SummaryBackgroundThe scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.MethodsWe synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).FindingsWorldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.InterpretationThe pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI...

BackgroundPublished data on influenza in severe acute respiratory infection (SARI) patients are limited. We conducted SARI surveillance in central China and estimated hospitalization rates of SARI attributable to influenza by viral type/subtype.MethodsSurveillance was conducted at four hospitals in Jingzhou, China from 2010 to 2012. We enrolled hospitalized patients who had temperature ≥37·3°C and at least one of: cough, sore throat, tachypnea, difficulty breathing, abnormal breath sounds on auscultation, sputum production, hemoptysis, chest pain, or chest radiograph consistent with pneumonia. A nasopharyngeal swab was collected from each case-patient within 24 hours of admission for influenza testing by real-time reverse transcription PCR.ResultsOf 17 172 SARI patients enrolled, 90% were aged <15 years. The median duration of hospitalization was 5 days. Of 16 208 (94%) SARI cases tested, 2057 (13%) had confirmed influenza, including 1427 (69%) aged <5 years. Multiple peaks of influenza occurred during summer, winter, and spring months. Influenza was associated with an estimated 115 and 142 SARI hospitalizations per 100 000 during 2010–2011 and 2011–2012 [including A(H3N2): 55 and 44 SARI hospitalizations per 100 000; pandemic A(H1N1): 33 SARI hospitalizations per 100 000 during 2010–2011; influenza B: 26 and 98 hospitalizations per 100 000], with the highest rate among children aged 6–11 months (3603 and 3805 hospitalizations per 100 000 during 2010–2011 and 2011–2012, respectively).ConclusionsIn central China, influenza A and B caused a substantial number of hospitalizations during multiple periods each year. Our findings strongly suggest that young children should be the highest priority group for annual influenza vaccination in China.

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This study is the first nationally representative survey of e-cigarette use among youth in China. It found that among middle school students, prevalence of e-cigarette use is 1.2% and prevalence of e-cigarette awareness is 45.0%. Chinese youths use e-cigarettes as a tobacco product rather than an aid to quitting. Among never-smokers, e-cigarette users were more likely to have intentions to use a tobacco product in the next 12 months, more likely to use a tobacco product offered by their best friends and enjoy smoking a cigarette than nonusers.

In a preceding paper 1 we reported on a systematic study of potentiometric responses to neutral phenols (ArOH) by poly(vinyl chloride) (PVC) matrix liquid membranes based on quaternary ammonium or phosphonium salts (Q + X -), and proposed a new model for the observed anionic responses. In this model, the decrease in the amount of Q + and X -that are chargeseparated across the membrane interface is explained on the basis of the following two processes: (i) Complexation of Q + X -and the extracted ArOH, leading to a net movement of anionic species (X -) from the aqueous to the membrane phase. (ii) Proton dissociation of the complexed ArOH and concomitant ejection of HX into the aqueous phase, involving a net movement of cationic species (H + ) from the membrane to the aqueous phase. A theoretical treatment based on the above model reproduced the potentiometric response behaviors for undissociated phenols. This model was further supported by optical second harmonic generation (SHG), which enabled a direct observation of the processes occurring at the interface of a liquid membrane and an aqueous solution.Based on the findings of Kimura et al.2 that a macrocyclic polyamine forms complexes with neutral phenols in aqueous solutions, we previously examined potentiometric responses to phenols by a PVC matrix liquid membrane based on lipophilic macrocyclic pentaamine 1, and found that the membrane exhibits anionic responses to undissociated, neutral phenols.3,4 This response behavior is quite similar to that observed for PVC matrix liquid membranes based on quaternary ammonium or phosphonium salts. A variety of lipophilic amines incorporated in PVC matrix liquid membranes exhibited anionic potentiometric responses to phenolic compounds at the pH conditions under which the phenols exist mainly or exclusively in their undissociated, neutral forms. The examined lipophilic amines include a macrocyclic pentaamine, tri(decyl)amine, 4,7-diphenyl-1,10-phenanthroline (bathophenanthroline), 4-octadecylpyridine, and sapphyrin. The potentiometric selectivities of the membranes based on lipophilic aliphatic amines (B) reflected the acidity (hydrogen bond donor activity) and lipophilicity (extractability) of the phenols (ArOH), similarly as membranes based on lipophilic quaternary ammonium salts (Q + X -). The anionic responses were explained on the basis of a decrease in the charge separation of protonated amines (BH + ) and their counteranions (X -) across the membrane interface. Possible processes leading to a decrease in the charge separation between BH + and X -are (i) complexation between ArOH and BH + X -, followed by proton dissociation and ejection of HX into the aqueous phase, as well as (ii) complexation between ArOH and B. The membrane based on sapphyrin showed a high potentiometric selectivity to catechol, possibly due to geometrical discrimination of the ortho dihydroxy structure of catechol by the nitrogen(s) on the rigid macrocyclic structure of sapphyrin.