The Lancet Regional Health: Western Pacific最新文献

{"title":"A contemporary analysis of the Australian clinical and genetic landscape of spinal muscular atrophy: a registry based study","authors":"","doi":"10.1016/j.lanwpc.2024.101237","DOIUrl":"10.1016/j.lanwpc.2024.101237","url":null,"abstract":"<div><h3>Background</h3><div>New paradigms of diagnosis and treatment have changed the neurodegenerative trajectory for individuals with spinal muscular atrophy (SMA). Registries are a critical tool to provide real-world data on treatment patterns, their effects and health care provision within this evolving paradigm of care. This study aimed to evaluate the phenotypic and genotypic landscape, treatment patterns and health impact of SMA in Australia through the national registry.</div></div><div><h3>Methods</h3><div>This cross-sectional study investigated demographic, clinical and genetic information, sequelae of weakness, treatment patterns and patient-reported outcomes amongst individuals with SMA enrolled in the Australian Neuromuscular Disease Registry (ANMDR) from 1st January 2020 to 30th April 2023. Descriptive statistics were used for analysis and Chi-Squared or Fisher's exact tests for associations.</div></div><div><h3>Findings</h3><div>195 individuals with SMA enrolled into the ANMDR. 5/195 (2.6%) were deceased by censor date. Of (n = 190) individuals living with SMA, 104/190 (54.7%) were children. Minimum Australian prevalence was 0.73/100,000. <em>SMN2</em> copies were inversely associated with phenotype in those with homozygous <em>SMN1</em> deletions (<em>p &lt; 0.0001</em>)). Treatment was utilised in 154/190 (81%) of the population, with 65/137 (47.6%) of individuals perceiving improvements with therapeutic intervention on Patient/Parent Global Impression of Improvement scale (<em>p &lt; 0.0001</em>). Engagement with multidisciplinary care practitioners was significantly higher among children with SMA than adults (93% versus 12%, <em>p &lt; 0.0001</em>).</div></div><div><h3>Interpretation</h3><div>Despite diagnostic and therapeutic advances, mortality and the multi-systemic health impact of SMA continue to be experienced within the Australian population. Healthcare provision must align with patient-centred outcomes, adapting to meeting their changing but ongoing care requirements. The study identified the considerable unmet need for multidisciplinary care, not only for adults with SMA but also for the emerging cohort of treated children, emphasising the imperative for comprehensive healthcare provision to address their evolving needs.</div></div><div><h3>Funding</h3><div>No funding was received for this study.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A complex intervention to reduce antibiotic prescribing in rural China: a cluster randomised controlled trial","authors":"","doi":"10.1016/j.lanwpc.2024.101236","DOIUrl":"10.1016/j.lanwpc.2024.101236","url":null,"abstract":"<div><h3>Background</h3><div>Excessive use of antibiotics is a widespread problem. We aim to evaluate the efficacy of a multifaceted intervention for reducing antibiotic use in patients with respiratory tract infections (RTIs).</div></div><div><h3>Methods</h3><div>In this two-arm cluster randomized controlled trial, we enrolled patients aged 18+ with symptomatic RTIs at 40 township health centers (THCs) selected from 10 counties in Anhui, China. The THCs were randomized using an online tool (‘Sealed Envelope’) to intervention or usual care (1:1 ratio), stratified by baseline antibiotic prescribing and with random block sizes (4 or 6). The intervention had five components: a half-day clinician training, a WeChat-based peer support group, a decision aid, a poster commitment letter and a patient leaflet. The primary outcome was whether antibiotics were prescribed at the index consultation. Secondary measures included defined daily dose (DDD), illness recovery rate, re-visits to other care-givers or retail pharmacies and incremental cost-effectiveness ratio (ICER). These measures were analyzed using generalized linear mixed modeling controlling for clustering. The study was registered as ISRCTN30652037.</div></div><div><h3>Findings</h3><div>Between December 2021 and September 2022, 1053 patients were recruited (intervention, 21 THCs, n = 552; control, 19 THCs, n = 501), using consecutive sampling. Antibiotic prescribing rate was 55.25% and 66.67% in the intervention and control arms (Odds ratio 0.52, 95% confidence interval [CI]: 0.27, 0.98; p = 0.044). The intervention group also had lower, significant or non-significant, differences for other markers of antibiotic use: DDD (1.57 vs 2.75); prescriptions of two or more types of antibiotics (9.78% vs 11.58%); obtaining antibiotics from retail pharmacies (3.68% vs 5.78) or from other clinics (2.70% vs 4.05%). The intervention resulted in a cost reduction of 9.265 RMB (1.471 USD) per consultation episode and an ICER of −7769.98 RMB or −1233.33 USD/QALYs. The intervention did not encounter any major adverse event.</div></div><div><h3>Interpretation</h3><div>The intervention package was effective and cost-effective in reducing antibiotics prescribing without adverse effects.</div></div><div><h3>Funding</h3><div>The trial was supported by <span>National Natural Science Foundation of China</span> (No. <span><span>81861138049</span></span>) and <span>United Kingdom Research Innovation</span> (No. <span><span>MR/S013717/1</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of time to antibiotics on clinical outcome in paediatric febrile neutropenia: a target trial emulation of 1685 episodes","authors":"","doi":"10.1016/j.lanwpc.2024.101226","DOIUrl":"10.1016/j.lanwpc.2024.101226","url":null,"abstract":"<div><h3>Background</h3><div>Prompt antibiotic administration for febrile neutropenia (FN) is standard of care, and targets of time to antibiotics (TTA) &lt;60 min are common. We sought to determine the effect of TTA ≥60 versus &lt;60 min on adverse outcomes (intensive care unit (ICU) admission or death) in children with cancer and FN. Effect modification by a decision rule that predicts infection (AUS-rule) and bacteraemia were also investigated.</div></div><div><h3>Methods</h3><div>The prospective, multi-centre (n = 8), Australian PICNICC study dataset was analysed. To control for confounding, we used outcome regression adjusted for propensity score modelled as restricted cubic spline with two degrees of freedom. The propensity score was estimated from a logistic regression model for the exposure on the confounders, identified <em>a priori</em> (age, sex, severely unwell, disease, chemotherapy intensity and site). TTA was defined as time from from emergency triage to first antibiotic dose.</div></div><div><h3>Findings</h3><div>1685 FN episodes in 976 patients were included. Median TTA was 53 min (IQR 37–77 min, 1542 (92%) &lt;120 min). An adverse outcome occurred in 43 (2.6%) episodes (39 ICU; 5 deaths). The confounder-adjusted point estimate suggested a lower risk for adverse outcome associated with TTA ≥60 min (RR 0.62, 95% CI 0.32–1.21), but the wide 95% CI precluded definitive judgement about strength and direction of the effect (unadjusted RR 0.52; 95% CI 0.26, 1.05). Similarly, although the point estimates were suggestive of a null association or reduced risk for adverse outcome associated with TTA ≥60 min for all comparisons across bacteraemia or AUS-rule strata, the 95% CIs were imprecise.</div></div><div><h3>Interpretation</h3><div>For children with FN, there was no definite evidence that TTA ≥60 min from hospital triage (but within 2 h), increased risk of adverse outcome or prolonged hospital admission. This study has important implications for FN TTA mandates, suggesting a more nuanced approach is required.</div></div><div><h3>Funding</h3><div><span>National Health and Medical Research Council</span> and <span>Medical Research Future Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why I decide to leave South Korea healthcare system","authors":"","doi":"10.1016/j.lanwpc.2024.101232","DOIUrl":"10.1016/j.lanwpc.2024.101232","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an agenda of action and research for making health systems responsive to the needs of people with disabilities","authors":"","doi":"10.1016/j.lanwpc.2024.101225","DOIUrl":"10.1016/j.lanwpc.2024.101225","url":null,"abstract":"<div><div>Ensuring health systems responsiveness is crucial for health equity and outcomes of all individuals, particularly disadvantaged groups such as people with disabilities. However, attention to and discussions on health system responsiveness for people with disabilities remains lacking. This viewpoint highlights the pervasive issues within health systems rooted in ableism and proposes an agenda to tackle ableism, aiming to make health systems responsive to the needs of people with disabilities. Their needs are complex and diverse, varying with the disability, its severity, progression, and intersection with other factors. Ableism creates significant obstacles to identifying and addressing their needs and expectations, damages provider–patient interactions, poses multiple challenges in healthcare, and impacts the overall responsiveness of the health system to the populations it is meant to serve. The proposed agenda outlines areas for action and research across six building blocks of health systems as a way forward to enhance the health system's responsiveness to the needs of people with disabilities.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human carcinogen, leisure food, or local specialty: navigating areca nut regulation in China","authors":"","doi":"10.1016/j.lanwpc.2024.101230","DOIUrl":"10.1016/j.lanwpc.2024.101230","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"China's health national adaptation plan for climate change: action framework 2024–2030","authors":"","doi":"10.1016/j.lanwpc.2024.101227","DOIUrl":"10.1016/j.lanwpc.2024.101227","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the incidence of dementia in New Zealand: a cohort study applying capture-recapture modelling to routinely collected linked health datasets","authors":"","doi":"10.1016/j.lanwpc.2024.101216","DOIUrl":"10.1016/j.lanwpc.2024.101216","url":null,"abstract":"<div><h3>Background</h3><div>Issues of under-diagnosis and under-coding of dementia in routinely collected health data limit their utility for estimating dementia prevalence and incidence in Aotearoa New Zealand (NZ). Capture-recapture techniques can be used to estimate the number of dementia cases missing from health datasets by modelling the relationships and interactions between linked data sources. The aim of this study was to apply this technique to routinely collected and linked health datasets and more accurately estimate the incidence of dementia in NZ.</div></div><div><h3>Methods</h3><div>All incident cases of dementia in the NZ 60+ population were identified in three linked national health data sets—interRAI, Public hospital discharges, and Pharmacy. Capture-recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of cases missing from all three datasets, and thereby estimate the ‘true’ incidence of dementia. Incidence rates were calculated by 5-year age bands, sex and ethnicity.</div></div><div><h3>Findings</h3><div>Modelled estimates indicate 36% of incident cases are not present in any of the datasets. Modelled incidence rates in the 60+ age group were 19.2 (95% CI 17.3–22.0)/1000py, with an incident rate ratio of 1.9 (95% CI 1.9–2.0) per 5-year age band. There was no difference in incidence rates between males and females. Incidence rates in Asian (p &lt; 0.001) but not Māori (p = 0.974) or Pacific peoples (p = 0.110) were significantly lower compared to Europeans, even after inclusion of missing cases.</div></div><div><h3>Interpretation</h3><div>This is the first study to provide estimates of age 60+ dementia incidence in NZ and for the four main ethnic groups and suggests over a third of incident dementia cases are undiagnosed. This highlights the need for better access to dementia assessment and diagnosis so that appropriate supports and interventions can be put in place to improve outcomes for people living with dementia and their families.</div></div><div><h3>Funding</h3><div>Nil.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rohingya refugee health and well-being in Malaysia: a call for research and action","authors":"","doi":"10.1016/j.lanwpc.2024.101229","DOIUrl":"10.1016/j.lanwpc.2024.101229","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Covid is a significant health crisis in China too","authors":"","doi":"10.1016/j.lanwpc.2024.101223","DOIUrl":"10.1016/j.lanwpc.2024.101223","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}