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Introduction Cancer poses a formidable challenge to global public health, with significant disparities in care access persisting across regions and socioeconomic groups. Utilizing data from the Global Burden of Disease 2021 study, we analyzed epidemiological trends for total cancers and 29 site-specific cancer types between 1990 and 2021. Methods To quantify trends in cancer burden, we calculated the Estimated Annual Percentage Changes (EAPCs) in age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We also examined the temporal trends in socio-demographic index (SDI)-related disparities across all cancer types by using the slope index of inequality (SII) and the concentration index (CI). Additionally, we calculated the Quality of Care Index (QCI) and explored its correlation with SDI using Pearson correlation coefficients. Results In 2021, the global incidence of total cancers reached 23.56 million cases, and we observed a growing trend in the age-standardized incidence. In contrast, the age-standardized mortality and disability-adjusted life years rates showed a downward trend. A substantial cancer burden was concentrated in high-SDI countries. Trends in global cancer inequality improved overall. We observed a significant shift in the burden of certain cancer types toward low-SDI regions in recent years, suggesting that the unequal distribution of the cancer burden has changed across regions. The correlation coefficient between the QCI and the SDI for total cancers was 0.87 in 2021. And the QCI was highly positively correlated with the SDI for 16 out of the 29 cancer groups, while non-melanoma skin cancer showed the lowest correlation. Conclusion This study highlights that although global cancer treatment has improved and cancer deaths/DALYs inequality across countries has decreased, there are still challenges with high cancer incidence worldwide. Notably, cancer care quality remains closely correlated with the social development index. The distinctions between the 29 cancers have significant therapeutic ramifications, highlighting the significance of allocating resources and developing cancer treatment plans according to the kind of disease. Furthermore, these results provide insightful direction for the creation of future health policies.

Background The purpose of this study is to address the serious challenges China faces in diabetes prevention and treatment. Amidst the rapid global increase in diabetes prevalence, China now has the largest number of diabetes patients worldwide. To address this problem, the present study aimed to evaluate a family doctor-led community intervention model to provide an effective and sustainable solution for diabetes management. Methods Using a randomized controlled trial design in this 3-month intervention study (conducted from March to June 2023), 180 participants were divided into an intervention and control group. The control group received only routine diabetes management; the intervention group received additional services provided by a family doctor, including a professional treatment plan, diabetes education, medication reminders, personalized follow-up, and guidance assessment. Differential analysis and multiple factor linear regression analysis were used to evaluate the effects of intervention measures in patients with type 2 diabetes mellitus. Results After intervention, the intervention group demonstrated a significant decrease in glycated hemoglobin levels (t = 8.184, P  < 0.001), as well as significant improvements in knowledge, attitude, behavior, and medication taking scores ( P  < 0.001). Further studies showed that improvements in knowledge (β = 0.720, P  < 0.001), attitude (β = 0.135, P  < 0.001), behavior (β = 0.526, P  < 0.001), and medication taking (β = 0.205, P  < 0.001) all contributed to the enhancement of self-management capabilities in patients with type 2 diabetes mellitus, jointly accounting for 99.9% of the improvement in overall self-management (adjusted R² = 0.999). Conclusions Implementing a comprehensive intervention led by family doctors for patients with type 2 diabetes mellitus in the community significantly improved patients’ key physiological indicators and enhanced various aspects of patients’ knowledge, attitude, behavior and medication taking. Trial registration Chinese Clinical Trial Registry, ChiCTR2400079653, retrospectively registered on 09 January 2024.

On April 18, 2024, the U.S. Food and Drug Administration officially required updating of the \"boxed warning\" for T cell malignancies for all chimeric antigen receptor T cell (CAR-T) therapies. Given the clinical significance of these therapies, a rigorous safety assessment is paramount. However, comprehensive real-world safety studies have been lacking for the newly marketed CAR-T products idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), which target B cell maturation antigen, especially regarding the risk of secondary malignancies. Therefore, we aimed to thoroughly analyze the adverse events (AEs) information in the FDA Adverse Event Reporting System (FAERS) database to comprehensively understand the safety risks of ide-cel and cilta-cel. We extracted AE reports related to ide-cel and cilta-cel from the FAERS database (https://fis.fda.gov/extensions/FPD-QDE-FAERS/FPD-QDE-FAERS.html.) from January 1, 2019 to December 31, 2023. Disproportionality analysis and Bayesian analysis were used to identify risk signals across subgroups and specific cases (including for death and secondary malignancies). Weibull distribution analysis was employed to determine the time to AE onset. A total of 695 AE reports for ide-cel and 848 for cilta-cel were included in the FAERS database. This analysis identified 81 positive signals for ide-cel and 74 for cilta-cel. Notably, comparisons with the drug labels revealed \"unexpected signals,\" including febrile bone marrow aplasia (reporting odds ratio=69.10; confidence interval 39.12-122.03) and plasma cell myeloma (12.45; 8.18-18.95) for ide-cel, and increased serum ferritin (24.98; 8.0-77.58) and large intestine perforation (18.57; 5.98-57.69) for cilta-cel. Both drugs showed a higher AE incidence among male recipients and patients aged ≥65 years, although female recipients faced a greater risk. Most AEs occurred at the early stage of administration. However, secondary malignancies were detected for both drugs, primarily occurring one-year post-administration. This study provides a foundation for understanding the safety profile of CAR-T cell therapy, particularly in relation to the emergence of secondary malignancies. Such insights are helpful for clinical decision-making and the safe and effective utilization of these therapeutic agents.

Background Multimorbidity is prevalent among the elderly, with long-term medication use posing increasing adherence challenges. This study examines the evolution of multimorbidity patterns and their dynamic association with medication adherence to generate empirical evidence for the design of personalized treatment strategies and targeted health interventions for older adults with multimorbidity. Methods Using data from 2,798 elderly individuals with multimorbidity in the 2011–2020 China Health and Retirement Longitudinal Study, this study employs latent transition analysis and a semi-Markov model to assess adherence transitions across four multimorbidity patterns. Relative Transition Rates (RTRs) were used to quantify differences in adherence improvement and deterioration probabilities. Results The cardiovascular disease group remained relatively stable, with other patterns shifting toward it over time. Between 2013 and 2018, the incidence of adherence improvement (60.60%) was more frequent than deterioration (39.40%), especially in the multi-system disorders (62.08%) and respiratory diseases groups (67.59%), while deterioration was higher in the gastrointestinal metabolism (40.75%) and cardiovascular disease groups (39.64%). Compared to the multi-system disorders group, the gastrointestinal metabolism group was less likely to improve from low to moderate adherence (RTR = 0.63, 95% CI: 0.41–0.98), while both the gastrointestinal metabolism (RTR = 4.45, 95% CI: 1.92–10.18) and cardiovascular disease groups (RTR = 2.57, 95% CI: 1.07–6.11) had higher risks of declining from high to moderate adherence. Conclusions Cardiovascular diseases appear increasingly central in elderly multimorbidity, with gastrointestinal metabolism and respiratory conditions potentially serving as early or coexisting risk factors. Early cardiovascular risk monitoring may be beneficial in these groups, while long-term adherence support remains important for gastrointestinal and cardiovascular patterns.

This study aimed to evaluate and compare the disease burden of pharmacovigilance-related events in European countries, to identify the factors related to pharmacovigilance-related inputs in various countries, and to analyze and compare the comprehensive benefits of pharmacovigilance-related events in various countries. Using the Global Burden of Disease Study 2021 database, we combined information on adverse effects of medical treatment and drug use disorders to identify all pharmacovigilance-related events. We used principal component analysis to synthesize six first-level indicators to compare the burden of disease in each country in each year. We used data envelopment analysis to compare the efficiency of pharmacovigilance in each country. In 2021, the Quality of care index for pharmacovigilance-related events was highest in Northern and Western European countries. Looking at data from 1990 to 2021, the change node of this index in most countries occurred around 2000 to 2010, and the value changed steadily. Countries with relatively low investment in health resources and less experience in the supervision of adverse drug reactions have higher comprehensive benefits of nursing for pharmacovigilance-related events. The effect of the development of a system for pharmacovigilance has a hysteresis. The disease burden is affected by various factors such as population aging, human resource investment, and medical and health needs, and the policy is highly dominant.

This study aimed to develop an evaluation framework for primary pharmacovigilance systems based on the Chinese context, with potential applicability to regions with similar system maturity. The framework was informed by the WHO manual and tailored to national policies and resource constraints to support consistent pharmacovigilance practices in similar settings and enhance medication safety. This study employed semi-structured interviews, literature review, brainstorming, group discussions, and other common methods to establish a preliminary indicator system. The Delphi Method was employed to screen indicators at various levels based on inclusion principles. Subsequently, the Analytic Hierarchy Process (AHP) was applied to determine indicator weights. The effective response rates for both rounds of questionnaires were 100%. Furthermore, the coefficients of reliability were 0.87 and 0.88 for each round, and the Kendall's W for the process and outcome indicators were 0.173 and 0.236. The significance tests for Kendall's W were both P < 0.001. The final evaluation indicator system consisted of 3 first-level indicators, 9 second-level indicators, and 35 third-level indicators. This study developed a practical and context-sensitive evaluation framework for primary pharmacovigilance systems in China. The framework offers a feasible assessment tool and may serve as a reference for regions with similar development stages or incomplete pharmacovigilance systems, providing guidance for system improvement and resource allocation.

Objectives We aimed to explore the current status of medication adherence, safety awareness and practice among patients with lung cancer. Methods We conducted a questionnaire‐guided cross‐sectional study in Xi'an, Yulin, Hanzhong and Weinan in Shaanxi Province, China, from April to June 2021 for a period of 3 months. The study questionnaire was developed according to previous related studies reported in the literature, and includes basic demographic information and patients' medication safety questions. The data were double‐entered using EpiData 3.1 software; descriptive statistics, t‐test, analysis of variance, the Kruskal–Wallis test and the Mann–Whitney U‐test were performed to analyse the data. Results A total of 567 participants were included, and 409 valid questionnaires were finally completed, with an effective response rate of 72.13%. More than 80% of patients showed good medication adherence; the average adherence score was 22 ± 2.68 of 25. The average score for medication safety awareness was 16.40 ± 4.41, which was significantly lower than that of medication adherence (p < .001). Only 22.74% of patients always checked their medicines before a nurse administered them; 17.60% of patients never checked their medicines. Few patients actively consulted an health care professional to understand safety information before taking a medication. A significant difference existed in safety awareness scores among age groups (p = .039) and geographic regions (p < .001). Patients with three or more comorbidities had the lowest awareness scores (p = .027). Conclusion We found that patients with lung cancer showed better medication adherence, but their awareness about medication safety was poor. Older patients, those with comorbidities and patients in regions with poor medical resources may have worse awareness about safety. Current medication education for patients should not only aim to improve adherence but should also encourage patients to take greater responsibility for their own safety and to actively participate in their medication safety. Greater systematic and individualized medication safety information is needed for older patients, those with more comorbidities and patients in areas with poor medical resources. Patient Contribution We conducted a questionnaire‐guided cross‐sectional study on hospitalized lung cancer patients in Shaanxi Province to explore the patients' practices related to safety medication, including medication adherence and medication safety awareness.

Previous studies have focused on the fact that government policies are the key factors in promoting the development of intelligent construction in construction enterprises. However, how to select different forms of policy support and quantify the intensity of policy support, as well as the impact on the behavioral strategies of construction enterprises and the government, still needs in-depth exploration. This paper constructs an evolutionary game model between construction companies and the government, using the system dynamics simulation software Vensim to analyze the model under three different government policy support scenarios. The study explores how varying levels of policy support and key factors influence the strategic choices of the game participants, providing valuable insights for promoting the development of intelligent construction. The key findings are as follows: (1) The willingness to adopt intelligent construction is heavily dependent on policy incentives. The incentive effect of the three single policies is much lower than that of the combined policies, and only high-intensity special fund support (more than 8 CNY/m2) significantly promotes widespread adoption. Among combinations of policies, tax incentives coupled with special funds prove most effective. (2) The government’s decision to actively promote intelligent construction hinges on a cost–benefit analysis. Under medium to high levels of special fund support, medium to low levels of service support are more beneficial for reaching a stable state of intelligent construction implementation. (3) Reducing the incremental costs of intelligent construction transformation is the primary key factor in promoting construction. The findings contribute to a deeper understanding of how both the government and construction companies can adjust their strategies in response to policy changes, ultimately leading to more effective policy implementation and strategic decision-making.

IntroductionThe management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state, and the most suitable management methods for diabetic patients are still being explored. Few studies have used community-based family doctors to perform interventions of appropriate intensity. This protocol describes a planned randomised controlled trial to evaluate the effectiveness of a family doctor-led intervention model for diabetes self-management and medication adherence in type 2 diabetes mellitus patients.Methods and analysisThis is a Standard Protocol Items: Recommendations for Interventional Trials-compliant cluster randomised controlled trial. The study will be conducted at four CHCs (community health centers). The control group will receive conventional medical services and health education. The intervention group will receive an intervention led by community family doctors based on the conventional medical services and health education. It will include five parts: usual care, a medication reminder, a 4-week plan, a weekly phone interview and a monthly interview. The primary outcomes are changes in fasting blood glucose, glycosylated haemoglobin, self-management knowledge and behaviour, and medication adherence from baseline to the 3rd and 6th months. The secondary outcome is the proportion of people whose blood sugar and glycosylated haemoglobin are under control in the 3rd and 6th months.Ethics and disseminationThe study proposal was approved by the Biomedical Ethics Committee of the Medical Department of Xi’an Jiaotong University (no. 2021-1371). The findings will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberChinese Clinical Trial Registry, ChiCTR2100051685.