BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.

背景与目标： : 认识到其他国家卫生系统的可靠信息可以为英国国家卫生服务局提供宝贵的经验教训，卫生部委托一个学术团队为国际医疗保健比较提供 “随叫随到的设施” 2005年。本文介绍了这种新颖的政策通报方法的工作，并回顾了前两年的经验。它说明了卫生系统比较分析的有据可查的挑战。一个重要的问题是了解卫生系统的背景，以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严谨之间的潜在紧张关系，以及需要及时分析以告知卫生部迅速变化的政策议程。所涵盖主题的多样性和性质以及快速的周转时间意味着该设施必须仔细平衡严谨性和及时性，以确保报告的价值和相关性。与国际国家专家网络相联系的强大研究基础促进以相对较低的成本提供高质量的分析。然而，这种安排只有在为额外的初级研究提供空间的情况下才能持续下去。尚未对英格兰对医疗保健政策制定的影响进行正式评估。这些知识对于在其他地方开发类似资源至关重要。

BACKGROUND & AIMS: :Sicilian reservoirs constitute the most important water resources available on the island. During summer 2001, the intense water utilization of Lake Arancio reservoir reduced the water level significantly, which coincided with the formation of intense blooms formed by the microcystin (MC)-producing cyanobacterium Microcystis aeruginosa. During summer 2003, Lake Arancio was continuously filled and the vertical stratification of the water column was maintained resulting in five to sixfold lower cell numbers of M. aeruginosa. For both years, a significant relationship between MC net production and Microcysytis cell growth was observed, implying that Microcystis cell numbers can be used to infer MC concentrations in water. Unexpectedly, dense blooms of the MC-producing cyanobacterium Planktothrix rubescens occurred during winter 2005/2006 in the reservoirs Lake Pozzillo, Prizzi, Nicoletti, and Garcia but have not been reported earlier. In this season, MC concentrations higher than those recorded in summer were measured, implying that monitoring of Mediterranean drinking water reservoirs needs to be intensified during winter, a season usually considered to be less prone to the formation of cyanobacterial blooms.

背景与目标： : 西西里水库是岛上最重要的水资源。在夏季2001，阿兰西奥湖水库的强烈水分利用显着降低了水位，这与产生微囊藻毒素 (MC) 的蓝藻铜绿微囊藻形成的强烈水华形成相吻合。在夏季2003，阿兰西奥湖持续充满，并保持水柱的垂直分层，导致铜绿假单胞菌的细胞数降低了五到六倍。在这两年中，观察到MC净产生与微囊炎细胞生长之间存在显着关系，这意味着微囊藻细胞数量可用于推断水中的MC浓度。出乎意料的是，冬季2005/2006期间，在Pozzillo湖，Prizzi，Nicoletti和Garcia的水库中发生了产生MC的蓝藻蓝藻的密集开花，但尚未有报道。在这个季节，测量的MC浓度高于夏季记录的MC浓度，这意味着在冬季需要加强对地中海饮用水水库的监测，而冬季通常被认为不太容易形成蓝藻水华。

BACKGROUND & AIMS: STUDY QUESTION:Is there an association between polycystic ovary syndrome (PCOS) and the sex hormone-binding globulin (SHBG) rs1799941, rs6257, rs6259 and rs727428 variants in a large series of Mediterranean women? SUMMARY ANSWER:The rs727428 and rs6259 variants are associated with PCOS in Mediterranean women. WHAT IS KNOWN ALREADY:The level of SHBG, the primary plasma transport protein for sex steroids, which regulates the bioavailability of these hormones to target tissues, is reduced in patients with PCOS. Single-nucleotide polymorphisms in the SHBG gene influence circulating SHBG levels in American patients with PCOS and may predict the development of type 2 diabetes. STUDY DESIGN, SIZE AND DURATION:This was a genetic case-control association study including 1004 premenopausal Mediterranean women. PARTICIPANTS/MATERIALS, SETTING AND METHODS:In an Academic setting, we genotyped a clinical cohort consisting of 281 patients with PCOS and 142 women without any evidence of androgen excess, and a population-based cohort comprised of 581 unselected female blood donors from Spain and Italy. The latter included 31 patients with PCOS and 550 controls, of whom 298 had no evidence of any androgen excess disorder and were considered hyper-normal controls. MAIN RESULTS AND THE ROLE OF CHANCE:Mutant alleles of the rs727428 variant were more frequent in patients with PCOS compared with controls and with hyper-normal controls. This association was independent of obesity. Carrying mutant alleles of rs727428 was found to be associated with a 1.29 odds ratio (OR) for PCOS, whereas carrying mutant alleles of rs6259 associated with a 0.68 OR for PCOS. The rs1799941 and rs6257 variants were not associated with PCOS. None of the SHBG variants influenced serum SHBG concentrations. LIMITATIONS AND REASONS FOR CAUTION:The associations found here were relatively weak and, arising from a case-control study, do not necessarily indicate a causative role of the SHBG variants in the development of PCOS. Also, we studied different patients and controls from different sources, making some of the interpretations difficult. Finally, the rs1799941 variant was not in Hardy-Weinberg equilibrium in the small group of patients with PCOS recruited from the general population, yet this variant was not associated with PCOS. WIDER IMPLICATIONS OF THE FINDINGS:SHBG variants that influenced circulating SHBG levels in American patients with PCOS are also associated with this syndrome in Mediterranean women, pointing to SHBG as a candidate gene for PCOS. STUDY FUNDING/COMPETING INTEREST(S):This study was supported by grants PI080944 and PI110357 from Instituto de Investigación Carlos III, Spanish Ministry of Economy and Competitiveness. CIBERDEM is also an initiative of Instituto de Investigación Carlos III. The Authors have no competing interests to declare.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Meta-analyses enable summarization and interpretation of data across clinical trials. When applied to safety data they allow for detection of rare events. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was approved in multiple countries worldwide for routine immunization of infants and young children. This meta-analysis was conducted to identify potentially clinically important rare safety events associated with PCV13. OBJECTIVE:To summarize the safety of PCV13 compared with 7-valent pneumococcal conjugate vaccine (PCV7) administered to infants and toddlers. METHODS:A meta-analysis was performed of integrated safety data from 13 infant studies (PCV13 n=4729 and PCV7 n=2760) conducted in 9 North American, European, and Asian countries. Local reactions at the vaccine injection site and systemic events were collected for 4-7 days after each dose into electronic diaries. Adverse events (AEs) were collected after each vaccination. RESULTS:Overall, rates of local reactions after any dose of the infant series were similar between PCV13 and PCV7 groups: tenderness (46.7% vs 44.8%, respectively); swelling (28.5% vs 26.9%); and redness (36.4% vs 33.9%). After the toddler dose, tenderness was significantly higher among PCV7 subjects than PCV13 subjects (54.4% vs 48.8%; P=0.005). Frequencies of fever (≥38°C) were similar in both groups and mostly mild (≤39°C); incidence of moderate fever (>39°C to ≤40°C) with PCV13 was ≤2.8% after any infant dose and 5.0% after the toddler dose, compared with ≤2.6% and 7.3%, respectively, with PCV7. Fever >40°C was uncommon in both groups. Frequencies of decreased appetite, irritability, and sleep disturbances were similar in both groups. AEs were the types of conditions and symptoms expected in infants and children, and clinically significant differences between vaccine groups were not observed. CONCLUSION:PCV13 has a favorable safety profile similar to that of PCV7, a vaccine for which there is >10 years clinical experience.

背景与目标：

BACKGROUND & AIMS: :We have conducted a systematic review to update available information on plasmid-mediated colistin resistance (mobilized colistin resistance [mcr]) genes in North African countries. We have searched the articles of PubMed, Scopus, and Web of Science databases reporting plasmid-mediated colistin resistance bacteria isolated in North African countries. After searching and selection, 30 studies that included 208 mcr-positive isolates were included. Different mcr-positive strains frequencies were recorded and ranged from 2% in clinical isolates to 12.3% in environmental samples. Escherichia coli was the predominant species recorded and these microorganisms showed high resistance to ciprofloxacin and cotrimoxazole. IncHI2 plasmids are probably the key vectors responsible for the dissemination of mcr genes in these countries. This review highlighted that the mcr-positive isolates are circulating in different ecological niches with different frequencies. Therefore, actions should be implemented to prevent the dissemination of the mcr genes within and outside of these countries, such as microbiological and molecular surveillance programs and restriction use of colistin in farming.

背景与目标： : 我们已经进行了系统的审查，以更新有关北非国家中质粒介导的粘菌素抗性 (动员粘菌素抗性 [mcr]) 基因的可用信息。我们搜索了PubMed，Scopus和Web of Science数据库的文章，这些数据库报告了在北非国家分离的质粒介导的粘菌素抗性细菌。经过搜索和选择，包括208个mcr阳性分离株的30项研究被纳入。记录了不同的mcr阳性菌株频率，范围从临床分离株中的2% 到环境样品中的12.3%。大肠杆菌是记录的主要物种，这些微生物对环丙沙星和复方新诺明表现出很高的抗性。IncHI2质粒可能是在这些国家/地区传播mcr基因的关键载体。这篇评论强调了mcr阳性分离株以不同的频率在不同的生态位中循环。因此，应采取行动防止mcr基因在这些国家内外的传播，例如微生物和分子监测计划以及在农业中限制使用粘菌素。

BACKGROUND & AIMS: Background:Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods:For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results:The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions:Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.

背景与目标：

BACKGROUND & AIMS: Importance:Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective:To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants:This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures:Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures:Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results:Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance:In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The Mediterranean diet is one of the healthier diet models. Mediterranean food patterns are suffering a deterioration that can especially affect children and adolescents. OBJECTIVE:Determine adherence to the Mediterranean diet in adolescents of southern Spain and its relationship with the residence area, sex, age, life satisfaction, anthropometry, and habits of physical activity and sedentary activities. METHODOLOGY:A total of 1973 adolescents (11-18 years) of southern Spain participated in this descriptive cross-sectional study. Cut-off value between rural and urban locations was 10000 inhabitants. Adherence to the Mediterranean diet was calculated from the KIDMED questionnaire. Life satisfaction, physical activity, and sedentary activities also were measured through valid and reliable questionnaires. Body mass index and % body fat were measured using the TANITA BC-420-S body analyzer. RESULTS:30.9% of the adolescents reported an optimal quality diet, percent higher in rural locations (P < 0.05). Adherence was lower in older adolescents (P < 0.001), it was not different between sexes or according to anthropometric variables. Adolescents more satisfied with their lives (P < 0.001), more active (P < 0.001), more studious (P < 0.001), and less sedentary in front of a screen (P < 0.001) showed greater adherence to the Mediterranean food pattern. CONCLUSION:The majority of adolescents need to improve their nutritional quality. Compared with these subjects, the adolescents most adherent to the Mediterranean diet had a healthier lifestyle and they showed greater life satisfaction. :Introducción: La dieta mediterránea es uno de los modelos más saludables de dieta. Los patrones alimentarios mediterráneos están sufriendo un deterioro que puede afectar especialmente a niños y adolescentes. Objetivo: Determinar la adherencia a la dieta mediterránea de los adolescentes del sur de España y su relación con el área de residencia, sexo, edad, satisfacción con la vida, características antropométricas y hábitos de actividad física y sedentaria. Métodos: Un total de 1.973 adolescentes (11-18 años) del sur de España participaron en este estudio descriptivo transversal. El punto de corte entre poblaciones rurales y urbanas fue 10.000 habitantes. La adherencia a la dieta mediterránea fue calculada a partir del cuestionario KIDMED. Satisfacción con la vida, actividad física y sedentarismo también mediante cuestionarios fiables y válidos. Índice de masa corporal y % de grasa corporal fueron medidos utilizando el analizador corporal TANITA BC-420-S. Resultados: El 30,9% de los adolescentes reportó una dieta de calidad óptima, porcentaje superior en poblaciones rurales (P < 0,05). La adherencia fue menor en los adolescentes de mayor edad (P < 0,001), sin diferir entre sexos ni según las variables antropométricas. Los adolescentes más satisfechos con sus vidas (P < 0,001), más activos (P < 0,001), más estudiosos (P < 0,001) y menos sedentarios delante de una pantalla (P < 0,001) mostraron mayor adherencia al patrón alimentario mediterráneo. Conclusión: La mayoría de adolescentes necesitan mejorar su calidad nutricional. En comparación con estos sujetos, los más adheridos a la dieta mediterránea llevaban un estilo de vida más saludable y mostraron mayor satisfacción con sus vidas.

背景与目标：

BACKGROUND & AIMS: :The Bemisia tabaci Mediterranean (MED) cryptic species has been rapidly invading most parts of the world owing to its strong ecological adaptability, particularly its strong resistance to temperature stress. Epigenetic mechanisms play important roles in mediating ecological plasticity. In particular, DNA methylation has been the focus of attempts to understand the mechanism of phenotypic plasticity. The relationship between temperature and DNA methylation and how it affects the adaptability of invasive insects remain unknown. To investigate the temperature resistance role of DNA methyltransferase 1 (Dnmt1) in MED, we cloned and sequenced BtDnmt1 homology and identified its functions under various temperature conditions. The full-length cDNA of MED BtDnmt1 homology was 5,958 bp and has a 4,287 bp open reading frame that encodes a 1,428-amino-acid protein. BtDnmt1 mRNA expression levels were significantly down-regulated after feeding with dsRNA. Furthermore, after feeding with dsBtDnmt1, the MED adults exhibited significantly higher mortality under temperature stress conditions than the controls, suggesting that MED BtDnmt1 homology plays an essential role in the temperature tolerance capacity of MED. Our data improve our understanding of the temperature resistance and temperature adaptability mechanisms that have allowed the successful invasion and colonization of various environments by this alien species.

背景与目标： : 烟粉虱地中海 (MED) 隐秘物种由于其强大的生态适应性，特别是对温度胁迫的抵抗力，已迅速入侵世界大部分地区。表观遗传机制在介导生态可塑性中起着重要作用。特别是，DNA甲基化一直是试图理解表型可塑性机制的重点。温度与DNA甲基化之间的关系以及它如何影响入侵昆虫的适应性仍然未知。为了研究DNA甲基转移酶1 (Dnmt1) 在MED中的耐温作用，我们克隆并测序了BtDnmt1同源性，并鉴定了其在各种温度条件下的功能。MED BtDnmt1同源性的全长cDNA为5,958  bp，并具有编码1,428氨基酸蛋白的4,287  bp开放阅读框。喂食dsRNA后，BtDnmt1 mRNA表达水平显着下调。此外，用dsBtDnmt1喂养后，MED成年人在温度胁迫条件下的死亡率明显高于对照组，这表明MED BtDnmt1同源性在MED的温度耐受能力中起着至关重要的作用。我们的数据提高了我们对耐温性和温度适应性机制的理解，这些机制使这种外来物种成功地入侵和定居了各种环境。

BACKGROUND & AIMS: AIMS:The factors contributing to the establishment of high-quality radiotherapy services in low- and middle-income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high-quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. METHODS:An exploratory-descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. FINDINGS:Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high-income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non-Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence-based practice, strategic partnerships, motivation to provide patient-centered care, and availability of supportive technology. CONCLUSIONS:Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.

背景与目标：

BACKGROUND & AIMS: :The main objective of this study was to assess the economic cost of Alzheimer's disease (AD) in Shanghai, China, as a pilot study for future evaluations. Sixty-seven patients with AD were interviewed, and the information of the AD-related cost and resources used was collected from October 2005 to September 2006. By retrospective analysis, annual costs were calculated and expressed in Chinese renminbi (RMB). Direct cost per patient per year averaged approximately 8,432 RMB (1,058 USD), indirect cost per patient per year was 10,568 RMB (1,326 USD), and annual costs were 19,001 RMB (2,384 USD) per patient per year in this investigation. Total cost was significantly associated with the degree of severity including cognitive function (MMSE) and activity of daily living (ADL). With the increase in the number of persons at risk for developing AD, the economic burden of AD patients in China is significantly heavy.

背景与目标： : 这项研究的主要目的是评估中国上海阿尔茨海默氏病 (AD) 的经济成本，作为未来评估的试点研究。对67名AD患者进行了访谈，并从2005年10月到2006年9月收集了与AD相关的费用和所使用资源的信息。通过回顾性分析，计算年度成本，并以人民币表示。在这项调查中，每位患者每年的直接成本平均约为8,432元人民币 (1,058美元)，每位患者每年的间接成本为10,568元人民币 (1,326美元)，每位患者每年的年度成本为19,001元人民币 (2,384美元)。总成本与严重程度 (包括认知功能 (MMSE) 和日常生活活动 (ADL)) 显着相关。随着发生AD风险人数的增加，我国AD患者的经济负担明显加重。

BACKGROUND & AIMS: :Chronic non-communicable diseases such as epilepsy, diabetes, cardiac disease and hypertension represent a growing but neglected burden in developing countries. Rural sufferers, distant from health facilities, bear this most acutely. In response, a community care programme has been developed at Jimma University Hospital and its allied health centres in rural southwest Ethiopia. This involves general duty nurses at rural health centres being trained to provide care for chronic disease patients, with regular supervision from the hospital physicians. The programme allows treatment to be provided away from the main hospital so that those who cannot afford to travel can access care near their homes. Improved access increases the request for care, and helps to address the large unmet need for chronic disease treatment. This is a good model in which rural healthcare delivery through a team can bring widespread benefit. In this article chronic disease care is discussed with a particular focus on diabetes and epilepsy. The model can be replicated in more or less developed countries and may also be relevant for HIV care.

背景与目标： : 癫痫、糖尿病、心脏病和高血压等慢性非传染性疾病在发展中国家是一个日益增长但被忽视的负担。远离医疗机构的农村患者对此最为敏锐。作为回应，吉马大学医院及其埃塞俄比亚西南部农村的相关保健中心制定了一项社区护理方案。这涉及农村保健中心的普通值班护士接受培训，在医院医生的定期监督下为慢性病患者提供护理。该方案允许在远离主要医院的地方提供治疗，以便那些负担不起旅行费用的人可以在家附近获得护理。改善获取途径增加了对护理的要求，并有助于解决大量未满足的慢性疾病治疗需求。这是一个很好的模式，通过团队提供农村医疗保健可以带来广泛的利益。在本文中，讨论了慢性病护理，特别关注糖尿病和癫痫。该模型可以在或多或少的发达国家中复制，并且也可能与艾滋病毒护理有关。

BACKGROUND & AIMS: BACKGROUND:The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS:The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS:Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION:Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING:WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. METHODS:From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. RESULTS:Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. CONCLUSION:Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

背景与目标：

BACKGROUND & AIMS: :The World Health Organization and other institutions are considering Artificial Intelligence (AI) as a technology that can potentially address some health system gaps, especially the reduction of global health inequalities in low- and middle-income countries (LMICs). However, because most AI-based health applications are developed and implemented in high-income countries, their use in LMICs contexts is recent and there is a lack of robust local evaluations to guide decision-making in low-resource settings. After discussing the potential benefits as well as the risks and challenges raised by AI-based health care, we propose five building blocks to guide the development and implementation of more responsible, sustainable, and inclusive AI health care technologies in LMICs.

背景与目标： : 世界卫生组织和其他机构正在考虑将人工智能 (AI) 视为一种技术，可以潜在地解决某些卫生系统差距，特别是减少中低收入国家 (lmic) 的全球卫生不平等现象。然而，由于大多数基于人工智能的卫生应用程序是在高收入国家开发和实施的，它们在lmic背景下的使用是最近的，并且缺乏强有力的本地评估来指导低资源环境下的决策。在讨论了基于人工智能的医疗保健带来的潜在好处以及风险和挑战之后，我们提出了五个构建模块，以指导lmic中更具责任感，可持续性和包容性的人工智能医疗技术的开发和实施。