The Lancet Regional Health: Western Pacific最新文献

{"title":"Prevalence and incidence of chronic kidney diseases in Hong Kong: a 12-year territory-wide retrospective cohort study","authors":"Noel C. Yue ,&nbsp;Shun-Cheong Ho ,&nbsp;Jonathan K.L. Mak ,&nbsp;Franco W.T. Cheng ,&nbsp;Edward Y.W. Tam ,&nbsp;Wallis C.Y. Lau ,&nbsp;Ruby L.C. Hoo ,&nbsp;Kathryn C.B. Tan ,&nbsp;Desmond Y.H. Yap ,&nbsp;Ching-Lung Cheung","doi":"10.1016/j.lanwpc.2025.101726","DOIUrl":"10.1016/j.lanwpc.2025.101726","url":null,"abstract":"<div><h3>Background</h3><div>Over the past decades, epidemiology studies on chronic kidney disease (CKD) have been widely conducted globally, but research on its prevalence and incidence in Chinese population remain scarce. This retrospective cohort study utilized all creatinine and urine albumin-to-creatinine ratio data obtained from the Clinical Data Analysis and Reporting System (CDARS), a territory-wide electronic medical database in Hong Kong, to provide the most up-to-date and largest Chinese cohort with long-term follow-up for comprehensive analysis of the trends in CKD prevalence and incidence.</div></div><div><h3>Methods</h3><div>Patients diagnosed with CKD between 2010 and 2021 were identified from CDARS. Prevalence, crude incidence, and age-standardized incidence using the United Nations population in 2018 as a reference were estimated. Subgroups of age and sex were also estimated accordingly. Joinpoint regression was used to estimate the annual percent change (APC) and average annual percent change (AAPC).</div></div><div><h3>Findings</h3><div>A total of 496,796 CKD patients between 2010 and 2021 were identified from CDARS. The prevalence of CKD (per 100,000 persons) increased from 3065.76 (95% confidence interval, CI: 3051.68–3079.88) to 6296.38 (95% CI: 6277.02–6315.78) between 2010 and 2021, with males generally having higher prevalence. The overall prevalence AAPC was 6.69% (95% CI: 6.45–7.03; p &lt; 0.001), with the APC trend decelerating from 13.82% (95% CI: 11.17–16.10; p &lt; 0.001) in 2012 to 4.06% (95% CI: 3.30–4.52; p &lt; 0.001) in 2021. Both crude and age-standardized incidence (per 100,000 persons) showed a decreasing trend, in which the age-standardized incidence decreased from 533.61 (95% CI: 528.4–538.86) to 391.14 (95% CI: 387.2–395.11) between 2010 and 2021, with an AAPC of −3.74% (95% CI: −5.04 to −2.50; p &lt; 0.001). Disparity in trends was observed among sex and age groups.</div></div><div><h3>Interpretation</h3><div>The deceleration in CKD prevalence growth after 2012, along with the declining incidence trends may reflect the impact of the strategic framework launched by the Hong Kong government to prevent and control chronic diseases. Meanwhile, the sex differences in CKD trends support evidence that Asian males generally have a higher prevalence than females, differing from patterns observed in other regions. Further studies in diverse Asian populations are needed to reduce geographical bias and enhance understanding of CKD.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101726"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466902","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}

{"title":"Age-specific trends in colorectal, appendiceal, and anal tumour incidence by histological subtype in Australia from 1990 to 2020: a population-based time-series analysis","authors":"Aaron L. Meyers ,&nbsp;James G. Dowty ,&nbsp;Khalid Mahmood ,&nbsp;Finlay A. Macrae ,&nbsp;Christophe Rosty ,&nbsp;Daniel D. Buchanan ,&nbsp;Mark A. Jenkins","doi":"10.1016/j.lanwpc.2025.101728","DOIUrl":"10.1016/j.lanwpc.2025.101728","url":null,"abstract":"<div><h3>Background</h3><div>Early-onset bowel cancer incidence (age &lt;50 years) has increased worldwide and is highest in Australia, but how trends vary across age, histology, and anatomical site remains unclear. We investigated appendiceal, proximal colon, distal colon, rectal, and anal cancer incidence trends by age and histology in Australia.</div></div><div><h3>Methods</h3><div>Cancer incidence rate data were obtained from nation-wide cancer registries (1990–2020). Birth cohort-specific incidence rate ratios (IRRs) and annual percentage change were estimated using age-period-cohort modelling and joinpoint regression.</div></div><div><h3>Findings</h3><div>Combining all malignant tumour histologies, early-onset incidence rose 5–9% annually, yielding 4072 excess cases (1·5 per 100,000 person-years; 15% appendix, 28% colon, 48% rectum, 9% anus). Trends varied by site, period, and age: appendiceal cancer rose from 1990 to 2020 in 30–49-year-olds; colorectal cancers rose from around 1990–2010 in 20–29-year-olds and from 2010 to 2020 in 30–39-year-olds; anal cancer rose from 1990 to 2009 in 40–49-year-olds. Across sites, IRRs increased with successive birth cohorts since 1960. Adenocarcinoma incidence in the 1990s versus 1950s cohort was 2–3-fold for colorectum and 7-fold for appendix. The greatest subtype-specific increases occurred for appendiceal mucinous adenocarcinoma, colorectal non-mucinous adenocarcinoma, and anal squamous cell carcinoma. Colorectal neuroendocrine neoplasms, squamous cell carcinomas, and signet ring cell carcinomas rose across early-onset and later-onset strata.</div></div><div><h3>Interpretation</h3><div>Appendiceal, colorectal, and anal cancer incidence is rising in Australia, with variation across age and histology. These generational shifts suggest evolving risk factor profiles and early-life exposures, highlighting the need to identify drivers of this growing burden.</div></div><div><h3>Funding</h3><div>Australian Government.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101728"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419428","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}

{"title":"Leveraging malaria microscopy infrastructure to diagnose common and neglected skin diseases using direct microscopy in Sumba, Indonesia","authors":"Gladys O. Siregar ,&nbsp;Maria Harianja ,&nbsp;Dallas J. Smith ,&nbsp;Messe R. Ataupah ,&nbsp;Ruth D. Laiskodat ,&nbsp;Claus Bøgh ,&nbsp;Hardyanto Soebono ,&nbsp;Marlous L. Grijsen","doi":"10.1016/j.lanwpc.2025.101739","DOIUrl":"10.1016/j.lanwpc.2025.101739","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101739"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467661","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}

{"title":"Mortality among transgender persons: a Taiwan matched-population and sibling-comparison cohort study","authors":"Chih-Wei Hsu ,&nbsp;Yang-Chieh Brian Chen ,&nbsp;Liang-Jen Wang ,&nbsp;Mu-Hong Chen ,&nbsp;Yao-Hsu Yang ,&nbsp;Chih-Sung Liang ,&nbsp;Po-Yen Chen ,&nbsp;Edward Chia-Cheng Lai","doi":"10.1016/j.lanwpc.2025.101715","DOIUrl":"10.1016/j.lanwpc.2025.101715","url":null,"abstract":"<div><h3>Background</h3><div>Transgender persons have been reported to experience excess mortality, but evidence is dominated by Western cohorts and seldom addresses familial confounding.</div></div><div><h3>Methods</h3><div>We conducted a nationwide, retrospective cohort study using two prespecified comparison designs: matched population controls (1:4, matched on legal sex and birth date) and within-family cisgender sibling comparisons. Transgender persons were identified by ≥2 psychiatrist-recorded gender identity disorder diagnoses during 2001–2021; cohort entry required age ≥6 years. Participants were followed until death or December 31, 2022. We compared all-cause, external-cause (suicide and accidents), and internal-cause mortality using Cox regression adjusted for sociodemographics and medical comorbidity.</div></div><div><h3>Findings</h3><div>Among 3906 transgender persons (mean age 24.6 years; 70.6% with a male legal sex) and 15,624 controls (mean follow-up 9.5 years), psychiatric conditions were markedly over-represented in the transgender cohort (e.g., depressive disorders 40.8% vs 5.7%). Adjusted hazard ratios were 1.40 (95% confidence interval 1.06–1.84) for all-cause mortality, 2.03 (1.39–2.96) for external causes, and 4.07 (2.52–6.59) for suicides; accidents (0.56, 0.21–1.45) and internal-cause (0.98, 0.65–1.48) mortality did not differ. In sibling comparisons (4765 siblings), excess all-cause and external-cause mortality were not observed (0.96, 0.67–1.36; and 1.14, 0.70–1.85), suicide risk was higher (2.57, 1.32–5.00), and accident mortality lower (0.19, 0.06–0.67). Relative hazards were greatest in those with a female legal sex and in adolescents. Adjustment for psychiatric clusters attenuated—but did not eliminate—the suicide mortality excess.</div></div><div><h3>Interpretation</h3><div>In Taiwan, transgender persons had higher all-cause and suicide mortality than population controls; in within-family comparisons, the suicide mortality excess persisted, indicating influences beyond shared familial factors. Prevention should prioritize targeted mental-health and safety interventions, with particular attention to adolescents and those with a female legal sex.</div></div><div><h3>Funding</h3><div><span>Taiwan National Science and Technology Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101715"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323443","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}

{"title":"Corrigendum to Policies, resource allocation, and interventions for child and adolescent mental health in low- and middle-income countries in the Western Pacific Region: a scoping review [The Lancet Regional Health—Western Pacific, Vol 62 (2025), 101674]","authors":"Jiang Long ,&nbsp;Stephanie Zhang ,&nbsp;Lingjun Chu ,&nbsp;Juliet Balkian ,&nbsp;Isabel Giovannucci ,&nbsp;Cody Mui ,&nbsp;Yiqun Luan ,&nbsp;Odille Chang ,&nbsp;Phetsavanh Chanthavilay ,&nbsp;Kartika Goundar ,&nbsp;Munkh-Erdene Luvsan ,&nbsp;Elissa Kennedy ,&nbsp;Dang Nguyen ,&nbsp;Picholas Kian Ann Phoa ,&nbsp;Caroline Mae Ramirez ,&nbsp;Bach Xuan Tran ,&nbsp;Siyan Yi ,&nbsp;Paula Melizza Valera ,&nbsp;Sovanvorleak Tep ,&nbsp;Mengieng Ung ,&nbsp;Chunling Lu","doi":"10.1016/j.lanwpc.2025.101742","DOIUrl":"10.1016/j.lanwpc.2025.101742","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101742"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517512","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}

{"title":"Sustainable age-friendly cities and communities in China: a scoping review and narrative assessment of national policies","authors":"Yanhui Jia ,&nbsp;Siwon Lee ,&nbsp;Mikiko Kanda ,&nbsp;Pankyu Park ,&nbsp;Sally J. Edwards ,&nbsp;Jiuxuan Gao ,&nbsp;Weiju Zhou ,&nbsp;John S. Ji","doi":"10.1016/j.lanwpc.2025.101723","DOIUrl":"10.1016/j.lanwpc.2025.101723","url":null,"abstract":"<div><h3>Background</h3><div>Climate change, aging populations, and rapid urbanization intersect to pose public health challenges in China, impacting the livelihoods of older adults. This review maps China's national policies shaping Sustainable Age-Friendly Cities and Communities (AFCC), highlights supporting sub-national innovations, and identifies potential policy gaps and opportunities.</div></div><div><h3>Methods</h3><div>We searched 26 national government websites for policy documents published from January 1, 2020, to December 20, 2024, screening 35,809 records and including 125 that met criteria.</div></div><div><h3>Findings</h3><div>National frameworks (National Strategy for Climate Change Adaptation 2035, Healthy China 2030, Healthy Cities) have parallel efforts linking climate resilience and healthy aging. However, policy domains are siloed: age-friendly policies focus on healthcare accessibility, whereas sustainability policies target ecological restoration. Sub-national innovations, such as 15-min life circles, sponge cities for flood, “one old, one young” inter-generational hubs, advance climate adaptation. The large-scale Three-North Shelter Forest Program indirectly benefits older adults respiratory risk by controlling dust and desertification. However, these initiatives run in parallel, with limited shared targets, data systems, and co-financing. Institutional fragmentation and regional disparities in geographic, economic, and administrative capacities impede uniform implementation, risking inefficient spending and missed synergies.</div></div><div><h3>Interpretation</h3><div>Effective action on concurrent aging and climate risks hinges on policy-and-practice integration of AFCC and sustainability agendas. Age-friendly plans should include sustainability and vice versa. China's administrative grid and large-scale ecological programs provide infrastructure for delivery of dual-benefits.</div></div><div><h3>Funding</h3><div>This work is supported by the <span>World Health Organization</span> (<span><span>WPRO/2024-02/AGE-DHP/22552 4</span></span>), the <span>National Natural Science Foundation</span> of China (<span><span>82422064</span></span>, <span><span>82250610230</span></span>, <span><span>42307535</span></span>, <span><span>42577488</span></span>), the <span>Natural Science Foundation of Beijing</span> (<span><span>IS23105</span></span>), and the <span>National Bureau for Disease Control and Prevention</span> (<span><span>20241660047</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101723"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466904","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}

{"title":"Epidemiological characteristics of heatstroke in China, 2010–2023: a longitudinal study based on a national heatstroke surveillance system","authors":"Xiaoye Wang ,&nbsp;Fan Ding ,&nbsp;Xiaoqi Qi ,&nbsp;Ziyi Wang ,&nbsp;Yingxin Pei ,&nbsp;Lijie Zhang ,&nbsp;Jinghuan Ren ,&nbsp;Yeping Wang ,&nbsp;Qing Guo ,&nbsp;Biao Zeng ,&nbsp;Shiyao Xu ,&nbsp;Tian Liu ,&nbsp;Rui Wang ,&nbsp;Zhifeng Wang ,&nbsp;Guoqing Shi","doi":"10.1016/j.lanwpc.2025.101722","DOIUrl":"10.1016/j.lanwpc.2025.101722","url":null,"abstract":"<div><h3>Background</h3><div>Heatstroke causes numerous pathophysiological changes and can lead to death. Extreme heat events have been increasing in frequency, duration, and intensity worldwide in recent decades and are causing growing public health concern. However, epidemiological studies of heatstroke are limited in number and scope, and have had relatively small sample sizes. To better understand the epidemiological characteristics of heatstroke and advance evidence-based prevention and control strategies, we conducted an observational study of reported heatstroke cases in China.</div></div><div><h3>Methods</h3><div>Cases included in this study were patients clinically diagnosed with heatstroke during the study period of 2010–2023, reported through a dedicated heatstroke surveillance system established by China CDC. We used descriptive statistical methods to determine the epidemiological characteristics of heatstroke in China.</div></div><div><h3>Findings</h3><div>There were 86,406 heatstroke cases reported during the study period, with an increasing reporting trend (Spearman correlation coefficient <em>r</em> = 0·79). Annual incidence (Spearman <em>r</em> = 0·77) and proportion of severe cases (Pearson <em>r</em> = 0·67) were positively correlated with the number of nationwide average annual high-temperature days. The overall incidence was 44·83 per 10 million person-years, and the mortality rate was 0·89 per 10 million person-years; 32·02% of cases were severe; the overall case fatality rate (CFR) was 1·98%, and the CFR for severe cases was 6·19%. Most cases and deaths were reported in summer, with peaks in late July. The peaks of incidence, duration, and severity varied by region. The mean age was (50·46 ± 18·73) years, with male cases younger than female cases (49·21 ± 17·41 vs 53·60 ± 21·36; <em>t</em> = −28·73, <em>p</em> &lt; 0·0001). For every five-year increase in age, the risks of severe heatstroke and death increased by 14·64% (95% <em>CI</em>: 1·1415–1·1513) and 25·76% (<em>CI:</em> 1·2400–1·2755), respectively. The male:female ratio was 2·49:1; males exhibited a higher risk of suffering from heatstroke and having greater disease severity than females.</div></div><div><h3>Interpretation</h3><div>Our study provides a clear profile of heatstroke cases, and highlights differences by population, region, and time of year. Results inform formulation of evidence-based strategies for enhanced heatstroke preparedness and response, such as enhancing public health early warning systems, prioritizing protection for vulnerable groups, and advancing localized interventions for risk communication and clinical management.</div></div><div><h3>Funding</h3><div><span>Public Health Talent Program of China’s National Disease Control and Prevention Administration</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101722"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419430","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}

{"title":"Risk-stratified classification of pulmonary nodule malignancy via a machine learning model integrating imaging and cell-free DNA: a model development and validation study (DECIPHER-NODL)","authors":"Huiting Wang ,&nbsp;Hairong Huang ,&nbsp;Feng Li ,&nbsp;Ying Deng ,&nbsp;Changyong Wang ,&nbsp;Wei Wei ,&nbsp;Song Wang ,&nbsp;Dongqin Zhu ,&nbsp;Hao Xu ,&nbsp;Hua Bao ,&nbsp;Zheng Li ,&nbsp;Wenjun Ye ,&nbsp;Yuan Zhang ,&nbsp;Caichen Li ,&nbsp;Bo Cheng ,&nbsp;Xiwen Liu ,&nbsp;Liping Liu ,&nbsp;Zheng Li ,&nbsp;Jing Yang ,&nbsp;Wei Chen ,&nbsp;Wenhua Liang","doi":"10.1016/j.lanwpc.2025.101730","DOIUrl":"10.1016/j.lanwpc.2025.101730","url":null,"abstract":"<div><h3>Background</h3><div>Accurate risk stratification of pulmonary nodules is critical for early lung cancer detection. This study aimed to improve malignancy classification and invasiveness prediction using machine learning models integrating low-dose computed tomography (LDCT) radiomics and plasma cell-free DNA (cfDNA) fragmentomics.</div></div><div><h3>Methods</h3><div>This multicenter study enrolled 1356 participants across discovery (n = 1147) and external validation (n = 209) cohorts. A deep learning-based imaging model processed LDCT scans for automated lung nodule detection and malignancy classification. A parallel cfDNA model analyzed four whole-genome fragmentation features: copy number variation, fragment size ratio, fragment-based methylation, and mutation context and signature. The two models were integrated via a stacked ensemble algorithm. An invasion prediction model evaluated tumor aggressiveness.</div></div><div><h3>Findings</h3><div>The integrated imaging-cfDNA model outperformed individual models, with an AUC of 0.950 (95% CI: 0.926–0.975) in the internal test set and 0.966 (95% CI: 0.940–0.991) in the external validation. The combined model's specificity increased to 0.60 (95% CI: 0.49–0.71) while maintaining 95% sensitivity, compared to specificities of 0.50 (95% CI: 0.41–0.59) and 0.33 (95% CI: 0.23–0.44) at equivalent sensitivity levels for the imaging and cfDNA models, respectively. The combined model consistently outperformed the other two models across nodule characteristics, with particular improvement for 10–20 mm and pure solid nodules. The invasion prediction model stratified lung cancers with an AUC of 0.884 (internal) and 0.880 (external). Prediction scores increased stepwise with tumor aggressiveness, from adenocarcinoma in situ to minimally invasive adenocarcinoma, and were highest for invasive adenocarcinoma.</div></div><div><h3>Interpretation</h3><div>This multimodal approach enhances pulmonary nodule risk stratification by integrating radiomic and molecular biomarkers. The model significantly improves diagnostic accuracy, potentially reducing unnecessary procedures while minimizing missed diagnoses, supporting its clinical utility in lung cancer screening.</div></div><div><h3>Funding</h3><div><span>Noncommunicable Chronic Diseases-National Science and Technology Major Project</span>, <span>National Key Research &amp; Development Programme</span>, <span>China National Science Foundation</span>, the <span>Science and Technology Planning Project of Guangzhou</span>, and <span>Guangzhou National Laboratory</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101730"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517453","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}

{"title":"Drug-resistant gram-negative bacterial infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data, and key evidence gaps","authors":"Daniel K. Yeoh ,&nbsp;Alison Boast ,&nbsp;Sophie CH. Wen ,&nbsp;Phoebe CM. Williams ,&nbsp;Lesley Voss ,&nbsp;Brett Ritchie ,&nbsp;Mona Mostaghim ,&nbsp;Flora Lutui ,&nbsp;Alice Lei ,&nbsp;Tony Lai ,&nbsp;Adam D. Irwin ,&nbsp;Kiera Harwood ,&nbsp;Thomas Ewin ,&nbsp;Celia Cooper ,&nbsp;Emma Best ,&nbsp;Sarah Bannister ,&nbsp;Amanda Gwee","doi":"10.1016/j.lanwpc.2025.101735","DOIUrl":"10.1016/j.lanwpc.2025.101735","url":null,"abstract":"<div><div>Gram-negative bacterial infections remain a major cause of morbidity and mortality in children and neonates globally, compounded by the rise of antimicrobial resistance. Barriers to paediatric antibiotic licencing lead to reduced availability of potentially effective agents for treatment. For children and neonates in the Oceania region, specific challenges remain including a paucity of surveillance data on local rates of antimicrobial resistance, and lack of availability of newer, more costly agents. In this review, we summarise available regional epidemiological data on the WHO priority pathogens: extended spectrum B-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant <em>Pseudomonas aeruginosa</em>, and carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB). Paediatric clinical trial and pharmakinetic data for the antimicrobials recommended for treatment of these pathogens are reviewed, and paediatric knowledge gaps identified to inform future collaborative research.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101735"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466908","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}

{"title":"Cardiovascular complications in acute dengue infection: a population-based cohort study","authors":"Liang En Wee ,&nbsp;Wei Zhi Tan ,&nbsp;Jo Yi Chow ,&nbsp;Jue Tao Lim ,&nbsp;Calvin Chiew ,&nbsp;Po Ying Chia ,&nbsp;Lee Ching Ng ,&nbsp;Mohammed Rizwan Amanullah ,&nbsp;Jonathan Yap ,&nbsp;Khung Kheong Yeo ,&nbsp;Mark Yan Yee Chan ,&nbsp;Derek J. Hausenloy ,&nbsp;Yee Sin Leo ,&nbsp;David Chien Lye ,&nbsp;Kelvin Bryan Tan","doi":"10.1016/j.lanwpc.2025.101713","DOIUrl":"10.1016/j.lanwpc.2025.101713","url":null,"abstract":"<div><h3>Background</h3><div>Acute dengue-virus (DENV) infection, while associated with mild disease in most instances, is anecdotally associated with more severe cardiovascular complications. However, more accurate estimates of cardiac complications are required to evaluate the actual burden of dengue-associated morbidity, given significant contribution of cardiovascular events to overall morbidity and rising incidence of DENV-infection attributable to climate change.</div></div><div><h3>Methods</h3><div>A population-based cohort of DENV-infected Singaporean adults (2017–2023) and population-based controls (without DENV-infection) was constructed using the national-dengue-registry. Overlap weights were employed to balance baseline covariates. Logistic regression was used to estimate odds of cardiovascular events in DENV-infected cases versus uninfected controls up to 30 days from T₀ (notification-date in DENV-infected adults; randomly assigned in population-based controls following distribution of T₀ amongst DENV-infected cases).</div></div><div><h3>Findings</h3><div>65,207 DENV-infected cases and 1,616,865 uninfected controls were included. Higher odds of any cardiovascular event (adjusted-odds-ratio, aOR = 10.63 [95% CI = 7.56, 15.48]), major-adverse-cardiac-event (MACE) (aOR = 2.92 [95% CI = 1.81–4.88]), dysrhythmia (aOR = 18.44 [95% CI = 11.25 = 32.96]) and ischemic-heart-disease (aOR = 3.00 [95% CI = 1.83–5.15]) were observed up to 30 days post-DENV-infection, versus uninfected controls. Odds of acute cardiovascular events remained higher in both ambulatory/hospitalised DENV-infected cases, DENV-IgG-positive/negative cases, and across DENV1/2 and DENV3-predominant transmission, versus uninfected controls. However, overall excess burden (EB) of acute cardiovascular events in DENV-infected adults was modest, with &lt;1 excess event per-100-cases except amongst those aged ≥60 years (EB = 1.25 [95% CI = 1.05–1.44]).</div></div><div><h3>Interpretation</h3><div>Acute DENV-infection was associated with higher odds of cardiovascular events up to 30 days post-infection; though excess-burden was modest. Older adults at higher risk should be monitored for cardiac complications following acute DENV-infection.</div></div><div><h3>Funding</h3><div>National-Medical-Research-Council, Singapore.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101713"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323444","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}