Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101787
S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , E.A.-L. Holt
This viewpoint piece examines Global Health in the Pacific region. The purpose of the article is to provide a Pacific, female perspective to Global Health by considering the history, context, and current practices in the region. Reflecting on a history of colonialism and exclusion of Indigenous Pacific Peoples worldviews, we re-imagine a future that prioritises Pacific aspirations. Central to this shift is a Global Health approach that ensures Pacific priorities, leadership and aspirations through four action areas of sovereignty, integrating worldviews, connectivity, and equity and participation. We draw on examples of lived experiences that include health systems strengthening, research and policy.
{"title":"Re-imagining Global Health: perspectives from the next generation in the Pacific region","authors":"S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , E.A.-L. Holt","doi":"10.1016/j.lanwpc.2025.101787","DOIUrl":"10.1016/j.lanwpc.2025.101787","url":null,"abstract":"<div><div>This viewpoint piece examines Global Health in the Pacific region. The purpose of the article is to provide a Pacific, female perspective to Global Health by considering the history, context, and current practices in the region. Reflecting on a history of colonialism and exclusion of Indigenous Pacific Peoples worldviews, we re-imagine a future that prioritises Pacific aspirations. Central to this shift is a Global Health approach that ensures Pacific priorities, leadership and aspirations through four action areas of sovereignty, integrating worldviews, connectivity, and equity and participation. We draw on examples of lived experiences that include health systems strengthening, research and policy.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101787"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101794
Charlie G.Y. Lim , Crystal C.Y. Chong , Yvonne H.M. Wong , Jiali Yao , Stefen Ma , John C. Chambers , Khung Keong Yeo , E Shyong Tai , Jasper Tromp , Rob M. van Dam , Saima Hilal , Charumathi Sabanayagam , Ching-Yu Cheng , Xueling Sim
Background
The rising burden of cardiovascular diseases (CVD) in Asia requires risk assessment tools tailored to Asian populations. Therefore, we recalibrated the ACC/AHA Pooled Cohort Equations for non-Hispanic Whites (PCE-W) and compared its performance in predicting 10-year CVD risk with two other established CVD prediction models that have been recently recalibrated for Asian populations.
Methods
We used data from the Singapore Multi-Ethnic Cohort (MEC1) and the Singapore Epidemiology of Eye Diseases (SEED) cohort comprising ethnic Chinese, Indian, and Malay participants. The PCE-W was recalibrated using data from MEC1, externally validated in the SEED cohort, and compared against the Singapore-modified Framingham Risk Score (SG-FRS-2023) and the SCORE2 Asia–Pacific model using the concordance index (C-index). Calibration was assessed using the calibration-in-the-large method, the calibration slope, and a goodness-of-fit test.
Findings
All three models demonstrated possibly helpful to clearly useful discrimination in MEC1 and SEED, with overall C-indices ranging from 0.728 to 0.811. The recalibrated PCE-W outperformed the original PCE-W in MEC1 and SEED, although some misestimations remained among Chinese men and women and Malay women (calibration-in-the-large ranged from −0.479 to 0.260). The SG-FRS-2023 displayed generally satisfactory calibration across both MEC1 and SEED but tended to overestimate risk in Chinese (calibration-in-the-large −0.671) and Indian men (calibration-in-the-large −0.214) in the SEED cohort. The SCORE2 Asia–Pacific model performed satisfactorily among Indians but overestimated risk in Chinese (calibration-in-the-large ranged from −0.570 to −1.185) and showed poor model fit in Malays.
Interpretation
The recalibrated PCE-W, SG-FRS-2023, and SCORE2 Asia–Pacific model demonstrated possibly helpful to clearly useful discrimination across two multi-ethnic cohorts in Singapore. In terms of calibration, the recalibrated PCE-W and SG-FRS-2023, both recalibrated using local data, performed better than the SCORE2 Asia–Pacific model. Our study supports the use of the established CVD prediction models in Asian populations following appropriate local recalibration.
Funding
This work was supported by the Singapore Ministry of Health’s National Medical Research Council and the Singapore Biomedical Research Council.
{"title":"Cardiovascular disease risk prediction in multi-ethnic Asian populations: evidence from two population-based cohorts in Singapore","authors":"Charlie G.Y. Lim , Crystal C.Y. Chong , Yvonne H.M. Wong , Jiali Yao , Stefen Ma , John C. Chambers , Khung Keong Yeo , E Shyong Tai , Jasper Tromp , Rob M. van Dam , Saima Hilal , Charumathi Sabanayagam , Ching-Yu Cheng , Xueling Sim","doi":"10.1016/j.lanwpc.2025.101794","DOIUrl":"10.1016/j.lanwpc.2025.101794","url":null,"abstract":"<div><h3>Background</h3><div>The rising burden of cardiovascular diseases (CVD) in Asia requires risk assessment tools tailored to Asian populations. Therefore, we recalibrated the ACC/AHA Pooled Cohort Equations for non-Hispanic Whites (PCE-W) and compared its performance in predicting 10-year CVD risk with two other established CVD prediction models that have been recently recalibrated for Asian populations.</div></div><div><h3>Methods</h3><div>We used data from the Singapore Multi-Ethnic Cohort (MEC1) and the Singapore Epidemiology of Eye Diseases (SEED) cohort comprising ethnic Chinese, Indian, and Malay participants. The PCE-W was recalibrated using data from MEC1, externally validated in the SEED cohort, and compared against the Singapore-modified Framingham Risk Score (SG-FRS-2023) and the SCORE2 Asia–Pacific model using the concordance index (C-index). Calibration was assessed using the calibration-in-the-large method, the calibration slope, and a goodness-of-fit test.</div></div><div><h3>Findings</h3><div>All three models demonstrated possibly helpful to clearly useful discrimination in MEC1 and SEED, with overall C-indices ranging from 0.728 to 0.811. The recalibrated PCE-W outperformed the original PCE-W in MEC1 and SEED, although some misestimations remained among Chinese men and women and Malay women (calibration-in-the-large ranged from −0.479 to 0.260). The SG-FRS-2023 displayed generally satisfactory calibration across both MEC1 and SEED but tended to overestimate risk in Chinese (calibration-in-the-large −0.671) and Indian men (calibration-in-the-large −0.214) in the SEED cohort. The SCORE2 Asia–Pacific model performed satisfactorily among Indians but overestimated risk in Chinese (calibration-in-the-large ranged from −0.570 to −1.185) and showed poor model fit in Malays.</div></div><div><h3>Interpretation</h3><div>The recalibrated PCE-W, SG-FRS-2023, and SCORE2 Asia–Pacific model demonstrated possibly helpful to clearly useful discrimination across two multi-ethnic cohorts in Singapore. In terms of calibration, the recalibrated PCE-W and SG-FRS-2023, both recalibrated using local data, performed better than the SCORE2 Asia–Pacific model. Our study supports the use of the established CVD prediction models in Asian populations following appropriate local recalibration.</div></div><div><h3>Funding</h3><div>This work was supported by the Singapore <span>Ministry of Health’s National Medical Research</span> Council and the Singapore <span>Biomedical Research Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101794"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101784
Xiaomei Zhang , Carl J.E. Suster , Eby M. Sim , Connie Lam , Elena Martinez , Taryn Crighton , Ellen J. Donnan , Ben J. Marais , Vitali Sintchenko
Background
Tuberculosis (TB) remains a global public health challenge. Even low-incidence countries, like Australia, are struggling to achieve ambitious targets to eliminate local TB transmission. Whole genome sequencing (WGS) of Mycobacterium tuberculosis facilitates accurate transmission tracking, but its integration into public health response remains limited. This study conducted spatiotemporal analyses of routine WGS data and assessed its potential value to guide programmatic TB control responses.
Methods
WGS and geolocation data from 2492 M. tuberculosis isolates were examined, representing 94.9% of culture-confirmed and 64.2% of all notified TB cases in New South Wales, Australia (2017–2023). We performed genomic clustering, assessed genetic and geographic distances between cases, and applied Bayesian dated phylogeny to estimate the likely time of strain introduction.
Findings
Most notified TB cases were successfully sequenced and geolocated, with 88.3% (2200/2492) residing in metropolitan Sydney. The local health districts (LHDs) with the highest case counts were South Western (523/2492, 21.0%) and Western Sydney (476/2492, 19.1%). Using a 5-SNP threshold, WGS identified 106 putative transmission clusters involving 288 cases (11.7%), with 50% spanning multiple LHDs. Eight large clusters (≥5 members) were identified, containing 64 cases (2.6%). The largest cluster (17 members) was caused by a Lineage 1 strain, although most large clusters were associated with Lineage 2 strains; two were isoniazid resistant. There was poor correlation between genetic and geographic distances, which showed some improvement with removal of outliers. Most recent common ancestor estimates suggested recent introduction of strains associated with local transmission. Strain clustering and lineage-through-time analyses revealed temporal patterns in cluster expansion and contraction, facilitating accurate monitoring of cluster spread across all of NSW.
Interpretation
The findings demonstrate the added value of integrating genomic and spatiotemporal clustering data to detect persistent transmission and guide targeted interventions to pursue the aspirational goal of “zero local TB transmission”.
Funding
NHMRC Centre for Research Excellence in Tuberculosis (www.tbcre.org.au) and New South Wales Health Prevention Research Support Program.
{"title":"Spatio-temporal patterns of tuberculosis revealed by routine Mycobacterium tuberculosis sequencing in Australia: an extended patient cohort analysis (2017–2023)","authors":"Xiaomei Zhang , Carl J.E. Suster , Eby M. Sim , Connie Lam , Elena Martinez , Taryn Crighton , Ellen J. Donnan , Ben J. Marais , Vitali Sintchenko","doi":"10.1016/j.lanwpc.2025.101784","DOIUrl":"10.1016/j.lanwpc.2025.101784","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a global public health challenge. Even low-incidence countries, like Australia, are struggling to achieve ambitious targets to eliminate local TB transmission. Whole genome sequencing (WGS) of <em>Mycobacterium tuberculosis</em> facilitates accurate transmission tracking, but its integration into public health response remains limited. This study conducted spatiotemporal analyses of routine WGS data and assessed its potential value to guide programmatic TB control responses.</div></div><div><h3>Methods</h3><div>WGS and geolocation data from 2492 <em>M. tuberculosis</em> isolates were examined, representing 94.9% of culture-confirmed and 64.2% of all notified TB cases in New South Wales, Australia (2017–2023). We performed genomic clustering, assessed genetic and geographic distances between cases, and applied Bayesian dated phylogeny to estimate the likely time of strain introduction.</div></div><div><h3>Findings</h3><div>Most notified TB cases were successfully sequenced and geolocated, with 88.3% (2200/2492) residing in metropolitan Sydney. The local health districts (LHDs) with the highest case counts were South Western (523/2492, 21.0%) and Western Sydney (476/2492, 19.1%). Using a 5-SNP threshold, WGS identified 106 putative transmission clusters involving 288 cases (11.7%), with 50% spanning multiple LHDs. Eight large clusters (≥5 members) were identified, containing 64 cases (2.6%). The largest cluster (17 members) was caused by a Lineage 1 strain, although most large clusters were associated with Lineage 2 strains; two were isoniazid resistant. There was poor correlation between genetic and geographic distances, which showed some improvement with removal of outliers. Most recent common ancestor estimates suggested recent introduction of strains associated with local transmission. Strain clustering and lineage-through-time analyses revealed temporal patterns in cluster expansion and contraction, facilitating accurate monitoring of cluster spread across all of NSW.</div></div><div><h3>Interpretation</h3><div>The findings demonstrate the added value of integrating genomic and spatiotemporal clustering data to detect persistent transmission and guide targeted interventions to pursue the aspirational goal of “zero local TB transmission”.</div></div><div><h3>Funding</h3><div>NHMRC Centre for <span>Research Excellence in Tuberculosis</span> (<span><span>www.tbcre.org.au</span><svg><path></path></svg></span>) and <span>New South Wales Health Prevention Research</span> Support Program.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101784"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101768
Marine Corbin , Hayley J. Denison , Jeroen Douwes , Mina Whyte , Stephanie G. Thompson , Matire Harwood , Alan Davis , John N. Fink , P. Alan Barber , John H. Gommans , Dominique A. Cadilhac , William M. Levack , Harry McNaughton , Joosup Kim , Valery L. Feigin , Anna Ranta
Background
Using community-based incidence studies and clinical registries to assess stroke care and outcomes is resource intensive and often geographically limited. Linked administrative data are lower-cost and wider-reaching, but potentially less accurate and complete. This study compared administrative data to national hospital-based study data to assess whether administrative data represents a valid alternative.
Methods
We linked and compared data from the REGIONS Care Study, a New Zealand nationwide observational study, with administrative data from Statistics New Zealand’s Integrated Data Infrastructure (IDI). Sensitivity, specificity, positive predictive value, and Cohen’s kappa coefficient were used to assess case identification, risk factors, post-stroke outcomes, and interventions as applicable. Additional audits explored the validity of IDI ‘true false positives.’
Findings
From May to July 2018, 1719 patients with stroke were captured in REGIONS Care and 1833 in the IDI. Using REGIONS Care as the reference standard, the sensitivity of the IDI for stroke case identification was 83% and the positive predictive value 77%. There were 300 false-negatives and 414 false positives. The audit of two hospitals showed that some cases identified in IDI but excluded by REGIONS were actual strokes. For stroke risk factors, the IDI showed high sensitivity and specificity for diabetes (93% and 91%, respectively), atrial fibrillation (87% and 90%), and smoking (71% and 97%) but lower specificity for hypertension (61%), and dyslipidaemia (52%). A derived IDI favourable outcome measure showed good agreement with the modified Rankin Scale (sensitivity 88%, specificity 82%, kappa 0.67). The IDI accurately identified post-stroke medication use (sensitivities 81%–94%, specificities 78%–91%) and thrombectomy interventions (sensitivity 88%, kappa 0.91).
Interpretation
The use of administrative data to ascertain stroke cases, risk factors, interventions and outcomes was feasible and compared well with manual hospital data collection making an administrative data based national stroke register possible, although supplementary data collection for comprehensive care evaluation may be required.
Funding
The study was funded by the NZ Health Research Council (HRC 17/037).
{"title":"Can administrative data be used for a national register of hospitalised stroke patients? A New Zealand validation study","authors":"Marine Corbin , Hayley J. Denison , Jeroen Douwes , Mina Whyte , Stephanie G. Thompson , Matire Harwood , Alan Davis , John N. Fink , P. Alan Barber , John H. Gommans , Dominique A. Cadilhac , William M. Levack , Harry McNaughton , Joosup Kim , Valery L. Feigin , Anna Ranta","doi":"10.1016/j.lanwpc.2025.101768","DOIUrl":"10.1016/j.lanwpc.2025.101768","url":null,"abstract":"<div><h3>Background</h3><div>Using community-based incidence studies and clinical registries to assess stroke care and outcomes is resource intensive and often geographically limited. Linked administrative data are lower-cost and wider-reaching, but potentially less accurate and complete. This study compared administrative data to national hospital-based study data to assess whether administrative data represents a valid alternative.</div></div><div><h3>Methods</h3><div>We linked and compared data from the REGIONS Care Study, a New Zealand nationwide observational study, with administrative data from Statistics New Zealand’s Integrated Data Infrastructure (IDI). Sensitivity, specificity, positive predictive value, and Cohen’s kappa coefficient were used to assess case identification, risk factors, post-stroke outcomes, and interventions as applicable. Additional audits explored the validity of IDI ‘true false positives.’</div></div><div><h3>Findings</h3><div>From May to July 2018, 1719 patients with stroke were captured in REGIONS Care and 1833 in the IDI. Using REGIONS Care as the reference standard, the sensitivity of the IDI for stroke case identification was 83% and the positive predictive value 77%. There were 300 false-negatives and 414 false positives. The audit of two hospitals showed that some cases identified in IDI but excluded by REGIONS were actual strokes. For stroke risk factors, the IDI showed high sensitivity and specificity for diabetes (93% and 91%, respectively), atrial fibrillation (87% and 90%), and smoking (71% and 97%) but lower specificity for hypertension (61%), and dyslipidaemia (52%). A derived IDI favourable outcome measure showed good agreement with the modified Rankin Scale (sensitivity 88%, specificity 82%, kappa 0.67). The IDI accurately identified post-stroke medication use (sensitivities 81%–94%, specificities 78%–91%) and thrombectomy interventions (sensitivity 88%, kappa 0.91).</div></div><div><h3>Interpretation</h3><div>The use of administrative data to ascertain stroke cases, risk factors, interventions and outcomes was feasible and compared well with manual hospital data collection making an administrative data based national stroke register possible, although supplementary data collection for comprehensive care evaluation may be required.</div></div><div><h3>Funding</h3><div>The study was funded by the <span>NZ Health Research Council</span> (HRC 17/037).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101768"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101791
Lina Madaniyazi , Jefferson Alpizar , Chau-Ren Jung , Whanhee Lee , Xerxes Seposo , Ryusuke Ae , Eun-Hee Ha , Ho Kim , Masahiro Hashizume , Shoji F. Nakayama , Aurelio Tobias
Kawasaki Disease (KD) is an acute pediatric vasculitis with unclear etiology, though environmental triggers have been proposed. This scoping review synthesized epidemiological evidence on outdoor environmental exposures and KD incidence. A systematic search up to December 2024 identified 32 eligible studies. KD incidence is highest in East Asia, particularly Japan, South Korea, and Taiwan, where most research has been concentrated. Meteorological variables and air pollutants were most studied. Approximately half of the studies on meteorological variables found associations with KD, with some suggesting the role of temperatures or wind-driven transport of airborne agents. Air pollution studies showed inconsistent short-term effects, but more consistent links with long-term or prenatal particulate matter exposure. Studies on airborne biological agents, though fewer, showed consistent positive findings. These results suggest a multifactorial etiology. However, heterogeneity in methods limits comparability. Little is known about chemical substances in soil, water, or other outdoor sources, which may also affect immune pathways relevant to KD. Standardized, multinational research is needed to clarify environmental contributions and guide prevention in high-risk regions.
{"title":"Kawasaki disease and outdoor environmental stressors: a scoping review","authors":"Lina Madaniyazi , Jefferson Alpizar , Chau-Ren Jung , Whanhee Lee , Xerxes Seposo , Ryusuke Ae , Eun-Hee Ha , Ho Kim , Masahiro Hashizume , Shoji F. Nakayama , Aurelio Tobias","doi":"10.1016/j.lanwpc.2025.101791","DOIUrl":"10.1016/j.lanwpc.2025.101791","url":null,"abstract":"<div><div>Kawasaki Disease (KD) is an acute pediatric vasculitis with unclear etiology, though environmental triggers have been proposed. This scoping review synthesized epidemiological evidence on outdoor environmental exposures and KD incidence. A systematic search up to December 2024 identified 32 eligible studies. KD incidence is highest in East Asia, particularly Japan, South Korea, and Taiwan, where most research has been concentrated. Meteorological variables and air pollutants were most studied. Approximately half of the studies on meteorological variables found associations with KD, with some suggesting the role of temperatures or wind-driven transport of airborne agents. Air pollution studies showed inconsistent short-term effects, but more consistent links with long-term or prenatal particulate matter exposure. Studies on airborne biological agents, though fewer, showed consistent positive findings. These results suggest a multifactorial etiology. However, heterogeneity in methods limits comparability. Little is known about chemical substances in soil, water, or other outdoor sources, which may also affect immune pathways relevant to KD. Standardized, multinational research is needed to clarify environmental contributions and guide prevention in high-risk regions.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101791"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101783
Xiaoran Yu , Huan Wang , Jian Wang , Xin Yuan , Xiaoding Zhou , Qiushui He , Igor Mokrousov , Lin Sun , Yanhui Dong , Zhiyong Zou
The WHO Southeast Asia and Western Pacific regions, home to more than half of the world's population, bear a disproportionate burden of antimicrobial resistance (AMR), including some of the most severe resistance patterns. The convergence of rapidly growing economies and persistent health system challenges in these regions creates a critical platform for understanding the dynamics of AMR and developing scalable governance approaches relevant to other low- and middle-income countries. This Viewpoint reviews current progress in AMR governance globally and study regions, with a focus on country-specific National Action Plans, and highlights the discrepancies between policy intentions and actual implementation. Implementation science, developed to address research-to-practice gaps, provides a systematic framework for identifying and overcoming barriers to implementation, thereby translating political commitments into actionable interventions. Given the cross-sectoral complexity of AMR, we propose novel strategic priorities to enhance AMR governance by embedding implementation science within the One Health approach. This involves a four-step process: selecting and adapting evidence-based practices, assessing multilevel barriers and enablers, selecting, using and adapting implementation strategies, and evaluating and sustaining their impact. Together, this framework provides a blueprint for localising and operationalising overarching policy concepts into concrete, context-specific actions, with potential lessons for other regions globally.
{"title":"Using implementation science to bridge the gaps between political commitment and action in antimicrobial resistance governance under the one health approach in the WHO Southeast Asia and Western Pacific regions","authors":"Xiaoran Yu , Huan Wang , Jian Wang , Xin Yuan , Xiaoding Zhou , Qiushui He , Igor Mokrousov , Lin Sun , Yanhui Dong , Zhiyong Zou","doi":"10.1016/j.lanwpc.2025.101783","DOIUrl":"10.1016/j.lanwpc.2025.101783","url":null,"abstract":"<div><div>The WHO Southeast Asia and Western Pacific regions, home to more than half of the world's population, bear a disproportionate burden of antimicrobial resistance (AMR), including some of the most severe resistance patterns. The convergence of rapidly growing economies and persistent health system challenges in these regions creates a critical platform for understanding the dynamics of AMR and developing scalable governance approaches relevant to other low- and middle-income countries. This Viewpoint reviews current progress in AMR governance globally and study regions, with a focus on country-specific National Action Plans, and highlights the discrepancies between policy intentions and actual implementation. Implementation science, developed to address research-to-practice gaps, provides a systematic framework for identifying and overcoming barriers to implementation, thereby translating political commitments into actionable interventions. Given the cross-sectoral complexity of AMR, we propose novel strategic priorities to enhance AMR governance by embedding implementation science within the One Health approach. This involves a four-step process: selecting and adapting evidence-based practices, assessing multilevel barriers and enablers, selecting, using and adapting implementation strategies, and evaluating and sustaining their impact. Together, this framework provides a blueprint for localising and operationalising overarching policy concepts into concrete, context-specific actions, with potential lessons for other regions globally.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101783"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-26DOI: 10.1016/j.lanwpc.2025.101782
Sandro Demaio, Sally J. Edwards, John S. Ji, Anders Nordström, Enkhtsetseg Shinee, Susan Mercado
{"title":"The next five years of the WHO Asia–Pacific Centre for Environment and Health","authors":"Sandro Demaio, Sally J. Edwards, John S. Ji, Anders Nordström, Enkhtsetseg Shinee, Susan Mercado","doi":"10.1016/j.lanwpc.2025.101782","DOIUrl":"10.1016/j.lanwpc.2025.101782","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101782"},"PeriodicalIF":8.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.lanwpc.2025.101781
Haobo Li , Zhu Zhang , Hong Chen , Yuanhua Yang , Jun Wan , Xiaomao Xu , Yingqun Ji , Guoru Yang , Ping Zhang , Jing Han , Kejing Ying , Qixia Xu , Ling Zhu , Tao Yang , Yingyun Fu , Haoyi Weng , Dingyi Wang , Yunxia Zhang , Shuai Zhang , Qiang Huang , Chen Wang
Background
The ABO blood group locus is a well-established genetic determinant of venous thromboembolism (VTE) risk in both individuals of European and East Asian ancestry. Recent studies have identified key ABO haplotypes tagged by four common SNPs—rs2519093 (A1), rs1053878 (A2), rs8176743 (B), and rs8176719/rs41302905 (O1/O2)—that influence both incident and recurrent VTE risk in Europeans. However, marked differences in ABO allele frequencies and haplotype structures across ancestries may render European findings inapplicable to East Asians, highlighting a critical gap in understanding the genetic basis of VTE in this population.
Methods
We conducted a haplotype-based association study using ABO-tagging SNPs (including rs512770 that distinguishes between O1.1 and O1.2) in 1576 VTE cases from China Pulmonary Thromboembolism Registry Study (CURES) and 17,535 ancestry-matched controls, adjusted for age, sex, and genetic principal components to evaluate the effects of ABO haplotypes on VTE risk and recurrence.
Findings
Our analyses revealed key population-specific differences: in East Asians, the rs1053878-A allele is consistently co-inherited with the rs2519093-T allele, precluding its use as a specific marker for the A2 blood group, unlike in Europeans. Furthermore, all non-O1 haplotypes were homogeneously associated with a ∼1.4-fold increased risk of VTE (p = 5.2 × 10−20) and a ∼1.7-fold increased risk of recurrence (p = 0.023), compared to the O1.1 group. Notably, the O1.2 blood group was also associated with a 1.7-fold increased risk of recurrence (p = 0.039).
Interpretation
These findings highlight fundamental differences in ABO haplotype structure and disease associations between East Asians and Europeans. Our study provides a population-specific SNP panel—rs8176719, rs2519093, rs1053878, rs8176743, and rs512770—for accurate genetic risk assessment of VTE in East Asians, underscoring the importance of ancestry-tailored approaches to thrombotic disease prediction.
Funding
This study is funded by the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (No. 2024-I2M-TS-035, No. 2021-I2M-1-061), National Key Research and Development Program of China (No. 2024YFE0101900, No. 2023YFC2507200), National Natural Science Foundation of China (No. 82470046, No. 82241029) and Noncommunicable Chronic Diseases-National Science and Technology Major Project (No. 2024ZD0528700).
{"title":"Population-specific ABO haplotypes reveal distinct venous thromboembolism risk in East Asians: insights from a large-scale genetic study","authors":"Haobo Li , Zhu Zhang , Hong Chen , Yuanhua Yang , Jun Wan , Xiaomao Xu , Yingqun Ji , Guoru Yang , Ping Zhang , Jing Han , Kejing Ying , Qixia Xu , Ling Zhu , Tao Yang , Yingyun Fu , Haoyi Weng , Dingyi Wang , Yunxia Zhang , Shuai Zhang , Qiang Huang , Chen Wang","doi":"10.1016/j.lanwpc.2025.101781","DOIUrl":"10.1016/j.lanwpc.2025.101781","url":null,"abstract":"<div><h3>Background</h3><div>The ABO blood group locus is a well-established genetic determinant of venous thromboembolism (VTE) risk in both individuals of European and East Asian ancestry. Recent studies have identified key <em>ABO</em> haplotypes tagged by four common SNPs—rs2519093 (A1), rs1053878 (A2), rs8176743 (B), and rs8176719/rs41302905 (O1/O2)—that influence both incident and recurrent VTE risk in Europeans. However, marked differences in ABO allele frequencies and haplotype structures across ancestries may render European findings inapplicable to East Asians, highlighting a critical gap in understanding the genetic basis of VTE in this population.</div></div><div><h3>Methods</h3><div>We conducted a haplotype-based association study using ABO-tagging SNPs (including rs512770 that distinguishes between O1.1 and O1.2) in 1576 VTE cases from China Pulmonary Thromboembolism Registry Study (CURES) and 17,535 ancestry-matched controls, adjusted for age, sex, and genetic principal components to evaluate the effects of <em>ABO</em> haplotypes on VTE risk and recurrence.</div></div><div><h3>Findings</h3><div>Our analyses revealed key population-specific differences: in East Asians, the rs1053878-A allele is consistently co-inherited with the rs2519093-T allele, precluding its use as a specific marker for the A2 blood group, unlike in Europeans. Furthermore, all non-O1 haplotypes were homogeneously associated with a ∼1.4-fold increased risk of VTE (<em>p</em> = 5.2 × 10<sup>−20</sup>) and a ∼1.7-fold increased risk of recurrence (<em>p</em> = 0.023), compared to the O1.1 group. Notably, the O1.2 blood group was also associated with a 1.7-fold increased risk of recurrence (<em>p</em> = 0.039).</div></div><div><h3>Interpretation</h3><div>These findings highlight fundamental differences in <em>ABO</em> haplotype structure and disease associations between East Asians and Europeans. Our study provides a population-specific SNP panel—rs8176719, rs2519093, rs1053878, rs8176743, and rs512770—for accurate genetic risk assessment of VTE in East Asians, underscoring the importance of ancestry-tailored approaches to thrombotic disease prediction.</div></div><div><h3>Funding</h3><div>This study is funded by the <span>Chinese Academy of Medical Science Innovation Fund</span> for <span>Medical Sciences</span> (No. <span><span>2024-I2M-TS-035</span></span>, <span><span>No. 2021-I2M-1-061</span></span>), <span>National Key Research and Development Program</span> of China (No. <span><span>2024YFE0101900</span></span>, No. <span><span>2023YFC2507200</span></span>), <span>National Natural Science Foundation of China</span> (No. <span><span>82470046</span></span>, No. <span><span>82241029</span></span>) and <span>Noncommunicable Chronic Diseases-National Science and Technology Major Project</span> (No. <span><span>2024ZD0528700</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101781"},"PeriodicalIF":8.1,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.lanwpc.2025.101779
Yah Ru Juang , Meijing Hu , Miao Hui , Adeline Seow , Iain Bee Huat Tan , Dawn Qingqing Chong , Cheng Ean Chee , Wei Jie Seow
Background
Lung cancer remains a leading cause of cancer-related deaths globally. Although evidence indicates rising early-onset cases and increasing incidence among females and never-smokers in Asia, these trends remain underexplored in Singapore. This study comprehensively examined historical incidence trends by age, sex, smoking status, and stage to inform targeted prevention and management strategies.
Methods
We analyzed lung cancer cases from administrative health records in Singapore (1968–2021) to calculate age-standardized and age-specific incidence by age (30–49 years, 50–64 years, ≥65 years), sex (male, female), smoking status (ever-, never-smokers), and stage (I–IV). Joinpoint regression identified significant trend changes, reporting annual percent change (APC), average annual percent change (AAPC), and 95% confidence intervals (CIs). AAPCs were evaluated for the full study period and the most recent five years, with Benjamini-Hochberg adjustment for multiple comparisons.
Findings
From 1968 to 2021, 53,308 lung cancer cases were recorded in Singapore, predominantly in males (67.7%) and Chinese (87.8%), with 81.6% at advanced stages (III–IV). Incidence rose significantly only in females aged 30–49 years (AAPC = 0.79%, 95% CI: 0.41–1.18) and declined in all male age groups, especially 50–64 years (AAPC = −1.34%, 95% CI: −1.53 to −1.12). Stage I diagnoses increased significantly in both sexes (females: AAPC = 7.19%, 95% CI: 5.24–9.22; males: AAPC = 3.79%, 95% CI: 1.94–5.46) and incidence among never-smokers rose significantly, particularly among females (AAPC = 4.06%, 95% CI: 2.99–5.11).
Interpretation
The narrowing male-female gap, rising early-onset cases among females, and increasing incidence in female never-smokers, particularly those ≥65 years, highlight a shifting lung cancer burden in Singapore. Despite improvements in early-stage detection, most cases remained advanced, emphasizing the need to strengthen lung cancer management and screening strategies in Singapore.
Funding
This work is supported by the National Medical Research Council (Singapore) Health Promotion, Preventive Health, Population Health and Health Services Research (HPHSR) Clinician Scientist Award (HCSAINV24jul-0002).
{"title":"Trends in lung cancer incidence and stage at diagnosis in Singapore: a population-based joinpoint regression analysis by age, sex, and smoking status","authors":"Yah Ru Juang , Meijing Hu , Miao Hui , Adeline Seow , Iain Bee Huat Tan , Dawn Qingqing Chong , Cheng Ean Chee , Wei Jie Seow","doi":"10.1016/j.lanwpc.2025.101779","DOIUrl":"10.1016/j.lanwpc.2025.101779","url":null,"abstract":"<div><h3>Background</h3><div>Lung cancer remains a leading cause of cancer-related deaths globally. Although evidence indicates rising early-onset cases and increasing incidence among females and never-smokers in Asia, these trends remain underexplored in Singapore. This study comprehensively examined historical incidence trends by age, sex, smoking status, and stage to inform targeted prevention and management strategies.</div></div><div><h3>Methods</h3><div>We analyzed lung cancer cases from administrative health records in Singapore (1968–2021) to calculate age-standardized and age-specific incidence by age (30–49 years, 50–64 years, ≥65 years), sex (male, female), smoking status (ever-, never-smokers), and stage (I–IV). Joinpoint regression identified significant trend changes, reporting annual percent change (APC), average annual percent change (AAPC), and 95% confidence intervals (CIs). AAPCs were evaluated for the full study period and the most recent five years, with Benjamini-Hochberg adjustment for multiple comparisons.</div></div><div><h3>Findings</h3><div>From 1968 to 2021, 53,308 lung cancer cases were recorded in Singapore, predominantly in males (67.7%) and Chinese (87.8%), with 81.6% at advanced stages (III–IV). Incidence rose significantly only in females aged 30–49 years (AAPC = 0.79%, 95% CI: 0.41–1.18) and declined in all male age groups, especially 50–64 years (AAPC = −1.34%, 95% CI: −1.53 to −1.12). Stage I diagnoses increased significantly in both sexes (females: AAPC = 7.19%, 95% CI: 5.24–9.22; males: AAPC = 3.79%, 95% CI: 1.94–5.46) and incidence among never-smokers rose significantly, particularly among females (AAPC = 4.06%, 95% CI: 2.99–5.11).</div></div><div><h3>Interpretation</h3><div>The narrowing male-female gap, rising early-onset cases among females, and increasing incidence in female never-smokers, particularly those ≥65 years, highlight a shifting lung cancer burden in Singapore. Despite improvements in early-stage detection, most cases remained advanced, emphasizing the need to strengthen lung cancer management and screening strategies in Singapore.</div></div><div><h3>Funding</h3><div>This work is supported by the National Medical Research Council (Singapore) Health Promotion, Preventive Health, Population Health and Health Services Research (HPHSR) Clinician Scientist Award (HCSAINV24jul-0002).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101779"},"PeriodicalIF":8.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.lanwpc.2025.101780
Zheng Zhu , Xu Zhou , Mingling Chen , Chun Dou , Dong Liu , Lijie Kong , Chaojie Ye , Min Xu , Yu Xu , Mian Li , Zhiyun Zhao , Jie Zheng , Jieli Lu , Yuhong Chen , Weiqing Wang , Guang Ning , Yufang Bi , Tiange Wang
Background
Whether leisure-time physical activity modifies the association between frailty and mortality in older adults is unclear.
Methods
We analyzed the interactions between physical activity and frailty status on all-cause mortality risk using Cox proportional hazards models across five nationally representative cohorts: Survey of Health, Ageing and Retirement in Europe (56,555 participants, median follow-up 6.5 years), China Health and Retirement Longitudinal Study (12,271 participants, 9.0 years); Health and Retirement Study (13,729 participants, 11.9 years); English Longitudinal Study of Ageing (9100 participants, 9.8 years); and Mexican Health and Aging Study (11,262 participants, 19.3 years). Frailty status was classified as robust, prefrail, and frail based on deficit accumulation models, including common disease, functional, locomotor, sensory, mental, and cognitive deficit. Physical activity was classified as regular (meeting World Health Organization recommendations) or inactive.
Findings
Across five cohorts (median age 58.0–65.0 years), physical activity consistently interacted with frailty on all-cause mortality (all Pinteraction ≤ 0.036). In pooled analyses, frailty was associated with higher risks of mortality in inactive participants (multivariable-adjusted HR: 3.72, 95% CI: 2.54–5.45 for frailty) than in regularly active participants (2.40, 1.71–3.36 for frailty; Pinteraction < 0.001); results of each cohort were meta-analyzed by random-effects models (I2 within-subgroup >78.7%, P < 0.001). Whereby, the inverse association between regular activity and mortality was more evident in frail participants (0.56; 0.53–0.59) than in robust participants (0.80, 0.73–0.87); results were meta-analyzed by fixed effects models (I2 within-subgroup >18.6%, P > 0.296). Such interaction patterns remained between each deficit of frailty and physical activity in at least one cohort.
Interpretation
Consistent findings across five cohorts demonstrated that regular physical activity mitigates frailty-associated mortality, and frail adults might gain more survival benefits from regular activity than robust adults.
Funding
The Noncommunicable Chronic Diseases-National Science and Technology Major Project, the National Natural Science Foundation of China, the National Key R&D Program of China, the “Shu-Guang Scholar Programme” from Shanghai Municipal Education Commission, the “Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support” from Shanghai Jiao Tong University School of Medicine, and the Innovative Research Team of High-level Local Universities in Shanghai.
背景：目前尚不清楚闲暇时间的体育活动是否能改变老年人身体虚弱和死亡率之间的关系。方法：采用Cox比例风险模型分析了身体活动和虚弱状态对全因死亡风险的相互作用，研究对象包括5个具有全国代表性的队列：欧洲健康、老龄化和退休调查（56555人，中位随访6.5年）、中国健康和退休纵向研究（12271人，9.0年）；健康和退休研究（13,729名参与者，11.9岁）；英国老龄化纵向研究（9100名参与者，9.8岁）；墨西哥健康与老龄化研究（11,262名参与者，19.3岁）。根据缺陷积累模型，包括常见疾病、功能、运动、感觉、精神和认知缺陷，将虚弱状态分为健壮、体弱和体弱。体育活动被分为定期（符合世界卫生组织的建议）和不活动。在5个队列中（中位年龄58.0-65.0岁），体力活动与虚弱对全因死亡率的影响持续存在相互作用（所有p相互作用≤0.036）。在汇总分析中，不运动的参与者（多变量调整后的HR: 3.72, 95% CI: 2.54-5.45）比经常运动的参与者（2.40,1.71-3.36，p相互作用<； 0.001）的死亡风险更高；每个队列的结果采用随机效应模型进行meta分析（I2 -亚组内>；78.7%, P < 0.001）。因此，身体虚弱的参与者（0.56;0.53-0.59）与健壮的参与者（0.80,0.73-0.87）相比，规律运动与死亡率之间的负相关更为明显；结果采用固定效应模型进行meta分析（I2在亚组内>；18.6%, P > 0.296）。在至少一个队列中，这种相互作用模式仍然存在于每一种虚弱缺陷和身体活动之间。五个队列的一致发现表明，有规律的体育活动可以减轻与虚弱相关的死亡率，体弱多病的成年人可能比健壮的成年人从有规律的体育活动中获得更多的生存益处。资助非传染性慢性病国家科技重大专项、国家自然科学基金、国家重点研发计划、上海市教委“曙光学者计划”、上海交通大学医学院“上海市教委高峰临床医学资助项目”、上海市地方高水平大学创新科研团队。
{"title":"Interaction between physical activity and deficit-based frailty on all-cause mortality in older adults: a prospective study of five population-based cohorts","authors":"Zheng Zhu , Xu Zhou , Mingling Chen , Chun Dou , Dong Liu , Lijie Kong , Chaojie Ye , Min Xu , Yu Xu , Mian Li , Zhiyun Zhao , Jie Zheng , Jieli Lu , Yuhong Chen , Weiqing Wang , Guang Ning , Yufang Bi , Tiange Wang","doi":"10.1016/j.lanwpc.2025.101780","DOIUrl":"10.1016/j.lanwpc.2025.101780","url":null,"abstract":"<div><h3>Background</h3><div>Whether leisure-time physical activity modifies the association between frailty and mortality in older adults is unclear.</div></div><div><h3>Methods</h3><div>We analyzed the interactions between physical activity and frailty status on all-cause mortality risk using Cox proportional hazards models across five nationally representative cohorts: Survey of Health, Ageing and Retirement in Europe (56,555 participants, median follow-up 6.5 years), China Health and Retirement Longitudinal Study (12,271 participants, 9.0 years); Health and Retirement Study (13,729 participants, 11.9 years); English Longitudinal Study of Ageing (9100 participants, 9.8 years); and Mexican Health and Aging Study (11,262 participants, 19.3 years). Frailty status was classified as robust, prefrail, and frail based on deficit accumulation models, including common disease, functional, locomotor, sensory, mental, and cognitive deficit. Physical activity was classified as regular (meeting World Health Organization recommendations) or inactive.</div></div><div><h3>Findings</h3><div>Across five cohorts (median age 58.0–65.0 years), physical activity consistently interacted with frailty on all-cause mortality (all P<sub>interaction</sub> ≤ 0.036). In pooled analyses, frailty was associated with higher risks of mortality in inactive participants (multivariable-adjusted HR: 3.72, 95% CI: 2.54–5.45 for frailty) than in regularly active participants (2.40, 1.71–3.36 for frailty; P<sub>interaction</sub> < 0.001); results of each cohort were meta-analyzed by random-effects models (I<sup>2</sup> within-subgroup >78.7%, P < 0.001). Whereby, the inverse association between regular activity and mortality was more evident in frail participants (0.56; 0.53–0.59) than in robust participants (0.80, 0.73–0.87); results were meta-analyzed by fixed effects models (I<sup>2</sup> within-subgroup >18.6%, P > 0.296). Such interaction patterns remained between each deficit of frailty and physical activity in at least one cohort.</div></div><div><h3>Interpretation</h3><div>Consistent findings across five cohorts demonstrated that regular physical activity mitigates frailty-associated mortality, and frail adults might gain more survival benefits from regular activity than robust adults.</div></div><div><h3>Funding</h3><div>The Noncommunicable Chronic Diseases-<span>National Science and Technology</span> Major Project, the <span>National Natural Science Foundation of China</span>, the <span>National Key R&D Program of China</span>, the “Shu-Guang Scholar Programme” from Shanghai Municipal Education Commission, the “Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support” from <span>Shanghai Jiao Tong University School of Medicine</span>, and the Innovative Research Team of High-level Local Universities in Shanghai.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101780"},"PeriodicalIF":8.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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