With China’s rapidly aging population, intrinsic capacity (IC) impairment among older adults has emerged as a critical public health issue, significantly contributing to increased disease burden and mortality. Currently, most studies focus on the impact of sleep duration on a single domain of IC in older adults; however, the overall association between sleep duration and IC remains largely unexplored. This study aims to investigate the relationship between sleep duration and IC in older adults and analyze the interrelationships across IC domains using Bayesian Network (BN). Data were retrieved from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2011 to 2020. A total of 5,430 participants without IC impairment at baseline were followed up to assess the prevalence of IC impairment across different sleep duration groups. Additionally, BN analysis was conducted on 42,746 participants between 2010 and 2020 to examine the relationship between sleep duration and five domains of IC. The prevalence of IC impairment in 2011 was 21.4

BackgroundSustained glycemic control in type 2 diabetes mellitus (T2DM) remains difficult in routine care. Long-term real-world evidence on diabetes management platforms in Traditional Chinese Medicine (TCM) hospitals is limited.MethodsWe conducted a real-world retrospective observational study at Guangdong Provincial Hospital of Traditional Chinese Medicine. Adults with T2DM enrolled in a hospital-based chronic disease management platform between January 2017 and December 2018 were followed for up to 36 months. Primary outcomes were longitudinal changes in glycated hemoglobin (HbA1c) and HbA1c target attainment (<7.0%). Secondary outcomes included fasting blood glucose (FBG), postprandial blood glucose (PBG), body mass index (BMI), and self-reported lifestyle and self-management behaviors. Linear mixed-effects models and generalized estimating equations were used for longitudinal analyses.ResultsA total of 546 patients were included. HbA1c decreased significantly over 36 months, and the proportion achieving HbA1c <7.0% increased from 30% at baseline to 49% at 12 months and remained around 45% at 24 and 36 months. Patients with baseline HbA1c >9.0% showed the greatest absolute reductions, whereas those with baseline HbA1c <7.0% generally maintained near-target levels. Clinically meaningful HbA1c reductions were common among participants with paired measurements, and sustained HbA1c target attainment was also observed across follow-up visits. In contrast, longitudinal changes in FBG were not significant, while reductions in PBG and BMI were modest. Improvements in lifestyle and self-management behaviors were limited.ConclusionsIn this TCM hospital setting, platform-based chronic disease management was associated with sustained improvement in HbA1c over 3 years. Greater benefit was observed in patients with poor baseline glycemic control, although improvements in behavioral indicators and other metabolic measures were limited.

The BRICS+ countries now encompass nearly half of the global population, yet the burden of lower respiratory infections (LRI) in this region remains largely unquantified. Employing robust age-period-cohort models on data sourced from the Global Burden of Disease Study (GBD) 2019, we systematically quantify the temporal patterns, underlying causes, and risk determinants of LRI within the BRICS+ cohort over nearly three decades (1990-2019). However, no studies have systematically assessed the disease burden caused by LRI in these countries. Using data from the Global Burden of Disease Study (GBD) 2019 and age-period-cohort models, we estimate the temporal patterns, causes, and risk determinants of LRI burden between 1990 and 2019. The findings showed between 1990 and 2019, BRICS+ countries faced a staggering total of 256,821,260 LRI events, reflecting more than half (52.5%) of the global incidence and a significant toll on public health, with LRI responsible for 34.2% of all related global deaths in 2019. Local drift showed that the improvement was most pronounced in children. In terms of numbers, pneumococci are the common LRI type in all countries. In terms of risk factors, our analysis reveals marked heterogeneity in risk factors across BRICS+ nations, highlighting the necessity for tailored public health strategies. The result shows that the observed decline in LRI burden concomitant with increasing socio-developmental indices suggests that collaborative health initiatives and knowledge sharing within the BRICS framework could markedly enhance public health outcomes for lower respiratory infections across the developing world.

Many countries aim to promote patient-centered, effective, efficient, and collaborative health systems. This study provides an overview of key design and operational features of medical alliances in China. It highlights the critical role of governmental political will, investment in health financing systems, consolidation of health resources, development of appropriate incentives, and establishment of robust monitoring and evaluation mechanisms in facilitating the effective operation of medical alliances.

Extensive evidence indicates intrinsic capacity (IC) as a strong predictor for health outcomes. Identifying conditions associated with IC impairment provides an opportunity to intervene to slow down, stop or reverse the declines. However, current evidence on factors affecting IC remains limited and inconsistent. This study aimed to identify factors associated with IC and the degree of IC impairment in older adults, thereby assisting in the development of comprehensive intervention strategies to mitigate the IC impairment. We analyzed data of 10,654 participants sourced from the fifth wave of the Chinese Longitudinal Healthy Longevity Survey (2020). Chi-square tests, and multinomial logistic regression analysis were employed to analyze the possible variables associated with IC impairment based on Andersen Model. 10,617 participants were included into this study, and 86.9

In China, internal migrants are a vulnerable population due to the challenges of the health and social system. With the increase of population aging, older migrants have an increasing risk of developing chronic conditions. To date, limited research is available to document the life and health status of older migrants with hypertension, especially those who live alone. This study aims to report and compare the life and health status of older migrants with hypertension among those who live alone or do not. Data were collected from the 2018 China Health and Retirement Longitudinal Survey (CHARLS). We included 40 older migrants with hypertension who lived alone and 214 who did not. The T-test, Chi-square test, Fisher exact test and Goodman and Kruskal’s Gamma were employed to test the differences between these groups. Additionally, multivariable linear and logistic regression analyses were used to confirm such differences. Of the 254 participants, 51.6

BACKGROUND:Diabetes mellitus (DM) is a rapidly growing global health emergency of the 21st century. Comorbidities, such as DM and depression, are common, presenting challenges to the healthcare system. AIM:To investigate the prevalence of depression and its associated factors in patients with DM and to strengthen the management of depression in this patient group. METHODS:Participants were selected from the 2018 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale, with a score of 10 or more indicating depression. Group differences were compared using analysis of variance and χ 2 tests. Binary logistic regression was conducted to explore the odds ratios (ORs) of independent variables. Following Andersen's behavioral model, predisposing, enabling, health need, and health behavior variables were introduced stepwise into the logistic model. RESULTS:Of the 1673 patients with diabetes, 41.4% had depressive symptoms. Regarding the predisposing characteristics, patients who were male (OR 0.426, P < 0.05), married (OR 0.634, P < 0.05), and received a high school education or higher (OR 0.432, P < 0.05) reported fewer depressive symptoms. Healthcare needs, including better self-rated health (OR 0.458 for fair and OR 0.247 for good, P < 0.05) and more sleep (OR 0.642, P < 0.05), were associated with a lower likelihood of depressive symptoms. In contrast, pain (OR 1.440 for mild and OR 2.644 for severe, P < 0.05) and impairment in the basic activities of daily living (OR 1.886, P < 0.05) were inversely associated. Additionally, patients highly satisfied with healthcare services (OR 0.579, P < 0.05) were less likely to have depressive symptoms. CONCLUSION:Nearly half of the patients with DM reported depressive symptoms, which were strongly associated with predisposing characteristics and healthcare needs, particularly physical pain and impairment in basic activities of daily living. Our study emphasizes the significance of enhanced screening and intervention for depression in diabetes care along with improved management of functional impairments.

OBJECTIVE:China has continued to improve tuberculosis (TB) control in the past decade; however, the sudden outbreak of COVID-19 hindered this progress. As a province with a large population and frequent international exchanges, Guangdong has been seriously affected by COVID-19. This study aimed to understand the effect of COVID-19 on TB detection in Guangdong based on the autoregressive integrated moving average (ARIMA) model. DESIGN:Time-series study. SETTING:Guangdong, China. OUTCOME MEASURES:We used the ARIMA model to quantify the effect of COVID-19 by comparing reported cases during the COVID-19 pandemic with predicted cases under a counterfactual scenario of no COVID-19 pandemic. After model evaluation, we chose ARIMA (0,1,2)(0,1,1)12 as the prediction model. We also highlighted that there were three emergency response periods in which the responses and public responses to COVID-19 varied. RESULTS:During the pandemic period, the average annual TB notification rate was 57.95/100 000, which decreased by 27.97% compared with the pre-pandemic period. Although it decreased by 6.17% on average annually in the pre-pandemic period, it decreased by 14.92% in 2020 as compared with 2019, but only decreased by 0.34% in 2021 as compared with 2020. The results of the ARIMA model showed that the number of reported cases in 2020 decreased by 6.62% compared with that of the predicted cases, but this decreased by 0.42% only in 2021. The most seriously affected period was the second-level emergency response period in 2020, when the relative difference between reported and predicted cases reached the peak (-16.43%). The least affected period was the third-level emergency response period of 2021, the reported cases recovered and exceeded the predicted cases, with a gap of 0.77%. CONCLUSIONS:TB detection in Guangdong had generally declined during the COVID-19 pandemic, which might be related to the movement restrictions, diverted resources and patients' concerns. This decline would lead to the delay or even interruption of diagnosis and treatment, which would cause the regression of TB control. To improve TB detection, it is important for stakeholders to take consorted effort during public health emergencies.

The impairment of intrinsic capacity (IC) among older adults is a significant global health challenge, impacting their well-being and quality of life. Despite global efforts to promote healthy aging, research on the prevalence of IC impairment in the Chinese population remains limited. This study aims to examine the prevalence of IC impairment among Chinese older adults and to explore the associations between sociodemographic, health status, and lifestyle factors with IC impairment. This study utilized data from the China Health and Aging Tracking Survey (CHARLS) 2020. IC was assessed across five domains in line with WHO guidelines: cognition, locomotion, vitality, sensory, and psychological. Associations between IC impairment and sociodemographic, health status, and lifestyle factors were analyzed using chi-square tests. Binary logistic regression was employed to identify factors associated with IC impairment. Among 6,941 respondents aged 60 years and above, 83.8

Background: Recent setbacks in malaria control in Comoros demand a reassessment of its evolving epidemiology. Methods: Using the Global Burden of Disease (GBD) Study 2021 data, we analyzed malaria trends from 2010 to 2021, stratified by sex. We quantified the contributions of demographic and epidemiological factors to these trends and identified risk factors for malaria-related disability-adjusted life years (DALYs). Results: From 2010 to 2021, malaria cases, deaths, and DALYs in Comoros fell by −90.22%, −94.44%, and −94.88%; and the corresponding age-standardized rates declined with EAPCs of −18.70% (95% CI: −33.77 to −0.20), −23.89% (95% CI: −36.58 to −8.66), and −24.49% (95% CI: −36.88 to −9.66), with steeper declines in males. Nevertheless, all indicators increased in 2018 and again in 2021. In sub-Saharan Africa, only cases increased, while other metrics declined slightly. In Comoros, incidence shifted mainly to adults ≥25 years, unlike sub-Saharan Africa, where children < 5 years were most affected. Population growth drove increases in cases, deaths and DALYs, whereas epidemiological shifts had the opposite effect. Child underweight was the leading risk factor for malaria DALYs. Conclusions: Existing interventions can achieve malaria control in Comoros; however, rebounds in 2018 and 2021 highlight the need to identify and address drivers of resurgence.

Background:Little is known about the relationship between syndromes in Traditional Chinese Medicine (TCM) and chronic diseases coded by Western Medicine (WM). TCM hospitals where both WM and TCM are practiced offer an opportunity to assess this relationship. TCM, based on syndrome differentiation and treatment, may aid in guiding treatment and predicting length of stay and healthcare costs. However, inconsistent coding of TCM syndromes arises due to variations in diagnostic interpretation, subjective assessment, and lack of standardized coding practices. The objective was to assess the correlation between WM diagnoses and TCM syndromes, accounting for diagnostic miscoding in the data. Methods:We examined discharge data from 1,218,224 records for patients aged 45 and above, diagnosed with cardiometabolic diseases and admitted to TCM hospitals between 2017 and 2022, stays ranging from 24-hours to 90 days. Latent class analysis (LCA) was used to measure the correlation between TCM syndromes and WM. To address potential diagnostic errors, we applied bivariate probit models with instrumental variable (IV). Results:There were 580,698 (47.67%) records for males, while 989,702 (81.24%) records from Tertiary-A hospitals. The LCA and probit models revealed that TCM syndrome diagnoses had a high ratio of noise to signal. After correcting for diagnostic errors, significant associations were found between WM diagnoses and TCM syndromes. Notably, diabetes mellitus was strongly associated with syndrome/pattern of qi and yin deficiency (coefficient = 2.711); cerebrovascular diseases showed strong associations with syndrome/pattern of qi deficiency with blood stasis (coefficient = 2.433) and syndrome/pattern of wind and phlegm blocking collaterals (coefficient = 3.176). All patterns had strong marginal effects (P < 0.001). Conclusion:This large-scale study quantitatively maps the relationship between TCM and WM diagnoses. It introduces a new statistical approach to understanding the correlation between these two diagnostic systems, offering insights into integrated medicine for secondary prevention.

Background The decline in intrinsic capacity (IC) among older adults is a significant global health challenge, impacting their well-being and quality of life. Despite global efforts to promote healthy aging, research on factors contributing to IC decline in the Chinese population is limited. This study aims to investigate the decline of intrinsic capacity in Chinese older adults and to explore the influence of sociodemographic, health status, and lifestyle factors on the decline of intrinsic capacity. Methods Prevalence of intrinsic capacity decline was described using frequency analysis, while chi-square tests were used to analyze its associations with sociodemographic characteristics, health status, and lifestyle factors. Binary logistic regression analysis was used to identify significant factors influencing the decline of intrinsic capacity (α = 0.05). Results Among 6,941 respondents aged 60 years and above, 83.8% reported a decline in intrinsic capacity. Cognitive impairment was predominant (71.8%), followed by psychological (40.4%), locomotion (19.8%), vitality (17.2%), and sensory impairments (8.9%). Sociodemographic factors associated with a decline in intrinsic capacity included female gender, age 80 and older, unmarried, divorced or widowed status, rural residence, low education, and lack of health or pension insurance (p < 0.05). From the perspective of health status, factors associated with higher rates of intrinsic capacity decline include poor self-rated health, multiple chronic conditions, recent falls, frequent physical pain, recent outpatient visits, hospitalizations, and pessimistic life expectancy (p < 0.05). Lifestyle factors such as alcohol consumption, lack of social participation, prolonged sleep duration, and no Internet use were also linked to higher rates of intrinsic capacity decline (p < 0.05). The results of the binary logistic regression indicated that age, marital status, residence address, education level, pension insurance status, self-rated health, the presence of multiple chronic conditions, frequency of perceived physical pain, subjective life expectancy, social participation, sleep duration, and Internet access significantly influenced the decline of intrinsic capacity in older adults (p < 0.05). Conclusions The decline in intrinsic capacity among older adults in China, particularly in cognitive impairment, is concerning. Targeted interventions are necessary for vulnerable populations, especially those who are older, divorced or widowed, living in rural areas, or have lower education levels. Enhancing social pensions, promoting social participation, encouraging healthy sleep patterns, and improving digital inclusion to improve intrinsic capacity among older adults is important.

With the inclusion of new member states, nearly half of the world's population today residence in the BRICS + countries. However, no studies have systematically assessed the disease burden caused by lower respiratory tract infections (LRI) in these countries. Using data from the Global Burden of Disease Study (GBD) 2019 and age-period-cohort models, we estimate the temporal patterns, causes, and risk determinants of LRI burden between 1990 and 2019. The findings showed BRICS + experienced a total of 256821260 LRI events, accounting for 52.5% of the global incidence (488902504), accounting for 34.2% of the global LRI deaths [2493199 (2736184 to 2268183)] In 2019. The age standardized mortality rate of LRIs in BRICS + countries ranged from 13.8 to 86.4 cases per 100,000 people. Local drift showed that the improvement was most pronounced in children. In terms of numbers, pneumococci are the common LRI type in all countries. In terms of risk factors, countries show strong heterogeneity. From 1990 to 2019, the burden of LRI generally decreased as SDI increased. The result shows that BRICS countries should strengthen cooperation and exchanges in health and provide better experience for other developing countries to reduce the burden of LRI.

Background The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage. Objective This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China. Methods Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI. Results Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI. Conclusions We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.

Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235–2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235–3.737, primary to secondary school education: OR 1.964, 95% CI 1.272–3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075–3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080–2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138–2.226), pain (OR 1.392, 95% CI 1.005–1.928) and abnormal sleep (OR 1.557, 95% CI 1.126–2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.

Abstract Background During the COVID-19 pandemic, the Chinese government implemented nationwide public health interventions to control its spread. However, the impact of these measures on other infectious diseases remains unclear. Methods The incidence of three types of notifiable infectious diseases in China were analyzed between 2013 and 2021. The seasonal Mann-Kendall test and Mann-Kendall mutation test were employed to examine trends and mutations in the time series. Based on the counterfactual inference, historical incidence rates were employed to construct SARIMA models and predict incidence between January 2020 and December 2021. Differences between reported and predicted incidences during the pandemic were compared using the Mann-Whitney U test. Results Between 2013 and 2019, the incidence rate of three types of notifiable infectious diseases fluctuated between 494.05/100,000 and 550.62/100,000. No discernible trend was observed for types A and B infectious diseases (Z = −1.344, P = 0.18). A significant upward trend was observed for type C infectious diseases (Z = 2.56, P = 0.01). In 2020, the overall incidence rate of three types of notifiable infectious diseases decreased to 367.08/100,000. Compared to predicted values, the reported incidence of three types of infectious diseases was, on average, 30.05% lower in 2020 and 16.58% lower in 2021. Conclusion The public health interventions implemented during the pandemic had a positive consequence on the prevention and control of other infectious diseases, with a particularly notable effect on type C infectious diseases. Among the diseases with different transmission routes, respiratory diseases and gastrointestinal or enteroviral diseases decreased significantly.

Background With the change of disease spectrum and the development of modern medical model,traditional Chinese medicine(TCM)is playing an important role in disease prevention,health care and rehabilitation.It is necessary to further promote the development of prevention of disease in TCM and vigorously promote the unique role of TCM in maintaining and promoting people's health.However,popularization and education of the concept of prevention of disease in TCM among community residents remains unclear.Objective To understand the overall awareness,trust,and adoption behavior of prevention of disease in TCM of community residents in Guangzhou,and explore the influencing factors of community residents'trust in prevention of disease in TCM services.Methods From April to August 2022,a stratified cluster sampling method was used to interview 652 community residents from 12 streets in 4 administrative regions of Guangzhou city based on geographic location(central city,urban-rural areas,and suburbs)and economic factors by questionnaires.The survey included residents'basic information,awareness and access to knowledge of prevention of disease in TCM,as well as their demand,utilization and trust in it.The influencing factors of community residents'trust in prevention of disease in TCM services were explored by binary Logistic regression analysis.Results Among the 652 community residents,67.79%(442/652)were aware of prevention of disease in TCM,77.91%(508/652)trusted prevention of disease in TCM services,69.63%(454/652)had received traditional TCM physiotherapy,and only 6.59%(43/652)had received prevention of disease in TCM services more than 4 times in the past year.Univariate correlation analysis showed that age(χ2=9.218),household type(χ2=19.356),marriage status(χ2=2.490),occupation(χ2=17.889),and medical insurance payment type(χ2=13.516)were influencing factors of residents'trust in prevention of disease in TCM services.Binary Logistic regression analysis showed that household type(non-agricultural,agricultural to resident,and non-agricultural to resident)was an influential factor for community residents'trust in prevention of disease in TCM services(OR=2.646,5.593,10.502).Conclusion The overall awareness(67.79%)and trust(77.91%)of prevention of disease in TCM among community residents in Guangzhou are relatively high,but the actual number of services received is insufficient,with a phenomenon of knowledge-attitude-practice separation.Community residents with non-agricultural household type have a higher level of trust,while those with agricultural household type have a lower level of trust.During popularization and services of prevention of disease in TCM,it is necessary to fully utilize the residents'preferred forms,as well as to target specific groups,so as to cultivate the health habits of prevention of disease in community residents.

Background: Antibiotic resistance has become a serious global public health threat this century. This study aimed to assess knowledge, attitudes, and practices (KAP) towards antibiotics and antibiotic resistance among the public at different education attainment. Methods: This cross-sectional study was conducted in China from November 2020 to April 2021. Knowledge, attitude and practices of antibiotics and antibiotic resistance were assessed using a self-administered questionnaire. The questionnaire included sociodemographic characteristics, KAP for antibiotics and antibiotic resistance. Linear regression analysis and XGBoost models were employed to identify factors associated with KAP of antibiotics and antibiotic resistance. Results: A total of 3,135 respondents completed the questionnaire, of which there were slightly more respondents with a college degree and above (1697, 54.1%) than those with a below college degree (1438, 45.9%). Respondents’ knowledge, attitude, and practices concerning antibiotics and antibiotic resistance remained at a moderate level. Both linear regression analysis and XGBoost models revealed that education attainment was significantly associated with KAP of respondents. Respondents with higher education attainment exhibited better knowledge, a more positive attitude, and more rational practices regarding antibiotics and antibiotic resistance. Conclusion: The insufficient KAP of the public towards antibiotics and antibiotic resistance may lead to an increase in irrational antibiotic use. It is necessary to enhance public education on antibiotics and antibiotic resistance by diversifying the forms of education.

OBJECTIVES:This study investigated the genotype-specific dynamics of molecular HIV clusters (MHCs) in Guangzhou, China, aiming to enhance HIV control. METHODS:HIV pol sequences from people with HIV (PWH) in Guangzhou (2008-2020) were obtained for genotyping and molecular network creation. MHCs were identified and categorized into three types: emerging, growing, or stable. Clustering rates, proportions of cluster types, and members within each type were calculated and their trends were assessed using joinpoint regression. RESULTS:Among 8395 PWH, the most prevalent HIV-1 genotypes were CRF07_BC (39.7%) and CRF01_AE (32.6%). The genotype composition has been stable since 2012 (Ps > 0.05). The overall clustering rate was 43.3%, with significant variations across genotypes (P < 0.001), indicating genotype-specific transmission fitness. Significant declines in overall and genotype-specific clustering rates toward the end of 2020 (Ps < 0.05), potentially offer support for HIV control efforts in reducing local infections. The continuously increasing proportions of stable clusters and the gradually decreasing proportions of emerging and growing clusters (either Ps < 0.05 or Ps > 0.05) suggest a trend toward stable molecular network structure. However, growing clusters exhibited CRF55_01B, CRF07_BC, and CRF59_01B dominance that indicate their priority for interventions. CONCLUSION:The evolving MHCs highlight the genotype-specific cluster dynamics, providing fresh insights for enhanced prevention and control strategies.

Objectives The objective of this study is to understand the characteristics and patterns of the first antibiotic prescriptions for children with acute respiratory infections (ARIs) in rural primary healthcare (PHC) in Guangdong province, China.Design Cross-sectional study.Setting and participants We used prescription data generated from the electronic medical record system of 37 township hospitals in two counties of Shaoguan City, Guangdong province. 46 699 first prescriptions for ARIs in children aged 0–18 years were screened from 444 979 outpatient prescriptions recorded between November 2017 and October 2018.Outcome measures Descriptive analyses were used to report sociodemographic characteristics and antibiotic prescribing profiles. χ2 analysis and binary logistic regression were used to analyse the factors associated with antibiotic prescriptions in children.Results Of the 46 699 sampled cases, 83.00% (n=38 759) received at least one antibiotic as part of their first prescription. Of the 38 759 sampled cases treated with antibiotics, 40.76% (n=15 799), 56.15% (n=21 762) and 31.59% (n=12 244) received parenteral antibiotics, broad-spectrum antibiotics and two or more kinds of antibiotics, respectively. Multivariable analysis showed that children aged ≤5 years were less likely to be prescribed with antibiotics than those aged 16–18 years (OR 0.545, p<0.001). Those with health insurance were more likely to be prescribed with antibiotics than those without health insurance (OR 1.677, p<0.001).Conclusions Misuse and overuse of antibiotics were found in the prescriptions of children with ARIs in rural PHC. Antibiotic stewardship programme should be established to reduce the level of antibiotic prescriptions among children with ARIs in rural PHC, especially regarding the prescriptions of broad-spectrum antibiotics and parenteral antibiotics, tailored to different ages, sex and health insurance groups.