The Lancet Regional Health: Western Pacific最新文献

英文中文

Challenges introduced by Japan's drug pricing policy 日本药品定价政策带来的挑战

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101212

Shotaro Kinoshita , Taishiro Kishimoto

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Corrigendum to “Current and future burden of ross river virus infection attributable to increasing temperature in Australia: a population-based study” the Lancet Regional Health–Western Pacific 2024;48: 101124 可归因于澳大利亚气温升高的罗斯河病毒感染的当前和未来负担：一项基于人口的研究》的更正，《柳叶刀区域健康-西太平洋》2024;48: 101124

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101224

Yohannes Tefera Damtew , Blesson Mathew Varghese , Olga Anikeeva , Michael Tong , Alana Hansen , Keith Dear , Ying Zhang , Geoffrey Morgan , Tim Driscoll , Tony Capon , Michelle Gourley , Vanessa Prescott , Peng Bi

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Radiotherapy services in the Philippines: exploring geographical barriers to improve access to care 菲律宾的放射治疗服务：探索地理障碍以改善医疗服务的可及性

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101219

Jerickson Abbie S. Flores , Charles Cedy C. Lo , John Michael P. Tomagan , Jaffar C. Pineda , Miriam Joy C. Calaguas , Enrico D. Tangco , Misael C. Cruz , Edward Christopher Dee , Jake John P. Galingana , Eleanore S. Altubar , Jhonatan B. Riparip

引用次数: 0

Integration of customised LLM for discharge summary generation in real-world clinical settings: a pilot study on RUSSELL GPT 在实际临床环境中整合定制 LLM 以生成出院摘要：RUSSELL GPT 试点研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101211

Chun En Chua , Ngoh Lee Ying Clara , Mohammad Shaheryar Furqan , James Lee Wai Kit , Andrew Makmur , Yih Chung Tham , Amelia Santosa , Kee Yuan Ngiam

引用次数: 0

Efficacy and safety of visepegenatide as an add-on therapy to metformin in patients with type 2 diabetes: a randomised, double-blind, parallel, placebo-controlled, phase 3 study 维塞那肽作为二甲双胍附加疗法对 2 型糖尿病患者的疗效和安全性：一项随机、双盲、平行、安慰剂对照的 3 期研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101197

Xiaoling Cai , Linong Ji , Mingxia Yuan , Jianhua Ma , Fang Bian , Sheli Li , Wuyan Pang , Shuang Yan , Huimin Zhou , Minghui Hou , Wenhui Li , Ying Jia , Li Liu , Ke Ding , Michael Xu

Background

Visepegenatide, a once-weekly glucagon-like peptide-1 receptor agonist injection, demonstrated effective glycaemic control and good tolerability without the requirement of dose titration in the two completed phase 2 studies. We aimed to evaluate the efficacy and safety of visepegenatide in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin monotherapy in this phase 3 clinical study.

Methods

This multicentre phase 3 clinical study included a 24-week, randomised, placebo-controlled, double-blind period followed by a 28-week open-label extended treatment period. Patients (N = 620) aged ≥18 and ≤75 years with glycated haemoglobin (HbA_1c) ≥7.0% and ≤10.5% [≥53.0 and ≤91.27 mmol/mol], were randomized in a 1:1 ratio to receive visepegenatide 150-μg or placebo once-weekly subcutaneous injection during the double-blind period. Subsequently, the patients in the placebo group were switched to visepegenatide treatment (placebo→visepegenatide group), and the patients in the visepegenatide group continued the same treatment during the open-label extended treatment period. The primary endpoint was the change in HbA_1c from baseline to week 24.

Findings

At week 24, the placebo-adjusted least squares mean (LSM) change of HbA_1c was −0.57% (95% CI −0.71 to −0.43) with visepegenatide (p < 0.001). The proportion of patients achieving HbA_1c < 7.0% and ≤6.5% [<53 and ≤ 48 mmol/mol] was higher in the visepegenatide group versus the placebo group (115 [40.5%] vs 50 [17.9%]; p < 0.001, and 60 [21.1%] vs 17 [6.1%]; p < 0.001). Visepegenatide demonstrated a significant reduction in fasting plasma glucose and 2-h postprandial glucose compared with placebo. Trends in the improvement of these variables were maintained during the open-label extended treatment period. No severe gastrointestinal adverse event or severe hypoglycaemia was reported during the 52-week study period.

Interpretation

Once-weekly injection of visepegenatide 150 μg as an add-on treatment to metformin therapy significantly improved glycaemic control and was generally well tolerated in Chinese patients with T2DM who were inadequately controlled with metformin monotherapy.

Funding

The study was funded by PegBio Co., Ltd, Suzhou, China.

背景在已完成的两项2期研究中，每周注射一次的胰高血糖素样肽-1受体激动剂维塞那肽显示出有效的血糖控制和良好的耐受性，且无需剂量滴定。这项多中心 3 期临床研究包括 24 周随机、安慰剂对照、双盲期和 28 周开放标签延长治疗期。年龄≥18岁和≤75岁、糖化血红蛋白（HbA1c）≥7.0%和≤10.5%[≥53.0和≤91.27 mmol/mol]的患者（N = 620）按1:1的比例随机分配，在双盲期每周一次皮下注射维塞那肽150微克或安慰剂。随后，安慰剂组患者转为接受维塞庚那肽治疗（安慰剂→维塞庚那肽组），维塞庚那肽组患者在开放标签延长治疗期内继续接受同样的治疗。研究结果第24周时，维塞那肽的安慰剂调整后最小二乘法均值（LSM）变化为-0.57%（95% CI -0.71至-0.43）（p <0.001）。与安慰剂组相比，维塞那肽组达到 HbA1c <7.0%和≤6.5% [<53 和≤48 mmol/mol]的患者比例更高（115 [40.5%] vs 50 [17.9%]；p <0.001；60 [21.1%] vs 17 [6.1%]；p <0.001）。与安慰剂相比，维塞那肽可显著降低空腹血浆葡萄糖和餐后 2 小时血糖。在开放标签延长治疗期间，这些变量的改善趋势得以保持。在为期52周的研究期间，没有严重胃肠道不良事件或严重低血糖的报道。解释作为二甲双胍治疗的附加疗法，每周注射一次150微克的维培那肽可显著改善二甲双胍单药治疗控制不佳的中国T2DM患者的血糖控制，且耐受性良好。

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引用次数: 0

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study 消除种族歧视能在多大程度上减少土著居民和托雷斯海峡岛民儿童在心理健康和睡眠问题上的不平等？因果中介研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101196

Naomi Priest , Shuaijun Guo , Rushani Wijesuriya , Catherine Chamberlain , Rosemary Smith , Sharon Davis , Janine Mohamed , Margarita Moreno-Betancur

Background

Racism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children's mental health and sleep problems if interpersonal racial discrimination was eliminated.

Methods

We drew on cross-sectional data from the Speak Out Against Racism (SOAR; N = 2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N = 8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10–15 years; LSAC: 4–5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10–15 years; LSAC: 12–13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10–15 years; LSAC: 14–15 years). An interventional effects causal mediation approach was used.

Findings

Aboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40.1% versus 13.5%; LSAC: 25.3% versus 7.6%) and sleep problems (SOAR: 28.5% versus 18.4%; LSAC: 14.0% versus 9.9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children's experiences of interpersonal racial discrimination could reduce 42.4% and 48.5% of mental health and sleep inequities in SOAR (equivalent to 11.2% and 4.7% absolute reductions) and 25.6% and 1.6% of mental health and sleep inequities in LSAC (equivalent to 5.5% and 0.1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes.

Interpretation

Targeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.

Funding

National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia.

背景种族主义是原住民和托雷斯海峡岛民儿童健康不平等的根本原因。我们估算了如果消除人际间的种族歧视，原住民和托雷斯海峡岛民儿童的心理健康和睡眠问题不平等现象可能会减少的程度。方法我们利用了 "大声反对种族主义"（SOAR；N = 2818）的横断面数据和 "澳大利亚儿童纵向研究"（LSAC；N = 8627）的纵向数据。SOAR于2017年完成，LSAC对2004年至2014年的幼儿园队列儿童和2008年至2018年的出生队列儿童进行了跟踪调查。接触：原住民和托雷斯海峡岛民身份（原住民和托雷斯海峡岛民/英裔欧洲人），结构性种族主义的替代测量（SOAR：10-15年；LSAC：4-5年）；中介：人际种族歧视（是/否）（SOAR：10-15年；LSAC：12-13年）；结果：心理健康问题（是/否）和睡眠问题（是/否）（SOAR：10-15年；LSAC：14-15年）。研究结果与英裔欧洲儿童相比，土著儿童和托雷斯海峡岛民儿童的心理健康问题发生率（SOAR：40.1%对13.5%；LSAC：25.3%对7.6%）和睡眠问题发生率（SOAR：28.5%对18.4%；LSAC：14.0%对9.9%）更高。假设采取干预措施消除原住民和托雷斯海峡岛民儿童遭受人际种族歧视的经历，可分别减少原住民和托雷斯海峡岛民儿童42.4%和48.5%的心理健康和睡眠不公平现象（相当于绝对减少11.2%和4.7%），以及25.6%和1.6%的心理健康和睡眠不公平现象（相当于绝对减少5.5%和0.1%）。在这两项研究中，剩余的绝对不平等在两项结果中都相似。解释有针对性的政策干预，消除对土著居民和托雷斯海峡岛民儿童的种族歧视，很有可能减少心理健康和睡眠问题方面的不平等。解决种族主义和种族歧视问题需要在土著居民和托雷斯海峡岛民社区的指导下采取多成分、多层次的方法。

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引用次数: 0

RSV severity in New Zealand 2021 and 2022: applying the WHO severity assessment framework 新西兰 2021 年和 2022 年 RSV 严重程度：应用世界卫生组织严重程度评估框架

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-10-01 DOI: 10.1016/j.lanwpc.2024.101221

David Broderick , Isabella Cheung , Janine Paynter , Jane O'Donnell , Steffen Albrecht , Nayyereh Aminisani , Adrian Trenholme , Cameron C. Grant , Sue Huang , Nikki Turner , Catherine A. Byrnes , Peter McIntyre

引用次数: 0

The impact of sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on insulin utilisation and costs in Australia: a national retrospective observational cross-sectional study 钠葡萄糖协同转运体 2 抑制剂和胰高血糖素样肽 1 受体激动剂对澳大利亚胰岛素使用率和成本的影响：一项全国性回顾观察横断面研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-24 DOI: 10.1016/j.lanwpc.2024.101207

Peter S. Hamblin , Arul Earnest , Anthony W. Russell , Stella Talic , Ella Zomer , Sophia Zoungas

Background

Global insulin requirements for type 2 diabetes were predicted to increase by more than 20% from 2018 to 2030. However, this did not anticipate the rapid increase in use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors that has occurred over recent years. The current study aims to examine changes in insulin utilisation and costs in Australia from 2003 to 2023.

Methods

We conducted a large-scale observational study of national insulin utilisation and expenditure in Australia from 2003 to 2023 using the Australian Pharmaceutical Benefits Scheme. The proportion of insulin-treated people with type 2 diabetes between 2013 and 2023 was estimated using National Diabetes Services Scheme data. Joinpoint models and interrupted time series analysis were used to examine utilisation trends.

Findings

Insulin utilisation (units of insulin per person with diabetes) increased by an average of 2.71% per annum (95% CI 1.97, 3.73) from 2003 to 2015, then fell by 2.70% per annum (95% CI −4.55, −1.39) from 2015 to 2023. The proportion of insulin-treated people with type 2 diabetes increased by 1.00% per annum (95% CI 0.81, 1.25) from 2013 to 2020, then fell by 0.66% per annum (95% CI −1.62, −0.04) from 2020 to 2023. A 43% reduction in inflation-adjusted insulin expenditure was observed between 2015 and 2023 due to a combination of reduced utilisation and reduction in the price of insulin glargine.

Interpretation

Projected global insulin requirements and costs may be less than previously anticipated if reduced use of insulin in Australia is similarly observed in other countries.

Funding

No funding was received for this study.

背景据预测，从 2018 年到 2030 年，全球 2 型糖尿病的胰岛素需求量将增加 20% 以上。然而，这并没有预见到近年来胰高血糖素样肽-1受体激动剂和钠-葡萄糖共转运体2抑制剂使用量的快速增长。本研究旨在探讨 2003 年至 2023 年澳大利亚胰岛素使用情况和成本的变化。方法我们利用澳大利亚药品福利计划，对 2003 年至 2023 年澳大利亚全国胰岛素使用情况和支出进行了大规模观察研究。利用国家糖尿病服务计划数据估算了2013年至2023年接受胰岛素治疗的2型糖尿病患者的比例。研究结果胰岛素使用量（每位糖尿病患者使用胰岛素的单位）从2003年到2015年平均每年增长2.71%（95% CI 1.97，3.73），然后从2015年到2023年每年下降2.70%（95% CI -4.55，-1.39）。从 2013 年到 2020 年，接受胰岛素治疗的 2 型糖尿病患者比例每年增加 1.00%（95% CI 0.81，1.25），然后从 2020 年到 2023 年每年下降 0.66%（95% CI -1.62，-0.04）。由于使用量减少和格列卫胰岛素价格下降，2015 年至 2023 年期间，经通胀调整后的胰岛素支出减少了 43%。释义如果澳大利亚胰岛素使用量的减少在其他国家也出现类似情况，预计全球胰岛素需求量和成本可能会低于之前的预期。

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引用次数: 0

Heterogeneity of colistin resistance mechanism in clonal populations of carbapenem-resistant Klebsiella pneumoniae in Vietnam 越南耐碳青霉烯类肺炎克雷伯氏菌克隆群体对可乐定耐药机制的异质性

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-23 DOI: 10.1016/j.lanwpc.2024.101204

Bui Tien Sy , Sébastien Boutin , Le Thi Kieu Linh , Simone Weikert-Asbeck , Elias Eger , Susanne Hauswaldt , Truong Nhat My , Nguyen Trong The , Jan Rupp , Le Huu Song , Katharina Schaufler , Thirumalaisamy P. Velavan , Dennis Nurjadi

引用次数: 0

Population attributable fractions of depression and anxiety among Aboriginal and Torres Strait Islander peoples: a population-based study 土著居民和托雷斯海峡岛民中抑郁症和焦虑症的人口可归因比例：一项基于人口的研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2024-09-20 DOI: 10.1016/j.lanwpc.2024.101203

Subash Thapa , Kedir Y. Ahmed , Santosh Giri , Anayochukwu E. Anyasodor , M. Mamun Huda , Peter Gibbs , Shakeel Mahmood , Feleke H. Astawesegn , Jamie Newman , Allen G. Ross

Background

Aboriginal and Torres Strait Islander peoples face an increased risk of common mental disorders, which may be associated with underlying socio-economic challenges, racism, and discrimination. This is the first study to calculate the population attributable fractions (PAFs) for depression and anxiety attributed to potentially modifiable risk factors such as health behaviour, social and cultural characteristics, and past adverse events among Aboriginal and Torres Strait Islander peoples aged ≥15 years.

Methods

This cross-sectional study examined the 2018–19 National Aboriginal and Torres Strait Islander Health Survey conducted by the Australian Bureau of Statistics. Logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor.

Findings

This study included a weighted sample of 5362 individuals, with a mean age of 40.8 years (SD = ±17.2). Personal income below the national average (PAF = 13.4%; 95% CI: 12.4, 14.5), severed access to Indigenous cultural affiliations (PAF = 12.8%; 95% CI: 11.8, 13.8), central obesity (PAF = 7.2%; 95% CI: 6.4, 8.0), daily smoking (PAF = 5.9%; 95% CI: 5.2, 6.7) and severed access to Indigenous knowledge (PAF = 5.2%; 95% CI: 4.5, 5.8) were associated with 45% of depression cases. Personal income below the national average (PAF = 10.7%; 95% CI: 9.8, 11.7), limited access to Aboriginal Community Controlled Health Services (PAF = 10.6%; 95% CI: 9.7, 11.6), central obesity (PAF = 7.1%; 95% CI: 6.3, 7.9), severed access to Indigenous knowledge (PAF = 5.7%; 95% CI: 4.9, 6.4) and the experience of discrimination in the last 12 months (PAF = 4.7%; 95% CI: 4.0, 5.3) were associated with 39% of anxiety cases.

Interpretation

To reduce the burden of depression and anxiety disorder among Aboriginal and Torres Strait Islander peoples, addressing socio-economic and cultural harms that constrain healthy connections to people/kin, their rights, languages, land, and healthy food sources should be a priority.

Funding

This work was funded by a grant from the Commonwealth of Australia, represented by the Department of Health and Aged Care (Grant Activity 4-DGEJZ1O/4-CW7UT14).

背景土著居民和托雷斯海峡岛民罹患常见精神障碍的风险增加，这可能与潜在的社会经济挑战、种族主义和歧视有关。这是第一项计算年龄≥15岁的原住民和托雷斯海峡岛民因健康行为、社会和文化特征以及既往不良事件等潜在可改变风险因素导致的抑郁症和焦虑症人群可归因分数（PAFs）的研究。方法这项横断面研究考察了澳大利亚统计局开展的2018-19年全国原住民和托雷斯海峡岛民健康调查。采用逻辑回归模型计算几率比（ORs）。使用调整后的 ORs 和每个风险因素的患病率估计值计算出根据社区性调整后的 PAFs。个人收入低于全国平均水平（PAF = 13.4%; 95% CI: 12.4, 14.5）、与土著文化的联系被切断（PAF = 12.8%; 95% CI: 11.8, 13.8）、中心性肥胖（PAF = 7.2%; 95% CI: 6.4, 8.0）、每天吸烟（PAF = 5.9%; 95% CI: 5.2, 6.7）和与土著知识断绝联系（PAF = 5.2%; 95% CI: 4.5, 5.8）与 45% 的抑郁症病例有关。个人收入低于全国平均水平（PAF = 10.7%; 95% CI: 9.8, 11.7）、获得原住民社区控制医疗服务的机会有限（PAF = 10.6%; 95% CI: 9.7, 11.6）、中心性肥胖（PAF = 7.1%; 95% CI: 6.3，7.9）、无法获得土著知识（PAF = 5.7%；95% CI：4.9，6.4）和在过去 12 个月中遭受歧视（PAF = 4.7%；95% CI：4.0，5.3）与 39% 的焦虑病例有关。为减轻原住民和托雷斯海峡岛民的抑郁症和焦虑症负担，应优先解决制约与人/亲属、其权利、语言、土地和健康食物来源之间健康联系的社会经济和文化危害。

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