Liwen Fang

Intracerebral hemorrhage (ICH) incidence is poorly documented in Asia, where it is highest globally. We examined ICH incidence in Shandong Province, East China, using a population-based stroke surveillance system established in 2012, aiming to inform ICH prevention in East China. We obtained the ICH data from Shandong Province in eastern China, covering a period of ten years from 2012 to 2021. Crude, age-standardized, age-specific, gender-specific, and region-specific incidence were calculated.Seasonal trend was assessed and Joinpoint regression was used to compute the Annual Percent Change (APC) in incidence.The life table method was used to estimate ICH early onset probability among residents aged 30–54 years. Spatial autocorrelation analysis was used to identify ICH hot spots. A total of 96,978 cases of ICH were reported. Crude ICH incidence rose from 57.96 to 76.54 per 100,000 (2012 - 2018; APC=4.48%[95%CI:2.66-6.32], P < 0.001), then dropped nonsignificantly to 69.14 (2018 - 2021; APC=- 2.61%[-7.53-2.57], P = 0.250). Males, rural areas, and those ≥45 years old had higher incidence. The probability of early onset (aged 30 - 54 years) increased from 0.75% to 1.11% (2012 - 2018; APC=6.36%[2.24-10.65], P=0.010), then decreased nonsignificantly. Significant seasonal variation was confirmed (P<0.001), with peak observed in January (accounting for 10.86% of all cases) and trough in July (accounting for 6.62% of all cases). We also found ICH hot spots in northern (Liaocheng, Dezhou, Binzhou), western (Heze), and southern (Linyi) regions of Shandong Province in 2021. Over 10 years, ICH incidence in Shandong Province shifted from increasing to stable and was more higher in males, rural areas, and those ≥45 years old, with seasonal peaks in winter. The identification of spatial clusters in specific regions underscored the need of targeted prevention strategies.

Background: The proportion of healthcare workers (HCWs) who receive and recommend seasonal influenza vaccination to their patients remains low in China. This study aims to understand why HCWs infrequently use and recommend the influenza vaccine and how to improve utilization. Methods: A cross‐sectional questionnaire survey and a focus group interview were conducted among primary HCWs in Hubei Province in September 2018 and May 2019. We analyzed qualitative data using descriptive methods and a general inductive approach following a quantitative analysis. In addition, we used the Health Belief Model (HBM) framework to summarize predictors of HCW vaccination and recommendation. Results: Primary HCWs acquired basic knowledge about influenza infection and vaccination and were less likely to receive and recommend influenza vaccination. However, from the focus group, HCWs reported influenza was a mild disease and would not recommend vaccination for patients who looked healthy. HCWs raised concerns about adverse events, cost‐effectiveness, and contraindications to influenza vaccination. HCWs reported, “I would be more likely to recommend vaccination if my employer required that I do so.” Conclusions: Health education materials for HCWs could be improved by providing scientific evidence on the burden of influenza disease, the benefits of vaccination, and national and international policies on influenza vaccination. In addition, interventions that may improve influenza vaccination coverage include workplace requirements for influenza vaccination of HCWs and requirements for HCWs to recommend influenza vaccination to high‐risk groups in addition to providing no‐cost and on‐site vaccination.

Introduction Solid fuel combustion is a significant source of household air pollution and an important risk factor for chronic obstructive pulmonary disease (COPD). This study presents the rates and change in the use of solid fuels for cooking and heating in China. Methods Based on data from the Chinese Chronic Obstructive Pulmonary Disease Surveillance, the research estimated the rates and change of solid fuels usage for cooking and heating from 2014–2015 to 2019–2020 and the rate of primary cooking solid fuels usage in 2019–2020, and analyzed the association between solid fuels usage and COPD. Results The rates of solid fuels usage for cooking and heating significantly decreased, dropping from 45.3% to 28.0% and from 33.5% to 23.2%, respectively. Usage rates were higher among rural residents, with 47.2% using it for cooking and 37.7% for heating in 2019-2020. The usage of solid fuels for cooking is associated with increased risk of COPD. Among rural residents, combined usage of biomass and coal for cooking (OR=1.29, 95% CI: 1.12, 1.48) and using coal as primary fuel for cooking (OR=1.18, 95% CI: 1.00, 1.38) are associated with higher risk of COPD. The usage of biomass for cooking is associated with an increased risk of COPD in urban residents (OR=1.17, 95% CI: 1.03, 1.32). Conclusions The study demonstrates a significant decline in the use of household solid fuels. Nevertheless, high utilization rates persist among individuals in rural settings and those from lower socioeconomic backgrounds. It is of great public health importance to propose targeted fuel substitution measures for various solid fuels in different regions to reduce the risk of COPD.

This study aims to investigate the characteristics of the phenotype and management of chronic obstructive pulmonary disease (COPD) patients in the general population in China. We analyzed spirometry-confirmed COPD patients who were identified from a population-based, nationally representative sample in China. All participants were measured with airflow limitation severity based on post-bronchodilator FEV₁ percent predicted, bronchodilator responsiveness, exacerbation history, and respiratory symptoms. Among a total of 9134 COPD patients, 90.3% were non-exacerbators, 2.9% were frequent exacerbators without chronic bronchitis, 2.0% were frequent exacerbators with chronic bronchitis, and 4.8% were asthma-COPD overlap. Less than 5% of non-exacerbators ever had pulmonary function testing performed. The utilization rate of inhaled medication in non-exacerbators, exacerbators without chronic bronchitis, exacerbators with chronic bronchitis, and asthma-COPD overlap was 1.4, 23.5, 29.5, and 19.4%, respectively. A comprehensive strategy for the management of COPD patients based on phenotype in primary care is urgently needed.