The Lancet Regional Health: Western Pacific最新文献

{"title":"A population-based study of traumatic brain injury incidence and mechanisms in New Zealand: 2021–2022 compared with 2010–2011","authors":"Kelly Jones ,&nbsp;Alice Theadom ,&nbsp;Nicola Starkey ,&nbsp;Irene Zeng ,&nbsp;Shanthi Ameratunga ,&nbsp;Suzanne Barker-Collo ,&nbsp;Laura Wilkinson-Meyers ,&nbsp;Braden Te Ao ,&nbsp;Nathan Henry ,&nbsp;Luke A. McClean ,&nbsp;Jennifer Chua ,&nbsp;Leah Haumaha ,&nbsp;Michael Kahan ,&nbsp;Grant Christey ,&nbsp;Natalie Hardaker ,&nbsp;Amy Jones ,&nbsp;Anthony Dowell ,&nbsp;Valery Feigin","doi":"10.1016/j.lanwpc.2026.101797","DOIUrl":"10.1016/j.lanwpc.2026.101797","url":null,"abstract":"<div><h3>Background</h3><div>Monitoring traumatic brain injury (TBI) incidence and epidemiological patterns is important for evidence-based strategic planning, policy, prevention, and resource allocation. We revisited population-based estimates and examined patterns of TBI incidence (all ages, severities) in 2021–2022 compared with 2010–2011 in New Zealand (NZ).</div></div><div><h3>Methods</h3><div>Examining an urban (Hamilton) and rural (Waikato District) region in NZ (May 2021–April 2022, unintentionally following the start of the COVID-19 pandemic), we calculated crude annual age-, sex-, ethnic-, urban/rural area- and mechanism-specific TBI incidence per 100,000 person-years with 95% Confidence Intervals (CI). Poisson regression was used to derive adjusted Risk Ratios (aRRs) to compare age-standardised rates between sex, ethnicity, and area groups. Direct standardisation was used to age-standardise rates to the world population. We calculated Incidence Rate Ratios (IRRs) with 95% CI to compare 2021–2022 with 2010–2011 age-standardised rates.</div></div><div><h3>Findings</h3><div>Total TBI incidence per 100,000 person-years was 852 cases (95% CI 816–890), including 791 cases (756–828) of mild TBI, and 61 cases (52–72) of moderate to severe TBI. TBI affected males more than females (IRR 1.31, 95% CI 1.29–1.33), and urban more than rural residents (IRR 1.57, 1.43–1.73). Most TBI (61%) occurred in people aged 15–64 years and were due to falls (48%). European and Asian peoples had lower risk of TBI than Māori (aRRs 0.68, 0.31 respectively). Compared to 2010–2011, total TBI incidence and rates among Māori were stable; TBI incidence was greater among females, urban residents, and adults aged ≥34 years; and TBI due to falls significantly increased (IRR 1.20, 95% CI 1.03–1.40).</div></div><div><h3>Interpretation</h3><div>Noting increased risks for underestimation due to COVID-19, findings suggest overall TBI incidence rate in NZ was similar in 2021–2022 to 2010–2011, while highlighting changes in TBI distribution. Age-, sex-, area-, ethnic-, and mechanism-specific distributions should be considered when revisiting prevention strategies to reduce TBI incidence.</div></div><div><h3>Funding</h3><div><span>Health Research Council of New Zealand</span> of NZ.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101797"},"PeriodicalIF":8.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037848","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":"Prevalence and serotype distribution of nasopharyngeal carriage of Streptococcus pneumoniae in Vietnam: a systematic review and meta-analysis","authors":"Xuanchen Tao ,&nbsp;Ketaki Sharma ,&nbsp;Catherine King ,&nbsp;Toan Trong Nguyen ,&nbsp;Thu-Anh Nguyen ,&nbsp;Huyen Thi Thanh Dang ,&nbsp;Linh Thuy Duong ,&nbsp;Thi Huynh Mai Duong ,&nbsp;Phoebe CM. Williams ,&nbsp;Sanjay Jayasinghe ,&nbsp;Beth Temple ,&nbsp;Kim Mulholland ,&nbsp;Kristine Macartney","doi":"10.1016/j.lanwpc.2026.101799","DOIUrl":"10.1016/j.lanwpc.2026.101799","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;em&gt;Streptococcus pneumoniae&lt;/em&gt; (&lt;em&gt;S. pneumoniae&lt;/em&gt;) is a leading cause of childhood morbidity and mortality worldwide. While pneumococcal conjugate vaccines (PCVs) have significantly reduced the global burden of pneumococcal disease, Vietnam has yet to introduce PCV into their National Immunisation Program. Better understanding of pneumococcal disease in Vietnamese children is key to informing vaccination policy, including PCV product selection. The aim of this study was to assess the prevalence, serotype distribution, and antimicrobial susceptibility patterns of nasopharyngeal carriage of &lt;em&gt;S. pneumoniae&lt;/em&gt; among children in Vietnam.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a systematic review and meta-analysis of &lt;em&gt;S. pneumoniae&lt;/em&gt; carriage studies in Vietnamese children under 18 years of age. Seven international biomedical research databases and 13 key Vietnamese-language journals were searched without language or publication date restrictions. The Joanna Briggs Institute critical appraisal tools were used to assess the quality of articles. We extracted data on the prevalence of &lt;em&gt;S. pneumoniae&lt;/em&gt; carriage and the serotype distribution. Where available, we also extracted the proportions of isolates that were non-susceptible to selected antibiotics. The pooled prevalence, serotype distribution, and antibiotic resistance rates were calculated with 95% confidence intervals (CIs) using random-effects models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 1197 studies were searched, of which 594 unique studies were identified and screened. 15 studies, conducted between 1996 and 2020, were included in the systematic review and meta-analysis. The pooled prevalence of nasopharyngeal carriage of &lt;em&gt;S. pneumoniae&lt;/em&gt; among Vietnamese children was 33% (95% CI: 28%–39%). The most common vaccine serotypes associated with colonisation were 6A (23%), 19F (17%), 6B (15%), 23F (10%), 14 (8%), and 19A (3%). High non-susceptibility rates were observed for penicillin (64%), macrolides (70%–91%), sulfamethoxazole–trimethoprim (70%), tetracycline (84%), and several other antibiotics. Moderate to low non-susceptibility rates were observed for amoxicillin (22%), amoxicillin-clavulanate (6%), moxifloxacin (1%), vancomycin (1%), and rifampicin (0%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The prevalence of &lt;em&gt;S. pneumoniae&lt;/em&gt; nasopharyngeal carriage in children, a surrogate for potential invasive disease, was high in Vietnam, with substantial antimicrobial resistance detected. The predominant serotypes circulating in the community are covered by available PCVs. Inclusion of PCV into the country's National Immunisation Program at the earliest opportunity will have a large impact on childhood disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Gavi&lt;/span&gt;, the &lt;span&gt;Vaccine Alliance&lt;/span&gt;, and &lt;span&gt;Australia’s Department of Foreign Affairs and Trade&lt;/span&gt; (DFAT) provided funding support for this proje","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101799"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037668","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":"Measuring cancer equity globally: harmonising international rural-urban classifications for exploring cancer outcomes","authors":"Charlene Wright ,&nbsp;Sharina Riva ,&nbsp;Megan Crichton ,&nbsp;Helena Rodi ,&nbsp;Hannah Jongebloed ,&nbsp;Lucy Leigh ,&nbsp;Elizabeth A. Johnston ,&nbsp;Rebecca J. Bergin ,&nbsp;Anna Chapman ,&nbsp;Laura Alston ,&nbsp;Fiona Crawford–Williams ,&nbsp;Nicolas H. Hart ,&nbsp;Joel Rhee ,&nbsp;Lan Gao ,&nbsp;Kate Gunn ,&nbsp;Harry Gasper ,&nbsp;Anna Ugalde ,&nbsp;Skye Marshall","doi":"10.1016/j.lanwpc.2025.101737","DOIUrl":"10.1016/j.lanwpc.2025.101737","url":null,"abstract":"<div><div>Geographic disparities in cancer outcomes represent a critical health equity challenge, with rural populations consistently experiencing poorer outcomes than urban populations. The lack of harmonised rurality measures creates substantial barriers to evidence synthesis and has precluded meta-analyses. This perspectives paper discusses concepts of rurality, identifies rurality classification systems used by cancer researchers in OECD countries that can be harmonised with the OECD Extended Typology, and develops recommendations for consistent rural-urban coding. Targeted searches of grey and published literature on cancer policy and rurality classification systems were conducted. The secondary analysis examined studies identified through systematic database searching of OVID Medline, Elsevier Embase, CINAHL, and Web of Science. From 289 studies across 22 OECD countries, twenty-seven rurality classification systems were identified, with eleven systems harmonised to create the Rural-Urban Classification System Harmonisation Framework featuring a consistent five-point rurality scale and standardised urban-rural dichotomisation. Implementation recommendations address system selection, standardised categorisation, and reporting standards. Adopting this harmonisation framework will improve research comparability and strengthen evidence to inform equitable cancer policies.</div></div><div><h3>Funding</h3><div>Commonwealth of Australia's <span>Medical Research Future Fund</span> (MRF2030313).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101737"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077535","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":"Association of rurality status with all-cause and cancer-specific survival: a systematic review and meta-analysis adjusting for clinical factors, demographics, and geographical remoteness","authors":"Skye Marshall ,&nbsp;Charlene Wright ,&nbsp;Lucy Leigh ,&nbsp;Sharina Riva ,&nbsp;Megan Crichton ,&nbsp;Helena Rodi ,&nbsp;Hannah Jongebloed ,&nbsp;Elizabeth A. Johnston ,&nbsp;Rebecca J. Bergin ,&nbsp;Anna Chapman ,&nbsp;Fiona Crawford-Williams ,&nbsp;Nicolas H. Hart ,&nbsp;Laura Alston ,&nbsp;Joel Rhee ,&nbsp;Lan Gao ,&nbsp;Kate Gunn ,&nbsp;Anna Ugalde","doi":"10.1016/j.lanwpc.2025.101744","DOIUrl":"10.1016/j.lanwpc.2025.101744","url":null,"abstract":"<div><div>The association of rurality status with cancer survival has not been consistently reported. In people diagnosed with cancer, this review aims to determine the association of rural and remote living with survival as compared to urban living, and to determine the modifying effects of geographical, medical, demographic, and socioeconomic factors on cancer survival. A systematic review with meta-analysis and meta-regression was conducted, searching four databases in August 2024. Observational cohort studies were eligible if they reported all-cause or cancer-specific survival according to rurality status in Organisation for Economic Co-operation and Development (OECD) countries. All ages, sexes, and cancer types were eligible. Risk of bias was assessed using the Newcastle–Ottawa Scale and pooled models were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Meta-analyses and meta-regressions were performed using R statistical environment. 37 studies reporting on 110 comparator groups were included. People with cancer in rural areas were at a survival disadvantage compared to people in urban areas, with 15% lower odds of all-cause survival (OR 0.85 [95% CI 0.74, 0.97]) and 10% lower odds of cancer-specific survival (OR: 0.90 [95% CI 0.86, 0.95]). Cancer type and degree of geographical remoteness were consistent modifiers of survival in univariable and multivariable regression. Increasing degree of geographical remoteness was associated with lower odds of all-cause survival (OR 0.28 [95% CI 0.12–0.67]). People living in rural areas diagnosed with cancer have lower odds of all-cause and cancer-specific survival which worsened with increasing geographical remoteness. Type of cancer was consistently found to be a modifying factor of cancer survival. Increased recognition of people living in rural areas as a priority population group in health and cancer policies is needed to improve cancer equity.</div></div><div><h3>Funding</h3><div><span>Commonwealth of Australia's Medical Research Future</span> Fund (MRF2030313).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101744"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077534","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":"Re-imagining Global Health: perspectives from the next generation in the Pacific region","authors":"S. Boladuadua ,&nbsp;F. Langridge ,&nbsp;R. Qin ,&nbsp;R. Ng Shiu ,&nbsp;J. McCool ,&nbsp;J. Mani ,&nbsp;J. Kailawadoko ,&nbsp;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}

{"title":"The potential for dementia prevention in Japan: a population attributable fraction calculation for 14 modifiable risk factors and estimates of the impact of risk factor reductions","authors":"Koichiro Wasano ,&nbsp;Kasper Jørgensen","doi":"10.1016/j.lanwpc.2025.101792","DOIUrl":"10.1016/j.lanwpc.2025.101792","url":null,"abstract":"<div><h3>Background</h3><div>As dementia prevalence increases globally, preventive strategies targeting modifiable risk factors have become increasingly important. In Japan, with its super-ageing society, dementia is the leading cause of increased disability-adjusted life years among older adults. This study quantified the contribution of 14 potentially modifiable risk factors for dementia in older adults using Japan-specific prevalence data.</div></div><div><h3>Methods</h3><div>We calculated population attributable fractions (PAFs) and potential impact fractions (PIFs) using recent publicly available prevalence data from national surveys and cohort studies in Japan, and relative risks and communality weights from the 2024 <em>Lancet</em> Commission report on dementia. We then modelled how 10% and 20% reductions in each risk factor would affect national dementia prevalence.</div></div><div><h3>Findings</h3><div>The weighted combined PAF for all 14 risk factors was 38.9%, indicating that nearly 4 in 10 dementia cases in Japan might be preventable. Hearing loss (6.7%), physical inactivity (6.0%), and high LDL cholesterol (4.5%) were the largest contributors. Reducing all risk factors by 10% could prevent ∼208,000 dementia cases; reducing them by 20% could prevent ∼407,000 cases.</div></div><div><h3>Interpretation</h3><div>Dementia preventive efforts in Japan should prioritise hearing care, physical activity, and metabolic health. Japan-specific data confirmed that hearing loss is a leading contributor to dementia, underscoring the urgency to increase public awareness and access to hearing interventions.</div></div><div><h3>Funding</h3><div>The <span>Royal Danish Embassy in Japan</span>, <span>Danish Ministry of Foreign Affairs</span>, <span>Danish Ministry of Health</span>, and <span>Japan Agency for Medical Research and Development</span> funded this study.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101792"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077539","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 disease risk prediction in multi-ethnic Asian populations: evidence from two population-based cohorts in Singapore","authors":"Charlie G.Y. Lim ,&nbsp;Crystal C.Y. Chong ,&nbsp;Yvonne H.M. Wong ,&nbsp;Jiali Yao ,&nbsp;Stefen Ma ,&nbsp;John C. Chambers ,&nbsp;Khung Keong Yeo ,&nbsp;E Shyong Tai ,&nbsp;Jasper Tromp ,&nbsp;Rob M. van Dam ,&nbsp;Saima Hilal ,&nbsp;Charumathi Sabanayagam ,&nbsp;Ching-Yu Cheng ,&nbsp;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}

{"title":"Spatio-temporal patterns of tuberculosis revealed by routine Mycobacterium tuberculosis sequencing in Australia: an extended patient cohort analysis (2017–2023)","authors":"Xiaomei Zhang ,&nbsp;Carl J.E. Suster ,&nbsp;Eby M. Sim ,&nbsp;Connie Lam ,&nbsp;Elena Martinez ,&nbsp;Taryn Crighton ,&nbsp;Ellen J. Donnan ,&nbsp;Ben J. Marais ,&nbsp;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}

{"title":"Implementation strategies for evidence-based healthcare interventions in rural and remote settings: a scoping review","authors":"Anna Chapman ,&nbsp;Cadeyrn J. Gaskin ,&nbsp;Hannah Beks ,&nbsp;Charlene Wright ,&nbsp;Skye Marshall ,&nbsp;Elizabeth A. Johnston ,&nbsp;Rebecca J. Bergin ,&nbsp;Sharina Riva ,&nbsp;Fiona Crawford-Williams ,&nbsp;Camille E. Short ,&nbsp;Nicole Kiss ,&nbsp;Sze Lin Yoong ,&nbsp;Nicolas H. Hart ,&nbsp;Anna Wong Shee ,&nbsp;Helena Rodi ,&nbsp;Hannah Jongebloed ,&nbsp;Anna Ugalde","doi":"10.1016/j.lanwpc.2025.101732","DOIUrl":"10.1016/j.lanwpc.2025.101732","url":null,"abstract":"<div><div>Globally, people living in rural and remote areas experience poorer healthcare access and outcomes than urban populations. Applying implementation strategies that support the translation of evidence-based healthcare interventions may help reduce these inequities; however, real-world implementation is complex, and it remains unclear how strategies are applied and tailored to rural and remote contexts. This scoping review synthesised evidence on implementation strategies for healthcare interventions in rural and remote settings of high-income countries. Five databases (Ovid MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science) were searched for peer-reviewed studies published between 1/1/2000 and 25/10/2024. Extracted data were synthesised using a descriptive narrative approach. From 11,887 records, 78 papers (75 studies) met inclusion criteria. Implementation efforts were multifaceted, commonly drawing on strategies from three Expert Recommendations for Implementing Change clusters: <em>train and educate stakeholders</em> (n = 70, 93%), <em>use evaluative and iterative strategies</em> (n = 55, 73%), and <em>develop stakeholder interrelationships</em> (n = 48, 64%). Few studies (n = 21; 28%) reported rural-specific design features. Although implementation in rural and remote contexts has focused on provider-level strategies, there is a need to also address system-level determinants to implementation. Context-specific design, meaningful engagement with local communities and stakeholders, and clearer reporting are essential to optimise implementation and reduce rural-urban health disparities.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101732"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077537","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":"Can administrative data be used for a national register of hospitalised stroke patients? A New Zealand validation study","authors":"Marine Corbin ,&nbsp;Hayley J. Denison ,&nbsp;Jeroen Douwes ,&nbsp;Mina Whyte ,&nbsp;Stephanie G. Thompson ,&nbsp;Matire Harwood ,&nbsp;Alan Davis ,&nbsp;John N. Fink ,&nbsp;P. Alan Barber ,&nbsp;John H. Gommans ,&nbsp;Dominique A. Cadilhac ,&nbsp;William M. Levack ,&nbsp;Harry McNaughton ,&nbsp;Joosup Kim ,&nbsp;Valery L. Feigin ,&nbsp;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}