The Lancet Regional Health: Western Pacific最新文献

{"title":"Ivermectin therapy for young children with scabies infection: a multicentre phase 2 non-randomized trial","authors":"Amanda Gwee ,&nbsp;Andrew Steer ,&nbsp;Khampheng Phongluxa ,&nbsp;Chanthaly Luangphaxay ,&nbsp;Khanpaseuth Senggnam ,&nbsp;Ammala Philavanh ,&nbsp;Alice Lei ,&nbsp;April Martinez ,&nbsp;Shan Huang ,&nbsp;Brett McWhinney ,&nbsp;Jacobus Ungerer ,&nbsp;Stephen Duffull ,&nbsp;Wenyu Yang ,&nbsp;Xiao Zhu ,&nbsp;Ben Coghlan","doi":"10.1016/j.lanwpc.2024.101144","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101144","url":null,"abstract":"<div><h3>Background</h3><p>Ivermectin, an effective treatment for scabies, is not licensed for children weighing &lt;15 kg. Pharmacokinetic modelling has shown a 3 mg dose in young children (2–4 years, weighing 10–14 kg) achieves comparable drug exposure to a 200 μg/kg dose in children aged ≥5 years. This trial evaluated a 3 mg dose in young children.</p></div><div><h3>Methods</h3><p>Multicentre, phase 2 trial in five health centres in Lao PDR. Children aged 2–4 years, weighing 10–14 kg with scabies received 3 mg ivermectin and had two plasma concentrations determined (<span>Clinicaltrials.gov</span><svg><path></path></svg> ID <span>NCT05500326</span><svg><path></path></svg>). On day 14, clinical outcomes and adverse effects were assessed, and a second dose given to complete treatment. The primary outcome was the mean plasma ivermectin exposure (AUC_0-∞) after the first dose (compared to a historical control of Indigenous Australian children aged ≥5 years weighing ≥15 kg receiving 200 μg/kg). Secondary outcomes were clinical improvement and adverse effects.</p></div><div><h3>Findings</h3><p>Overall, 100 children with a median age of 3.0 years (IQR 2.6–3.9) and weight of 11.9 kg (IQR 11.0–13.1) were enrolled. The mean observed ivermectin AUC_0-∞ was comparable to the historical control group aged 5–11 years (815 μg h/L vs 953 μg h/L, p = 0.256). Complete resolution of scabies occurred in 90/99 children by day 14. Adverse effects were mild, occurring in 7/99.</p></div><div><h3>Interpretation</h3><p>A 3 mg ivermectin dose in children aged 2–4 years and weighing 10–14 kg achieved a mean plasma AUC_0-∞ comparable to older children, was highly effective in treating scabies and well tolerated. This study supports extending ivermectin treatment to younger children improving global efforts to control this neglected disease.</p></div><div><h3>Funding</h3><p>Project funding provided by a <span>Thrasher Foundation Early Career Research</span> Award.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660652400138X/pdfft?md5=d061c29d9878386d9329d919f8d3c61a&pid=1-s2.0-S266660652400138X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141606708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions","authors":"Rachel Sze Jen Goh ,&nbsp;Bryan Chong ,&nbsp;Jayanth Jayabaskaran ,&nbsp;Silingga Metta Jauhari ,&nbsp;Siew Pang Chan ,&nbsp;Martin Tze Wah Kueh ,&nbsp;Kannan Shankar ,&nbsp;Henry Li ,&nbsp;Yip Han Chin ,&nbsp;Gwyneth Kong ,&nbsp;Vickram Vijay Anand ,&nbsp;Keith Andrew Chan ,&nbsp;Indah Sukmawati ,&nbsp;Sue Anne Toh ,&nbsp;Mark Muthiah ,&nbsp;Jiong-Wei Wang ,&nbsp;Gary Tse ,&nbsp;Anurag Mehta ,&nbsp;Alan Fong ,&nbsp;Lohendran Baskaran ,&nbsp;Nicholas W.S. Chew","doi":"10.1016/j.lanwpc.2024.101138","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101138","url":null,"abstract":"<div><h3>Background</h3><p>Given the rapidly growing burden of cardiovascular disease (CVD) in Asia, this study forecasts the CVD burden and associated risk factors in Asia from 2025 to 2050.</p></div><div><h3>Methods</h3><p>Data from the Global Burden of Disease 2019 study was used to construct regression models predicting prevalence, mortality, and disability-adjusted life years (DALYs) attributed to CVD and risk factors in Asia in the coming decades.</p></div><div><h3>Findings</h3><p>Between 2025 and 2050, crude cardiovascular mortality is expected to rise 91.2% despite a 23.0% decrease in the age-standardised cardiovascular mortality rate (ASMR). Ischaemic heart disease (115 deaths per 100,000 population) and stroke (63 deaths per 100,000 population) will remain leading drivers of ASMR in 2050. Central Asia will have the highest ASMR (676 deaths per 100,000 population), more than three-fold that of Asia overall (186 deaths per 100,000 population), while high-income Asia sub-regions will incur an ASMR of 22 deaths per 100,000 in 2050. High systolic blood pressure will contribute the highest ASMR throughout Asia (105 deaths per 100,000 population), except in Central Asia where high fasting plasma glucose will dominate (546 deaths per 100,000 population).</p></div><div><h3>Interpretation</h3><p>This forecast forewarns an almost doubling in crude cardiovascular mortality by 2050 in Asia, with marked heterogeneity across sub-regions. Atherosclerotic diseases will continue to dominate, while high systolic blood pressure will be the leading risk factor.</p></div><div><h3>Funding</h3><p>This was supported by the <span>NUHS</span> Seed Fund (NUHSRO/2022/058/RO5+6/Seed-Mar/03), <span>National Medical Research Council</span> Research Training Fellowship (MH 095:003/008-303), <span>National University of Singapore</span> Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme, <span>NUHS</span> Clinician Scientist Program (NCSP2.0/2024/NUHS/NCWS) and the CArdiovascular DiseasE National Collaborative <span>Enterprise</span> (CADENCE) <span>National Clinical Translational Program (MOH-001277-01)</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001329/pdfft?md5=5a82783d353f53e98e639f02f082160c&pid=1-s2.0-S2666606524001329-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141596477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Singapore's COVID-19 crisis decision-making through centralization, legitimacy, and agility: an empirical analysis","authors":"Sumegha Asthana ,&nbsp;Sanjana Mukherjee ,&nbsp;Alexandra L. Phelan ,&nbsp;J.J. Woo ,&nbsp;Claire J. Standley","doi":"10.1016/j.lanwpc.2024.101137","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101137","url":null,"abstract":"<div><h3>Background</h3><p>Decision-making during health crises differs from routine decision-making and is constrained by ambiguity about evolving epidemiological situations, urgency of response, lack of evidence, and fear. Recent analyses of governance and decision-making during COVID-19, focusing on leadership qualities, involvement of specific stakeholders, and effective resource management, do not adequately address a persisting gap in understanding the determinants of decision-making during health crises at the national level.</p></div><div><h3>Methods</h3><p>We undertook a study to understand the processes and characteristics of decision-making during the COVID-19 pandemic in Singapore. We used a case study approach and collected empirical evidence about public health decision-making, using a combination of key informant interviews and focus group discussions with stakeholders from government, academia and civil society organizations.</p></div><div><h3>Findings</h3><p>We argue that administrative centralization and political legitimacy played important roles in agile governance and decision-making during the pandemic in Singapore. We demonstrate the role of the Singapore government's centralization in creating a unified and coherent governance model for emergency response and the People's Action Party's (PAP) legitimacy in facilitating people's trust in the government. Health system resilience and financial reserves further facilitated an agile response, yet community participation and prioritization of vulnerable migrant populations were insufficient in the governance processes.</p></div><div><h3>Interpretation</h3><p>Our analysis contributes to the theory and practice of crisis decision-making by highlighting the role of political and administrative determinants in agile crisis decision-making.</p></div><div><h3>Funding</h3><p>This study is funded by the <span>U.S. Centers for Disease Control and Prevention</span> through a Cooperative Research Agreement (NU2HGH2020000037).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001317/pdfft?md5=65627a88bc07b083c5229d936d88d4a7&pid=1-s2.0-S2666606524001317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141596476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the triglyceride–glucose index with all-cause and cause-specific mortality: a population-based cohort study of 3.5 million adults in China","authors":"Guangda He ,&nbsp;Zenglei Zhang ,&nbsp;Chunqi Wang ,&nbsp;Wei Wang ,&nbsp;Xueke Bai ,&nbsp;Linkang He ,&nbsp;Shi Chen ,&nbsp;Guangyu Li ,&nbsp;Yang Yang ,&nbsp;Xiaoyan Zhang ,&nbsp;Jianlan Cui ,&nbsp;Wei Xu ,&nbsp;Lijuan Song ,&nbsp;Hao Yang ,&nbsp;Wenyan He ,&nbsp;Yan Zhang ,&nbsp;Xi Li ,&nbsp;Liang Chen","doi":"10.1016/j.lanwpc.2024.101135","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101135","url":null,"abstract":"<div><h3>Background</h3><p>The triglyceride-glucose (TyG) index has been recognized as a crucial risk factor for cardiovascular diseases. However, the association between the TyG index and mortality in the general population remains elusive.</p></div><div><h3>Methods</h3><p>Participants were enrolled from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART), a nationwide prospective cohort study. The outcomes of interest were all-cause, cardiovascular, and cancer mortality. Restricted cubic splines and Cox regression models were used to assess the associations between the TyG index and outcomes.</p></div><div><h3>Findings</h3><p>In total, 3,524,459 participants with a median follow-up of 4.6 (IQR, 3.1–5.8) years were included. The associations of the TyG index with all-cause and cardiovascular mortality were reverse L-shaped, with cut-off values of 9.75 for all-cause mortality and 9.85 for cardiovascular mortality. For each 1-unit increase in the TyG index, when below the cut-off values, the TyG index was not significantly associated with all-cause mortality (HR = 1.02, 95% CI: 1.00–1.03) and was only modestly associated with cardiovascular mortality (HR = 1.09, 95% CI: 1.06–1.11). Conversely, when the cut-off values were exceeded, the HRs (95% CI) were 2.10 (1.94–2.29) for all-cause mortality and 1.99 (1.72–2.30) for cardiovascular mortality. However, the association between the TyG index and cancer mortality was linearly negative (HR = 0.97, 95% CI: 0.94–0.99).</p></div><div><h3>Interpretation</h3><p>The associations of the TyG index with all-cause and cardiovascular mortality displayed reverse L-shaped patterns, while an elevated TyG index showed a slight negative association with cancer mortality. We suggest that &lt;9.75 could be the optimal TyG index cut-off value among the Chinese general population. Individuals at high risk of mortality might benefit from proper management of a high TyG index.</p></div><div><h3>Funding</h3><p><span>The National High Level Hospital Clinical Research Funding</span> (2023-GSP-ZD-2, 2023-GSP-RC-01), the Ministry of Finance of China and National Health Commission of China.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001299/pdfft?md5=46aad433c55c643c8fd8c5522179d744&pid=1-s2.0-S2666606524001299-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141596475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the management of type 2 diabetes in China using a multifaceted digital health intervention in primary health care: the SMARTDiabetes cluster randomised controlled trial","authors":"Puhong Zhang ,&nbsp;Xuanchen Tao ,&nbsp;Yuxia Ma ,&nbsp;Yaosen Zhang ,&nbsp;Xinyan Ma ,&nbsp;Hongyi Song ,&nbsp;Yu Liu ,&nbsp;Anushka Patel ,&nbsp;Stephen Jan ,&nbsp;David Peiris","doi":"10.1016/j.lanwpc.2024.101130","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101130","url":null,"abstract":"<div><h3>Background</h3><p>There is limited evidence, mainly from high-income countries, that digital health interventions improve type 2 diabetes (T2DM) care. Large-scale implementation studies are lacking.</p></div><div><h3>Methods</h3><p>A multifaceted digital health intervention comprising: (1) a self-management application (‘app’) for patients and lay ‘family health promotors’ (FHPs); and (2) clinical decision support for primary care doctors was evaluated in an open-label, parallel, cluster randomized controlled trial in 80 communities (serviced by a primary care facility for &gt;1000 residents) in Hebei Province, China. People &gt;40 years with T2DM and a glycated haemoglobin (HbA1c) ≥7% were recruited (∼25/community). After baseline assessment, community clusters were randomly assigned to intervention or control groups (1:1) via a web-based system, stratified by locality (rural/urban). Control arm clusters received usual care without access to the digital health application or family health promoters. The primary outcome was at the participant level defined as the proportion with ≥2 “ABC” risk factor targets achieved (HbA1c &lt; 7.0%, blood pressure &lt; 140/80 mmHg and LDL-cholesterol &lt; 2.6 mmol/L) at 24 months.</p></div><div><h3>Findings</h3><p>A total of 2072 people were recruited from the 80 community clusters (40 urban and 40 rural), with 1872 (90.3%) assessed at 24 months. In the intervention arm, patients used FHPs for support more in rural than urban communities (252 (48.6%) rural vs 92 (21.5%) urban, p &lt; 0.0001). The mean monthly proportion of active app users was 46.4% (SD 7.8%) with no significant difference between urban and rural usage rates. The intervention was associated with improved ABC control rates (339 [35.9%] intervention vs 276 [29.9%] usual care; RR 1.20, 95% CI 1.02–1.40; p = 0.025), with significant heterogeneity by geography (rural 220 [42.6%] vs 158 [31.0%]; urban 119 [27.9%] vs 118 [28.6%]; p = 0.022 for interaction). Risk factor reductions were mainly driven by improved glycaemic control (mean HbA1C difference −0.33%, 95% CI −0.48 to −0.17; p = 0.00025 and mean fasting plasma glucose difference −0.58 mmol, 95% CI −0.89 to −0.27; p = 0.00013). There were no changes in blood pressure and LDL-cholesterol levels.</p></div><div><h3>Interpretation</h3><p>A multifaceted digital health intervention improved T2DM risk factor control rates, particularly in rural communities where there may be stronger relationships between patients and doctors and greater family member support.</p></div><div><h3>Funding</h3><p><span>National Health and Medical Research Council</span> <span>Global Alliance for Chronic Diseases</span> (ID <span>1094712</span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660652400124X/pdfft?md5=58b68f0764eaf451f093d37b874a0c78&pid=1-s2.0-S266660652400124X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-designing interventions to strengthen the primary health care system for the management of hypertension and type 2 diabetes in China","authors":"Shangzhi Xiong ,&nbsp;Wei Jiang ,&nbsp;Yongchen Wang ,&nbsp;Guosheng Wang ,&nbsp;Xinyi Zhang ,&nbsp;Chi Hu ,&nbsp;Mingjia Bao ,&nbsp;Fan Li ,&nbsp;Jiajuan Yang ,&nbsp;Huinan Hou ,&nbsp;Nan Peng ,&nbsp;Qiujun Wang ,&nbsp;Rui Jiang ,&nbsp;Tingzhuo Liu ,&nbsp;Jin'ge Wang ,&nbsp;Yanqiuzi Ma ,&nbsp;Pengpeng Ye ,&nbsp;Limin Mao ,&nbsp;David Peiris ,&nbsp;Maoyi Tian","doi":"10.1016/j.lanwpc.2024.101131","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101131","url":null,"abstract":"<div><h3>Background</h3><p>Policy makers and researchers are tasked with exploring ways to strengthen primary health care (PHC) to address the growing burden of non-communicable diseases (NCDs). This study aims to use a co-design approach (i.e., meaningful involvement of research end users in study planning and design) to develop PHC interventions to improve the management of hypertension and type 2 diabetes (T2DM) in four study sites in China.</p></div><div><h3>Methods</h3><p>The study adopted a three-step co-design approach, including (1) a two-round Delphi panel with health system and NCD professionals to identify prioritised health system challenges, (2) three co-design workshops (in each study site) with local health administrators, PHC providers, and residents with hypertension and/or T2DM, respectively, to develop interventions and identify factors influencing implementation, and (3) another round of co-design workshops with local health administrators to summarise findings and reach consensus. Qualitative synthesis was conducted to analyse results from the workshops.</p></div><div><h3>Findings</h3><p>Thirteen experts were involved in the two-round Delphi panel, which identified three prioritised health system challenges, including limited capacities of PHC providers, suboptimal service quality and evaluation mechanisms, and unreliable health information systems. The co-design workshops involved 116 local stakeholders in 16 sessions (four in each site), and developed three groups of interventions to address the challenges: (1) empowering PHC providers through on-the-job training for capacity building; (2) empowering patient communities through health education on healthy lifestyles and NCD self-management; and (3) empowering health administrators through local health data monitoring and strengthening governance for local PHC programs. Site-specific interventions were also considered to cater for different local contexts. Several recommendations were further identified for the implementation of these interventions, emphasising the importance of local customisation, community participation, and cross-sectoral collaborations.</p></div><div><h3>Interpretation</h3><p>By engaging multiple stakeholders in priority setting and solution generation, this study summarised several key areas for change in health workforce, service delivery, and health information. Future research should examine the effectiveness and implementation of these interventions to improve NCD management in PHC in China.</p></div><div><h3>Funding</h3><p>This study is funded by <span>National Health and Medical Research Council</span> (NHMRC) <span>Global Alliance for Chronic Diseases funding</span> (APP1169757) and <span>National Natural Science Foundation of China</span> (72074065). Shangzhi Xiong is supported by <span>University of New South Wales</span> tuition fee scholarship.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001251/pdfft?md5=57ee50ee97ae8debe20c46e1d8c49ae5&pid=1-s2.0-S2666606524001251-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of appropriateness of antibiotic prescribing in primary healthcare institutions in China using proxy indicator","authors":"Haishaerjiang Wushouer ,&nbsp;Junxuan Yu ,&nbsp;Kexin Du ,&nbsp;Weihsin Ko ,&nbsp;Weibin Li ,&nbsp;Kairui Zhang ,&nbsp;Shuo Chen ,&nbsp;Bo Zheng ,&nbsp;Luwen Shi ,&nbsp;Xiaodong Guan","doi":"10.1016/j.lanwpc.2024.101132","DOIUrl":"https://doi.org/10.1016/j.lanwpc.2024.101132","url":null,"abstract":"<div><h3>Background</h3><p>Our objectives were to develop a set of proxy indicators (PIs) suited for assessing antibiotic use appropriateness in China's primary healthcare institutions (PHIs), and assess performance scores of these PIs while exploring factors that influence the antibiotic appropriateness.</p></div><div><h3>Methods</h3><p>We selected potential PIs for the PHIs through a RAND–modified Delphi procedure, and assessed clinimetric properties, focusing on measurability, applicability, and potential for improvement. PIs with favorable clinimetric properties were used to evaluate antibiotic prescription appropriateness by calculating performance scores of each PI. Institutions were categorized into three clusters representing different levels of appropriateness. We used the chi–square test and an ordinal logistic regression model at PHI level to explore factors influencing antibiotic appropriateness.</p></div><div><h3>Findings</h3><p>Eighteen PIs were developed through two rounds of online surveys and one face–to–face meeting involving 20 stakeholders. All PIs met the clinimetric properties criteria and were used to analyze 209,662 antibiotic prescriptions across 269 PHIs. The percentage of PHIs meeting the target ranged from 3.1% to 69.3%, with 6 PIs below 10%. The appropriateness of antibiotic prescriptions was significantly associated with percentages of patients’ gender of the PHIs.</p></div><div><h3>Interpretation</h3><p>The varied and suboptimal performance of the PIs indicated the need for diverse efforts to enhance the rational antibiotic use at PHI level. It was necessary to devise distinct sets of PIs for diverse settings in future endeavors.</p></div><div><h3>Funding</h3><p>This work was supported by the <span>National Natural Science Foundation of China</span> (grant numbers <span>72374009</span>, <span>81973294</span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001263/pdfft?md5=a908531c1b27bbc7deca2ad88a3854e6&pid=1-s2.0-S2666606524001263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}