Importance:Clinical decision support systems (CDSSs) are increasingly used to improve guideline-based hypertension care; however, their association with antihypertensive treatment intensification and blood pressure (BP) control in primary care practices remains unclear. Objectives:To evaluate whether CDSS implementation was associated with improvement in antihypertensive treatment intensification and BP control in primary care practices and to examine the association between treatment intensification and BP change. Design, Setting, and Participants:This post hoc secondary analysis used the data from a pragmatic cluster randomized clinical trial conducted from August 1, 2019, to July 31, 2022, in urban primary care practices in China among 4612 adult patients with hypertension and uncontrolled BP at baseline. Data analysis was conducted from August 1, 2024, to September 1, 2025. Interventions:Practices randomized to the intervention group used a real-time, guideline-based CDSS for guiding antihypertensive treatment, while control practices delivered usual care. Main Outcomes and Measures:Treatment intensification rate, defined as the percentage of clinic visits with uncontrolled BP during which there was an increase in the class or dose of antihypertensive medication. Among patients with uncontrolled BP at baseline, treatment intensification was assessed at visits with uncontrolled BP, and BP control was evaluated at the last follow-up visit. Treatment intensity was summarized using a treatment intensification score reflecting the frequency of medication intensification relative to guideline expectations. Results:Among 4612 patients with uncontrolled BP at baseline (median age, 63 years [IQR, 52-74 years]; 2648 men [57.4%]; 2134 [46.3%] in CDSS group and 2478 [53.7%] in control group) from 93 practices, treatment intensification rates were higher in the CDSS group than in the usual care group (47.3% [95% CI, 40.1%-54.6%] vs 11.6% [95% CI, 8.9%-14.9%]; adjusted odds ratio [OR], 6.87 [95% CI, 4.90-9.64]; P < .001). The median treatment intensification score was higher in the CDSS group than in the usual care group (-0.25 [IQR, -0.50 to 0] vs -0.50 [IQR, -0.75 to -0.30]; mean difference, 0.22 [95% CI, 0.17-0.28]). Each 0.22-point increase in the treatment intensification score was associated with a mean systolic BP change of -3.8 mm Hg (95% CI, -4.1 to -3.5 mm Hg). BP control rates were similar between groups. Conclusions and Relevance:In this post hoc analysis of a cluster randomized clinical trial, CDSS implementation was associated with increased treatment intensification but was not associated with improvements in overall BP control. These findings suggest that stronger implementation strategies may be needed to translate treatment intensification into improved BP outcomes. Trial Registration:ClinicalTrials.gov Identifier: NCT03636334.

BACKGROUND:We aimed to develop and validate a model to predict 1-year mortality risk among patients hospitalized for acute heart failure (AHF), build a risk score and interpret its application in clinical decision making. METHODS:By using data from China Patient-Centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, which prospectively enrolled patients hospitalized for AHF in 52 hospitals across 20 provinces, we used multivariate Cox proportional hazard model to develop and validate a model to predict 1-year mortality. RESULTS:There were 4,875 patients included in the study, 857 (17.58%) of them died within 1-year following discharge of index hospitalization. A total of 13 predictors were selected to establish the prediction model, including age, medical history of chronic obstructive pulmonary disease and hypertension, systolic blood pressure, Kansas City Cardiomyopathy Questionnaire-12 score, angiotensin converting enzyme inhibitor or angiotensin receptor blocker at discharge, discharge symptom, N-terminal pro-brain natriuretic peptide, high-sensitivity troponin T, serum creatine, albumin, blood urea nitrogen, and highly sensitive C-reactive protein. The model showed a high performance on discrimination (C-index was 0.759 [95% confidence interval: 0.739, 0.778] in development cohort and 0.761 [95% confidence interval: 0.731, 0.791] in validation cohort), accuracy, calibration, and outperformed than several existed risk scores. A point-based risk score was built to stratify low- (0-12), intermediate- (13-16), and high-risk group (≥17) among patients. CONCLUSIONS:A prediction model using readily available predictors was developed and internal validated to predict 1-year mortality risk among patients hospitalized for AHF. It may serve as a useful tool for individual risk stratification and informing decision making to improve clinical care.

Background: To examine the associations between cumulative depressive symptoms and subsequent mortality among patients hospitalized for acute hear failure (AHF). Methods: By using data from a prospective cohort study of patients with HF, depressive symptoms were measured by using Patient Health Questionnaire-2 (PHQ-2) at admission, 1-and 12-month after discharge. Cumulative depressive symptoms were interpreted by cumulative PHQ-2 score and cumulative times of depressive symptoms. Outcomes included subsequent 3-year all-cause and cardiovascular mortality. Results: We included 2347 patients with the median follow-up of 4.4 (interquartile range [IQR]: 4.0-5.0) years. Tertile 3 of cumulative PHQ-2 score had the highest risk of all-cause (hazard ratio [HR]: 1.47, 95 % confidence interval [CI]: 1.21-1.78) and cardiovascular mortality (HR: 1.51, 95 % CI: 1.21-1.89) compared with Tertile 1; patients with >= 2 times of depressive symptoms had the highest risk of all-cause (HR: 1.62, 95 % CI: 1.31-2.00) and cardiovascular mortality (HR: 1.60, 95 % CI: 1.25-2.05) compared with patients without any depressive symptom. Cumulative PHQ-2 score provided the highest level of incremental prognostic ability in predicting the risk of all-cause (C-statistics: 0.64, 95 % CI: 0.62-0.66) and cardiovascular mortality (C-statistics: 0.65, 95 % CI: 0.62-0.67) on the basis of Get With The Guidelines-Heart Failure score. Conclusion: Cumulative depressive symptoms were associated with the increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with HF. Repeated depressive symptom measurements could be helpful to monitor long-term depressive symptoms, identify targeted patients and perform psychological interventions and social support to improve clinical outcomes among patients with AHF.

Scarlet fever (SF) is an acute respiratory transmitted disease that primarily affects children. The influence of meteorological factors and air pollutants on SF in children has been proved, but the relevant evidence in Northwest China is still lacking. Based on the weekly reported cases of SF in children in Lanzhou, northwest China, from 2014 to 2018, we used geographical detectors, distributed lag nonlinear models (DLNM), and bivariate response models to explore the influence of meteorological factors and air pollutants with SF. It was found that ozone (O3), carbon monoxide (CO), sulfur dioxide (SO2), temperature, pressure, water vapor pressure and wind speed were significantly correlated with SF based on geographical detectors. With the median as reference, the influence of high temperature, low pressure and high pressure on SF has a risk effect (relative risk (RR) > 1), and under extreme conditions, the dangerous effect was still significant. High O3 had the strongest effect at a 6-week delay, with an RR of 5.43 (95

Background To examine the association between cumulative cognitive function and subsequent mortality among patients hospitalized for acute heart failure (AHF).Methods Based on a prospective cohort of patients hospitalized for AHF, cognitive function was measured using Mini-Cog test at admission, 1- and 12-month following discharge. Cumulative cognitive function was interpreted by cumulative Mini-Cog score and cumulative times of cognitive impairment. Outcomes included subsequent all-cause and cardiovascular mortality.Results 1 454 patients hospitalized for AHF with median follow-up of 4.76 (interquartile range [IQR]: 4.18-5.07) years were included. Tertile 1 of cumulative Mini-Cog score had the highest risk of all-cause (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.14-2.03) and cardiovascular mortality (HR: 1.40, 95% CI: 1.02-1.93) compared with Tertile 3; patients with >= 2 times of cognitive impairment had the highest risk of all-cause (HR: 1.34, 95% CI: 1.03-1.73) and cardiovascular mortality (HR: 1.25, 95% CI: 0.93-1.67) compared with patients without any cognitive impairment. Cumulative Mini-Cog score provided the highest incremental prognostic ability in predicting all-cause (C-statistics: 0.64, 95% CI: 0.61-0.66) and cardiovascular mortality (C-statistics: 0.63, 95% CI: 0.60-0.67) risk on the basis of Get With The Guidelines-Heart Failure score.Conclusions Poor cumulative cognitive function was associated with increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with AHF. Longitudinal assessment and monitoring of cognitive function among patients with AHF would be of great importance in identifying patients at greater risk of self-care absence for optimizing personal disease management in clinical practice.

Japanese encephalitis (JE), a mosquito-borne zoonotic disease, has emerged as a major public health concern around the world. Previous research has shown that JE has serious sequelae, and the recent shift in the population from children to adults presents a significant challenge for JE treatment and prevention. Therefore, we examined the differences in clinical manifestations (clinical symptoms, clinical signs, complications, and clinical typing) of JE between children and adults over the 15 years in Gansu Province to provide a theoretical basis for better response to JE treatment. Clinical typing was found to be statistically significant in the child versus adult groups and the groups with or without vaccination. Only the dysfunction of consciousness differed statistically between children with and without vaccination, whereas neurological symptoms such as vomiting (jet vomiting), irritability, drowsiness, convulsions, and hyperspasmia differed statistically between children and adults, and the rest of the symptoms did not differ statistically. Only pupil size changes were statistically different in clinical signs between the children with and without vaccination, while blood pressure changes, change in pupil size, positive meningeal stimulation signs, and positive pathological reflexes (increased muscle tone and Babinski's sign) were statistically different between adults and children. Bronchopneumonia was the most common complication, especially in adults. Therefore, the authors believe that children and adults differ in some clinical manifestations and propose that efforts should be directed toward developing individualized treatment plans for different age groups and employing more effective supportive treatment for various populations. In addition, we suggest expanding the coverage of the JE vaccine and increasing overall vaccination rates and adopting multiple measures in conjunction with JE prevention and control.

In 2008, Mainland China included the Japanese encephalitis (JE) vaccine in the Expanded Program on Immunization (EPI) to control the JE epidemic. However, Northwest China experienced the largest JE outbreak since 1994 in 2018, and the effects of the EPI in different regions are unclear. Therefore, we used an interrupted time series design to evaluate the effects of the EPI in different regions. In this study, β1 and β1+β3 represented the slope or trend of the JE incidence before and after the EPI, respectively; β2 was the level change of the JE incidence immediately after the EPI; β3 represented the slope change of the JE incidence before and after the EPI. We found that the JE incidence in all regions showed a decreasing trend before the EPI (β1<0.000, P<0.05). The JE incidence in Mainland China (β2=-7.669, P<0.05), East China (β2=-9.791, P<0.05), Central China (β2=-10.695, P<0.05), South China (β2=-6.551, P<0.05) and Southwest China (β2=-2.216, P<0.05) decreased by 7.669/100,000, 9.791/100,000, 10.695/100,000, 6.551/100,000 and 2.216/100,000 immediately after the EPI, and the EPI had short-term effects on the JE incidence in these regions. The slope of the JE incidence in Mainland China (β3=0.272, P<0.05), East China (β3=0.337, P<0.05), Central China (β3=0.381, P<0.05), South China (β3=0.254, P<0.05) and Southwest China (β3=0.081, P<0.05) increased by 0.272, 0.337, 0.381, 0.254 and 0.081 after the EPI, and the EPI had long-term effects on the JE incidence in these regions. The JE incidence in many regions (excluding North China) showed a decreasing trend after the EPI (β1+β3 <0.000). Northwest China (GDP from 2008 to 2020 ranked last in Mainland China) and Southwest China (GDP from 2008 to 2020 ranked fifth in Mainland China), with underdeveloped economy, used to be low-epidemic regions of JE, but they have become high-epidemic regions in recent years. Economic development may contribute to the geographic variations in the effects of the EPI. Therefore, it is significant for JE control in Mainland China to increase support for underdeveloped regions and adjust the vaccine strategy according to the new epidemic situation of JE.

This paper aims to study the cumulative lag effect of meteorological factors on brucellosis incidence and the prediction performance based on Random Forest model. The monthly number of brucellosis cases and meteorological data from 2015 to 2019 in Yongchang of Gansu Province, northwest China, were used to build distributed lag nonlinear model (DLNM). The number of brucellosis cases of lag 1 month and meteorological data from 2015 to 2018 were used to build RF model to predict the brucellosis incidence in 2019. Meanwhile, SARIMA model was established to compare the prediction performance with RF model according to R 2 and RMSE. The results indicated that the population had a high incidence risk at temperature between 5 and 13 °C and lag between 0 and 18 days, sunshine duration between 225 and 260 h and lag between 0 and 1 month, and atmosphere pressure between 789 and 793.5 hPa and lag between 0 and 18 days. The R 2 and RMSE of train set and test set in RF model were 0.903, 1.609, 0.824, and 2.657, respectively, and the R 2 and RMSE in SARIMA model were 0.530 and 7.008. This study found significant nonlinear and lag associations between meteorological factors and brucellosis incidence. The prediction performance of RF model was more accurate and practical compared with SARIMA model.

Acute exacerbation of chronic obstruction pulmonary disease (AECOPD) as a respiratory disease, is considered to be related to air pollution by more and more studies. However, the evidence on how air pollution affect the incidence of AECOPD and whether there are population differences is still insufficient. Therefore, we select PM10, PM2.5, SO2, NO2, CO, and O3 as representatives combined with daily AECOPD admission data from 1 January 2015 to 26 June 2016 in the rural areas of Qingyang, northwestern China to explore the associations of air pollution with AECOPD. Based on a time‐stratified case‐crossover design, we constructed a distributed lag nonlinear model to qualify the single and cumulative lagged effects of air pollution on AECOPD. Stratified related risks by sex and age were also reported. The cumulative exposure‐response curves were approximately linear for PM2.5, “V”‐shaped for PM10, “U”‐shaped for NO2 and inverted‐“V” for SO2, CO and O3. Exposure to high‐PM2.5 (42 μg/m3), high‐PM10 (91 μg/m3), high‐SO2 (58 μg/m3), low‐NO2 (12 μg/m3), and high‐CO (1.55 mg/m3) increased the risk of AECOPD. Females aged 15–64 were more susceptible under extreme concentrations of PM2.5, SO2, CO, and low‐PM10 than other subgroups. In addition, adults aged 15–64 were more sensitive to extreme concentrations of NO2 compared with the elderly ≥65 years old, while the latter were more sensitive to high‐PM10. High‐SO2, high‐NO2, and extreme concentrations of PM2.5 had the greatest effects on the day of exposure, while low‐SO2 and low‐CO had lagged effects on AECOPD. Precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for AECOPD associated with air pollutants.

Background: We aimed to quantify the impact of each vaccine strategy (including the P3-inactivated vaccine strategy [1968-1987], the SA 14-14-2 live-attenuated vaccine strategy [1988-2007], and the Expanded Program on Immunization [EPI, 2008-2020]) on the incidence of Japanese encephalitis (JE) in regions with different economic development levels. Methods: The JE incidence in mainland China from 1961 to 2020 was summarized by year, then modeled and analyzed using an interrupted time series analysis. Results: After the P3-inactivated vaccine was used, the JE incidence in Eastern China, Central China, Western China and Northeast China in 1968 decreased by 39.80 % (IRR = 0.602, P < 0.001), 7.80 % (IRR = 0.922, P < 0.001), 10.80 % (IRR = 0.892, P < 0.001) and 31.90 % (IRR = 0.681, P < 0.001); the slope/trend of the JE incidence from 1968 to 1987 decreased by 30.80 % (IRR = 0.692, P < 0.001), 29.30 % (IRR = 0.707, P < 0.001), 33.00 % (IRR = 0.670, P < 0.001) and 41.20 % (IRR = 0.588, P < 0.001). After the SA 14-14-2 live-attenuated vaccine was used, the JE incidence in Eastern China and Northeast China in 1988 decreased by 2.60 % (IRR = 0.974, P = 0.009) and 14.70 % (IRR = 0.853, P < 0.001); the slope/trend of the JE incidence in Eastern China and Central China from 1988 to 2007 decreased by 4.60 % (IRR = 0.954, P < 0.001) and 4.70 % (IRR = 0.953, P < 0.001). After the EPI was implemented, the JE incidence in Eastern China, Central China and Western China in 2008 decreased by 10.50 % (IRR = 0.895, P = 0.013), 18.00 % (IRR = 0.820, P < 0.001) and 24.20 % (IRR = 0.758, P < 0.001), the slope/ trend of the JE incidence in Eastern China from 2008 to 2020 decreased by 17.80 % (IRR = 0.822, P < 0.001). Conclusions: Each vaccine strategy has different effects on the JE incidence in regions with different economic development. Additionally, some economically underdeveloped regions have gradually become the main areas of the JE outbreak. Therefore, mainland China should provide economic assistance to areas with low economic development and improve JE vaccination plans in the future to control the epidemic of JE.

目的 探讨甘肃省2017-2018年流行性乙型脑炎(简称乙脑)的流行病学特征和疾病负担.方法 利用甘肃省2017年1月1日—2018年12月31日乙脑病例数据和随访数据,计算乙脑的发病率、死亡率、病死率以及潜在减寿年数,比较不同分组的乙脑病例病情转归情况,采用二项Logistic回归分析模型分析甘肃省乙脑患者病情转归的主要影响因素.结果 乙脑发病率、死亡率以及病死率随着年龄增长而增加.不同年龄(H=61.797,P＜0.001)、不同临床分型(H=53.953,P＜0.001)、有无意识障碍(H=64.367,P＜0.001)以及有无脑膜刺激征(H=5.251,P=0.022)的乙脑病例病情转归比较均有统计学差异.二项Logistic逐步回归分析模型结果显示,年龄(OR=3.217,P＜0.001)、临床分型(OR=1.621,P＜0.001)及有无意识障碍(OR=1.969,P=0.002)对甘肃省乙脑病例病情转归的影响均有统计学意义.甘肃省2017年和2018年乙脑病例的潜在寿命损失分别为945.84人年和1 056.92人年,0～＜15岁损失最小,女性损失高于男性.结论 成人乙脑发病率、死亡率及病死率均高于儿童,乙脑造成的潜在寿命损失也主要以成人为主,影响乙脑病例转归的主要因素为年龄、临床分型以及有无意识障碍.

目的 探索Group LASSO(least absolute shrinkage and selection operator)Logistic回归分析模型在研究流行性乙型脑炎(简称乙脑)早期临床症状与预后之间的关系中的应用.方法 收集整理2017-2018年甘肃省乙脑报告发病数据,建立乙脑预后影响因素的Group LASSO Logistic回归分析模型,通过交叉验证法选择惩罚参数,筛选出影响乙脑预后的早期临床症状.结果 纳入的866名乙脑患者中,有预后结局的共764名,其中死亡者占22.5％、有后遗症者占12.6％、好转者占17.8％、痊愈者占47.1％.筛选出的变量有意识障碍、呼吸衰竭、呼吸节律改变、肌张力增强及乙脑疫苗接种史.结论 通过构建Group LASSO Logistic回归分析模型可以筛选出对预后有影响的早期临床症状.

Background : Previous studies have always focused on the impact of various meteorological factors on bacillary dysentery (BD). However, only few studies have investigated the effects of climate and air pollutants on BD incidence simultaneously. This study aimed to investigate the effects of temperature and air pollutants on BD in Lanzhou. Methods: Daily data of BD cases and environmental factors from 2014 to 2017 were collected. A generalized additive model (GAM) was conducted to explore the relationship between environmental factors and BD. Then a distributed lag non-linear model (DLNM) was developed to assess the lag and cumulative effect. Furthermore, this study explored the variability across gender and age groups. Results: A total of 7102 cases of BD were notified over the study period. High temperature can significantly increase the risk of BD during the whole lag period, temperature has different exposure effects on different genders and age groups. With 9℃ as the reference value, each 1℃ rise in temperature result in a 4.8% (RR=1.048, 95%CI: 0.996, 1.103) increase in the number of cases BD at lag 0 day. With 50μg/m 3 as the reference value, each 5μg/m 3 rise in PM2.5 caused a 11.3% (RR=1.113, 95%CI: 1.066, 1.162) increase in the number of BD cases at lag 0. Low concentration of PM10 in the lag of 10-14 days can significantly increase the risk of BD, while high concentration PM10 in the lag of 6-14 days can significantly increase the risk of BD. Conclusions: Temperature, PM2.5 and PM10 are closely related to the incidence of bacillary dysentery. Our findings suggest adaptation plans that target vulnerable populations in susceptible communities should be developed to reduce health risks.

目的 探讨支持向量回归(support vector regression,SVR)模型联合气象和空气污染物指标在兰州市细菌性痢疾发病预测中的应用,为细菌性痢疾防控提供科学的参考依据.方法 利用兰州市2013年12月-2016年8月细菌性痢疾发病时间序列数据,结合同期气象和空气污染物数据作为训练集建立SVR模型,以2016年9月-2017年12月的发病数据及同期气象和空气污染数据作为验证集验证模型,并比较不同来源数据模型的拟合及预测效果.结果 2013年12月-2017年12月兰州市共报告细菌性痢疾7 192例.除气压外,其他气象和空气污染因子与细菌性痢疾发病数的相关系数均＞0.4.基于整合数据对拟合模型的参数进行选择,得到最小测试误差值所对应的三个参数分别为:C=5、γ =0.02和ε=0.000 1.利用验证集对不同来源的拟合模型进行测试显示整合数据模型具有最好的预测精度性和稳健性,均方根误差(root mean squared error,RMSE)为0.1647,平均绝对百分比误差(mean absolute percentage error,MAPE)为16.405％.结论 应用SVR模型联合气象和空气污染指标预测细菌性痢疾效果良好.