Importance:Optimal clinical decision support system (CDSS) implementation for chronic kidney disease (CKD) management in Chinese primary care remains undefined despite the high disease burden. Objective:To examine whether a CDSS for CKD could improve physician behavior and patient outcomes in primary care. Design, Setting, and Participants:This cluster randomized clinical trial is being conducted in Chinese primary care centers. The trial spans a 3-year period (January 1, 2023, to December 31, 2026) and is divided into 2 phases; this phase 1 analysis includes data from the initial 6-month follow-up (June 10 to December 10, 2023). Centers were stratified by size and randomized 1:1 to intervention or control. Participants are adults (aged ≥18 years) with CKD who had 2 visits or more during the 1-year screening period, all enrolled before randomization. Interventions:Both groups received government-supported, nephrologist-delivered training on CKD management. The intervention group was additionally equipped with a CDSS embedded into the electronic health record. Main Outcomes and Measures:The primary outcome was a 36-month composite of kidney-related and cardiovascular hospitalizations (phase 2). This phase 1 analysis evaluated 6-month process measures (ie, CKD diagnosis and renin-angiotensin-aldosterone system inhibitor or sodium-dependent glucose transporter 2 inhibitor use) and clinical outcomes (ie, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol control). Results:A total of 3390 patients (mean [SD] age, 72.0 [10.2] years; 1881 [55.5%] female) from 30 primary care centers were included (1912 in the intervention group and 1478 in the control group). Follow-up at 6 months was completed by 3055 patients (90.1%; 1743 [91.2%] in the intervention group and 1312 [88.8%] in the control group). CKD diagnosis rates increased by 21.4 (95% CI, 18.6-24.3) percentage points in the intervention group and by 27.9 (95% CI, 24.4-31.3) percentage points in the control group, with a nonsignificant between-group difference (adjusted odds ratio [AOR], 0.91; 95% CI, 0.72-1.14). Renin-angiotensin-aldosterone system inhibitor use (AOR, 0.96; 95% CI, 0.78-1.19), sodium-dependent glucose transporter 2 inhibitor use (AOR, 1.02; 95% CI, 0.78-1.32), and low-density lipoprotein cholesterol control (AOR, 1.10; 95% CI, 0.83-1.46) showed parallel improvements with no between-group differences. Blood pressure (AOR, 0.88; 95% CI, 0.71-1.09) and glycated hemoglobin (AOR, 1.22; 95% CI, 0.74-2.01) control showed no improvement. Conclusions and Relevance:In this cluster randomized trial of a CDSS for CKD in primary care, both the intervention and control groups demonstrated comparable improvements in 6-month outcomes, with no independent effect of the CDSS detected. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR2300070555.

INTRODUCTION:While it has been postulated that population-based strategies targeting modifiable dementia risk factors are cost effective in high-income settings, their health and economic impact in China remains unclear. METHODS:A Markov model evaluated five interventions: salt substitution, smoke-free legislation, increased tobacco tax, sugar-sweetened beverage tax, and alcohol tax. Outcomes included dementia cases, deaths averted, life years gained, and lifetime cost-savings, assessed from a societal perspective over an infinite time horizon. Subgroup and sensitivity analyses were performed. RESULTS:All interventions were assessed to be cost-saving. Salt substitution was modeled to have the greatest impact, resulting in 1,940,000 quality-adjusted life years gained and lifetime cost savings of US$65 to US$70 billion. Smoke-free policies and tobacco taxes also showed significant benefits. Beverage and alcohol taxes had smaller but meaningful effects. Males generally benefited more. DISCUSSION:We estimated that population-level interventions would reduce costs in China, with the largest gains from targeting hypertension and smoking. Prioritizing such strategies may generate substantial health gains while reducing long-term societal costs.

By the end of 2022, China adjusted its zero-COVID policy, followed by unprecedented waves of SARS-CoV-2, influenza, and RSV infections. This study aims to evaluate the influenza vaccination intentions and influencing factors among primary healthcare (PHC) workers in Jinan city, particularly in the context of the triple infection waves. A cross-sectional study was conducted in 2023 using a random-cluster sampling method, surveying 1,673 PHC workers in the selected community and township health centers. The Confidence-Complacency-Convenience (3C model) was adapted to assess vaccination intentions. Among the participants,1,232/1,673 (73.6

BACKGROUND:Although influenza vaccines are available free of charge to older adults in Beijing (China), coverage remains low. Limited spatial accessibility to vaccination services may be an important contributing factor. We quantified spatial accessibility to points of vaccination (PoVs) and examined its association with acute respiratory infection (ARI)-related hospitalisations among older adults. METHODS:We used high-resolution, real-time travel data to quantify spatial accessibility to PoVs by walking, driving, and public transport, incorporating variation by day of week and time of day, at the jiedao (subdistrict) level. Negative binomial regression models examined associations between accessibility and ARI-related hospitalisations among older adults across three influenza seasons (2016-2019), adjusting for confounders. RESULTS:Weekend accessibility was substantially worse than weekday accessibility, with 56.4% of jiedaos experiencing >30 min of additional travel time. Better accessibility was associated with lower ARI-related hospitalisations. Incidence rate ratios were 0.76 (95% CI: 0.61-0.95), 0.73 (95% CI: 0.59-0.90), and 0.60 (95% CI: 0.47-0.76) across three influenza seasons. Model estimates suggest that ensuring all jiedaos have accessible PoVs could avert 1300-3500 ARI-related hospitalisations annually, corresponding to USD 3-8 million in direct medical cost savings per season. DISCUSSION:Spatial accessibility to vaccination services remains a barrier to vaccine uptake in urban settings. The presence of facilities alone does not ensure access, particularly for older adults reliant on others for travel. Improved accessibility is linked to lower ARI-related hospitalisations and could reduce healthcare burden. Expanding PoVs (e.g. by extending weekend hours) may help close this gap.

BACKGROUND:Primary health care workers play a vital role in both routine health services and responses to public health emergencies. This study aims to examine long-term changes in work attitudes and burnout among primary health care workers during the years after COVID-19 breakout in Jinan, China. METHODS:We conducted repeated cross-sectional surveys of primary health care workers in selected districts of Jinan in August 2020, 2023, 2024, and 2025. Standardised questionnaires measured job satisfaction, organisational commitment, and burnout. A total of 5,535 workers were included across four survey waves. Regression models were used to examine changes over time and associated factors. Principal component analysis was used to identify underlying vulnerability profiles. Matched subsamples were used to compare changes within the same workers across the 2023-2024, 2024-2025, and 2023-2025 periods. RESULTS:Here we show that recovery in work attitudes is partial and uneven. Job satisfaction declines in 2023, partly recovers in 2024, and decreases again in 2025, remaining below the 2020 level. Organisational commitment increases from 2020 to 2024 but shows a slight decline in 2025. Burnout remains a persistent concern, with depersonalisation and emotional exhaustion worsening by 2025. Severe coronavirus disease 2019 infection and newly recruited public health roles are associated with less favourable changes. CONCLUSIONS:These findings show that the effects of pandemic-related stress continue beyond the acute crisis. Sustained mental health support, stronger organisational resources, and long-term workforce policies are needed to protect primary health care workers and support resilient health systems.

E-cigarette taxation has been increasingly implemented worldwide as a fiscal and regulatory tool to curb consumption, generate revenue, and mitigate public health risks. However, the effectiveness of such policies remains uncertain, particularly given differences in tax structures, market dynamics, and consumer behaviors. This study systematically reviews and synthesizes evidence on the impact of e-cigarette taxation on governments, businesses, and consumers. Following PRISMA guidelines, seven electronic databases and grey literature sources were utilized to identify relevant studies. Eligible studies included quantitative research on e-cigarette taxation policies. Data synthesis involved a narrative summary focusing on tax pass-through rates and elasticity. Meta-analysis calculated pooled odds ratios (OR) for e-cigarette usage between tax and no tax groups. Quality assessment was conducted using JBI Critical Appraisal Checklists. A total of 27 studies were included. The meta-analysis based on three US studies suggested a modest reduction in e-cigarette use among adults (OR: 0.89, 95

Objective:To assess the spatial accessibility of pediatric healthcare resources in Beijing and to develop an optimization model for resource allocation under a fixed additional resource constraint,with the aim of exploring optimal allocation strategies for 2025 and 2030.Methods:Using communities as the unit of analysis,this study integrated data on Beijing's child population in 2020 and pediatric healthcare resources in 2022.An improved two-step floating catchment area(2SFCA)method was ap-plied to measure spatial accessibility.Based on projected child population data for 2025 and 2030,an optimization model was constructed to minimize regional disparities in accessibility.Under the constraint of a fixed total number of additional resources,optimal spatial allocation schemes were derived and com-pared with a conventional population-based allocation approach.Results:In 2022,Beijing had 4 704 pe-diatric beds and 4 011 pediatric physicians.The mean spatial accessibility for pediatric beds and pediatric physicians was 1.17 and 0.97,respectively,with a standard deviation of 2.78 for bed accessi-bility,exhibiting a clear spatial pattern of higher accessibility in central districts and lower accessibility in suburban districts.In the same year,the number of pediatric physicians per 1 000 children in Beijing reached 1.52,already exceeding the targets for 2025 and 2030;therefore,no additional increase in total physician numbers was required.Under the 2025 optimization scenario,the mean accessibility of pediatric beds increased to 1.68,with the standard deviation declining to 2.45,indicating a reduction in regional disparities.Under the 2030 scenario,the mean accessibility further increased to 2.31,with a standard deviation of 2.56,reflecting continued improvement in accessibility.The optimization model identified Daxing District,Tongzhou District,and Mentougou District as priority districts for additional bed allocation,whereas the conventional population-based approach allocated more resources to Daxing District,Haidian District,and Tongzhou District.While the two approaches showed general consistency in overall spatial allocation,the optimization model more effectively addressed inter-district disparities in accessibility.Conclusion:Significant spatial disparities were identified in the distribution of pediatric healthcare resources in Beijing.The accessibility-oriented optimization approach,under a fixed resource constraint,improved the alignment between supply and demand and reduced regional inequities.It served as a useful complement to conventional population-based allocation methods and provided quantitative evi-dence to support refined planning and dynamic adjustment of pediatric healthcare resources.Given that the total number of pediatric physicians has already met national targets,leveraging integrated medical consorti-um and multi-site practice policies to promote the mobility of qualified pediatric physicians toward under-served areas represents a promising pathway toward structural optimization of spatial resource distribution.

AIM:Acute kidney injury (AKI) is a serious complication in older patients. A practical prediction model may aid in identifying high-risk patients for early intervention. METHODS:We included hospitalized patients aged ≥ 65 years (2018-2020) with available serum creatinine (Scr). Data from 2018 to 2019 were used for model development, and data from 2020 were used for validation. The primary outcome was hospital-acquired AKI. A multivariable logistic regression model was built using baseline, latest, and trend-based variables. Four models were constructed using the least absolute shrinkage and selection operator (LASSO) and stepwise selection, and the Senior Hospitalized Adults' AKI Risk Prediction (SHARP) score was derived as a simplified scoring system. Performance was evaluated using the area under the receiver-operating characteristic curve (AUC), calibration curves, and the Hosmer-Lemeshow test. RESULTS:Among 14 576 derivation and 7328 validation admissions, AKI incidence was 6.2% and 5.3%, respectively. The model incorporated eight risk factors: heart failure, chronic kidney disease, baseline prealbumin, baseline Scr, highest B-type natriuretic peptide, highest blood urea nitrogen, highest C-reactive protein, latest heart rate. It showed strong discrimination (AUC: 0.86-0.87) and good calibration (Hosmer-Lemeshow p > 0.05). The simplified SHARP score maintained excellent performance, effectively stratifying AKI risk. In the validation cohort, the SHARP score predicted AKI with a median lead time of 40.73, 38.64, and 24.05 h for low, moderate, and high-risk groups, respectively. CONCLUSION:The SHARP score allows clinicians to quickly assess the risk of AKI in older hospitalized patients. Future studies should focus on external validation to confirm its predictive accuracy and generalizability.

Urban resilience has risen rapidly on policy agendas after COVID-19, and health systems are described as core pillars of resilient cities. Yet little is known about how urban resilience agendas are actually perceived and taken up within health sector. Drawing on 43 interviews with 79 participants from related health agencies in seven Chinese cities, this study explores how resilient city construction are understood, translated and enacted in everyday practice. We find that resilience largely arrives as a top-down political and planning term: many respondents first heard it only after COVID-19, often treat it as a new label for existing work, or view it as an external political task rather than an internal organising principle. To interpret these patterns, we develop the Elliptical Focus Resonance Model, which distinguishes three configurations of interdepartmental relations: separated circles of routine mandates in normal times; crisis-induced convergence and temporary deformation during major incidents; and longer-term “elliptical” dual-focus configurations under a central gravitational agenda such as resilient city construction. The model suggests that weak health sector engagement with urban resilience is largely a structural effect of how cross-sector agendas are layered onto existing mandates and incentive systems, rather than simply a problem of awareness or motivation.

Beijing’s district-level reform of emergency medical centers represents a pivotal step in strengthening the city’s prehospital emergency medical system. The reform aims not only to enhance workforce stability and financial transparency but also to improve system-wide management and coordination across municipal, district, and local levels. While these efforts have improved efficiency and accountability, challenges persist, including limited funding, uneven capacity, and unclear career pathways for non-technical staff. Beijing’s experience highlights the need for differentiated, context-specific strategies to balance autonomy and integration, ensuring the sustainable, equitable, and safe development of China’s prehospital emergency services.

BackgroundTuberculosis (TB) remains a major poverty-associated infectious disease worldwide. This study is the first to quantify the incidence and determinants of catastrophic costs among drug-susceptible TB patients in Guangxi, providing critical evidence for developing poverty alleviation policies and promoting equitable TB care access.MethodsThe study included 250 drug-susceptible TB patients who were registered and completed treatment between June 2023 and June 2024 in local designated TB hospitals across three counties in Guangxi with different per capita disposable income. Using structured questionnaires, we collected comprehensive data on socioeconomic characteristics and TB-related direct/indirect costs. All statistical analyses were performed using SPSS 27.0.ResultsDuring the pre-diagnosis stage, post-diagnosis stage, and the entire course of TB care, the median out-of-pocket payments per TB patient were 2501.5 RMB, 2323.8 RMB, and 6323.7 RMB, respectively. Direct medical costs constituted the largest proportion of total costs at each stage of TB care. The incidence of catastrophic costs due to TB was 45.6% (114/250). The results of the x2 test showed that there were statistically significant differences in the incidence of catastrophic costs according to education levels, annual household income, medical insurance type, and number of hospitalization days after diagnosis (p < 0.05). The results of the binary logistic regression analysis showed that patients with annual household income ≦20,000 RMB and those with more than 7 hospitalization days after diagnosis had a higher risk of catastrophic costs due to TB, and the ORs (95%CI) were 34.168 (12.742–91.625) and 7.488 (2.474–22.664), respectively.ConclusionMost costs were incurred before diagnosis and were primarily direct medical costs. To reduce catastrophic costs, we recommend targeted TB health education, enhanced screening/treatment monitoring, improved multi-tiered insurance coverage, support for rural low-income populations, early cost-warning systems, and sustainable TB-related poverty prevention mechanisms.

The study aims to elucidate the existence forms(original constituents and metabolites) of Notoginseng Radix et Rhizoma in rats and reveal its metabolic pathways. After Notoginseng Radix et Rhizoma was administered orally once a day for seven consecutive days to rats, all urine and feces samples were collected for seven days, while the blood samples were obtained 6 h after the last administration. Using the ultra high performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry(UHPLC-Q-TOF-MS/MS) technique, this study identified 6, 73, and 156 existence forms of Notoginseng Radix et Rhizoma in the rat plasma, urine, and feces samples, respectively. Among them, 101 compounds were identified as new existence forms, and 13 original constituents were identified by comparing with reference compounds. The metabolic reactions of constituents from Notoginseng Radix et Rhizoma were mainly deglycosylation, dehydration, hydroxylation, hydrogenation, dehydrogenation, acetylation, and amino acid conjugation. Furthermore, the possible in vivo metabolic pathways of protopanaxatriol(PPT) in rats were proposed. Through comprehensive analysis of the liquid chromatography-mass spectrometry(LC-MS) data, isomeric compounds were discriminated, and the planar chemical structures of 32 metabolites were clearly identified. According to the literature, 48 original constituents possess antitumor and cardiovascular protective bioactivities. Additionally, 32 metabolites were predicted to have similar bioactivities by SuperPred. This research lays the foundation for further exploring the in vivo effective forms of Notoginseng Radix et Rhizoma.

We examine the significant increase in staffing at the Chinese Center for Disease Control and Prevention (CDC) following the COVID-19 pandemic and compare it to the staffing changes post-2003 SARS outbreak. This analysis views the surge not only as compensation for long-term understaffing, but also as a response to the immediate demands of the COVID-19 crisis. We explore the implications of this increase, addressing the financial burden it imposes on the government, the challenges in maintaining a balanced human resource structure, and the potential long-term effects on public health infrastructure. Additionally, we propose strategic recommendations including reforming the income model for CDC employees, implementing strategic workforce planning, and making infrastructure improvements. These measures aim to support a more effective and resilient public health system in China.

Importance:Expanding access to genetic testing and availability of validated breast cancer (BC) risk prediction models are increasingly identifying women at elevated BC risk who do not carry high-penetrance BRCA1/BRCA2/PALB2 pathogenic variants. The precise BC risk threshold for offering risk-reducing mastectomy (RRM) for BC prevention is unknown. Objective:To define the lifetime BC risk thresholds for RRM to be cost-effective compared with nonsurgical alternatives for BC prevention. Design, Setting, and Participants:This economic evaluation used a decision-analytic Markov model to compare the cost-effectiveness of RRM with BC screening and medical prevention in a simulated cohort. Extensive sensitivity analyses were performed. The study setting was from a UK payer perspective over a lifetime horizon until age 80 years. The simulated cohort included women aged 30 to 60 years at varying lifetime BC risks from 17% to 50%. The study was conducted between September 2022 and September 2024. Exposures:Undergoing RRM or receiving risk-stratified BC screening with medical prevention (tamoxifen or anastrozole). Main Outcomes and Measures:The incremental cost-effectiveness ratio was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with the UK willingness-to-pay (WTP) threshold of £20 000 (US $27 037) to £30 000 (US $40 555) per QALY. BC cases prevented were estimated at the population level. Results:In the simulated cohort of 100 000 thirty-year-old women in the UK, undergoing RRM became cost-effective at a 34% lifetime BC risk using the £30 000 (US $40 555) per QALY WTP threshold. This increased to a 42% lifetime BC risk using the £20 000 (US $27 037) per QALY WTP threshold. The identified lifetime BC risk thresholds for RRM to be cost-effective among women aged 35, 40, 45, 50, 55, and 60 years were 31%, 29%, 29%, 32%, 36%, and 42%, respectively, using the £30 000 (US $40 555) per QALY WTP threshold. Overall, undergoing RRM was deemed cost-effective for women aged 30 to 55 years with a lifetime BC risk of at least 35%, with more than 50% of simulations being cost-effective in probabilistic sensitivity analysis. Offering RRM for women with a lifetime BC risk of 35% or higher could potentially prevent approximately 6538 (95% CI, 4454-7041), or approximately 11% (95% CI, 8%-12%), of the 58 756 BC cases occurring annually in women in the UK. In the probabilistic sensitivity analysis, 20.71% to 59.96%, 44.04% to 81.29%, and 97.26% to 99.35% of simulations were cost-effective for women with 35%, 40%, and 50% lifetime BC-risk undergoing RRM at age 30 under the £20 000 to £30 000 per QALY WTP threshold, respectively. Conclusions and Relevance:In this economic evaluation, undergoing RRM appears cost-effective for women aged 30 to 55 years with a lifetime BC risk of 35% or higher. These results could have significant clinical implications to expand access to RRM beyond BRCA1/BRCA2/PALB2 pathogenic variant carriers. Future studies evaluating the acceptability, uptake, and long-term outcomes of RRM among these women are warranted.

To investigate the humoral immunity and clinical characteristics of Chinese college students after experiencing a BA.5/BF.7 and/or XBB.1.5 wave. We enrolled 876 college students who received 2-3 vaccination doses of COVID-19 and followed by BA.5/BF.7 and/or XBB.1.5 breakthrough infections between January 2022 and October 2023. IgG and total antibodies against SARS-CoV-2 were measured by chemiluminescent immunoassay. Neutralizing antibodies were detected using a pseudovirus neutralization assay. Meanwhile, we created an Enterprise WeChat link for college students to self-report SARS-CoV-2 infections and clinical symptoms of COVID-19. We observed that among college students, the most common symptoms upon SARS-CoV-2 infection were fever, fatigue, and sore throat. Moreover, reinfected college students had higher levels of total antibodies and neutralizing antibodies against BA.5, XBB.1.5 and EG.5.1, especially after experiencing the XBB.1.5 wave. Finally, the neutralizing effect against the newly emerged Omicron subvariants XBB.1.5 and EG.5.1 is limited among the college students. Our study demonstrates that hybrid immunity, built from breakthrough infections and reinfections, enhances total antibody levels and bolsters neutralizing activity, contributing to milder clinical presentations upon reinfection. However, neutralization efficacy against newer subvariants, such as XBB.1.5 and EG.5.1, remains compromised.

Background: In 2022, there were approximately 19.96 million new cancer cases globally according to GLOBOCAN, with breast cancer emerging as the most commonly diagnosed female cancer. In China, there were 0.36 million new cases and 75,000 deaths due to breast cancer of women in 2022. However, studies focusing on the cost of treatment and the economic burden of female breast cancer patients in China were conducted within specific provinces, cities, or hospitals, and there lacks a comprehensive analysis of total treatment cost. This study aimed to analyze the costs associated with female breast cancer patients in China using data from the China Health Insurance Research Association (CHIRA) and to explore the factors influencing costs. Methods: Female breast cancer patients aged over 16 years were included in the CHIRA database between 2016 and 2018. Patients were identified according to ICD-10 code. Descriptive analysis and log-linear analysis were conducted to examine the treatments of breast cancer. The project was commissioned with an ethical exemption. Findings: A total of 28,464 breast cancer patients aged 16 years and older who were diagnosed with breast cancer in China between January 2016 and December 2018 were included in this study. The mean age of 54.49 years, and the highest proportion of breast cancer patients were aged 50-60 years (30.66%). Approximately 72.54% of patients were covered by Urban Employee Basic Medical Insurance (EBMI). In this study, 73.56% of breast cancer patients utilized inpatient services, although, this study found the proportion of patients seeking medical treatment in lower-level hospitals increased over time, over 82.07% of the study population still seek care at tertiary hospitals in China. The cost of treatment decreased with increasing age and increased among patients treated at higher-level hospitals. Age, health insurance type, region, and hospital level were found to be associated with both total medical costs and out-of-pocket expenses for breast cancer patients. The annual total medical cost per capita decreased for outpatients and increased for inpatients over the three years. Inequities have been identified in financial protection for patients covered by different health insurance schemes and in different regions. Interpretation: The costs of breast cancer patients in China exhibit significant regional and demographic differences, with Chinese patients being significantly younger compared to those in other countries. Efforts in expanding breast cancer screening are necessary to reduce the disease severity and financial burden. Considering the variance in quality of care across different levels of hospitals, efforts should also be made to enhance the quality of care for cancer treatment in lower-level hospitals, and to ensure favorable health outcomes for patients. Funding: This study was funded by National Key Research and Development Program of China, National Natural Science Foundation of China, China Medical Board, the Royal Society.

National Reimbursement Drug Price Negotiation (NRDPN) refers to a government-led process of negotiating with pharmaceutical companies to reach reasonable prices for exclusive drugs covered by national reimbursement. Since 2016, the Chinese government has regularly implemented eight rounds of NRDPN. This systematic review aimed to determine the effects of NRDPN on drug price, availability, affordability, utilization, cost, and health outcomes in China in the years 2016–2023. We searched the electronic databases PubMed (which includes MEDLINE), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP for all associated studies published in English or Chinese between January 2016 and December 2023. One of the following outcomes had to be reported: drug price, availability, affordability, utilization, cost, or health outcomes. The study design had to be a randomized or non-randomized trial, an interrupted time series (ITS) analysis, a repeated measures study, or a controlled before‐after (CBA) study. Two reviewers independently extracted data and assessed the studies according to Cochrane Effective Practice, Organization of Care (EPOC) guidelines. From a total of 2628 studies, we identified 20 studies that met the inclusion criteria (16 interrupted time‐series studies and 4 controlled before‐after studies). Most of the studies (66

INTRODUCTION:The COVID-19 vaccination coverage rate is notably high among the Chinese population; however, as China eased its zero-COVID policy in November 2022, the pandemic outbreak has imposed a substantial burden on Chinese society. This study aims to analyze real-world vaccination effectiveness and waning effects among community-based COVID-19 infection-naive individuals in China and among different sub-groups. METHODS:An online questionnaire survey was conducted in Beijing, China, from January 13th to February 9th, 2023 and a total of 45,344 eligible respondents were included in the analysis. Vaccination and infection status among different groups classified by age (under 18, 18-59, and over 60) and health conditions (having underlying disease, allergy, cancer, immune deficiency or organ transplant) were analyzed. Propensity score matching and ordered logistic regression were used to examine the effectiveness of different COVID-19 vaccine types, vaccination strategies and the waning effects. RESULTS:The infection rate was 82.42 % among sampled population. The vaccination rate was 94.70 %, with 23.73 % of them completed primacy vaccination series, 68.54 % completed homogenous booster vaccination and 2.43 % completed heterogenous booster vaccination; however, the high-risk population had a lower vaccination coverage. Results showed that real-world vaccine effectiveness (VE) of homogenous and heterogenous booster vaccination against infection were 11 % and 23 %, respectively, and the elderly benefited the most. Adolescents had a lower booster vaccination coverage and no significant VE was identified. No significant differences were observed among different vaccine types, and waning effects were identified in the booster vaccination group 12 months post-vaccination. CONCLUSIONS:Low vaccination coverage among high-risk and vulnerable may lead to a huge disease and societal burden, thus improving vaccine coverage of these groups should be prioritized. In addition, due to waning immunity, regular booster vaccination should be scheduled within 12 months.

Background:The smartphone use profoundly affects human health. At present, the effect of smartphone use on the risk of hypertension in adults aged 50 years and older remains unknown. This study aimed to explore the association between smartphone use and hypertension in this population. Methods:From 2018 to 2019, people aged 50 years and older were enrolled in the Fujian Provincial Eye Study (FJES), a population-based cross-sectional survey of the public's general and ocular health in Fujian Province, China. Information on smartphone use was obtained from the baseline survey, and blood pressure measurements were obtained via standardized on-site examination. Univariate and multivariable logistic regression analyses were performed on the study variables. P<0.05 were considered statistically significant. Results:This study ultimately enrolled 8,211 eligible participants aged ≥50 years, and the mean age was 64.39±8.87 years. The risk of hypertension decreased significantly with increasing smartphone use time, although people who spent more time on smartphones had higher systolic blood pressure (SBP). There was no significant association between smartphone use time and diastolic blood pressure (DBP). Multivariate logistic regression analysis showed that smartphone use time, along with age, BMI, diabetes and education level, was an independent predictor of hypertension risk. Conclusion:The duration of smartphone use demonstrated a significant inverse association with hypertension risk and was identified an independent predictor of hypertension risk in adults aged 50 years and older. Thus, smartphone use duration is a potentially useful indicator for assessing the risk of hypertension in this population.