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Cardiovascular disease risk prediction in multi-ethnic Asian populations: evidence from two population-based cohorts in Singapore 多种族亚洲人群心血管疾病风险预测:来自新加坡两个基于人群的队列的证据
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 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.
亚洲心血管疾病(CVD)负担的增加需要针对亚洲人群的风险评估工具。因此,我们重新校准了非西班牙裔白人的ACC/AHA合并队列方程(PCE-W),并将其在预测10年心血管疾病风险方面的表现与最近为亚洲人群重新校准的其他两种已建立的心血管疾病预测模型进行了比较。方法我们使用来自新加坡多民族队列(MEC1)和新加坡眼病流行病学队列(SEED)的数据,该队列包括华人、印度人和马来人。PCE-W使用来自MEC1的数据重新校准,在SEED队列中进行外部验证,并使用一致性指数(C-index)与新加坡修改的Framingham风险评分(SG-FRS-2023)和SCORE2亚太模型进行比较。采用大规模校准法、校准斜率和拟合优度检验对校准进行评估。结果表明,这三种模型可能有助于明确MEC1和SEED的有用区分,总c指数在0.728 ~ 0.811之间。重新校准的PCE-W在MEC1和SEED中的表现优于原始PCE-W,尽管在华人男性和女性以及马来女性中仍然存在一些错误估计(校准范围为- 0.479至0.260)。SG-FRS-2023在MEC1和SEED中显示出总体满意的校准,但在SEED队列中,中国男性(校准-大- 0.671)和印度男性(校准-大- 0.214)倾向于高估风险。SCORE2亚太模型在印度人中表现令人满意,但在华人中高估了风险(大校准范围从- 0.570到- 1.185),在马来人中显示出较差的模型拟合。重新校准的PCE-W、SG-FRS-2023和SCORE2亚太模型显示可能有助于在新加坡的两个多民族队列中明确有用的歧视。在校准方面,重新校准的PCE-W和SG-FRS-2023均使用当地数据进行重新校准,其性能优于SCORE2亚太模型。我们的研究支持在适当的当地重新校准后,在亚洲人群中使用已建立的CVD预测模型。这项工作得到了新加坡卫生部国家医学研究委员会和新加坡生物医学研究委员会的支持。
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引用次数: 0
Spatio-temporal patterns of tuberculosis revealed by routine Mycobacterium tuberculosis sequencing in Australia: an extended patient cohort analysis (2017–2023) 澳大利亚常规结核分枝杆菌测序揭示的结核病时空格局:一项扩展的患者队列分析(2017-2023)
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 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.
结核病(TB)仍然是一项全球公共卫生挑战。即使是像澳大利亚这样的低发病率国家,也在努力实现消除当地结核病传播的宏伟目标。结核分枝杆菌的全基因组测序(WGS)有助于准确追踪传播,但将其整合到公共卫生应对中仍然有限。本研究对常规WGS数据进行了时空分析,并评估了其对指导规划结核控制反应的潜在价值。方法分析2017-2023年澳大利亚新南威尔士州2492株结核分枝杆菌的swgs和地理定位数据,分别占培养确诊病例的94.9%和报告结核病例的64.2%。我们进行了基因组聚类,评估了病例之间的遗传和地理距离,并应用贝叶斯时间系统发育来估计菌株引入的可能时间。大多数报告的结核病例成功测序和定位,其中88.3%(2200/2492)居住在悉尼大都会。病例数最高的地方卫生区是西南区(523/2492,21.0%)和西悉尼区(476/2492,19.1%)。使用5-SNP阈值,WGS确定了106个假定的传播集群,涉及288例(11.7%),其中50%跨越多个lhd。共发现8个大集群(≥5个成员),共64例(2.6%)。最大的集群(17个成员)是由谱系1菌株引起的,尽管大多数大型集群与谱系2菌株有关;其中2例对异烟肼耐药。遗传距离与地理距离之间的相关性较差,在去除异常值后,这种相关性有所改善。最近的共同祖先估计表明,最近引入的菌株与当地传播有关。菌株聚类和时间谱系分析揭示了集群扩张和收缩的时间模式,有助于准确监测整个新南威尔士州的集群传播。研究结果表明,整合基因组和时空聚类数据在检测持续传播和指导有针对性的干预措施以实现“本地零结核病传播”的理想目标方面具有附加价值。资助nhmrc结核病卓越研究中心(www.tbcre.org.au)和新南威尔士州健康预防研究支助方案。
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引用次数: 0
Implementation strategies for evidence-based healthcare interventions in rural and remote settings: a scoping review 农村和偏远地区循证医疗保健干预措施的实施战略:范围审查
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 10.1016/j.lanwpc.2025.101732
Anna Chapman , Cadeyrn J. Gaskin , Hannah Beks , Charlene Wright , Skye Marshall , Elizabeth A. Johnston , Rebecca J. Bergin , Sharina Riva , Fiona Crawford-Williams , Camille E. Short , Nicole Kiss , Sze Lin Yoong , Nicolas H. Hart , Anna Wong Shee , Helena Rodi , Hannah Jongebloed , Anna Ugalde
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: train and educate stakeholders (n = 70, 93%), use evaluative and iterative strategies (n = 55, 73%), and develop stakeholder interrelationships (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.
在全球范围内,与城市人口相比,生活在农村和偏远地区的人口获得医疗保健的机会和结果更差。实施支持循证医疗干预措施转化的实施战略可能有助于减少这些不公平现象;然而,现实世界的实施是复杂的,目前尚不清楚如何将战略应用于农村和偏远地区。这项范围审查综合了高收入国家农村和偏远地区卫生保健干预措施实施战略的证据。检索了5个数据库(Ovid MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science),检索了2000年1月1日至2024年10月25日发表的同行评议研究。提取的数据使用描述性叙述方法进行综合。从11,887份记录中,78篇论文(75项研究)符合纳入标准。实施工作是多方面的,通常从实施变革集群的三个专家建议中借鉴策略:培训和教育利益相关者(n = 70, 93%),使用评估和迭代策略(n = 55, 73%),发展利益相关者之间的关系(n = 48, 64%)。少数研究(n = 21; 28%)报告了农村特有的设计特征。尽管农村和偏远地区的实施侧重于提供者层面的战略,但也需要解决实施的系统层面决定因素。针对具体情况设计、与当地社区和利益攸关方进行有意义的接触以及更明确的报告,对于优化执行和缩小城乡卫生差距至关重要。
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引用次数: 0
Can administrative data be used for a national register of hospitalised stroke patients? A New Zealand validation study 行政数据可以用于卒中住院患者的全国登记吗?一项新西兰验证性研究
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 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).
背景:使用基于社区的发病率研究和临床登记来评估卒中治疗和结果是资源密集型的,而且往往是地理上有限的。关联的行政数据成本较低,影响范围更广,但可能不那么准确和完整。本研究将行政数据与基于国家医院的研究数据进行比较,以评估行政数据是否代表一个有效的替代方案。方法我们将新西兰全国范围内的观察性研究区域护理研究的数据与新西兰统计局综合数据基础设施(IDI)的行政数据联系起来并进行比较。敏感性、特异性、阳性预测值和Cohen’s kappa系数用于评估病例识别、危险因素、卒中后结局和适用的干预措施。额外的审计探讨了IDI“真假阳性”的有效性。从2018年5月到7月,1719名中风患者在区域护理中心被捕获,1833名在IDI中被捕获。以REGIONS Care为参考标准,IDI对脑卒中病例识别的敏感性为83%,阳性预测值为77%。有300个假阴性和414个假阳性。对两家医院的审计表明,在IDI中确定但被各区域排除在外的一些病例实际上是中风。对于卒中危险因素,IDI对糖尿病(分别为93%和91%)、房颤(分别为87%和90%)和吸烟(分别为71%和97%)的敏感性和特异性较高,但对高血压(61%)和血脂异常(52%)的特异性较低。衍生的IDI有利结果测量与改进的Rankin量表(敏感性88%,特异性82%,kappa 0.67)吻合良好。IDI准确识别脑卒中后药物使用(敏感性81%-94%,特异性78%-91%)和取栓干预(敏感性88%,kappa 0.91)。使用行政数据来确定卒中病例、危险因素、干预措施和结果是可行的,并且与手工医院数据收集相比较,使得基于行政数据的国家卒中登记成为可能,尽管可能需要补充数据收集以进行综合护理评估。该研究由新西兰健康研究委员会(HRC 17/037)资助。
{"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}
引用次数: 0
HPV vaccine for adolescents in China: what is the next step? 中国青少年HPV疫苗:下一步是什么?
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 10.1016/j.lanwpc.2026.101810
The Lancet Regional Health – Western Pacific
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引用次数: 0
Towards equitable cancer outcomes for rural and remote communities: reflections, lessons and recommendations 为农村和偏远社区实现公平的癌症结果:反思、教训和建议
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 10.1016/j.lanwpc.2025.101756
Anna Ugalde , Hannah Jongebloed , Charlene Wright , Helena Rodi , Anna Chapman , Skye Marshall , Drew Aras , Rebecca J. Bergin , Sophie Boffa , Anna Boltong , Michele Conlin , Fiona Crawford–Williams , Carl de Wet , Wasek Faisal , Lan Gao , Harry Gasper , Kate Gunn , Nicolas H. Hart , Theresa Hayes , Florian Honeyball , Laura Alston
People living in rural and remote areas continue to face significant inequities in cancer outcomes compared to their metropolitan counterparts. Despite advances in cancer control, these disparities persist across the cancer trajectory. This personal view consolidates findings from our Equitable Cancer Outcomes for Rural and Remote Communities series, highlighting survival disadvantages, challenges in measuring and reporting rurality, barriers to implementing evidence-based interventions, and shortcomings in historical policy. We argue for place-based, system-level reform that genuinely partners with rural communities, leverages local strengths, and embeds rural voices in research, policy, and service delivery. Key recommendations include adopting a formal partnership position statement to guide collaboration across sectors, strengthening rural data infrastructure, harmonising rural-urban classifications, tailoring implementation strategies, and prioritising geographical equity within cancer policy. Achieving meaningful progress requires coordinated cross-sector action and sustained investment in rural capacity. Equitable cancer outcomes will only be achieved by recognising and addressing the responsibility to deliver best practice care for all people affected by cancer, regardless of where they live.
与城市居民相比,生活在农村和偏远地区的人们在癌症结果方面继续面临着严重的不平等。尽管在癌症控制方面取得了进展,但这些差异在整个癌症轨迹中仍然存在。这一个人观点整合了我们的《农村和偏远社区公平癌症结局》系列研究的结果,强调了生存劣势、衡量和报告乡村性方面的挑战、实施循证干预措施的障碍以及历史政策的缺点。我们主张以地方为基础的系统级改革,真正与农村社区合作,利用地方优势,并在研究、政策和服务提供中融入农村的声音。主要建议包括通过正式的伙伴关系立场声明来指导跨部门合作,加强农村数据基础设施,协调城乡分类,调整实施战略,以及在癌症政策中优先考虑地域公平。要取得有意义的进展,需要采取协调一致的跨部门行动,并对农村能力进行持续投资。公平的癌症治疗结果只有通过承认并解决为所有癌症患者提供最佳实践护理的责任,无论他们住在哪里,才能实现。
{"title":"Towards equitable cancer outcomes for rural and remote communities: reflections, lessons and recommendations","authors":"Anna Ugalde ,&nbsp;Hannah Jongebloed ,&nbsp;Charlene Wright ,&nbsp;Helena Rodi ,&nbsp;Anna Chapman ,&nbsp;Skye Marshall ,&nbsp;Drew Aras ,&nbsp;Rebecca J. Bergin ,&nbsp;Sophie Boffa ,&nbsp;Anna Boltong ,&nbsp;Michele Conlin ,&nbsp;Fiona Crawford–Williams ,&nbsp;Carl de Wet ,&nbsp;Wasek Faisal ,&nbsp;Lan Gao ,&nbsp;Harry Gasper ,&nbsp;Kate Gunn ,&nbsp;Nicolas H. Hart ,&nbsp;Theresa Hayes ,&nbsp;Florian Honeyball ,&nbsp;Laura Alston","doi":"10.1016/j.lanwpc.2025.101756","DOIUrl":"10.1016/j.lanwpc.2025.101756","url":null,"abstract":"<div><div>People living in rural and remote areas continue to face significant inequities in cancer outcomes compared to their metropolitan counterparts. Despite advances in cancer control, these disparities persist across the cancer trajectory. This personal view consolidates findings from our <em>Equitable Cancer Outcomes for Rural and Remote Communities</em> series, highlighting survival disadvantages, challenges in measuring and reporting rurality, barriers to implementing evidence-based interventions, and shortcomings in historical policy. We argue for place-based, system-level reform that genuinely partners with rural communities, leverages local strengths, and embeds rural voices in research, policy, and service delivery. Key recommendations include adopting a formal partnership position statement to guide collaboration across sectors, strengthening rural data infrastructure, harmonising rural-urban classifications, tailoring implementation strategies, and prioritising geographical equity within cancer policy. Achieving meaningful progress requires coordinated cross-sector action and sustained investment in rural capacity. Equitable cancer outcomes will only be achieved by recognising and addressing the responsibility to deliver best practice care for all people affected by cancer, regardless of where they live.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101756"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077536","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}
引用次数: 0
Kawasaki disease and outdoor environmental stressors: a scoping review 川崎病与室外环境压力源:范围综述
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 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.
川崎病(Kawasaki Disease, KD)是一种急性小儿血管炎,病因不明,但环境因素已被提出。这一范围综述综合了室外环境暴露和KD发病率的流行病学证据。到2024年12月,系统搜索确定了32项符合条件的研究。KD发病率在东亚最高,特别是日本、韩国和台湾,这些地区的研究最为集中。研究最多的是气象变量和空气污染物。大约一半关于气象变量的研究发现了与KD的关联,其中一些研究认为温度或空气介质的风驱动运输起了作用。空气污染研究显示出不一致的短期影响,但与长期或产前接触颗粒物的联系更为一致。对空气传播的生物制剂的研究,虽然较少,但显示出一致的积极结果。这些结果提示多因素病因。然而,方法的异质性限制了可比性。土壤、水或其他室外来源中的化学物质也可能影响与KD相关的免疫途径,但对这些化学物质知之甚少。需要标准化的多国研究来阐明环境贡献并指导高风险地区的预防工作。
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引用次数: 0
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 在世卫组织东南亚和西太平洋区域,利用实施科学弥合同一卫生方针下抗菌素耐药性治理方面的政治承诺与行动之间的差距
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 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.
世卫组织东南亚和西太平洋区域拥有世界一半以上的人口,承受着不成比例的抗菌素耐药性负担,包括一些最严重的耐药性模式。这些地区快速增长的经济体和持续存在的卫生系统挑战的融合为了解抗微生物药物耐药性的动态和制定与其他低收入和中等收入国家相关的可扩展治理方法提供了一个重要平台。本观点回顾了全球和研究区域在抗微生物药物耐药性治理方面的当前进展,重点关注具体国家的国家行动计划,并强调了政策意图与实际执行之间的差异。为解决从研究到实践的差距而发展起来的实施科学,为确定和克服实施障碍提供了一个系统框架,从而将政治承诺转化为可行动的干预措施。鉴于抗菌素耐药性的跨部门复杂性,我们提出了新的战略重点,通过在“同一个健康”方法中嵌入实施科学来加强抗菌素耐药性治理。这涉及一个四步过程:选择和调整基于证据的实践,评估多层次障碍和推动因素,选择、使用和调整实施战略,以及评估和维持其影响。总体而言,该框架提供了一份蓝图,可将总体政策概念本地化并付诸实施,转化为具体的、针对具体情况的行动,并可能为全球其他地区提供借鉴。
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引用次数: 0
Examining the historical evolution of cancer policy in Australia: impact of key initiatives on equity and outcomes 检查澳大利亚癌症政策的历史演变:对公平和结果的关键举措的影响
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-01 DOI: 10.1016/j.lanwpc.2025.101731
Helena Rodi , Anna Chapman , Rebecca J. Bergin , Paul Grogan , Megan Varlow , Anna Boltong , Anna Ugalde , Skye Marshall
Australia's cancer policy has progressed from fragmented, disease-specific initiatives in the 1960s–70s to coordinated national frameworks that aim to prioritise equity and patient-centred care. Early policies focused on treatment and prevention, with limited attention to disparities affecting different communities and population groups. This review aimed to examine the historical development of cancer policy in Australia and assess the impact of key initiatives on equity outcomes. A narrative review methodology was employed, drawing on policy documents, government reports, and peer-reviewed literature. Key milestones, systemic gaps, and strategies addressing disparities were identified and discussed. The review found a growing policy focus on addressing socioeconomic, geographic, and cultural barriers to care, reflected in initiatives such as the Australian Cancer Plan and Optimal Care Pathways. However, persistent challenges in implementation, resource allocation, and adherence monitoring limit progress. Strengthening monitoring systems and investing in prevention, early detection, high-quality care, and inclusive research remain critical to reducing the cancer burden and achieving equitable outcomes.
澳大利亚的癌症政策已从20世纪60年代至70年代零散的针对特定疾病的举措发展为旨在优先考虑公平和以患者为中心的护理的协调一致的国家框架。早期的政策侧重于治疗和预防,对影响不同社区和人口群体的差异关注有限。本综述旨在研究澳大利亚癌症政策的历史发展,并评估关键举措对公平结果的影响。我们采用了叙述性综述方法,参考政策文件、政府报告和同行评议文献。会议确定并讨论了关键里程碑、系统性差距和解决差异的战略。审查发现,越来越多的政策关注解决社会经济、地理和文化障碍的护理,反映在诸如澳大利亚癌症计划和最佳护理途径等倡议中。然而,在实施、资源分配和依从性监测方面的持续挑战限制了进展。加强监测系统并投资于预防、早期发现、高质量护理和包容性研究,对于减轻癌症负担和实现公平结果仍然至关重要。
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引用次数: 0
The next five years of the WHO Asia–Pacific Centre for Environment and Health 世卫组织亚太环境与健康中心的未来五年
IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-12-26 DOI: 10.1016/j.lanwpc.2025.101782
Sandro Demaio, Sally J. Edwards, John S. Ji, Anders Nordström, Enkhtsetseg Shinee, Susan Mercado
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引用次数: 0
期刊
The Lancet Regional Health: Western Pacific
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