The Lancet Regional Health: Western Pacific最新文献

{"title":"Personalized information support for hypertension management: an open-label cluster randomized controlled trial in rural Anhui, China","authors":"Xingrong Shen ,&nbsp;Ruirui Cui ,&nbsp;Nana Li ,&nbsp;Xin Yang ,&nbsp;Tongqing Xu ,&nbsp;Shumin Zeng ,&nbsp;Xuanhe Liu ,&nbsp;Yuning Wang ,&nbsp;Ying Li ,&nbsp;Dongying Xiao ,&nbsp;Xuewu Zhang ,&nbsp;Rong Liu ,&nbsp;Tingting Zhang ,&nbsp;Xiyan Kong ,&nbsp;Jing Chai ,&nbsp;Dongxiao Gu ,&nbsp;Debin Wang","doi":"10.1016/j.lanwpc.2025.101588","DOIUrl":"10.1016/j.lanwpc.2025.101588","url":null,"abstract":"<div><h3>Background</h3><div>Lack of personalized hypertension management (PHM) is the main driver of low treatment and control rates of blood pressure (BP). Digital intervention has great potential in realizing PHM.</div></div><div><h3>Methods</h3><div>This two-arm cluster randomized controlled trial aimed at assessing the added value of personalized information for leveraging commonly recognized objective behaviors facilitated by pragmatic digital applications. Implemented in Jieshou of Anhui Province, China, the intervention lasted for 12 months starting from August 2021. The primary outcome measure was systolic BP (SBP); and the secondary measures, diastolic BP (DBP), BP control rate, quality adjusted of life years (QALYs), deaths of and admissions for all-causes and hypertension complications and behavior scores. These measures were analyzed using mainly generalized linear mixed modeling controlled for clustering with or without imputation.</div></div><div><h3>Findings</h3><div>The trial recruited 2392 patients at a response rate of 96.84%. At 12-month follow-up, the intervention group demonstrated (via intent-to treat analysis) superior SBP, −5.60 mmHg (95% CI: −8.10, −3.09; <em>p</em> &lt; 0.001). Compared with 24-months follow-up, the adjusted difference decreased moderately to −3.93 mmHg (95% CI: −5.80, −2.05; <em>p</em> &lt; 0.001). The intervention arm demonstrated non-greater risks of all the adverse effects observed.</div></div><div><h3>Interpretation</h3><div>The study provides evidence to support the use of the personalized information support in controlling hypertension and its complications. The next step is an implementation strategy to incorporate the intervention into daily practice and realize its benefits.</div></div><div><h3>Funding</h3><div>The trial was supported by <span>National Natural Science Foundation of China</span> (No. <span><span>72004002</span></span>) and <span>Scientific Research Foundation of Education Department of Anhui Province of China</span> (No. <span><span>KJ2021A0259</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101588"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184448","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":"Long-term exposure to outdoor fine particulate and physical activity with mortality and cardiovascular events: an analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study","authors":"Jun Hao ,&nbsp;Zhiguang Liu ,&nbsp;Bo Hu ,&nbsp;Duolao Wang ,&nbsp;Sumathy Rangarajan ,&nbsp;Yang Wang ,&nbsp;Chuangshi Wang ,&nbsp;Lap Ah Tse ,&nbsp;Weida Liu ,&nbsp;Sidong Li ,&nbsp;Minghai Yan ,&nbsp;Qiujing Cai ,&nbsp;Salim Yusuf ,&nbsp;Wei Li ,&nbsp;PURE-China Investigators","doi":"10.1016/j.lanwpc.2025.101584","DOIUrl":"10.1016/j.lanwpc.2025.101584","url":null,"abstract":"<div><h3>Background</h3><div>Long-term exposure to PM2.5 and low physical activity are independently associated with an increased risk of cardiovascular disease (CVD). However, there is limited research investigating the combined effects of PM2.5 exposure and physical activity on CVD risk. This study aims to explore these interactions related to CVD and mortality.</div></div><div><h3>Methods</h3><div>We analysed data from the PURE-China cohort, including 39,970 adults aged 35–70 years, with a median follow-up of 11.9 years. PM2.5 exposure was estimated using a Bayesian hierarchical model. Physical activity was quantified using metabolic equivalent task (MET)-minutes per week. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models and restricted cubic splines were used to assess associations. Interaction effects were evaluated using measures of multiplicative and additive interaction, including the relative excess risk due to interaction (RERI) and the proportion attributable to interaction (AP).</div></div><div><h3>Findings</h3><div>Participants were divided into high and low PM2.5 exposure groups by the median concentration (47.70 μg/m³). In low-exposure areas, higher total physical activity significantly reduced the risk of composite outcome (HR: 0.84, 95% CI: 0.73–0.97, p trend = 0.012) and major cardiovascular events (HR: 0.80, 0.67–0.95, p trend = 0.022). However, in high-exposure regions, physical activity showed no protective effect for the composite outcome (HR: 0.97, 0.85–1.09, p trend = 0.551) and major cardiovascular events (HR: 0.98, 0.85–1.13, p trend = 0.864). Higher non-recreational physical activity reduced the risks of composite outcome and major CVD in low-exposure areas but provided no benefit in high-exposure regions (p interaction = 0.011, 0.024, respectively). Significant antagonistic interaction was observed between high PM2.5 exposure and low non-recreational physical activity for the composite outcome (RERI: −0.215, 95% CI: −0.406 to −0.024; AP: −0.155, 95% CI: −0.294 to −0.017).</div></div><div><h3>Interpretation</h3><div>Long-term exposure to high PM2.5 concentrations diminishes the cardiovascular benefits of physical activity, particularly non-recreational activities. These findings underscore the need for tailored physical activity guidelines and air quality interventions in heavily polluted regions to maximize public health benefits.</div></div><div><h3>Funding</h3><div>Funding sources are listed at the end of the Article.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101584"},"PeriodicalIF":7.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167132","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":"Optimizing outcomes: adherence to the ABC (Atrial fibrillation Better Care) pathway in Asian atrial fibrillation patients with chronic kidney disease","authors":"Boyoung Joung","doi":"10.1016/j.lanwpc.2025.101583","DOIUrl":"10.1016/j.lanwpc.2025.101583","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101583"},"PeriodicalIF":7.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146734","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":"Corrigendum to Associations of reallocating sedentary leisure-time to alternative discretionary movement behaviours with incident cardiometabolic diseases in 0.5 million Chinese adults. The Lancet Regional Health—Western Pacific, Volume 57, 101524","authors":"Paul J. Collings ,&nbsp;Mengyao Wang ,&nbsp;Harrison Hin Sheung Ho ,&nbsp;Shiu Lun Au Yeung ,&nbsp;Parco M. Siu ,&nbsp;Benjamin J. Cowling ,&nbsp;Stephen J. Sharp ,&nbsp;Søren Brage ,&nbsp;Nicholas J. Wareham ,&nbsp;Huaidong Du ,&nbsp;Derrick A. Bennett ,&nbsp;Youngwon Kim","doi":"10.1016/j.lanwpc.2025.101580","DOIUrl":"10.1016/j.lanwpc.2025.101580","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101580"},"PeriodicalIF":7.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070189","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":"Intergenerational association of adverse childhood experiences and perinatal mental health in adult female offspring: evidence from the longitudinal grandmothers, mothers, and their Children's health study in China","authors":"Hui Wang ,&nbsp;Yue Zhang ,&nbsp;Weijie Ding ,&nbsp;Jiyue Dai ,&nbsp;Xiaoqin Zhu ,&nbsp;Xiaolin Xu","doi":"10.1016/j.lanwpc.2025.101579","DOIUrl":"10.1016/j.lanwpc.2025.101579","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The cycle of maltreatment theory posits a linkage between mothers' and offspring's exposures to adverse childhood experiences (ACEs), and their associations with offspring's early-life mental health; however, such associations in adulthood remain unclear. This study aims to examine the intergenerational association between mothers' ACEs, offspring's ACEs, and offspring's mental health from pregnancy to three years after childbirth, and to explore the potential pathways.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We used data on 1931 mother-offspring dyads from the longitudinal Grandmothers, Mothers, and Their Children's Health study in Huai'an city, China. ACEs were retrospectively assessed based on the Childhood Trauma Screener. Offspring's symptoms of anxiety and depression were measured through self-reported diagnoses or symptoms and standard questionnaires (the 7-item Generalized Anxiety Disorder Scale for anxiety and the 10-item Centre for Epidemiological Studies Depression Scale for depression) during pregnancy, one year and three years after childbirth. Logistic regression models were conducted to estimate the associations. The structural equation model (SEM) was used to examine the potential mediating pathways.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 367 (19.0%) mothers and 271 (14.0%) female offspring reported the history of ACEs. Female offspring of mothers with ACEs also had higher odds of exposure to ACEs (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 2.51–4.53). Mothers' and female offspring's exposures to ACEs were both associated with higher odds of offspring experiencing mental disorders during the perinatal period. For example, female offspring with ACEs had 2.05-fold (95% CI: 1.54–2.72), 2.41-fold (95% CI: 1.75–3.33), and 2.30-fold (95% CI: 1.58–3.33) increased odds of the anxious or depressive symptoms during pregnancy, one year, and three years after childbirth, respectively, compared to offspring without ACEs. Results from the SEM indicated that mothers' ACEs and female offspring's perinatal mental health were linked mainly through the mediation role of female offspring's ACEs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Mothers' and female offspring's likelihood of exposure to ACEs are intergenerationally associated and are both related to offspring's perinatal mental health. Female offspring's ACEs mediate the association between mothers' ACEs and female offspring's adulthood mental health. Our findings highlight the need for policies to break the cycle of maltreatment and promote women's mental health across multiple generations, in particular through family-based interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study was supported by the &lt;span&gt;National Natural Science Foundation of China&lt;/span&gt; (&lt;span&gt;&lt;span&gt;72474197&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;China Medical Board&lt;/span&gt; Open Competition Program (21-416), Key Medical Program of &lt;span&gt;Jiangsu Health Commission&lt;/span&gt; (&lt;span&gt;&lt;span&gt;ZD","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101579"},"PeriodicalIF":7.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946683","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":"Genetic factors driving the Mycoplasma pneumoniae outbreak among children post-COVID-19 in China: a whole genome analysis","authors":"Weiwei Jiao ,&nbsp;Jie Wang ,&nbsp;Cuidan Li ,&nbsp;Peihan Wang ,&nbsp;Sihong Xu ,&nbsp;Jing Bi ,&nbsp;Liya Yue ,&nbsp;Fang Liu ,&nbsp;Lin Sun ,&nbsp;Hui Qi ,&nbsp;Tingting Jiang ,&nbsp;Xue Tian ,&nbsp;He Tang ,&nbsp;Xu Li ,&nbsp;Min Li ,&nbsp;Xuemei Yang ,&nbsp;Xiaoxuan Yang ,&nbsp;Yuting Sun ,&nbsp;Haitao Niu ,&nbsp;Wenbao Zhang ,&nbsp;Fei Chen","doi":"10.1016/j.lanwpc.2025.101578","DOIUrl":"10.1016/j.lanwpc.2025.101578","url":null,"abstract":"<div><h3>Background</h3><div><em>Mycoplasma pneumoniae (M. pneumoniae)</em> is a leading cause of community-acquired pneumonia in children. Post-COVID-19, a significant resurgence of <em>M. pneumoniae</em> infections has been observed in China, but whole-genome analyses on the genetic mechanisms driving this resurgence remain limited.</div></div><div><h3>Methods</h3><div>We performed whole-genome sequencing on 169 <em>M. pneumoniae</em> isolates from Beijing and Baoding, collected before and after COVID-19. All <em>M. pneumoniae</em> genomes from GenBank were included for analysis. Genotypes were identified using multilocus variable-number tandem-repeat analysis (MLVA), multilocus sequence typing (MLST), phylogenetic analysis. Genomic conservation and transmission patterns were assessed via SNP distance.</div></div><div><h3>Findings</h3><div>We identified a post-COVID-19 resurgence of <em>M. pneumoniae</em> infections among children, with infection rates peaking at 60%–70% in late 2023, higher than during the pandemic (10%–20%) and pre-pandemic (∼30%). Genomic analysis revealed distinct genotypes, with T1-2 (4-5-7-2) dominating in Beijing, and both T1-2 and T2-2 (3-5-6-2) prevalent in Baoding. Minimal SNP distances and genomic conservation indicated rapid spread of <em>M. pneumoniae</em>. Genomic analysis uncovered key genetic factors driving the outbreak: near-100% macrolide resistance and increased prevalence of the 4-5-7-2 genotype (enriched in virulence and metabolism-related genes).</div></div><div><h3>Interpretation</h3><div>This study provides a comprehensive genomic analysis of genetic factors driving the outbreak. With near-100% macrolide resistance in China, urgent changes in treatment policies are needed. The rising prevalence of 4-5-7-2 and its functional advantages warrant close monitoring. Our findings offer insights into the outbreak causes and guide future prevention and control strategies.</div></div><div><h3>Funding</h3><div><span>National Key R&amp;D Program of China</span>; Training Plan for <span>High level Public Health Technical Talents</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101578"},"PeriodicalIF":7.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937416","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":"Role of late gadolinium enhancement in the risk stratification of pediatric hypertrophic cardiomyopathy: based on a Chinese cohort","authors":"Xingrui Chen ,&nbsp;Wei Xiangli ,&nbsp;Xuan Ma ,&nbsp;Yun Tang ,&nbsp;Jiaxin Wang ,&nbsp;Zhixiang Dong ,&nbsp;Kankan Zhao ,&nbsp;Zhuxin Wei ,&nbsp;Xi Jia ,&nbsp;Pengyu Zhou ,&nbsp;Yujie Liu ,&nbsp;Yanyan Song ,&nbsp;Chen Cui ,&nbsp;Minjie Lu ,&nbsp;Kai Yang ,&nbsp;Xiuyu Chen ,&nbsp;Shujuan Yang ,&nbsp;Shihua Zhao","doi":"10.1016/j.lanwpc.2025.101573","DOIUrl":"10.1016/j.lanwpc.2025.101573","url":null,"abstract":"<div><h3>Background</h3><div>Recently, late gadolinium enhancement (LGE) has been identified as an important risk factor in pediatric hypertrophic cardiomyopathy (HCM). However, its prognostic significance in pediatric HCM remains to be fully validated, particularly in Asian population. This study aims to assess the prognostic value of LGE and explore its incremental utility in predicting sudden cardiac death (SCD) in pediatric HCM using data from a Chinese cohort.</div></div><div><h3>Methods</h3><div>231 primary HCM patients ≤18 years of age with cardiac magnetic resonance (CMR) were retrospectively and consecutively enrolled in a single center. The composite outcomes included SCD or equivalent events and heart failure-related events.</div></div><div><h3>Findings</h3><div>Of 231 patients (median age 15, IQR: 12–16), LGE was present in 195 (84.4%) with a median LGE extent of 4.7% (IQR: 2.0%–9.2%). During a median follow-up of 62 months (IQR: 39–85), 26 (11.3%) patients reached composite outcomes, and 13 (5.6%) patients experienced SCD events. Kaplan–Meier analysis showed a significantly increased risk of composite outcomes (log-rank P &lt; 0.001) and SCD (log-rank P &lt; 0.001) in the group with LGE extent ≥5%. In multivariable Cox analysis adjusted by clinical and imaging factors, LGE extent was independently associated with composite outcomes (adjusted HR: 1.15; P &lt; 0.001) and SCD (adjusted HR: 1.11; P = 0.009). For SCD events, the addition of LGE extent could improve the model performance of HCM Risk-Kids model (C-statistics: 0.65 versus 0.79, P = 0.015) and PRIMaCY model (C-statistics: 0.62 versus 0.82, P = 0.002), respectively.</div></div><div><h3>Interpretation</h3><div>In Chinese pediatric HCM, LGE serves as a risk factor in predicting adverse outcomes and may enhance SCD risk stratification strategies.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>National Key Research and</span> Development Program of China (<span><span>2021YFF0501400</span></span> and <span><span>2021YFF0501404</span></span>), the Key Project of the <span>National Natural Science Foundation of China</span> (<span><span>82430066</span></span>), and the <span>Yunnan Province Science and Technology</span> Platform and Talent Project (<span><span>202305AF150033</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"58 ","pages":"Article 101573"},"PeriodicalIF":7.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069988","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":"Breaking the cycle of panic and neglect: better preparedness for the next pandemic","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101586","DOIUrl":"10.1016/j.lanwpc.2025.101586","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"58 ","pages":"Article 101586"},"PeriodicalIF":7.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166910","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":"Evolution of strategic framework of policies related to dementia care and prevention in China from 2000 to 2024","authors":"Yu-ting Luo ,&nbsp;Xin Guan ,&nbsp;Qian Xiong ,&nbsp;Huali Wang","doi":"10.1016/j.lanwpc.2025.101561","DOIUrl":"10.1016/j.lanwpc.2025.101561","url":null,"abstract":"<div><h3>Background</h3><div>Dementia has emerged as a critical public health issue on the global policy agenda. Over the past 25 years, China has increasingly recognized the significant challenges posed by dementia and has made substantial strides in formulating relevant policies. This study aims to analyze the strategic framework of China’s dementia policy development to provide valuable insights for other low- and middle-income countries as they draft their national action plans.</div></div><div><h3>Methods</h3><div>Policy documents were systematically searched and retrieved from the official websites of pertinent policy agencies. The evolutionary phases of dementia policies were identified based on the timeline of policy issuance. A comparative thematic analysis was conducted to explore the evolution of policy content. Additionally, WordCloud analysis was utilized to examine the frequency of relevant terms within these documents. Co-occurrence network diagrams were then created to illustrate the evolving trends in the relationships among key terms and activities related to dementia care.</div></div><div><h3>Findings</h3><div>A total of 36 policy documents were included in this study. Three distinct phases were identified over the past 25 years: an incipient phase (2000–2014), a development phase (2015–2018), and a boom phase (2019–2024). Themes within dementia policies have progressively expanded and enriched across these phases. There has been a notable shift in focus from “intervention” during the incipient phase to “dementia prevention” in the boom phase, with themes such as “screening and evaluation” and “public education” gaining prominence. Stakeholder involvement has diversified to include entities like “community,” “institutions,” and “social workers.” Moreover, the scope of potential beneficiaries has broadened from “patients” to encompass “family members” and “caregivers.” The number of nodes related to dementia policies has increased, and their interconnections have strengthened over time.</div></div><div><h3>Interpretation</h3><div>Over 25 years, the themes, content, and stakeholders involved in China’s dementia-related policies have expanded significantly. Furthermore, the interconnection among key terms and content has grown stronger. These findings offer valuable references for advancing national dementia initiatives and updating dementia action plans in low- and middle-income countries.</div></div><div><h3>Funding</h3><div><span>Jiangxi Province Key Research</span> Base Program for Philosophy and Social Sciences (<span><span>23ZXSKJD28</span></span>) and <span>Beijing Medical Award Foundation</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"58 ","pages":"Article 101561"},"PeriodicalIF":7.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901925","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":"Unveiling pathways to enhance hypertension and diabetes care in rural China: a mixed methods study using the care cascade model","authors":"Xuejun Yin ,&nbsp;Zhenzhong Wang ,&nbsp;Jia Li ,&nbsp;Jiawen Ke ,&nbsp;Bin Jing ,&nbsp;Wenshuai Feng ,&nbsp;Qinglan Liu ,&nbsp;Jingsong Yang ,&nbsp;Alon Rasooly ,&nbsp;David Beran ,&nbsp;Kunihiro Matsushita ,&nbsp;Nizal Sarrafzadegan ,&nbsp;Yuxiu Li ,&nbsp;Luzhao Feng ,&nbsp;Ruitai Shao","doi":"10.1016/j.lanwpc.2025.101574","DOIUrl":"10.1016/j.lanwpc.2025.101574","url":null,"abstract":"<div><h3>Background</h3><div>Significant gaps remain in the screening, diagnosis, treatment, and control of hypertension and diabetes. This study aimed to assess the care cascade for these conditions in rural China, identifying barriers and facilitators at each stage to inform strategies for improving care delivery.</div></div><div><h3>Methods</h3><div>A sequential exploratory mixed methods study was conducted from July 2023 to June 2024 across three rural counties in China (Linqu, Gongyi, Wugang). The qualitative phase included in-depth interviews with policymakers, healthcare providers, and patients to identify contextual barriers and facilitators across each care cascade stage. Insights from the qualitative phase informed the design of a subsequent quantitative survey tool. The survey was administered to a stratified, non-random sample of rural residents to quantitatively assess factors identified in the qualitative phase.</div></div><div><h3>Findings</h3><div>Qualitative interviews were conducted with 82 participants, including 10 policymakers, 36 healthcare providers, and 36 patients with hypertension and/or diabetes. There were 7488 rural residents aged 35–74 years who completed the quantitative survey. Of these, 2668 (35.6%) had hypertension alone, 516 (6.9%) had diabetes alone, and 977 (13.0%) had both conditions. The care cascade for all conditions revealed significant gaps, with high rates of uncontrolled disease: 87.6% for hypertension, 72.3% for diabetes, and 96.6% for those with both conditions. Integrated qualitative and quantitative analyses highlighted key barriers at the patient level, including misconceptions about disease severity, low perceived need for care, and fear of diagnosis and lifelong medication use. Provider and system-level challenges, such as limited diagnostic capacity and inconsistent follow-up, were exacerbated by resource constraints in primary care. Facilitators included strong patient–provider relationships, targeted health education initiatives, the use of digital tools, and chronic disease reimbursement policies.</div></div><div><h3>Interpretation</h3><div>By combining qualitative and quantitative methods, the study identifies distinct care cascades for hypertension, diabetes, and comorbid hypertension and diabetes patients. The study highlights the need for integrated, context-specific strategies, including enhanced health education, stronger primary care systems, and the adoption of electronic health systems to improve the continuity of care in rural China.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>Chinese Academy of Medical Sciences</span> through the following grants: <span>Central Research Institute Fund</span> (Grant Nos. <span><span>2022-ZHCH330-01</span></span> and <span><span>2021-RC330-004</span></span>) and the <span>Disciplines Construction Project: Population Medicine</span> (Grant No. <span><span>WH10022022010</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"58 ","pages":"Article 101574"},"PeriodicalIF":7.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069467","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}