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Objective To quantify the association between reduction in child mortality and routine immunization across 204 countries and territories from 1990 to 2019. Methods We used child mortality and vaccine coverage data from the Global Burden of Disease Study. We used a modified child survival framework and applied a mixed-effects regression model to estimate the reduction in deaths in children younger than 5 years associated with eight vaccines. Findings Between 1990 and 2019, the diphtheria-tetanus-pertussis (DTP), measles, rotavirus and Haemophilus influenzae type b vaccines were significantly associated with an estimated 86.9 (95% confidence interval, CI: 57.2 to 132.4) million fewer deaths in children younger than 5 years worldwide. This decrease represented a 24.2% (95% CI: 19.8 to 28.9) reduction in deaths relative to a scenario without vaccines. The DTP and measles vaccines averted 46.7 (95% CI: 30.0 to 72.7) million and 37.9 (95% CI: 25.4 to 56.8) million deaths, respectively. Of the total reduction in child mortality associated with vaccines, 84.2% (95% CI: 83.0 to 85.1) occurred in 73 countries supported by Gavi, the Vaccine Alliance, with an estimated 45.4 (95% CI: 29.8 to 69.2) million fewer deaths from 2000 to 2019. The largest reductions in deaths associated with these four vaccines were in India, China, Ethiopia, Pakistan and Bangladesh (in order of the size of reduction). Conclusion Vaccines continue to reduce childhood mortality significantly, especially in Gavi-supported countries, emphasizing the need for increased investment in routine immunization programmes. Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. [phrase omitted] Objectif Quantifier le lien entre la baisse de la mortalite infantile et la vaccination systematique dans 204 pays et territoires entre 1990 et 2019. Methodes Nous avons exploite les donnees relatives a la mortalite infantile et a la couverture vaccinale issues de l'etude sur la charge mondiale de morbidite (GBD). Nous avons employe un cadre modifie pour la survie infantile et applique un modele de regression a effets mixtes afin de mesurer l'ampleur de la diminution des deces chez les enfants de moins de cinq ans en lien avec huit vaccins. Resultats Entre 1990 et 2019, les vaccins contre la diphterie, le tetanos et la coqueluche (DTC), la rougeole, le rotavirus et Haemophilus influenzae de type b ont eu un impact significatif en permettant d'eviter pres de 86,9 millions (intervalle de confiance de 95%, IC: 57,2 a 132,4) de deces a travers le monde chez les enfants de moins de cinq ans. Une baisse qui equivaut a 24,2% (IC de 95%: 19,8 a 28,9) de deces en moins par rapport a un scenario sans vaccins. Le vaccin contre la DTC a sauve 46,7 millions de vies (IC de 95%: 30,0 a 72,7), tandis que celui contre la rougeole en a sauve 37,9 millions (IC de 95%: 25,4 a 56,8). Les 73 pays soutenus par Gavi, l'Alliance du Vaccin, representent 84,2% (IC de 95%: 83,0 a 85,1) du pourcentage total de reduction de la mortalite infantile grace aux vaccins. Selon les estimations, 45,4 millions (IC de 95%: 29,8 a 69,2) de morts ont ainsi pu etre evitees entre 2000 et 2019. Pour ces quatre vaccins, c'est en Inde, en Chine, en Ethiopie, au Pakistan et au Bangladesh (par ordre d'importance) que les baisses de mortalite les plus consequentes ont ete observees. Conclusion Les vaccins continuent a exercer une influence considerable sur la reduction de la mortalite infantile, surtout dans les pays soutenus par Gavi, ce qui souligne la necessite d'investir davantage dans les programmes de vaccination systematique. Objetivo Cuantificar la asociacion entre la reduccion de la mortalidad Infantil y la inmunizacion sistematica en 204 paises y territorios entre 1990 y 2019. Metodos Se utilizaron datos de mortalidad infantil y cobertura vacunal del estudio sobre la carga mundial de morbilidad. Se utilizo un marco de supervivencia infantil modificado y se aplico un modelo de regresion de efectos mixtos para estimar la reduccion de muertes en ninos menores de 5 anos asociada a ocho vacunas. Resultados Entre 1990 y 2019, las vacunas contra la difteria-tetanos-tos ferina (DTP), el sarampion, el rotavirus y el Haemophilus influenzae tipo b se asociaron de manera significativa con un numero estimado de 86,9 (intervalo de confianza del 95%, IC: 57,2 a 132,4) millones menos de muertes en ninos menores de 5 anos en todo el mundo. Esta disminucion represento una reduccion del 24,2% (IC del 95%: 19,8 a 28,9) de las muertes en relacion con un escenario sin vacunas. Las vacunas DTP y contra el sarampion evitaron 46,7 (IC del 95%: 30,0 a 72,7) y 37,9 (IC del 95%: 25,4 a 56,8) millones de muertes, respectivamente. De la reduccion total de la mortalidad infantil asociada a las vacunas, el 84,2% (IC del 95%: 83,0 a 85,1) se produjo en 73 paises apoyados por Gavi, la Alianza para las Vacunas, con una reduccion estimada de 45,4 (IC del 95%: 29,8 a 69,2) millones de muertes entre 2000 y 2019. Las mayores reducciones de muertes asociadas a estas cuatro vacunas se produjeron en India, China, Etiopia, Pakistan y Bangladesh (por orden de magnitud de la reduccion). Conclusion Las vacunas siguen reduciendo en gran medida la mortalidad infantil, sobre todo en los paises que reciben apoyo de Gavi, lo que enfatiza la necesidad de aumentar la inversion en programas de inmunizacion sistematica., Introduction Vaccines have substantially reduced morbidity and mortality from infectious diseases and are essential for achieving sustainable development goal (SDG) 3, which aims to ensure healthy lives and promote well-being [...]

In this commentary, we elucidate two distinctive characteristics of China's primary health care system relative to the global primary health care framework: a more narrowly defined patient population and scope of services, along with a diminished clinical capacity in primary care. Building upon this foundation, we critically examine and juxtapose the two quintessential theoretical-practical models of the 20th century that are intimately linked with the integration of medication and prevention. They are the "Community-Oriented Primary Care" Model and the "Barefoot Doctor" Model. Additionally, leveraging a series of practical cases observed within Shanghai's primary care settings in the fourth quarter of 2023, we deliberate on viable approaches for adapting and applying these models in China's primary care infrastructure. We further delineate the requisite external conditions for such a transformation and offer targeted recommendations for the deployment of these models across diverse locales.

In recent years, there has been an increase in accidents involving vessels colliding with bridge piers. These ship–bridge collisions can result in tragic loss of life and severe damage to the bridge structure. To address this issue, a type of fender pile made of winding-formed glass fiber-reinforced polymer (GFRP) was proposed as a solution. In this article, three- and four-point bending tests were performed to compare and analyze the damage modes and load-carrying capacity of the fender piles at two different winding angles, namely 45° and 75°. Vertical impact test was simulated using ANSYS/LS-DYNA to verify finite element models. The results revealed variations in damage patterns and bending performance of GFRP piles under the two fiber winding angles. The simulation results suggest that GFRP fender piles can effectively increase the impact time of ship–bridge collisions and reduce the collision forces, thereby significantly improving the protection of bridge piers.