Pub Date : 2026-01-01Epub Date: 2026-01-06DOI: 10.1016/j.lanwpc.2025.101787
S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , E.A.-L. Holt
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.
{"title":"Re-imagining Global Health: perspectives from the next generation in the Pacific region","authors":"S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-11DOI: 10.1016/j.lanwpc.2025.101792
Koichiro Wasano , Kasper Jørgensen
Background
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.
Methods
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 Lancet Commission report on dementia. We then modelled how 10% and 20% reductions in each risk factor would affect national dementia prevalence.
Findings
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.
Interpretation
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.
Funding
The Royal Danish Embassy in Japan, Danish Ministry of Foreign Affairs, Danish Ministry of Health, and Japan Agency for Medical Research and Development funded this study.
{"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 , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-08DOI: 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.
{"title":"Spatio-temporal patterns of tuberculosis revealed by routine Mycobacterium tuberculosis sequencing in Australia: an extended patient cohort analysis (2017–2023)","authors":"Xiaomei Zhang , Carl J.E. Suster , Eby M. Sim , Connie Lam , Elena Martinez , Taryn Crighton , Ellen J. Donnan , Ben J. Marais , 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}
Pub Date : 2026-01-01Epub Date: 2025-11-26DOI: 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.
{"title":"Implementation strategies for evidence-based healthcare interventions in rural and remote settings: a scoping review","authors":"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","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}
Pub Date : 2026-01-01Epub Date: 2026-01-02DOI: 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.
{"title":"Cardiovascular disease risk prediction in multi-ethnic Asian populations: evidence from two population-based cohorts in Singapore","authors":"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","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}
Pub Date : 2026-01-01Epub Date: 2025-12-11DOI: 10.1016/j.lanwpc.2025.101771
Julienne Josephine O'Rourke , Mengji Chen , Natasha Cooke , Andreas Alois Reis , Nalei Taufa , Judith McCool , Collin Tukuitonga , Si Thu Win Tin , Kidong Park
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.
{"title":"The Pacific Way: advancing ethical research governance in the Pacific islands","authors":"Julienne Josephine O'Rourke , Mengji Chen , Natasha Cooke , Andreas Alois Reis , Nalei Taufa , Judith McCool , Collin Tukuitonga , Si Thu Win Tin , 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.lanwpc.2025.101781
Haobo Li , Zhu Zhang , Hong Chen , Yuanhua Yang , Jun Wan , Xiaomao Xu , Yingqun Ji , Guoru Yang , Ping Zhang , Jing Han , Kejing Ying , Qixia Xu , Ling Zhu , Tao Yang , Yingyun Fu , Haoyi Weng , Dingyi Wang , Yunxia Zhang , Shuai Zhang , Qiang Huang , Chen Wang
Background
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 ABO 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.
Methods
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 ABO haplotypes on VTE risk and recurrence.
Findings
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 (p = 5.2 × 10−20) and a ∼1.7-fold increased risk of recurrence (p = 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 (p = 0.039).
Interpretation
These findings highlight fundamental differences in ABO 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.
Funding
This study is funded by the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (No. 2024-I2M-TS-035, No. 2021-I2M-1-061), National Key Research and Development Program of China (No. 2024YFE0101900, No. 2023YFC2507200), National Natural Science Foundation of China (No. 82470046, No. 82241029) and Noncommunicable Chronic Diseases-National Science and Technology Major Project (No. 2024ZD0528700).
{"title":"Population-specific ABO haplotypes reveal distinct venous thromboembolism risk in East Asians: insights from a large-scale genetic study","authors":"Haobo Li , Zhu Zhang , Hong Chen , Yuanhua Yang , Jun Wan , Xiaomao Xu , Yingqun Ji , Guoru Yang , Ping Zhang , Jing Han , Kejing Ying , Qixia Xu , Ling Zhu , Tao Yang , Yingyun Fu , Haoyi Weng , Dingyi Wang , Yunxia Zhang , Shuai Zhang , Qiang Huang , 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<sup>−20</sup>) 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-26DOI: 10.1016/j.lanwpc.2025.101782
Sandro Demaio, Sally J. Edwards, John S. Ji, Anders Nordström, Enkhtsetseg Shinee, Susan Mercado
{"title":"The next five years of the WHO Asia–Pacific Centre for Environment and Health","authors":"Sandro Demaio, Sally J. Edwards, John S. Ji, Anders Nordström, Enkhtsetseg Shinee, Susan Mercado","doi":"10.1016/j.lanwpc.2025.101782","DOIUrl":"10.1016/j.lanwpc.2025.101782","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101782"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841392","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}
Pub Date : 2026-01-01Epub Date: 2026-01-07DOI: 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).
{"title":"Can administrative data be used for a national register of hospitalised stroke patients? A New Zealand validation study","authors":"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","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}
Pub Date : 2026-01-01Epub Date: 2026-01-02DOI: 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.
{"title":"Kawasaki disease and outdoor environmental stressors: a scoping review","authors":"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","doi":"10.1016/j.lanwpc.2025.101791","DOIUrl":"10.1016/j.lanwpc.2025.101791","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101791"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884745","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}
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