The Lancet Regional Health: Western Pacific最新文献

{"title":"Population-level productivity-adjusted life years lost in individuals with type 2 diabetes in Hong Kong: a life table modelling study","authors":"Hongjiang Wu ,&nbsp;Haobin Zhou ,&nbsp;Chuiguo Huang ,&nbsp;Aimin Yang ,&nbsp;Eric S.H. Lau ,&nbsp;Xinge Zhang ,&nbsp;Baoqi Fan ,&nbsp;Ronald C.W. Ma ,&nbsp;Alice P.S. Kong ,&nbsp;Elaine Chow ,&nbsp;Wing-Yee So ,&nbsp;Juliana N.M. Lui ,&nbsp;Juliana C.N. Chan ,&nbsp;Andrea O.Y. Luk","doi":"10.1016/j.lanwpc.2025.101585","DOIUrl":"10.1016/j.lanwpc.2025.101585","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes has become increasingly prevalent in young populations who are in their prime working years. We estimated the population-level productivity-adjusted life years (PALYs) lost in the working-age population with type 2 diabetes in Hong Kong.</div></div><div><h3>Methods</h3><div>We constructed life tables for individuals aged 20–64 years with type 2 diabetes, with simulated follow-up until retirement at 65 years. We then re-simulated the life tables for the same cohort with the hypothetical assumption that they did not have diabetes, adjusting for differences in mortality rates, labour force participation rates, and productivity. We calculated diabetes-related PALYs lost and assumed the cost of each PALY to be equivalent to the annual gross domestic product (GDP) per worker.</div></div><div><h3>Findings</h3><div>In 2019, 6.3% (n = 139,610) of men and 4.2% of women (n = 117,670) of working age had diagnosed type 2 diabetes in Hong Kong. Over their working lifetime, diabetes was associated with a 17.0% (95% CIs: 16.9%, 17.1%) reduction in PALYs in men and 27.8% (95% CIs: 27.6%, 28.0%) in women, equivalent to 1.0 (95% CIs: 1.0, 1.0) and 1.1 (95% CIs: 1.1, 1.1) PALYs lost per man and woman, respectively. Younger individuals with diabetes experienced greater per-person PALYs lost than older individuals. Men and women aged 20–24 years lost 3.9 (95% CIs: 3.9, 3.9) and 5.0 (95% CIs: 5.0, 5.0) PALYs per person due to diabetes, compared to 0.3 (95% CIs: 0.3, 0.3) PALYs in both sexes aged 60–64 years. The total PALYs lost resulted in a GDP loss of USD 15.3 (95% CIs: 15.2, 15.4) billion in men and USD 14.5 (95% CIs: 14.4, 14.6) billion in women.</div></div><div><h3>Interpretation</h3><div>Type 2 diabetes was associated with substantial reductions in PALYs and indirect economic costs in Hong Kong, with disproportionate impacts on women and younger populations. Targeted interventions are needed to address these disparities and mitigate the dual burden of health and economic consequences of diabetes.</div></div><div><h3>Funding</h3><div>Direct Grant for Research from <span>The Chinese University of Hong Kong</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101585"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221208","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":"Menstrual reform: cultural roots of delayed endometriosis diagnosis in the Asia–Pacific region","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101629","DOIUrl":"10.1016/j.lanwpc.2025.101629","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101629"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513850","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":"Effect of aspirin on small for gestational age neonates in pregnancies at high-risk for preeclampsia: a secondary analysis of a cluster randomised clinical trial","authors":"Yunyu Chen ,&nbsp;Long Nguyen-Hoang ,&nbsp;Linh Thuy Dinh ,&nbsp;Duy-Anh Nguyen ,&nbsp;Ritsuko K. Pooh ,&nbsp;Arihiro Shiozaki ,&nbsp;Mingming Zheng ,&nbsp;Yali Hu ,&nbsp;Runmei Ma ,&nbsp;Aditya Kusuma ,&nbsp;Tuangsit Wataganara ,&nbsp;Mahesh A. Choolani ,&nbsp;Mayumi Kaneko ,&nbsp;Suchaya Luewan ,&nbsp;Tung-Yao Chang ,&nbsp;Noppadol Chaiyasit ,&nbsp;Tongta Nanthakomon ,&nbsp;Yanmin Jiang ,&nbsp;Steven W. Shaw ,&nbsp;Wing Cheong Leung ,&nbsp;Liona C. Poon","doi":"10.1016/j.lanwpc.2025.101582","DOIUrl":"10.1016/j.lanwpc.2025.101582","url":null,"abstract":"<div><h3>Background</h3><div>Data on the effect of 100–160 mg/day aspirin prophylaxis on small for gestational age neonates (SGA) in pregnancies at high-risk for preeclampsia (PE) is limited. We aimed to determine the impact of aspirin administration on the incidence of SGA.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a multicenter stepped wedge cluster-randomized trial included 18 maternity/diagnostic units across ten Asian regions between 1st August 2019 and 28th February 2022. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At six-week intervals, one cluster was randomized to transition from non-intervention phase to intervention phase. In the intervention phase, women identified as high-risk for preterm-PE received aspirin from &lt;16 weeks until 36 weeks. Primary outcomes of the study were the delivery of an SGA neonate with birthweight &lt;10th, &lt;5th, or &lt;3rd percentile for gestational age, adjusted for maternal weight and height, gravida, parity, ethnicity and newborn sex. The trial was registered with <span><span>https://www.clinicaltrials.gov</span><svg><path></path></svg></span> (Unique identifier: <span><span>NCT03941886</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>42,897/48,647 women accepted screening for preterm-PE. 10,294 (26.91%) and 27,965 (73.09%) women were included in the non-intervention and intervention phases, respectively. 2909/4688 (62.05%) high-risk women received aspirin in the trial. Pooling data from the whole trial demonstrated that aspirin was associated with increased rates of early-SGA &lt;10th percentile (Relative risk, RR, 1.37, 95% confidence interval, CI 1.02 to 1.90). In the intervention phase, aspirin was associated with lower rates of SGA neonates with birthweight &lt;3rd, &lt;5th, and &lt;10th percentile, delivered before 32 weeks (early-SGA; RR, 0.39, 95% CI: 0.20 to 0.75, 0.38, 95%CI 0.20 to 0.70, 0.41, 95%CI 0.23 to 0.74 respectively) alongside a concurrent trend indicating an increased rate of late-SGA.</div></div><div><h3>Interpretation</h3><div>Aspirin prophylaxis appears to be associated with a reduction in the rate of early-SGA and a simultaneous increase in the rate of late-SGA neonates born at or after 32 weeks. These findings underscore the importance of implementing the screen-and-prevent program for preterm-PE to reduce early-SGA, and emphasizing the heightened alert in follow-up to optimize the outcomes for late-SGA.</div></div><div><h3>Funding</h3><div>This work was supported by the National Key Research and Development Program of China from the <span>Ministry of Science and Technology</span> of China (MOST <span><span>2021YFC2701604</span></span>) and a start up grant from the <span>Faculty of Medicine</span>, the <span>Chinese University of Hong Kong</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101582"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221245","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":"Primary healthcare quality of migraine in China: a study using unannounced standardized patients","authors":"Xueer Wu ,&nbsp;Qingping Xue ,&nbsp;Jay Pan","doi":"10.1016/j.lanwpc.2025.101594","DOIUrl":"10.1016/j.lanwpc.2025.101594","url":null,"abstract":"<div><h3>Background</h3><div>Migraine, a highly prevalent headache disorder, is associated with several adverse health outcomes if not properly managed, but little is known about the quality of primary healthcare for migraine. This study aims to assess the quality of primary healthcare for migraine in China using the unannounced standardized patient (USP) method.</div></div><div><h3>Methods</h3><div>This cross-sectional study, conducted as part of the Primary Health Care Quality Cohort in China (ACACIA) from April 2021 to January 2023, involved 196 unannounced visits for migraine across seven provinces. A two-step probability-proportional-to-size systematic sampling method was used to select institutions randomly. Ten qualified standardized patients (SPs) conducted the visits following standardized procedures. The quality of healthcare was assessed across five dimensions: effectiveness, safety, patient-centeredness, timeliness, and efficiency. The linear and logistic regression models were used to determine the factors influencing healthcare quality.</div></div><div><h3>Findings</h3><div>Our findings revealed that clinicians completed an average of 17.6% of the recommended questions and 4.9% of the recommended exams. The correct diagnosis and treatment rates were 31.1% and 62.2%, respectively. The average patient perception of patient-centeredness (PPPC) score was 2.5. The total time, including consultation and waiting time, averaged 14.5 min, with an average fee of 30.1 yuan. We found township health centers and hospitals outperformed clinics in completing recommended questions (<em>β</em> = 4.648, <em>P</em> = 0.024; <em>β</em> = 7.834, <em>P</em> &lt; 0.001, respectively), recommended exams (<em>β</em> = 2.485, <em>P</em> = 0.040 for hospitals) and diagnosis quality (<em>β</em> = 1.396, <em>P</em> = 0.005 for hospitals). Hospitals also charged higher fees (<em>β</em> = 19.666, <em>P</em> = 0.018) and had longer waiting times (<em>β</em> = 8.176, <em>P</em> &lt; 0.001) but shorter consultation times (<em>β</em> = −2.340, <em>P</em> = 0.020). Significant regional disparities were observed in western provinces, which are characterized by lower economic development and perform worse in terms of recommended questions, exams, and treatment despite incurring lower medical fees. While no significant differences in care quality between private and public institutions were found.</div></div><div><h3>Interpretation</h3><div>The quality of primary healthcare for migraine care in China is suboptimal, particularly in western regions and clinical settings. More actions are needed to enhance the quality of care and reduce regional and institutional disparities.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>National Science and Technology Major Project of China</span> (2024ZD0523902) and the <span>National Natural Science Foundation of China</span> (Grant No. 72374149).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101594"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280368","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":"A scoping review of health research in four Pacific Island countries and areas (Cook Islands, Fiji, Guam and Tonga) from 2014 to 2024","authors":"Greco Mark B. Malijan ,&nbsp;Mengji Chen ,&nbsp;Gui Xian Ong ,&nbsp;Johannes Paolo B. Cerrado ,&nbsp;Kidong Park","doi":"10.1016/j.lanwpc.2025.101602","DOIUrl":"10.1016/j.lanwpc.2025.101602","url":null,"abstract":"<div><div>Health research capacity remains constrained in Pacific Island Countries. This scoping review examined health research output in the Cook Islands, Fiji, Guam, and Tonga from 2014 to 2024 following the Arksey and O'Malley framework. A total of 752 publications met inclusion criteria, with output increasing markedly after 2020. A total of 447 studies (59%) were from Fiji, 142 (19%) from Guam, 95 (13%) from Tonga, and 68 (9%) from Cook Islands. Most studies described problems or causes, with fewer solution-focused, implementation, and evaluative studies. Majority of studies had international corresponding authors, and only half of studies included local co-authors. Where reported, two thirds had funding from primarily international sources, and local research ethics approval was present in less than half of the studies. These findings highlight concerns about research equity and sustainability, suggesting a need for greater local ownership, domestic funding, and ethical oversight to strengthen health research ecosystems in these countries.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101602"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329495","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":"The impact of integrated genomic surveillance on non-typhoidal Salmonella infection in Australia: an ecological study","authors":"Son Nghiem ,&nbsp;Nhung Mai ,&nbsp;My Tran ,&nbsp;Danielle M. Cribb ,&nbsp;Liliana Bulfone ,&nbsp;Patiyan Andersson ,&nbsp;Alireza Zahedi ,&nbsp;Tuyet Hoang ,&nbsp;Tehzeeb Zulfiqar ,&nbsp;Angeline Ferdinand ,&nbsp;Katie Glass ,&nbsp;Martyn D. Kirk ,&nbsp;Vitali Sintchenko ,&nbsp;Amy V. Jennison ,&nbsp;Benjamin P. Howden ,&nbsp;Emily Lancsar","doi":"10.1016/j.lanwpc.2025.101592","DOIUrl":"10.1016/j.lanwpc.2025.101592","url":null,"abstract":"<div><h3>Background</h3><div>Whole Genome Sequencing (WGS) is a powerful technology for monitoring and detecting outbreaks of infectious pathogens, including non-typhoidal <em>Salmonella</em> (NTS). Despite its higher cost than traditional typing methods, WGS offers numerous advantages, including higher resolution and potentially quicker turnaround time. However, evidence regarding its effectiveness in NTS surveillance has predominantly stemmed from micro-simulations or small-scale data. Notably, a recent systematic review identified a lack of real-world, large-scale evidence on the impact of WGS application in NTS surveillance. Our study fills this gap by estimating the effects of WGS on NTS surveillance in Australia using national notifiable disease datasets.</div></div><div><h3>Methods</h3><div>The main dataset was the National Notifiable Diseases Surveillance System (NNDSS) for NTS from 2009 to 2024. The treatment variable was defined as a binary variable representing the period when WGS was implemented in each jurisdiction of Australia. To minimise the effects of unobserved confounders, we employed a two-stage difference-in-difference (2sDiD) approach. This method estimated the parameters of state and period fixed-effects and then adjusted the observed outcomes from those fixed-effects in the first stage. The average treatment effect was obtained in the second stage by regressing the adjusted outcome against the treatment in the second stage. We also conducted a sensitivity analysis using a multi-period DiD model with a double machine-learning estimator.</div></div><div><h3>Findings</h3><div>Compared to the pre-WGS periods, the introduction of WGS was associated with an average of 11.6% reduction in NTS cases when a static specification was applied. Results of a dynamic specification were slightly higher, with a 12.7% reduction in NTS cases after WGS. The estimated effects increased to 17.5% when a multi-period DiD model with a double machine learning estimator was applied.</div></div><div><h3>Interpretation</h3><div>Our study shows that WGS was associated with a significant reduction (11.6%–17.5%) of NTS cases in Australia. Using the cost and break-even point of NTS from previous Australian studies, our findings suggest that WGS is associated with 7200–10,900 cases of NTS averted, saving US$11.3 m–US$17.0 m per year.</div></div><div><h3>Funding</h3><div><span>Australian National Health and Medical Research Council</span>, <span>Medical Research Futures Fund</span> (FSPGN00049), and <span>Investigator Grant</span> (GNT1196103) to BPH.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101592"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298443","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":"Early intensive blood pressure management after endovascular treatment in ischaemic stroke (IDENTIFY): a multicentre, open-label, blinded-endpoint, randomised controlled trial","authors":"Xuening Zhang ,&nbsp;Le Cao ,&nbsp;Simiao Wu ,&nbsp;Duolao Wang ,&nbsp;Hang Wang ,&nbsp;Dingwen Zhang ,&nbsp;Jian Wang ,&nbsp;Lizhang Chen ,&nbsp;Xue Lin ,&nbsp;Decai Qian ,&nbsp;Qinjun Zhang ,&nbsp;Lan Xiong ,&nbsp;Weiping Wang ,&nbsp;Yufeng Tang ,&nbsp;Bo Lei ,&nbsp;Tianzhu Liu ,&nbsp;Jie He ,&nbsp;Li Wang ,&nbsp;Fuqiang Guo ,&nbsp;Guangzong Li ,&nbsp;Yifei Ji","doi":"10.1016/j.lanwpc.2025.101589","DOIUrl":"10.1016/j.lanwpc.2025.101589","url":null,"abstract":"<div><h3>Background</h3><div>The optimal blood pressure (BP) management following successful endovascular treatment (EVT) in acute ischaemic stroke (AIS) patients remains unclear. This study investigated the safety and efficacy of intensive BP control in AIS patients who had received EVT within 6 h.</div></div><div><h3>Methods</h3><div>This randomised, multicentre, open-label, blinded-endpoint clinical trial (ChiCTR2200057770) was conducted at 63 stroke centres in China. Eligible participants had AIS due to large vessel occlusion in anterior circulation, underwent EVT within 6 h, and achieved successful recanalisation. Patients were randomised to intensive (systolic BP target &lt;130 mm Hg) or standard (systolic BP target &lt;180 mm Hg) management, maintained until 24 h post-EVT. The primary outcome was unfavourable functional outcome (modified Rankin Scale score of 3–6) at 90 days. The trial was terminated following a neutral interim analysis results and publication of counterpart randomised trials.</div></div><div><h3>Findings</h3><div>Between October 14, 2022 and March 18, 2024, 383 patients were randomised. Unfavourable functional outcome occurred in 71.0% (130/183) of the intensive-management group and 67.5% (135/200) of the standard-management group (risk ratio, 1.05; 95% CI, 0.92–1.20; p = 0.45). There was no significant difference in symptomatic intracerebral haemorrhage, malignant brain oedema, or all-cause death at 90 days.</div></div><div><h3>Interpretation</h3><div>Intensive BP management to &lt;130 mm Hg did not improve outcomes in AIS patients undergoing EVT within 6 h and achieved successful recanalisation. The optimal BP management strategies require further investigation.</div></div><div><h3>Funding</h3><div><span>Sichuan University West China Hospital</span>, <span>National Natural Science Foundation of China</span>, <span>National Key R&amp;D Programme of China</span>, and <span>Science and Technology Department of Sichuan Province</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101589"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221246","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":"Epidemiology of hand, foot, and mouth disease outbreaks before and during availability of EV-A71 vaccine in China's mainland: analysis of outbreak surveillance data from 2011 to 2023","authors":"Fengfeng Liu ,&nbsp;Yao Yi ,&nbsp;Yang Song ,&nbsp;Xiyu Zhang ,&nbsp;Tiancheng Xie ,&nbsp;Yanzhe Liu ,&nbsp;Yucun Chen ,&nbsp;Siping Huang ,&nbsp;Jie Zhang ,&nbsp;Yanping Zhang ,&nbsp;Zhaorui Chang ,&nbsp;Fuqiang Cui","doi":"10.1016/j.lanwpc.2025.101603","DOIUrl":"10.1016/j.lanwpc.2025.101603","url":null,"abstract":"<div><h3>Background</h3><div>Hand, foot, and mouth disease is a common contagious illness of childhood that causes a heavy disease burden in China's mainland. There are three enterovirus A71 (EV-A71) vaccines licensed and used in China since 2016. Our study describes changes in epidemiological characteristics of HFMD outbreaks following EV-A71 vaccine introduction.</div></div><div><h3>Methods</h3><div>Using HFMD outbreak data notified to China CDC during 2011–2023, we compared characteristics of HFMD outbreaks before and after EV-A71 vaccine licensure and availability. We determined risk factors associated with outbreak size with a multivariate regression model and explored county-level patterns of outbreak clusters using local indicators of spatial association (Anselin Local Moran's <em>I</em>).</div></div><div><h3>Findings</h3><div>During 2011–2023, there were 2838 HFMD outbreaks reported with more than ten cases each that were included in our study. There were 53,958 HFMD cases and 17 deaths in the included outbreaks. The median attack rate was 0.07% (IQR = 0.04%–0.13%) and the median outbreak duration was 14 days (IQR = 9–21). Outbreaks began before school seasons started and peaked during weeks 16–25; most (87.95%) occurred in kindergartens, followed by primary or secondary schools (6.69%). Coxsackievirus A16 (CV-A16) caused 54.94% of the HFMD outbreaks, EV-A71 caused 19.77%, CV-A6 caused 8.99%, CV-A10 caused 0.53%, and other enteroviruses caused 15.76%. After EV-A71 vaccine was introduced into the market as a non-National Immunization Program (NIP) vaccine, the proportion of outbreaks caused by EV-A71 declined to 2.93% in the southern provinces and 4.84% in the northern provinces, and CV-A16, CV-A6, CV-A10, and other enteroviruses increased in proportion. Before EV-A71 vaccine availability, high-high clusters occurred in 37 counties of nine provinces, expanding to 117 counties of nine provinces after vaccine introduction, mainly into southern provinces.</div></div><div><h3>Interpretation</h3><div>After EV-A71 vaccine was introduced to the market in China, fewer HFMD outbreaks were caused by EV-A71 and more were caused by CV-A16, CV-A6, and CV-A10. The changes of spectrum for HFMD and expansion of outbreaks hotspots associated with vaccine introduction calls for multi-enterovirus vaccine development for controlling HFMD outbreaks.</div></div><div><h3>Funding</h3><div><span>Key Laboratory of Epidemiology of Major Diseases (Peking University)</span>, <span>Ministry of Education</span>; <span>Prevention and Control Mechanisms for Major Infectious Diseases</span> in the Cyber-Physical-Social Tri-Space (2023YFC2308702).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101603"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313010","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":"The temporal shift of temperature-related injury incidence risk and its driving factors in China: a nationwide case-crossover study from 2006 to 2021","authors":"Jianxiong Hu ,&nbsp;Xiao Deng ,&nbsp;Shanghui Ye ,&nbsp;Ziyi Liang ,&nbsp;Ye Jin ,&nbsp;Yanfang Guo ,&nbsp;Tao Liu ,&nbsp;Yuliang Er ,&nbsp;Fangfang Zeng ,&nbsp;Pengpeng Ye ,&nbsp;Guanhao He ,&nbsp;Sujuan Chen ,&nbsp;Yuan Wang ,&nbsp;Ziqiang Lin ,&nbsp;Fengrui Jing ,&nbsp;Leilei Duan ,&nbsp;Cuirong Ji ,&nbsp;Wenjun Ma","doi":"10.1016/j.lanwpc.2025.101590","DOIUrl":"10.1016/j.lanwpc.2025.101590","url":null,"abstract":"<div><h3>Background</h3><div>Although several studies have demonstrated an association between ambient temperature and injury, the temporal trend of temperature-related injury risk remains unknown. This study aimed to examine changes in the effect of temperature on injury incidence and to explore its driving factors.</div></div><div><h3>Methods</h3><div>A time-stratified case-crossover study including over 11.5 million injury cases from 243 surveillance hospitals in China was conducted, and the injury incidence risks associated with temperature during the periods 2006–2013 and 2014–2021 were compared using conditional logistic regression model combined with distributed lag nonlinear model (DLNM). The socio-economic driving factors of the temporal change from 2006–2013 to 2014–2021 were further explored based on mixed-effects linear model and random forest algorithm.</div></div><div><h3>Findings</h3><div>The study encompassed a total of 11,512,467 injury cases from 2006 to 2021. The temperature-injury incidence relationship was linear, exhibiting a steeper slope between 2006 and 2013 compared to 2014 and 2021. The excess risk (ER) for per 1 °C increase in temperature was 1.08% (95% CI: 1.06%, 1.10%) for 2006–2013, which was significantly higher than the 0.83% (95% CI: 0.82%, 0.84%) for 2014–2021, representing a 23.31% (95% CI: 21.53%, 24.95%) decrease. Among 31 provinces, 74.19% experienced a decline in ER, predominantly in coastal regions. The primary factors influencing this temporal shift in temperature-related injury risk were identified as the child dependency ratio, air conditioners ownership per 100 rural households, and the birth rate.</div></div><div><h3>Interpretation</h3><div>Overall, the risk of temperature-related injuries in China has decreased over the past two decades, with demographic and socioeconomic factors playing pivotal roles in this decline.</div></div><div><h3>Funding</h3><div><span>National Natural Science Foundation of China</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101590"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213436","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":"Imaging in plasma cell disorders—consensus recommendations of the Asian myeloma network bone imaging workgroup","authors":"Chandramouli Nagarajan ,&nbsp;Natasha Fay Anthony ,&nbsp;Jens Hillengass ,&nbsp;Seok Jin Kim ,&nbsp;Chutima Kunacheewa ,&nbsp;Jay T. Datukan ,&nbsp;Gin Gin Gan ,&nbsp;Vo Thi Thanh Binh ,&nbsp;James Chim ,&nbsp;Jeffery S.Y. Huang ,&nbsp;Wenming Chen ,&nbsp;Kihyun Kim ,&nbsp;S. Vincent Rajkumar ,&nbsp;Brian G.M. Durie ,&nbsp;Wee Joo Chng ,&nbsp;Masahiro Abe","doi":"10.1016/j.lanwpc.2025.101597","DOIUrl":"10.1016/j.lanwpc.2025.101597","url":null,"abstract":"<div><div>The role of imaging in accurate classification and management of plasma cell disorders is substantial with the increasing evidence in the ability of cross-sectional imaging to identify disease related manifestations. International myeloma working group and nation-wide guidelines provide recommendations for guiding practice. However, there are remarkable variations in practice globally and in particular, adoption of incorrect imaging techniques due to lack of awareness/education, lack of equipment or personnel and resource constraints. These limitations are not specific to any particular geographic area. Hence in this complex and evolving imaging landscape, clinicians require practical guidance incorporating up-to-date and emerging evidence that is relevant to their healthcare system. In this manuscript we describe the two-pronged (minimum and enhanced) recommendations for imaging in different categories of plasma cell disorders from the Asian myeloma network bone imaging workgroup arrived through a questionnaire-based inquiry of prevailing imaging practices, discussion of those practices in the light of optimal evidence-based imaging recommendations, barriers in adoption of those recommendations and suggestions to overcome some of these barriers. There is an important role for these regionally relevant but globally applicable recommendations rooted in clinical practice which can serve as a medium for Physician/nursing, patient/carer education and to enable dialogue with healthcare technology appraisers/funders and secure interventions required to optimise practice in this field.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101597"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229986","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}