The Lancet Regional Health: Western Pacific最新文献

{"title":"Population-specific ABO haplotypes reveal distinct venous thromboembolism risk in East Asians: insights from a large-scale genetic study","authors":"Haobo Li ,&nbsp;Zhu Zhang ,&nbsp;Hong Chen ,&nbsp;Yuanhua Yang ,&nbsp;Jun Wan ,&nbsp;Xiaomao Xu ,&nbsp;Yingqun Ji ,&nbsp;Guoru Yang ,&nbsp;Ping Zhang ,&nbsp;Jing Han ,&nbsp;Kejing Ying ,&nbsp;Qixia Xu ,&nbsp;Ling Zhu ,&nbsp;Tao Yang ,&nbsp;Yingyun Fu ,&nbsp;Haoyi Weng ,&nbsp;Dingyi Wang ,&nbsp;Yunxia Zhang ,&nbsp;Shuai Zhang ,&nbsp;Qiang Huang ,&nbsp;Chen Wang","doi":"10.1016/j.lanwpc.2025.101781","DOIUrl":"10.1016/j.lanwpc.2025.101781","url":null,"abstract":"<div><h3>Background</h3><div>The ABO blood group locus is a well-established genetic determinant of venous thromboembolism (VTE) risk in both individuals of European and East Asian ancestry. Recent studies have identified key <em>ABO</em> haplotypes tagged by four common SNPs—rs2519093 (A1), rs1053878 (A2), rs8176743 (B), and rs8176719/rs41302905 (O1/O2)—that influence both incident and recurrent VTE risk in Europeans. However, marked differences in ABO allele frequencies and haplotype structures across ancestries may render European findings inapplicable to East Asians, highlighting a critical gap in understanding the genetic basis of VTE in this population.</div></div><div><h3>Methods</h3><div>We conducted a haplotype-based association study using ABO-tagging SNPs (including rs512770 that distinguishes between O1.1 and O1.2) in 1576 VTE cases from China Pulmonary Thromboembolism Registry Study (CURES) and 17,535 ancestry-matched controls, adjusted for age, sex, and genetic principal components to evaluate the effects of <em>ABO</em> haplotypes on VTE risk and recurrence.</div></div><div><h3>Findings</h3><div>Our analyses revealed key population-specific differences: in East Asians, the rs1053878-A allele is consistently co-inherited with the rs2519093-T allele, precluding its use as a specific marker for the A2 blood group, unlike in Europeans. Furthermore, all non-O1 haplotypes were homogeneously associated with a ∼1.4-fold increased risk of VTE (<em>p</em> = 5.2 × 10⁻²⁰) and a ∼1.7-fold increased risk of recurrence (<em>p</em> = 0.023), compared to the O1.1 group. Notably, the O1.2 blood group was also associated with a 1.7-fold increased risk of recurrence (<em>p</em> = 0.039).</div></div><div><h3>Interpretation</h3><div>These findings highlight fundamental differences in <em>ABO</em> haplotype structure and disease associations between East Asians and Europeans. Our study provides a population-specific SNP panel—rs8176719, rs2519093, rs1053878, rs8176743, and rs512770—for accurate genetic risk assessment of VTE in East Asians, underscoring the importance of ancestry-tailored approaches to thrombotic disease prediction.</div></div><div><h3>Funding</h3><div>This study is funded by the <span>Chinese Academy of Medical Science Innovation Fund</span> for <span>Medical Sciences</span> (No. <span><span>2024-I2M-TS-035</span></span>, <span><span>No. 2021-I2M-1-061</span></span>), <span>National Key Research and Development Program</span> of China (No. <span><span>2024YFE0101900</span></span>, No. <span><span>2023YFC2507200</span></span>), <span>National Natural Science Foundation of China</span> (No. <span><span>82470046</span></span>, No. <span><span>82241029</span></span>) and <span>Noncommunicable Chronic Diseases-National Science and Technology Major Project</span> (No. <span><span>2024ZD0528700</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101781"},"PeriodicalIF":8.1,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841240","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":"Trends in lung cancer incidence and stage at diagnosis in Singapore: a population-based joinpoint regression analysis by age, sex, and smoking status","authors":"Yah Ru Juang ,&nbsp;Meijing Hu ,&nbsp;Miao Hui ,&nbsp;Adeline Seow ,&nbsp;Iain Bee Huat Tan ,&nbsp;Dawn Qingqing Chong ,&nbsp;Cheng Ean Chee ,&nbsp;Wei Jie Seow","doi":"10.1016/j.lanwpc.2025.101779","DOIUrl":"10.1016/j.lanwpc.2025.101779","url":null,"abstract":"<div><h3>Background</h3><div>Lung cancer remains a leading cause of cancer-related deaths globally. Although evidence indicates rising early-onset cases and increasing incidence among females and never-smokers in Asia, these trends remain underexplored in Singapore. This study comprehensively examined historical incidence trends by age, sex, smoking status, and stage to inform targeted prevention and management strategies.</div></div><div><h3>Methods</h3><div>We analyzed lung cancer cases from administrative health records in Singapore (1968–2021) to calculate age-standardized and age-specific incidence by age (30–49 years, 50–64 years, ≥65 years), sex (male, female), smoking status (ever-, never-smokers), and stage (I–IV). Joinpoint regression identified significant trend changes, reporting annual percent change (APC), average annual percent change (AAPC), and 95% confidence intervals (CIs). AAPCs were evaluated for the full study period and the most recent five years, with Benjamini-Hochberg adjustment for multiple comparisons.</div></div><div><h3>Findings</h3><div>From 1968 to 2021, 53,308 lung cancer cases were recorded in Singapore, predominantly in males (67.7%) and Chinese (87.8%), with 81.6% at advanced stages (III–IV). Incidence rose significantly only in females aged 30–49 years (AAPC = 0.79%, 95% CI: 0.41–1.18) and declined in all male age groups, especially 50–64 years (AAPC = −1.34%, 95% CI: −1.53 to −1.12). Stage I diagnoses increased significantly in both sexes (females: AAPC = 7.19%, 95% CI: 5.24–9.22; males: AAPC = 3.79%, 95% CI: 1.94–5.46) and incidence among never-smokers rose significantly, particularly among females (AAPC = 4.06%, 95% CI: 2.99–5.11).</div></div><div><h3>Interpretation</h3><div>The narrowing male-female gap, rising early-onset cases among females, and increasing incidence in female never-smokers, particularly those ≥65 years, highlight a shifting lung cancer burden in Singapore. Despite improvements in early-stage detection, most cases remained advanced, emphasizing the need to strengthen lung cancer management and screening strategies in Singapore.</div></div><div><h3>Funding</h3><div>This work is supported by the National Medical Research Council (Singapore) Health Promotion, Preventive Health, Population Health and Health Services Research (HPHSR) Clinician Scientist Award (HCSAINV24jul-0002).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101779"},"PeriodicalIF":8.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798939","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":"Interaction between physical activity and deficit-based frailty on all-cause mortality in older adults: a prospective study of five population-based cohorts","authors":"Zheng Zhu ,&nbsp;Xu Zhou ,&nbsp;Mingling Chen ,&nbsp;Chun Dou ,&nbsp;Dong Liu ,&nbsp;Lijie Kong ,&nbsp;Chaojie Ye ,&nbsp;Min Xu ,&nbsp;Yu Xu ,&nbsp;Mian Li ,&nbsp;Zhiyun Zhao ,&nbsp;Jie Zheng ,&nbsp;Jieli Lu ,&nbsp;Yuhong Chen ,&nbsp;Weiqing Wang ,&nbsp;Guang Ning ,&nbsp;Yufang Bi ,&nbsp;Tiange Wang","doi":"10.1016/j.lanwpc.2025.101780","DOIUrl":"10.1016/j.lanwpc.2025.101780","url":null,"abstract":"<div><h3>Background</h3><div>Whether leisure-time physical activity modifies the association between frailty and mortality in older adults is unclear.</div></div><div><h3>Methods</h3><div>We analyzed the interactions between physical activity and frailty status on all-cause mortality risk using Cox proportional hazards models across five nationally representative cohorts: Survey of Health, Ageing and Retirement in Europe (56,555 participants, median follow-up 6.5 years), China Health and Retirement Longitudinal Study (12,271 participants, 9.0 years); Health and Retirement Study (13,729 participants, 11.9 years); English Longitudinal Study of Ageing (9100 participants, 9.8 years); and Mexican Health and Aging Study (11,262 participants, 19.3 years). Frailty status was classified as robust, prefrail, and frail based on deficit accumulation models, including common disease, functional, locomotor, sensory, mental, and cognitive deficit. Physical activity was classified as regular (meeting World Health Organization recommendations) or inactive.</div></div><div><h3>Findings</h3><div>Across five cohorts (median age 58.0–65.0 years), physical activity consistently interacted with frailty on all-cause mortality (all P_interaction ≤ 0.036). In pooled analyses, frailty was associated with higher risks of mortality in inactive participants (multivariable-adjusted HR: 3.72, 95% CI: 2.54–5.45 for frailty) than in regularly active participants (2.40, 1.71–3.36 for frailty; P_interaction &lt; 0.001); results of each cohort were meta-analyzed by random-effects models (I² within-subgroup &gt;78.7%, P &lt; 0.001). Whereby, the inverse association between regular activity and mortality was more evident in frail participants (0.56; 0.53–0.59) than in robust participants (0.80, 0.73–0.87); results were meta-analyzed by fixed effects models (I² within-subgroup &gt;18.6%, P &gt; 0.296). Such interaction patterns remained between each deficit of frailty and physical activity in at least one cohort.</div></div><div><h3>Interpretation</h3><div>Consistent findings across five cohorts demonstrated that regular physical activity mitigates frailty-associated mortality, and frail adults might gain more survival benefits from regular activity than robust adults.</div></div><div><h3>Funding</h3><div>The Noncommunicable Chronic Diseases-<span>National Science and Technology</span> Major Project, the <span>National Natural Science Foundation of China</span>, the <span>National Key R&amp;D Program of China</span>, the “Shu-Guang Scholar Programme” from Shanghai Municipal Education Commission, the “Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support” from <span>Shanghai Jiao Tong University School of Medicine</span>, and the Innovative Research Team of High-level Local Universities in Shanghai.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101780"},"PeriodicalIF":8.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798940","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":"Climate change and antimicrobial resistance in the Western Pacific: a mixed-methods systematic analysis","authors":"Lianping Yang ,&nbsp;Zishu Ma ,&nbsp;Fanqian Meng ,&nbsp;Ruonan Wang ,&nbsp;Shanquan Chen ,&nbsp;Chaojie Liu ,&nbsp;Hung Chak Ho ,&nbsp;Mingli Xu ,&nbsp;Alvin Qijia Chua ,&nbsp;Li Yang Hsu ,&nbsp;Yanhui Jia ,&nbsp;Yi Zhang ,&nbsp;Cunrui Huang ,&nbsp;John S. Ji","doi":"10.1016/j.lanwpc.2025.101772","DOIUrl":"10.1016/j.lanwpc.2025.101772","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Climate change and antimicrobial resistance (AMR) are escalating public health threats globally. The Western Pacific Region faces unique climatic and socioeconomic vulnerabilities, but evidence on this climate-AMR intersection is limited. We aimed to systematically provide evidence on this critical issue.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a three-stage mixed-methods systematic analysis: (1) a narrative review mapping the regional AMR landscape and summarizing potential climate-driven mechanisms; (2) a systematic review (PubMed and Google Scholar, January 2000–March 2025) of regional quantitative studies; and (3) an empirical quantitative analysis using a longitudinal panel dataset. This analysis completes our systematic approach by visualizing AMR mortality trends (using data from the GRAM project) and applying regression analysis to model AMR-attributable death rates based on climatic and socioeconomic factors, providing quantitative evidence of the regional situation and its potential drivers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Literature review evidence showed that increasing temperature caused by climate change directly accelerates bacterial growth and resistance mutation rates and indirectly affects healthcare disruptions and antibiotic misuse during extreme weather events. We included 18 quantitative studies synthesised using the SWiM framework, which provided more specific evidence that higher temperatures are associated with increased clinical resistance rates and enhanced environmental dissemination of antibiotic resistance genes (ARGs). Our quantitative analysis found that a 1 °C increase in mean ambient temperature was associated with higher AMR-attributable mortality from carbapenem-resistant &lt;em&gt;Acinetobacter baumannii&lt;/em&gt; (CRAB; β = 0.652, 95% CI 0.579–0.724, p &lt; 0.001) and carbapenem-resistant &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; (CRPA; β = 0.422, 95% CI 0.304–0.541, p &lt; 0.001). It also revealed that socioeconomic factors have heterogeneous effects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Climatic conditions and socioeconomic vulnerabilities jointly shape AMR risks in the Western Pacific Region. Projected increases in extreme weather events threaten to strain healthcare systems further and worsen antibiotic misuse. Strengthening climate-resilient health systems, improving multisectoral AMR governance, and establishing integrated AMR–climate surveillance networks are essential regional priorities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This work is supported by &lt;span&gt;World Health Organization&lt;/span&gt; (WPRO/2024-02/AGE-DHP/22552 4), &lt;span&gt;National Natural Science Foundation of China&lt;/span&gt; (&lt;span&gt;&lt;span&gt;82422064&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;82250610230&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;72374228&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;72074234&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;Natural Science Foundation of Beijing&lt;/span&gt; (&lt;span&gt;&lt;span&gt;IS23105&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;National Bureau for Disease Control and Prevention&lt;/span","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101772"},"PeriodicalIF":8.1,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753863","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":"Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand","authors":"Elliot Long ,&nbsp;Stephen Hearps ,&nbsp;Amanda Williams ,&nbsp;Ben Gelbart ,&nbsp;Warwick Butt ,&nbsp;Thomas Rozen ,&nbsp;Sarah McNab ,&nbsp;Meredith L. Borland ,&nbsp;Simon Erickson ,&nbsp;Shefali Jani ,&nbsp;Marino Festa ,&nbsp;Eunicia Tan ,&nbsp;Natalie Phillips ,&nbsp;Sainath Raman ,&nbsp;Amit Kochar ,&nbsp;Subodh Ganu ,&nbsp;Simon Craig ,&nbsp;Anna Lithgow ,&nbsp;Arjun Rao ,&nbsp;Emma Whyte ,&nbsp;Franz E. Babl","doi":"10.1016/j.lanwpc.2025.101777","DOIUrl":"10.1016/j.lanwpc.2025.101777","url":null,"abstract":"<div><h3>Background</h3><div>Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis.</div></div><div><h3>Methods</h3><div>Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0–&lt;18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected.</div></div><div><h3>Findings</h3><div>6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3–7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall and in 144 (45.8%) of those meeting Phoenix sepsis criteria. The most used first, second, and third-line vasoactive agents were adrenaline (90/179; 50.3%), noradrenaline (49/91; 53.8%), and vasopressin (16/40; 40.0%). When comparing noradrenaline vs adrenaline as first line agents, increasing age was associated with preferential use of noradrenaline (RR 1.06, 95% CI 1.03–1.09; p &lt; 0.001).</div></div><div><h3>Interpretation</h3><div>Children with suspected community acquired sepsis rarely received treatment with vasoactive agents. Adrenaline and noradrenaline were the most used agents, though there was substantial variation in their use and sequencing.</div></div><div><h3>Funding</h3><div>This study is funded in part by a <span>National Health and Medical Research Council</span> (NHMRC) <span>Medical Research Future Fund</span> grant (GNT1190814). The full list of funders is presented at the end of the paper.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101777"},"PeriodicalIF":8.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798941","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 Pacific Way: advancing ethical research governance in the Pacific islands","authors":"Julienne Josephine O'Rourke ,&nbsp;Mengji Chen ,&nbsp;Natasha Cooke ,&nbsp;Andreas Alois Reis ,&nbsp;Nalei Taufa ,&nbsp;Judith McCool ,&nbsp;Collin Tukuitonga ,&nbsp;Si Thu Win Tin ,&nbsp;Kidong Park","doi":"10.1016/j.lanwpc.2025.101771","DOIUrl":"10.1016/j.lanwpc.2025.101771","url":null,"abstract":"<div><div>Ethical research governance across Pacific island countries and areas (PICs) faces challenges from limited local capacity and disproportionate external influences. However, a shared commitment to advance and strengthen ethical oversight is increasingly emerging. In May 2025, WHO, the Pacific Community, and the Pacific Academy of Sciences convened a workshop with PIC representatives to review existing health research ethics ecosystems and define priorities for improvement. Mapping efforts revealed wide disparities: some countries have formal legal frameworks and established ethics committees, while others rely on informal processes or external approvals. Concerns were expressed about externally driven research, limited local control, inconsistent consent practices, and weak mechanisms to ensure communities benefit from research. Key priorities included developing national policies that clarify governance roles and standards, creating Pacific-wide ethical research guidelines that reflect regional values, and embedding long-term capacity building and fair benefit-sharing into research partnerships. The workshop highlighted that ethical research governance is not only a technical necessity but also central to self-determination, cultural integrity, and equity. Moving forward, progress will require sustained investment, regional collaboration, and global partners to support research led by the Pacific, for the benefit of Pacific communities.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101771"},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712182","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":"Determinants of male fertility in the Western Pacific Region: environmental, biological, and lifestyle influences","authors":"David A. Skerrett-Byrne ,&nbsp;Lee M. Ashton ,&nbsp;Brett Nixon ,&nbsp;Philip J. Morgan","doi":"10.1016/j.lanwpc.2025.101716","DOIUrl":"10.1016/j.lanwpc.2025.101716","url":null,"abstract":"<div><div>Over the past half-century, global fertility rates have declined, with the Western Pacific Region (WPR) experiencing a particularly notable drop. A recent World Health Organisation-commissioned report identified the WPR as exhibiting the highest infertility prevalence at 23.2%, compared to the global average of 17.5%. While the drivers of this decline are complex, one key contributor is male infertility, yet it remains under addressed in research and policy. In this paper, we synthesise current evidence on male infertility with a focus on the WPR. Specifically, we explore environmental, biological, and demographic correlates of male infertility, examine molecular mechanisms regulating sperm function and assess the impact of lifestyle interventions. Our findings highlight significant gaps in regional evidence, advocating for targeted research and culturally tailored interventions to enhance preconception male health within the WPR. Based on this synthesis, we propose preventive strategies and evidence-based recommendations to improve male preconception health in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101716"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839286","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":"Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data and key evidence gaps","authors":"Amanda Gwee ,&nbsp;Sarah Bannister ,&nbsp;Emma Best ,&nbsp;Jeremy Carr ,&nbsp;Kiera Harwood ,&nbsp;Tony Lai ,&nbsp;Alice Lei ,&nbsp;Flora Lutui ,&nbsp;Brendan McMullan ,&nbsp;Mona Mostaghim ,&nbsp;Lesley Voss ,&nbsp;Heather Weerdenburg ,&nbsp;Phoebe Williams ,&nbsp;Amanda Wilkins ,&nbsp;Daniel Yeoh ,&nbsp;KIDS DOSE group","doi":"10.1016/j.lanwpc.2025.101754","DOIUrl":"10.1016/j.lanwpc.2025.101754","url":null,"abstract":"<div><div>Antimicrobial resistance poses a significant threat to children's health, with up to 20% of 1.27 million deaths attributable to bacterial AMR annually, occurring in children &lt;5 years. The WHO 2024 Bacterial Priority Pathogens List identifies methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and vancomycin-resistant <em>Enterococcus faecium</em> (VRE) as critical pathogens. This review examines the epidemiology, treatment recommendations, dosing strategies, efficacy, and safety data for antibiotics targeting MRSA and VRE infections in children in Oceania. Paediatric MRSA infections are prevalent (13–43%) across Oceania, while VRE infections remain uncommon (3–5%). Disparate access to recommended treatments, particularly in Pacific Island Countries and Territories, highlights the need for paediatric licensing. Paediatric trials primarily assess safety, with efficacy data limited to vancomycin, teicoplanin, and daptomycin. Pharmacokinetic/pharmacodynamic studies show standard dosing in children under 12 years often fails to achieve therapeutic targets, highlighting the need for dedicated dosing studies. Addressing these gaps is essential to advancing paediatric access to optimal treatment for drug-resistant infections in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101754"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615708","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":"Diabetes care performance in Indonesia: a serial cross-sectional analysis of behavioral, clinical, and laboratory outcomes from 2013 to 2023","authors":"Farizal Rizky Muharram ,&nbsp;Julian Benedict Swannjo ,&nbsp;Dicky Lavenus Tahapary ,&nbsp;Sally Aman Nasution ,&nbsp;Delvac Oceandy","doi":"10.1016/j.lanwpc.2025.101759","DOIUrl":"10.1016/j.lanwpc.2025.101759","url":null,"abstract":"<div><h3>Background</h3><div>The growing diabetes burden in Indonesia necessitates a comprehensive understanding of national diabetes care performance, which remains inadequately characterized. Evaluating care quality across domains is essential to inform chronic disease policy and improve health outcomes. This study assesses trends in behavioral, clinical, and laboratory outcomes of diabetes care in Indonesia from 2013 to 2023.</div></div><div><h3>Methods</h3><div>We conducted a serial cross-sectional analysis of pooled data from the 2013, 2018, and 2023 Indonesian national health surveys (N = 42,224 for behavioral-clinical and N = 2957 for laboratory outcomes). Diabetes care performance was assessed across behavioral (treatment, smoking, diet, activity), clinical (blood pressure, BMI, waist length), and laboratory (glucose, lipids, renal function) domains. Composite scores and multilevel models were used to identify geographic and sociodemographic disparities.</div></div><div><h3>Findings</h3><div>Although linkage to diabetes care significantly improved from 68% to 92% between 2013 and 2023, performance in most other indicators remained stagnant or declined. In 2023, only 2.9% (95% CI 2.5–3.3%) met dietary fiber intake targets, 62.4% (95% CI 61.2–63.6%) achieved physical activity goals, and 83.9% (95% CI 82.9–84.8%) abstained from smoking. Clinical control was suboptimal, with 43.5% (95% CI 42.3–44.8%) meeting blood pressure targets and only 26.7% (95% CI 25.6–27.9%) and 33.1% (95% CI 32.0–34.3%) achieving BMI and waist circumference goals, respectively. Laboratory control was limited: only 25.2% (21.6–28.8%) achieved fasting glucose targets, 32.0% (95% CI 27.6–36.3%) had HbA1c &lt;7%, and only 22.6% (95% CI 19.1–26.2%) met LDL-C goals. Fewer than 5% of participants met all behavioral-clinical or laboratory composite targets. Composite performance declined in nearly all provinces, with disparities linked to older age, male sex, lower education, and rural residence.</div></div><div><h3>Interpretation</h3><div>Despite expanded healthcare coverage, Indonesia's diabetes care performance remains critically inadequate, particularly for achieving multiple targets. Strengthening national guidelines, embedding structured chronic care, and addressing social determinants are essential to improving diabetes outcomes.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101759"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615707","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":"Strengthening ASEAN's preparedness architecture: from fragmented efforts to a regional evidence and Policy Hub","authors":"Elil Renganathan ,&nbsp;Vinod R.M.T. Balasubramaniam ,&nbsp;Faith McLellan ,&nbsp;Aaron Koay ,&nbsp;Elisha Ab Rashid ,&nbsp;Mohammad Arshil Moideen","doi":"10.1016/j.lanwpc.2025.101773","DOIUrl":"10.1016/j.lanwpc.2025.101773","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101773"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736758","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}