BACKGROUND:Two natural experiment studies have found evidence that live attenuated herpes zoster vaccination prevents or delays dementia onset. We aimed to determine the effect of live attenuated herpes zoster vaccination on incident dementia diagnoses among people aged 70 years and older using a natural experiment in Ontario, Canada, and to triangulate these findings, using a second natural experiment in Ontario and a quasi-experimental approach that uses data from multiple Canadian provinces. METHODS:Our analysis of natural experiments included people born in Canada between Jan 1, 1930, and Dec 31, 1960, who were registered with one of 1434 primary care providers in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) on Sept 15, 2016. We compared patients born immediately before versus immediately after Jan 1, 1946, in our primary analysis, and immediately before versus immediately after Jan 1, 1945, in our secondary analysis, as these thresholds determined eligibility for herpes zoster vaccination in Ontario. The key strength of this natural experiment is that these comparison groups are not expected to differ in their health characteristics and behaviours given that all that divides them is a small discrepancy in age. Dementia diagnosis was established using electronic health records data from Jan 1, 1990, to June 30, 2022, from the primary care practices. We used a population-representative survey of people aged 65 years or older in Ontario to measure herpes zoster vaccination uptake. Using regression discontinuity analysis, we estimated the difference in vaccination uptake and dementia diagnoses between individuals born immediately on either side of the eligibility thresholds for herpes zoster vaccination. Additionally, we used synthetic difference-in-differences and a synthetic control method to compare trends in dementia incidence (before versus after the start date of the herpes zoster vaccination programme) among birth cohorts in Ontario who were eligible for vaccination with the same birth cohorts (all of whom were ineligible for vaccination) in other provinces of Canada. FINDINGS:We extracted data on 464 637 patients who were registered with a primary care provider in the CPCSSN as of Sept 15, 2016. Of 232 124 patients born in Ontario included in the analysis, 125 719 (54·2%) were female, 106 354 (45·8%) were male, and 51 (<0·5%) had missing information on sex. Patients born immediately before versus immediately after the two eligibility thresholds for herpes zoster vaccination did not differ in their health characteristics at the time of the start date of the vaccination programme, except for a large difference in their probability of receiving herpes zoster vaccination. Being born immediately before versus immediately after Jan 1, 1946, decreased the probability of receiving a new dementia diagnosis by an absolute difference of 2·0 percentage points (95% CI 0·4-3·5, p=0·012) over a 5·5-year follow-up. Using the Jan 1, 1945, threshold, dementia diagnoses were also reduced by 2·0 percentage points (0·2-3·8, p=0·025) over 5·5 years. After the start of the programme, new dementia diagnoses among the birth cohorts eligible for herpes zoster vaccination in Ontario were significantly less common than in the same birth cohorts in other Canadian provinces that did not have a herpes zoster vaccination programme. INTERPRETATION:This analysis of natural experiments provides evidence, which is more likely to reflect a causal relationship than previous evidence from more standard observational data analyses, that herpes zoster vaccination prevents or delays incident dementia. Mechanistic research into this effect could provide insights into the pathophysiology of dementia and maintenance of neuroimmune health in older age. FUNDING:National Institute on Aging, National Institute of Allergy and Infectious Diseases, Stanford Center for Digital Health, Stanford Knight Initiative for Brain Resilience, Biohub.

BACKGROUND:Compulsory and free basic education policies (hereafter called education policies) are essential for enhancing educational attainment, which has been linked to improved offspring health outcomes. However, existing studies do not provide strong evidence with causal inference on how these policies influence offspring mortality in low-income and middle-income countries (LMICs). Furthermore, although COVID-19 has substantially disrupted education systems in LMICs, its long-term consequences for offspring mortality remain unclear. METHODS:We extracted individual-level data from the nationally representative Demographic and Health Surveys from 1986 to 2022, and macro-level data on countries' population projection, COVID-19-related changes, and other social and economic indicators from multiple databases. Offspring deaths were measured using four indicators: neonatal mortality, infant mortality, childhood mortality, and deaths in children younger than 5 years (under-5). We identified 20 countries with at least two survey rounds and changes in education policies during varying survey periods. Using a difference-in-differences design with a two-way fixed-effects model, we investigated the effects of education policies on offspring mortality for mothers and fathers. The treatment group included observations from post-policy surveys, with younger parents exposed to the policy and older ones not, whereas the control group used pre-policy survey data. Subgroup analyses by household wealth status, place of residence, sex of the child, and sex of the household head were performed to explore potential heterogeneity in education policies' impact. We used mathematical modelling to project offspring deaths from 2030 to 2050 attributable to COVID-19-induced loss in educational instruction time and increased school dropout levels, assuming no further policy interventions to mitigate these losses. FINDINGS:A total of 347 013 mothers (100 113 control; 246 900 treatment) and 201 612 fathers (86 152 control; 115 460 treatment) were included in the study. Exposure to education policies was associated with significant reductions in offspring mortality among mothers, which was -11·71 per 1000 livebirths (95% CI -20·29 to -3·12, p=0·0093) for neonatal deaths, -18·66 (-27·06 to -10·25, p<0·0001) for infant deaths, -20·33 (-28·85 to -11·81, p<0·0001) for childhood deaths, and -20·43 (-28·96 to -11·90, p<0·0001) for under-5 deaths, compared with those not exposed to education policies. The effects among fathers were also statistically significant for all types of offspring deaths. Subgroup analyses revealed that education policies have significantly more pronounced impacts among those with lower household wealth. Projections for 2030 to 2050 suggest that reductions in parental education due to COVID-19 might contribute to increases in offspring deaths under a worst-case scenario with no compensatory policy interventions, with the largest effects arising from the loss of parental instruction time rather than from school dropouts. The impact is expected to peak around 2038, when under-5 deaths attributable to reduced parental instruction time and increased school dropouts are projected to reach 449 154 (95% CI 240 774-657 535) and 10 918 (7697-14 139), respectively, compared with a scenario without COVID-19-related educational disruptions. INTERPRETATION:Education policies significantly reduced offspring mortality in LMICs, with greater benefits for populations with lower household wealth. Modelling indicated that interruptions to educational instruction time led to a substantial increase in offspring mortality. There is a critical need for policies to mitigate educational disruptions to prevent offspring deaths. FUNDING:Research Fund, Vanke School of Public Health, Tsinghua University.

Male child marriage (before age 18 years) remains prevalent in many low- and middle-income countries (LMICs), yet its consequences for men’s roles in intimate partner violence (IPV) are poorly understood. Using Demographic and Health Survey data from 41 low- and middle-income countries (LMICs), we show that male child marriage is substantially associated with higher risks of perpetrating nearly all types of IPV and experiencing physical IPV in the past 12 months. These associations were stronger in contexts of lower gender inequality or higher income but were attenuated in disadvantaged settings. At the macro level, gender inequality was positively correlated with IPV among men without a history of child marriage, but not among those who married as boys. Child marriage is linked to a substantial proportion of IPV, accounting for an estimated 17%–25% of cases among men aged 20–24 years. These findings underscore the need for structural efforts to delay marriage alongside targeted support for individuals navigating early unions. Using Demographic and Health Survey data from 154,051 men across 41 low- and middle-income countries, this study reports that marriage before age 18 years among young men is associated with higher odds of physical intimate partner violence perpetration and victimization in adulthood, varying by national gender inequality and income.

Non-communicable chronic diseases disproportionately affect people living in low- and middle-income countries, with low linkage to care and healthcare utilization identified as contributors to the considerable unmet treatment need in these settings. Here we assess the effect of labelled cash transfers (LCTs) to incentivize clinic-based uptake of care for chronic conditions in rural Burkina Faso (German Clinical Trials Register DRKS00014734). N = 1,242 adults aged 40 years and older with diagnoses of hypertension, hyperlipidaemia and diabetes were randomized to one of three trial arms to receive a high LCT of 1,000 Franc de la Communauté Financière d'Afrique (FCFA) (~US$2), a lower payment of 500 FCFA or no cash transfer. Cash transfers were labelled with an explanation of their intent. The primary trial endpoints of linkage to care and treatment uptake were not found to be significantly affected by LCT receipt. Most secondary endpoints also did not meet significance. The secondary outcome of rates of face-to-face examinations was paradoxically significantly lower in LCT recipient groups than controls; however, this finding should be interpreted with caution.

Background:Chronic obstructive pulmonary disease (COPD) remains a major global health challenge, contributing significantly to morbidity and mortality. This study aims to provide a comprehensive analysis of the burden of COPD by age, sex and Sociodemographic Index (SDI), in addition to its attributable risk factors across 204 countries and territories from 1990 to 2021. Methods:This study is a systematic analysis of data from the Global Burden of Disease (GBD) 2021 from 1990 to 2021 across 204 countries and territories. The study calculates age-standardised rates (ASRs) for prevalence, deaths and disability-adjusted life-years (DALYs) by adjusting rates to a global age distribution and computed estimated annual percentage changes (EAPC) for these ASRs and the relative COPD burden, while also exploring the relationships between the SDI and age-standardised DALYs per 1000 population via linear regression. Results:In 2021, there were an estimated 213.4 million prevalent COPD cases globally, with an ASR of 2512.9 per 100 000. From 1990 to 2021, the EAPC for ASRs in prevalence was -0.044%, while the EAPC for percentage in prevalence was 1.224%. COPD caused 3.7 million deaths, with an ASR of 45.2 per 100 000, and 79.8 million DALYs, with an ASR of 940.7 per 100 000. The leading risk factor for COPD globally was particulate matter pollution, where it accounted for 41.7% of the global DALYs. Appreciable geographical and demographic variations were observed, with North America exhibiting the greatest ASRs for prevalence and South Asia showing the greatest ASRs for death rates. Conclusions:The study highlights the persistent and evolving global burden of COPD, emphasising the significant impact of environmental factors such as particulate matter pollution. It underscores the need for targeted public health interventions and resource allocation, particularly in low-income and middle-income countries, to mitigate the growing COPD challenge. To enhance COPD management, the recommendations include implementing regional plans to mitigate particulate pollution, strengthening surveillance of air quality and health outcomes, developing integrated health strategies and supporting a global framework for air quality improvement.

Abstract Background Asthma is a common chronic disease responsible for a considerable disease burden in China and around the world. Despite its burden, there is substantial unmet need for asthma care, including screening, diagnosis, treatment, and management. Symptom-based screening for asthma could support identification of undiagnosed asthma patients, as well as reference to higher-level hospitals for formal diagnoses and treatment. This study focuses on identifying suspected asthma patients and encouraging them to seek formal diagnoses and treatment. This approach aligns with the novel concept of population medicine, which aims to maximize overall population health rather than focusing on individual patients within the health system. Methods We are conducting a two-arm population-based stratified clustered randomized controlled trial (cRCT) to evaluate the effectiveness of a population medicine multimorbidity intervention package. The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a mountainous low-resource county in Southwestern China, covering 26 townships and more than 300,000 permanent residents. We considered each of the 26 townships in Xishui County as a cluster and stratified them into large and small townships based on population size. Townships with an above-average population were designated as “large,” and those with a below-average population were designated as “small.” We randomized the same number of residents in each township stratum (large and small) to undergo the European Community Respiratory Health Survey (ECRHS) for identifying suspected asthma patients. Individuals identified as suspected asthma patients were considered study participants and subsequently enrolled in the intervention or control arm. All participants in the intervention arm are followed for one year, with one telephone follow-up at month three and in-person follow-ups at months six and 12, while participants in the control arm are followed only at baseline and 12 months. Primary outcomes include the number of chronic conditions controlled, whether the participant received lung function testing, and Asthma Control Test (ACT) score. In addition, we are evaluating 42 secondary outcomes covering physiological and functional indicators such as lung function, health-related quality of life, mental health, behavioral risk factors, healthcare utilization, productivity loss, knowledge of asthma and chronic obstructive pulmonary disease (COPD), and care cascade indicators for asthma and other chronic diseases. Discussion This cRCT has been featured as an important case study in the Lancet Commission on Investing in Health report to evaluate the effectiveness of the integrated intervention package on priority conditions. The trial was designed under population medicine principles, with an aim providing holistic care and enhancing the overall health status of suspected asthma patients. The results of the trial will inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. Trial registration ClinicalTrials.gov Identifier: NCT06457009. Registered on June 7, 2024.

INTRODUCTION:Previous randomized trials and real-world observational studies of electronic alerts for acute kidney injury (AKI) have yielded conflicting results. The applicability of trial findings to routine clinical practice is also contested. Despite this, AKI e-alerts remain widely implemented. Here, we used Regression Discontinuity Design (RDD) to evaluate the real-world causal effect of the nationwide AKI e-alert initiative in Wales. METHODS:The study encompassed hospital and community-based systems serving 3.1 million adults (aged 18 years and older) residing in Wales, 2016-2020, following implementation of AKI e-alerts across all Welsh health boards, seven using passive alerts and one using interruptive alerts. We assessed outcomes across the e-alert threshold, including mortality, hospital admission/readmission, AKI severity and recovery, documentation of AKI, prescribing, and follow-up monitoring of proteinuria and blood pressure. RESULTS:Among 861,494 hospital and 354,505 community patient encounters, AKI alerts were triggered in 5.8% and 2.0% of cases respectively (mean age 64 years, 54% female). In both settings, AKI alerts led to no significant changes in mortality [complier average treatment effect +1.31% (95% Confidence Interval -3.07, 4.74); +2.07% (-3.44, 6.65)] or admissions/readmissions [+0.13% (-3.82, 4.21); +4.07% (-1.84, 8.27)]. AKI coding was infrequent across both settings. Alerts modestly increased hospital coding [+5.88% (2.22, 7.58)] but had minimal impact on primary care coding post discharge [+0.72% (-0.67, 1.30)] and led to only small improvements in proteinuria and blood pressure monitoring. Findings were consistent across passive and interruptive alert types, clinical settings and subgroups. CONCLUSIONS:We found no causal evidence that AKI e-alerts (specifically implemented at a 50% creatinine rise threshold) improved or worsened clinical outcomes in this nationwide real-world evaluation. Consistently poor outcomes, limited documentation and follow-up care, even in the presence of e-alerts, underscore the need for an improved clinical response to AKI.

BackgroundChronic obstructive pulmonary disease (COPD) and mental health conditions represent intersecting public health challenges, especially in resource-limited rural China. Existing care models often neglect the psychosocial needs of populations at high risk for COPD, resulting in limited effectiveness of prevention and management strategies. This study evaluates an integrated intervention designed to improve both mental and physical health outcomes among high-COPD-risk individuals with mental health symptoms, using a population medicine framework. ObjectiveThis study aims to evaluate the effect of an integrated, population medicine–based multimorbidity intervention package among high-COPD-risk individuals with mental health symptoms in Xishui County, Guizhou Province, China. MethodsWe are conducting a 12-month, 2-arm cluster randomized controlled trial across 26 townships in Xishui County, Guizhou, China. A total of 44,000 residents aged ≥35 years were screened using the Chronic Obstructive Pulmonary Disease Screening Questionnaire, identifying 10,000 individuals at high risk of COPD. Among them, 3807 individuals with Warwick-Edinburgh Mental Well-Being Scale scores below 45 were enrolled as participants. Intervention components include digital cognitive behavioral therapy–based mental health support, community screening, chronic disease management, patient education, digital follow-up, and team-based care. The primary outcomes are depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item General Anxiety Disorder), and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes are control of chronic diseases, physiological and functional indicators such as lung function, health-related quality of life, mental and behavioral health, health care utilization, knowledge of COPD and asthma, productivity loss, and care cascade indicators for chronic conditions. ResultsData collection for the POPMIX-MH trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and the 12-month follow-up assessments are planned to be completed in March 2026. ConclusionsThis study is the first to integrate psychological support, chronic disease management, and community-based screening into a single scalable intervention package targeting multimorbidity in China. It tests the feasibility of applying population medicine principles, emphasizing integrated, preventive, and population-level care, within primary care systems in low-resource settings. By targeting both mental and physical health, it redefines chronic care beyond traditional organ-specific approaches. Trial RegistrationClinicalTrials.gov NCT06458218; https://clinicaltrials.gov/ct2/show/NCT06458218 International Registered Report Identifier (IRRID)DERR1-10.2196/85853

Despite the disproportionately high burden of Chronic obstructive pulmonary disease (COPD) in rural China, disease awareness remains profoundly low. Existing quantitative assessments outline the prevalence of this awareness deficit but offer limited insight into the complex sociocultural and structural factors driving the awareness gap of COPD. This study aimed to identify the key facilitators and barriers shaping COPD awareness among multiple stakeholders in rural southwest China. Using a purposive sampling strategy in a rural county in Guizhou Province, we conducted semi-structured interviews with 128 stakeholders: high-COPD-risk individuals (n = 50), COPD patients (n = 46), healthcare providers (n = 13), and local administrators (n = 19). Transcripts were analyzed using Practical Thematic Analysis (PTA) and structured around the macro, meso, and micro levels of the Integrated Care for Chronic Conditions (ICCC) framework. Facilitators and barriers are not isolated entities but appeared to be distinct outcomes arising from the same situational factors. At the macro-level, while national health policies often appear disconnected and impractical in real-world application, screening programs sometimes bridge this gap by grounding their approach in tangible clinical engagement. At the meso-level, single educational content often fails to resonate; however, relying on local dialects for interpersonal communication and trust in messengers can significantly improve understanding. At the micro-level, some gradually emerging respiratory symptoms are often mistaken for aging or smoking, leading to delayed diagnosis until the condition worsens severely. On the other hand, observing the physical condition of peers with COPD and being aware of age-related physical vulnerability can prompt people to take proactive health-seeking behaviors. Our findings suggest that improving early COPD awareness in rural low-resource settings may require more context-sensitive and trust-based communication strategies. Empowering healthcare providers to deliver culturally appropriate, dialect-based health education appears to be a promising way to bridge the gap between national health strategies and rural residents’ everyday experiences.

Background Tobacco-related noncommunicable diseases (NCDs) present a major public health challenge in China, requiring population-level management. Chronic obstructive pulmonary disease (COPD) is the most common and prevalent chronic respiratory disease associated with tobacco use. In addition, COPD shares risk factors with other NCDs that frequently co-occur, leading to multimorbidity. This study focuses on the early detection and integrated management of COPD and related multimorbidity among high-risk populations. Population medicine, an emerging and evolving concept aimed at maximizing population health and well-being, provides a promising framework for shifting interventions against COPD from an individual patient focus to a population-level approach. Objective This study aims to evaluate the effectiveness of a population medicine–based multimorbidity intervention package among individuals at high risk for COPD. Methods We are conducting a 2-arm, population-based, stratified cluster randomized controlled trial (cRCT). The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a low-resource county in Southwestern China. Each of the 26 townships in Xishui County was considered a cluster and stratified into large and small townships based on population size. An equal number of residents from each township stratum (large and small) were randomized to undergo the COPD Screening Questionnaire. Individuals identified as being at high risk for COPD were considered study participants and were subsequently enrolled in either the intervention or control arm. The target sample size was approximately 2850 individuals. Results Data collection for the POPMIX-COPD trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and 12-month follow-up assessments are planned to be completed in March 2026. All participants in the intervention arm are being followed for 1 year, with 1 telephone follow-up at month 3 and in-person follow-ups at months 6 and 12. Primary outcomes for each participant include the number of chronic conditions controlled, receipt of lung function testing, and forced expiratory volume in 1 second. In addition, secondary outcomes were health-related quality of life, mental and behavioral health status, health care utilization, knowledge of COPD and asthma, and care cascade indicators for chronic conditions. Conclusions This cRCT is the first multimorbidity intervention study designed within the population medicine framework to target populations at high risk for COPD. It was featured as a case study in the report of the Lancet Commission on Investing in Health. The results of the trial are expected to inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. Trial Registration ClinicalTrials.gov NCT06456996; https://clinicaltrials.gov/ct2/show/NCT06456996 International Registered Report Identifier (IRRID) DERR1-10.2196/85597

Introduction Tobacco use is a major contributor to the burden of chronic obstructive pulmonary disease (COPD) and other non-communicable diseases in China. People at high risk for COPD who smoke, particularly those with pre-existing chronic conditions, often remain underserved by conventional smoking cessation programmes. Population medicine offers a promising framework for proactively identifying high-burden diseases, managing multimorbidity and prioritising interventions for vulnerable populations.Methods and analysis This protocol describes a stratified, two-arm cluster randomised controlled trial (Population Medicine Multimorbidity Intervention in Xishui County-Smoking) being conducted in Xishui County, a rural area of Guizhou Province, China. A total of 26 townships were stratified by population size and randomly assigned in a 1:1 ratio to receive either a multicomponent intervention or usual care. Eligible participants were individuals aged 35 years or older who smoked and were at high risk for COPD as identified by the COPD Screening Questionnaire. The intervention package integrates multiple components, including a digital smoking cessation programme, digital mental health support, community-based spirometry, tailored chronic disease management, health education and a performance-linked ‘pay-for-population’ scheme that aligns healthcare worker reimbursement with population health outcomes. Primary outcomes are smoking amount and nicotine dependence and secondary outcomes include COPD-related health outcomes, hypertension, diabetes, health risk behaviours, quality of life, healthcare utilisation and productivity loss. Follow-up occurs at 3, 6 and 12 months.Ethics and dissemination Ethical approval has been granted by the Peking Union Medical College Ethics Committee (CAMS&PUMC-IEC-2024-042). Informed consent was obtained from all participants prior to enrolment. Results will be shared through peer-reviewed publication and (inter)national conference presentations.Trial registration number NCT06458205.

Objective Waist circumference–based measures can improve diabetes risk assessment beyond body mass index (BMI). Yet, evidence to guide their integration into screening guidelines in low- and middle-income countries (LMICs) is limited, particularly to assess risk among individuals at intermediate BMI ranges. We evaluated the associations of waist circumference (WC), relative fat mass (RFM), and BMI with diabetes across 82 LMICs. Research Design and Methods We analyzed individual-level data from nationally representative surveys across 82 LMICs, comprising 598,883 adults aged ≥25 years with a BMI of 18.5–29.9 kg/m². Associations of anthropometric measures with diabetes were estimated as risk ratios using Poisson regression and area under the curve (AUC), stratified by sex and geographic region. Results Pooled diabetes prevalence was 9.1% (95% confidence interval: 8.51–9.68). Overall, risk of diabetes was greatest for WC and RFM at the highest quintile, compared to BMI. The AUC for WC and RFM as a classifier of diabetes status was higher than the AUC for BMI in men (AUC: WC 0.69, RFM 0.69, BMI 0.64) and women (AUC: WC 0.69, RFM 0.69, BMI 0.63). Generally, the AUC for RFM was higher than the AUC for BMI and either higher or equal to WC across regions and sex. Conclusions WC and RFM outperformed BMI as classifiers of diabetes status among adults with a BMI of 18.5–29.9 kg/m2 across 82 LMICs. Inclusion of WC-based measures in diabetes screening guidelines could improve timely diabetes detection and resource allocation in LMICs among individuals at intermediate BMI ranges.

OBJECTIVE:To evaluate the impact of a new blood donation incentive policy-an honour model promoting blood donation quality and quantity to inform future policy changes in China and worldwide. DESIGN:Staggered difference-in-differences analysis in China. SETTING:Blood donation policies (from provincial government official websites), annual blood donation data (from China's reports on blood safety and annual reports on development of China's blood collection and supply industry), and demographic and socioeconomic indicators (from China city statistical yearbooks and provincial statistical yearbooks) from 2012 to 2018. POPULATION:Blood stations from 30 provinces of China; four regions excluded because data not available. INTERVENTION:The honour model (social recognition through an honour card granting frequent blood donors honorary incentives such as free access to public bus services and outpatient consultations in hospitals) was piloted to stimulate blood donations in intervention provinces. MAIN OUTCOME MEASURE:Annual total count of blood donations and total count of whole blood donations to measure the quantity of blood donations, and annual donor eligibility rate to measure the quality of blood donations. RESULTS:The honour model increased blood donation counts by 3.55% (95% confidence interval 1.30% to 5.80%, P=0.003) by the end of the second year of implementation. By the end of the fifth year, this effect had doubled to 7.70% (2.42% to 12.98%, P=0.006). Most of these increases were driven by absolute increases in whole blood donation of 3.34% (1.11% to 5.56%, P=0.005) and 7.23% (1.90% to 12.56%, P=0.01) by the end of the second and fifth years, respectively. The honour model did not significantly affect the donor eligibility rate. The Borusyak-Jaravel-Spiess difference-in-differences analysis, synthetic difference-in-differences analysis, and placebo test all suggested the results were robust. CONCLUSIONS:The honour model of blood donation increased the quantity of blood donation in China, while donation quality remained unchanged. This impact was sustained after the introduction of the honour model within the study period.

Background:Launched in 2009, China's National Essential Public Health Services Program (NEPHSP) has been broadly implemented throughout the country. However, rigorous evaluations of its impact on chronic disease outcomes remain limited. Hypertension, being one of the major noncommunicable diseases targeted by the program, provides an important case study for assessing its effectiveness. Methods:We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 to evaluate the impact of receiving NEPHSP-covered services (from 2015 onward) on hypertension management. A difference-in-difference approach with two-way fixed effects was used on a cohort of 774 hypertensive adults to estimate changes in health and socioeconomic outcomes associated with NEPHSP coverage. Results:NEPHSP participation contributed to significant increases in hypertension control (9.8%; 95% CI: 2.7-16.9%; p<0.01) and treatment rates (9.9%; 95% CI: 3.8-16.1%; p<0.01). It also increased inpatient admissions by 0.17 per year (95% CI: 0.03-0.31; p<0.05). No significant effect was found on outpatient visits. In addition to clinical benefits, involvement in NEPHSP was linked to a 5.4% reduction in the Engel coefficient (95% CI: 1.2-9.6%; p<0.05), indicating improved household economic well-being. These impacts were more pronounced among younger adults and urban residents, highlighting disparities across subpopulations. Conclusion:The findings provide evidence that NEPHSP has improved hypertension management and household economic well-being. To further maximize these gains, future policy refinements should focus on adapting services to the specific needs of older age groups and other less-responsive subpopulations to ensure universal health equity.

Objective: Care cascade indicators are widely used to monitor national diabetes control efforts. However, diabetes definitions used to derive care cascades vary across studies, which may markedly affect results and subsequent policy decisions. Here, we examine the magnitude of resultant differences between approaches. Research Design and Methods: We analyzed nationally representative, cross-sectional data of 800,348 individuals aged ≥25 years from 88 countries in 2008-2021. We employed two different diabetes definitions: elevated biomarkers (HbA1c≥6.5%; fasting plasma glucose ≥7.0mmol/L; or random plasma glucose ≥11.1mmol/L) or self-reported diagnosis (“diagnosis-based definition”) versus elevated biomarkers or self-reported treatment (“treatment-based definition”). Care cascade estimates included (1) proportions of diabetes cases who were diagnosed, and proportions of diagnosed diabetes cases who (2) received treatment and (3) attained glycemic control. We benchmarked results against World Health Organization (WHO) diabetes targets. Results: Diabetes prevalence was 12.9% (95%-CI: 12.1-13.8) applying the diagnosis-based definition and 11.3% (95%-CI: 10.5-12.1) with the treatment-based definition. Using the diagnosis-based rather than treatment-based diabetes definition to derive care cascades consistently increased percentages who attain diagnosis and control stages but decreased percentages receiving treatment. Across countries, median differences between approaches were 11.3% (IQR: 5.1-24.7) for diabetes diagnosis, 21.6% (IQR: 14.5-37.8) for treatment, and 16.4% (IQR: 7.8-26.8) for control. The WHO 80%-glycemic control target was met by 22% versus 6% of countries when using the diagnosis-based versus treatment-based definition, respectively. Conclusions: Care cascade estimates diverged substantially and consistently across diabetes definitions, skewing policy implications in predictable ways. Harmonizing diabetes performance metrics may improve decision-making and facilitate cross-country comparisons.

In my view, we have never had as robust a body of evidence from observational data on an intervention for dementia as we do for live-attenuated shingles vaccination. Both a recent US National Institutes of Health expert workshop and an international expert consensus on Alzheimer’s disease drug repurposing identified large-scale randomized trials of shingles vaccination for dementia prevention as the crucial next step for the field.

Alcohol use and risky alcohol use are associated with health, social, and psychological complications and may interfere with HIV/AIDS treatment. This study assessed the prevalence and factors associated with alcohol use and risky alcohol use among adults living with HIV in Dar-es-Salaam, Tanzania. This cross-sectional study included data from 771 adults living with HIV on antiretroviral therapy (ART) who were enrolled in a non-inferiority cluster randomized controlled trial. Alcohol use and risky drinking in the past 12 months were assessed using the Alcohol Use Disorders Identification Test (AUDIT-C) tool. Log-binomial regression models were applied to identify factors associated with alcohol use and risky alcohol use. Overall, 31.4

[This corrects the article DOI: 10.1371/journal.pgph.0003161.].