), smoking (32.9%, 95% CI: 30.0%, 35.9%), and dual use (27.8%, 95% CI: 24.9%, 30.6%) peaked in wave 12 (mean age 20). Daily vaping had the highest frequency (17.2%, 95% CI: 14.7%, 19.8%) in wave 13 (mean age 21). For smoking and dual use, the highest frequency of daily use was also in wave 12 (smoking: 5.3%, 95% CI: 3.8%, 6.7%; dual use: 3.0% (95% CI: 1.9%, 4.2%)). Cumulative incidence by wave 13 was 75.8% (95% CI: 73.0%, 78.7%) for vaping and 60.2% (95% CI: 56.7%, 63.7%) for smoking. Use ≥4 days/week in ≥2 consecutive waves was 17.3% (95% CI: 14.8%, 19.8%) for vaping and 6.3% (95% CI: 4.6%, 8.0%) for smoking. Of those who vaped and smoked during adolescence, 40.1% (95% CI: 35.2%, 45.0%) started with vaping, 23.9% (95% CI: 19.5%, 28.4%) started with smoking, and 35.9% (95% CI: 31.1%, 40.7%) initiated both at the same wave.</div></div><div><h3>Interpretation</h3><div>These patterns of vaping and smoking in young Australians affirm that regulations and public health initiatives are urgently needed to prevent uptake of all nicotine and tobacco products.</div></div><div><h3>Funding</h3><div><span>National Health and Medical Research Council</span>, <span>Royal Children's Hospital Foundation</span>, <span>Gidleigh Foundation</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101719"},"PeriodicalIF":8.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365124","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":"Mortality among transgender persons: a Taiwan matched-population and sibling-comparison cohort study","authors":"Chih-Wei Hsu ,&nbsp;Yang-Chieh Brian Chen ,&nbsp;Liang-Jen Wang ,&nbsp;Mu-Hong Chen ,&nbsp;Yao-Hsu Yang ,&nbsp;Chih-Sung Liang ,&nbsp;Po-Yen Chen ,&nbsp;Edward Chia-Cheng Lai","doi":"10.1016/j.lanwpc.2025.101715","DOIUrl":"10.1016/j.lanwpc.2025.101715","url":null,"abstract":"<div><h3>Background</h3><div>Transgender persons have been reported to experience excess mortality, but evidence is dominated by Western cohorts and seldom addresses familial confounding.</div></div><div><h3>Methods</h3><div>We conducted a nationwide, retrospective cohort study using two prespecified comparison designs: matched population controls (1:4, matched on legal sex and birth date) and within-family cisgender sibling comparisons. Transgender persons were identified by ≥2 psychiatrist-recorded gender identity disorder diagnoses during 2001–2021; cohort entry required age ≥6 years. Participants were followed until death or December 31, 2022. We compared all-cause, external-cause (suicide and accidents), and internal-cause mortality using Cox regression adjusted for sociodemographics and medical comorbidity.</div></div><div><h3>Findings</h3><div>Among 3906 transgender persons (mean age 24.6 years; 70.6% with a male legal sex) and 15,624 controls (mean follow-up 9.5 years), psychiatric conditions were markedly over-represented in the transgender cohort (e.g., depressive disorders 40.8% vs 5.7%). Adjusted hazard ratios were 1.40 (95% confidence interval 1.06–1.84) for all-cause mortality, 2.03 (1.39–2.96) for external causes, and 4.07 (2.52–6.59) for suicides; accidents (0.56, 0.21–1.45) and internal-cause (0.98, 0.65–1.48) mortality did not differ. In sibling comparisons (4765 siblings), excess all-cause and external-cause mortality were not observed (0.96, 0.67–1.36; and 1.14, 0.70–1.85), suicide risk was higher (2.57, 1.32–5.00), and accident mortality lower (0.19, 0.06–0.67). Relative hazards were greatest in those with a female legal sex and in adolescents. Adjustment for psychiatric clusters attenuated—but did not eliminate—the suicide mortality excess.</div></div><div><h3>Interpretation</h3><div>In Taiwan, transgender persons had higher all-cause and suicide mortality than population controls; in within-family comparisons, the suicide mortality excess persisted, indicating influences beyond shared familial factors. Prevention should prioritize targeted mental-health and safety interventions, with particular attention to adolescents and those with a female legal sex.</div></div><div><h3>Funding</h3><div><span>Taiwan National Science and Technology Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101715"},"PeriodicalIF":8.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323443","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":"Pediatric MASLD in China: epidemiology, screening, diagnosis, and management","authors":"Xiaoguo Li ,&nbsp;Xiao-Dong Zhou ,&nbsp;Jie Wu ,&nbsp;Zhenhua Zhao ,&nbsp;Feng Xie ,&nbsp;Yiling Li ,&nbsp;Wenhui Li ,&nbsp;Xiaosong Yan ,&nbsp;Sumin Sui ,&nbsp;Liting Zhang ,&nbsp;Ming-Hua Zheng ,&nbsp;Yuemin Nan ,&nbsp;Xiaolong Qi","doi":"10.1016/j.lanwpc.2025.101717","DOIUrl":"10.1016/j.lanwpc.2025.101717","url":null,"abstract":"<div><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global epidemic, with a rapidly increasing burden among children and adolescents in China. This alarming trend is primarily driven by profound lifestyle shifts. Unlike earlier perceptions of pediatric MASLD as relatively benign, pediatric-onset MASLD is now recognized as a progressive condition associated with liver fibrosis, cirrhosis, cardiometabolic comorbidities, and elevated risks of hepatocellular carcinoma and early mortality. In China, this escalating burden is compounded by regional disparities, diagnostic challenges, and limited access to pediatric-specific screening and management tools. Yet early-life detection and intervention present a critical window to mitigate long-term liver-related and systemic health consequences. This review synthesizes the latest epidemiological data, screening strategies, diagnostic innovations, and therapeutic approaches for pediatric MASLD in the Chinese context. By integrating emerging evidence with national public health priorities, we aim to inform actionable policies and tailored intervention strategies to confront this growing epidemic.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101717"},"PeriodicalIF":8.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323440","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}