Pub Date : 2024-09-17DOI: 10.1016/j.lanwpc.2024.101199
Ilari Rautalin , Rita V. Krishnamurthi , Craig S. Anderson , P. Alan Barber , Suzanne Barker-Collo , Derrick Bennett , Ronald Boet , Jason A. Correia , Jeroen Douwes , Andrew Law , Balakrishnan Nair , Amanda G. Thrift , Braden Te Ao , Bronwyn Tunnage , Anna Ranta , Valery Feigin
Background
Although the incidence and case-fatality of subarachnoid haemorrhage (SAH) vary within countries, few countries have reported nationwide rates, especially for multi-ethnic populations. We assessed the nationwide incidence and case-fatality of SAH in New Zealand (NZ) and explored variations by sex, district, ethnicity and time.
Methods
We used administrative health data from the national hospital discharge and cause-of-death collections to identify hospitalised and fatal non-hospitalised aneurysmal SAHs in NZ between 2001 and 2018. For validation, we compared these administrative data to those of two prospective Auckland Regional Community Stroke Studies. We subsequently estimated the incidence and case-fatality of SAH and calculated adjusted rate ratios (RR) with 95% confidence intervals to assess differences between sub-populations.
Findings
Over 78,187,500 cumulative person-years, we identified 5371 SAHs (95% sensitivity and 85% positive predictive values) resulting in an annual age-standardised nationwide incidence of 8.2/100,000. In total, 2452 (46%) patients died within 30 days after SAH. Compared to European/others, Māori had greater incidence (RR = 2.23 (2.08–2.39)) and case-fatality (RR = 1.14 (1.06–1.22)), whereas SAH incidence was also greater in Pacific peoples (RR = 1.40 (1.24–1.59)) but lesser in Asians (RR = 0.79 (0.71–0.89)). By domicile, age-standardised SAH incidence varied between 6.3–11.5/100,000 person-years and case fatality between 40 and 57%. Between 2001 and 2018, the SAH incidence of NZ decreased by 34% and the case fatality by 12%.
Interpretation
Since the incidence and case-fatality of SAH varies considerably between regions and ethnic groups, caution is advised when generalising findings from focused geographical locations for public health planning, especially in multi-ethnic populations.
{"title":"Demographic disparities in the incidence and case fatality of subarachnoid haemorrhage: an 18-year nationwide study from New Zealand","authors":"Ilari Rautalin , Rita V. Krishnamurthi , Craig S. Anderson , P. Alan Barber , Suzanne Barker-Collo , Derrick Bennett , Ronald Boet , Jason A. Correia , Jeroen Douwes , Andrew Law , Balakrishnan Nair , Amanda G. Thrift , Braden Te Ao , Bronwyn Tunnage , Anna Ranta , Valery Feigin","doi":"10.1016/j.lanwpc.2024.101199","DOIUrl":"10.1016/j.lanwpc.2024.101199","url":null,"abstract":"<div><h3>Background</h3><p>Although the incidence and case-fatality of subarachnoid haemorrhage (SAH) vary within countries, few countries have reported nationwide rates, especially for multi-ethnic populations. We assessed the nationwide incidence and case-fatality of SAH in New Zealand (NZ) and explored variations by sex, district, ethnicity and time.</p></div><div><h3>Methods</h3><p>We used administrative health data from the national hospital discharge and cause-of-death collections to identify hospitalised and fatal non-hospitalised aneurysmal SAHs in NZ between 2001 and 2018. For validation, we compared these administrative data to those of two prospective Auckland Regional Community Stroke Studies. We subsequently estimated the incidence and case-fatality of SAH and calculated adjusted rate ratios (RR) with 95% confidence intervals to assess differences between sub-populations.</p></div><div><h3>Findings</h3><p>Over 78,187,500 cumulative person-years, we identified 5371 SAHs (95% sensitivity and 85% positive predictive values) resulting in an annual age-standardised nationwide incidence of 8.2/100,000. In total, 2452 (46%) patients died within 30 days after SAH. Compared to European/others, Māori had greater incidence (RR = 2.23 (2.08–2.39)) and case-fatality (RR = 1.14 (1.06–1.22)), whereas SAH incidence was also greater in Pacific peoples (RR = 1.40 (1.24–1.59)) but lesser in Asians (RR = 0.79 (0.71–0.89)). By domicile, age-standardised SAH incidence varied between 6.3–11.5/100,000 person-years and case fatality between 40 and 57%. Between 2001 and 2018, the SAH incidence of NZ decreased by 34% and the case fatality by 12%.</p></div><div><h3>Interpretation</h3><p>Since the incidence and case-fatality of SAH varies considerably between regions and ethnic groups, caution is advised when generalising findings from focused geographical locations for public health planning, especially in multi-ethnic populations.</p></div><div><h3>Funding</h3><p><span>NZ Health Research Council</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"52 ","pages":"Article 101199"},"PeriodicalIF":7.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001937/pdfft?md5=d4ac945cee1c70af791b843a3afb10cc&pid=1-s2.0-S2666606524001937-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1016/j.lanwpc.2024.101178
Anna Palagyi , Thomas Gadsden , Jenny Stephens , Myriam Abel , Lindah Peter , Siwon Lee , Tsogzolmaa Bayandorj , Christopher Bates , Sébastien Libert
Background
The Pacific Island country of Vanuatu is at the early stages of demographic ageing. The government is yet to develop a strategic approach to optimize the health and wellbeing of older indigenous Vanuatu residents (ni-Vanuatu).
Methods
Using policy mapping and semi-structured interviews with 42 ni-Vanuatu, this research aimed to explore the current policy context surrounding ageing in Vanuatu and the priorities of older adults to inform preliminary steps to develop a national response to healthy ageing. Analyses were grounded in the World Health Organization's Regional Action Plan on Healthy Ageing in the Western Pacific.
Findings
While the national policy context exhibited an indirect commitment to creating an environment conducive to healthy ageing, explicit policy commitments and monitoring indicators were lacking. Older persons reported numerous obstacles to healthy ageing, including financial insecurity, physical and psychological barriers to participation, and lack of community support.
Interpretation
Findings highlighted the need for policymakers and stakeholders to focus preliminary strategic efforts on select components of the Regional Action Plan: evidence generation, advocacy/awareness, financing, community engagement and coordination, and family-centred empowerment. To ensure acceptability and sustainability, it is vital that these leverage existing strengths of traditional community values and the prevailing role of faith and religion in the lives of older ni-Vanuatu.
Funding
This project was funded and supported by the World Health Organization (WHO) Regional Office for the Western Pacific (WPRO). Outcomes reflect the deliberations of authors and research partners.
{"title":"Pathways to healthy ageing in Vanuatu: a qualitative evaluation of national policy priorities","authors":"Anna Palagyi , Thomas Gadsden , Jenny Stephens , Myriam Abel , Lindah Peter , Siwon Lee , Tsogzolmaa Bayandorj , Christopher Bates , Sébastien Libert","doi":"10.1016/j.lanwpc.2024.101178","DOIUrl":"10.1016/j.lanwpc.2024.101178","url":null,"abstract":"<div><h3>Background</h3><p>The Pacific Island country of Vanuatu is at the early stages of demographic ageing. The government is yet to develop a strategic approach to optimize the health and wellbeing of older indigenous Vanuatu residents (ni-Vanuatu).</p></div><div><h3>Methods</h3><p>Using policy mapping and semi-structured interviews with 42 ni-Vanuatu, this research aimed to explore the current policy context surrounding ageing in Vanuatu and the priorities of older adults to inform preliminary steps to develop a national response to healthy ageing. Analyses were grounded in the World Health Organization's <em>Regional Action Plan on Healthy Ageing in the Western Pacific</em>.</p></div><div><h3>Findings</h3><p>While the national policy context exhibited an indirect commitment to creating an environment conducive to healthy ageing, explicit policy commitments and monitoring indicators were lacking. Older persons reported numerous obstacles to healthy ageing, including financial insecurity, physical and psychological barriers to participation, and lack of community support.</p></div><div><h3>Interpretation</h3><p>Findings highlighted the need for policymakers and stakeholders to focus preliminary strategic efforts on select components of the Regional Action Plan: evidence generation, advocacy/awareness, financing, community engagement and coordination, and family-centred empowerment. To ensure acceptability and sustainability, it is vital that these leverage existing strengths of traditional community values and the prevailing role of faith and religion in the lives of older ni-Vanuatu.</p></div><div><h3>Funding</h3><p>This project was funded and supported by the <span>World Health Organization</span> (WHO) Regional Office for the Western Pacific (WPRO). Outcomes reflect the deliberations of authors and research partners.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101178"},"PeriodicalIF":7.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660652400172X/pdfft?md5=594c5d9e802c360cb869e2f98a1383d3&pid=1-s2.0-S266660652400172X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.lanwpc.2024.101193
Zheng Hui , Wang Yu , Wang Fuzhen , Shen Liping , Zhang Guomin , Liu Jianhua , Wang Feng , Miao Ning , Li Jian , Ding Guowei , Meng Tongtong , Tang Lin , Zhang Shuang , Li Mingshuang , Li Yuan , Wang Xiaoqi , Liu Qianqian , Zhang Qian , Wu Dan , Yan Tingting , Wang Yu
Background
Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys.
Methods
Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals.
Findings
HBsAg prevalence in 1–69-year-olds was 5.86%; in children 1–4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals.
Interpretation
The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1–4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets.
Funding
The study was funded by the Major Science and Technology Special Project of China’s 13th 5-Year Plan (grant no. 2017ZX10105015); Central finance-operation of public health emergency response mechanism of Chinese Center for Disease Control and Prevention (131031001000200001, 102393220020010000017).
{"title":"New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020","authors":"Zheng Hui , Wang Yu , Wang Fuzhen , Shen Liping , Zhang Guomin , Liu Jianhua , Wang Feng , Miao Ning , Li Jian , Ding Guowei , Meng Tongtong , Tang Lin , Zhang Shuang , Li Mingshuang , Li Yuan , Wang Xiaoqi , Liu Qianqian , Zhang Qian , Wu Dan , Yan Tingting , Wang Yu","doi":"10.1016/j.lanwpc.2024.101193","DOIUrl":"10.1016/j.lanwpc.2024.101193","url":null,"abstract":"<div><h3>Background</h3><p>Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys.</p></div><div><h3>Methods</h3><p>Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals.</p></div><div><h3>Findings</h3><p>HBsAg prevalence in 1–69-year-olds was 5.86%; in children 1–4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals.</p></div><div><h3>Interpretation</h3><p>The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1–4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets.</p></div><div><h3>Funding</h3><p><span>The study was funded by the Major Science and Technology Special Project of China’s 13th 5-Year Plan</span> (grant no. <span><span>2017ZX10105015</span></span>); Central finance-operation of public health emergency response mechanism of <span>Chinese Center for Disease Control and Prevention</span> (<span><span>131031001000200001</span></span>, <span><span>102393220020010000017</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101193"},"PeriodicalIF":7.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001871/pdfft?md5=b9f6badec0d4ff0b1d334f1a575ae501&pid=1-s2.0-S2666606524001871-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.lanwpc.2024.101201
Daniel K. Yeoh , Christopher C. Blyth , Julia E. Clark , Joanne Abbotsford , Claudia Corrente , Sara Cook , Rishi S. Kotecha , Stacie S. Wang , Tim Spelman , Monica A. Slavin , Karin A. Thursky , Gabrielle M. Haeusler
Background
Invasive fungal disease (IFD) is a significant complication for children receiving treatment for leukaemia, contributing to morbidity and mortality. Recent regional paediatric epidemiological IFD data are lacking. Additionally uncertainty remains regarding the optimal prophylactic approach in this context.
Methods
In a multi-centre Australian cohort study of children diagnosed with de novo acute leukaemia between 1st January 2017 and 30th June 2020, we characterised antifungal prophylaxis prescribing and IFD prevalence. Impact of antifungal prophylaxis was assessed using Kaplan Meier curves and Cox-proportional hazards regression adjusting for known IFD risk factors.
Findings
A total of 434 children were included (47.2% female; median age 5.0 years, median follow-up 240 days). This cohort included 351 children with ALL (214 high-risk [HR-ALL]; 137 standard-risk [SR-ALL]), and 73 with AML. The prevalence of proven/probable IFD was 6.8% for AML, 14.0% for HR-ALL and 4.4% for SR-ALL. A mould was implicated as the causative pathogen in almost two thirds of cases. Antifungal prophylaxis was prescribed in 98.7% of chemotherapy cycles for AML, 56.7% for HR-ALL and 14.9% for SR-ALL. A mould-active agent was used in 77.4% of AML cycles and 21.2% of HR-ALL cycles. Mould-active prophylaxis was associated with a lower risk of IFD overall and increased IFD-free survival in AML.
Interpretation
These data demonstrate the persistent high regional burden of IFD in children with HR-ALL, and the potential for mould-active prophylaxis to ameliorate this. Strategies to increase uptake of appropriate prophylaxis are required in this cohort.
Funding
This study was supported by a Perth Children’s Hospital Foundation grant (PCHF9973).
{"title":"Invasive fungal disease and antifungal prophylaxis in children with acute leukaemia: a multicentre retrospective Australian cohort study","authors":"Daniel K. Yeoh , Christopher C. Blyth , Julia E. Clark , Joanne Abbotsford , Claudia Corrente , Sara Cook , Rishi S. Kotecha , Stacie S. Wang , Tim Spelman , Monica A. Slavin , Karin A. Thursky , Gabrielle M. Haeusler","doi":"10.1016/j.lanwpc.2024.101201","DOIUrl":"10.1016/j.lanwpc.2024.101201","url":null,"abstract":"<div><h3>Background</h3><p>Invasive fungal disease (IFD) is a significant complication for children receiving treatment for leukaemia, contributing to morbidity and mortality. Recent regional paediatric epidemiological IFD data are lacking. Additionally uncertainty remains regarding the optimal prophylactic approach in this context.</p></div><div><h3>Methods</h3><p>In a multi-centre Australian cohort study of children diagnosed with <em>de novo</em> acute leukaemia between 1st January 2017 and 30th June 2020, we characterised antifungal prophylaxis prescribing and IFD prevalence. Impact of antifungal prophylaxis was assessed using Kaplan Meier curves and Cox-proportional hazards regression adjusting for known IFD risk factors.</p></div><div><h3>Findings</h3><p>A total of 434 children were included (47.2% female; median age 5.0 years, median follow-up 240 days). This cohort included 351 children with ALL (214 high-risk [HR-ALL]; 137 standard-risk [SR-ALL]), and 73 with AML. The prevalence of proven/probable IFD was 6.8% for AML, 14.0% for HR-ALL and 4.4% for SR-ALL. A mould was implicated as the causative pathogen in almost two thirds of cases. Antifungal prophylaxis was prescribed in 98.7% of chemotherapy cycles for AML, 56.7% for HR-ALL and 14.9% for SR-ALL. A mould-active agent was used in 77.4% of AML cycles and 21.2% of HR-ALL cycles. Mould-active prophylaxis was associated with a lower risk of IFD overall and increased IFD-free survival in AML.</p></div><div><h3>Interpretation</h3><p>These data demonstrate the persistent high regional burden of IFD in children with HR-ALL, and the potential for mould-active prophylaxis to ameliorate this. Strategies to increase uptake of appropriate prophylaxis are required in this cohort.</p></div><div><h3>Funding</h3><p>This study was supported by a <span>Perth Children’s Hospital Foundation</span> grant (PCHF9973).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"52 ","pages":"Article 101201"},"PeriodicalIF":7.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001950/pdfft?md5=86dbe90311fb4a5872915dfe4c260857&pid=1-s2.0-S2666606524001950-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.lanwpc.2024.101198
Xuhao Zhao , Xiaolin Xu , Yifan Yan , Darren M. Lipnicki , Ting Pang , John D. Crawford , Christopher Chen , Ching-Yu Cheng , Narayanaswamy Venketasubramanian , Eddie Chong , Sergio Luis Blay , Maria Fernanda Lima-Costa , Erico Castro-Costa , Richard B. Lipton , Mindy J. Katz , Karen Ritchie , Nikolaos Scarmeas , Mary Yannakoulia , Mary H. Kosmidis , Oye Gureje , Xin Xu
<div><h3>Background</h3><p>Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.</p></div><div><h3>Methods</h3><p>Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.</p></div><div><h3>Findings</h3><p>Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (<em>P</em>s > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and
{"title":"Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic","authors":"Xuhao Zhao , Xiaolin Xu , Yifan Yan , Darren M. Lipnicki , Ting Pang , John D. Crawford , Christopher Chen , Ching-Yu Cheng , Narayanaswamy Venketasubramanian , Eddie Chong , Sergio Luis Blay , Maria Fernanda Lima-Costa , Erico Castro-Costa , Richard B. Lipton , Mindy J. Katz , Karen Ritchie , Nikolaos Scarmeas , Mary Yannakoulia , Mary H. Kosmidis , Oye Gureje , Xin Xu","doi":"10.1016/j.lanwpc.2024.101198","DOIUrl":"10.1016/j.lanwpc.2024.101198","url":null,"abstract":"<div><h3>Background</h3><p>Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.</p></div><div><h3>Methods</h3><p>Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.</p></div><div><h3>Findings</h3><p>Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (<em>P</em>s > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101198"},"PeriodicalIF":7.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001925/pdfft?md5=d91ed898d77fa26b93052bf20c7c622a&pid=1-s2.0-S2666606524001925-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality.
Methods
We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003–2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer.
Findings
Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75–1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75–1.52; transfer: aOR = 0.88, 95% CI 0.45–1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50–2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33–1.48).
Interpretation
Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality.
Funding
This study was funded by a National Health and Medical Research Foundation of Australia (NHMRC) Project Grant (#1162833).
背景目前还不清楚手术前转院与心脏手术患者再入院目的地之间的关系，也不清楚再入院到手术医院以外的医院是否与死亡率升高有关。方法我们分析了澳大利亚新南威尔士州居民的关联医院和死亡记录，这些居民年龄≥18岁，在2003-2022年期间接受冠状动脉旁路移植术（CABG）或主动脉瓣置换术（SAVR）后30天内急诊再入院。在接受心脏手术的 102,540 名患者中（孤立 CABG = 63,000 人，SAVR = 27,482 人，合并 = 12,058 人），28.7%（n = 29,398 人）在手术前转院，而 30 天内再入院率为 14.7%（n = 14,708 人）。在再入院期间，35.7%（3499/9795）没有手术前转院的患者和12.0%（590/4913）有手术前转院的患者返回了手术医院。在再次入院的患者中，再次入院到非指标医院的患者的 30 天死亡率没有显著差异，无论是总体上（调整后的几率比 [aOR] = 1.03 95% CI 0.75-1.41），还是按手术前转院进行的分层分析（未转院：aOR = 1.07，95% CI 0.75-1.52；转院：aOR = 0.88，95% CI 0.45-1.72）。在手术前转院的患者中，再次入住手术医院（参考）、最初入院医院（aOR = 1.00，95% CI 0.50-2.00）或第三家不同医院（aOR = 0.70，95% CI 0.33-1.48）的患者的 30 天死亡率相似。释义尽管许多澳大利亚患者在心脏手术后再次入院时，入院医院与手术医院或最初入院医院不同，但这种再次入院与死亡率增加无关。
{"title":"Readmission destination following cardiac surgery and its association with mortality outcomes: a population-based retrospective study","authors":"Md Shajedur Rahman Shawon , Sanja Lujic , Yashutosh Joshi , Louisa Jorm","doi":"10.1016/j.lanwpc.2024.101189","DOIUrl":"10.1016/j.lanwpc.2024.101189","url":null,"abstract":"<div><h3>Background</h3><p>It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality.</p></div><div><h3>Methods</h3><p>We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003–2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer.</p></div><div><h3>Findings</h3><p>Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75–1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75–1.52; transfer: aOR = 0.88, 95% CI 0.45–1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50–2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33–1.48).</p></div><div><h3>Interpretation</h3><p>Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality.</p></div><div><h3>Funding</h3><p>This study was funded by a <span>National Health and Medical Research Foundation</span> of Australia (NHMRC) Project Grant (<span><span>#1162833</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101189"},"PeriodicalIF":7.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001834/pdfft?md5=5411c0f6f61f7aa07ead12847456584c&pid=1-s2.0-S2666606524001834-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1016/j.lanwpc.2024.101194
Elke Mitchell , Aminiasi Tavui , Sarah Andersson , Susanna Lake , Aminiasi Koroivueti , Josefa Koroivueta , Ripeka Kaurasi , Vinaisi Bechu , John Kaldor , Andrew Steer , Lucia Romani
Background
Fiji has among the highest global reported prevalence of scabies. Mass drug administration (MDA) has been identified as a potentially effective strategy to control scabies, but acceptability of MDA from the perspectives of people receiving and delivering scabies MDA programs remains underexplored in Fiji and globally.
Methods
A qualitative study was conducted after completion of the national MDA campaign. Participants included 44 community members and 12 key informants across the Central and Western Divisions of Fiji. Semi-structured face-to-face and virtual interviews were conducted in August and September 2023. An interpretive research approach was adopted, and data were analysed using deductive and inductive techniques.
Findings
We identified several barriers and facilitators to scabies MDA acceptability. Facilitators included prior experiences of scabies and knowledge of the potential health benefit of MDA, community attitudes to MDA and neighbours’ adherence practices, endorsement of MDA by community leaders, community consultation and exposure to community sensitisation, and involvement of local key informants during planning and implementation. Barriers included a lack of trust in MDA campaigns, religious beliefs, limited reach of community sensitisation, and challenges to implementing MDA in urban locations.
Interpretation
This is the first qualitative study documenting acceptability of a nationwide scabies-MDA globally. It identified diverse socio-structural factors that influenced MDA implementation and acceptability. Future MDA programs could benefit from widespread community sensitisation, tailored approaches to urban and rural MDA design and delivery, and the inclusion of communities in the co-design and implementation of MDA programs.
Funding
The National Health and Medical Research Council (NHMRC) investigator grant—LR and the Macquarie Group Foundation 50th Celebration Awards–AS.
{"title":"Acceptability of a nationwide scabies mass drug administration (MDA) program in Fiji: a qualitative interview-based study","authors":"Elke Mitchell , Aminiasi Tavui , Sarah Andersson , Susanna Lake , Aminiasi Koroivueti , Josefa Koroivueta , Ripeka Kaurasi , Vinaisi Bechu , John Kaldor , Andrew Steer , Lucia Romani","doi":"10.1016/j.lanwpc.2024.101194","DOIUrl":"10.1016/j.lanwpc.2024.101194","url":null,"abstract":"<div><h3>Background</h3><p>Fiji has among the highest global reported prevalence of scabies. Mass drug administration (MDA) has been identified as a potentially effective strategy to control scabies, but acceptability of MDA from the perspectives of people receiving and delivering scabies MDA programs remains underexplored in Fiji and globally.</p></div><div><h3>Methods</h3><p>A qualitative study was conducted after completion of the national MDA campaign. Participants included 44 community members and 12 key informants across the Central and Western Divisions of Fiji. Semi-structured face-to-face and virtual interviews were conducted in August and September 2023. An interpretive research approach was adopted, and data were analysed using deductive and inductive techniques.</p></div><div><h3>Findings</h3><p>We identified several barriers and facilitators to scabies MDA acceptability. Facilitators included prior experiences of scabies and knowledge of the potential health benefit of MDA, community attitudes to MDA and neighbours’ adherence practices, endorsement of MDA by community leaders, community consultation and exposure to community sensitisation, and involvement of local key informants during planning and implementation. Barriers included a lack of trust in MDA campaigns, religious beliefs, limited reach of community sensitisation, and challenges to implementing MDA in urban locations.</p></div><div><h3>Interpretation</h3><p>This is the first qualitative study documenting acceptability of a nationwide scabies-MDA globally. It identified diverse socio-structural factors that influenced MDA implementation and acceptability. Future MDA programs could benefit from widespread community sensitisation, tailored approaches to urban and rural MDA design and delivery, and the inclusion of communities in the co-design and implementation of MDA programs.</p></div><div><h3>Funding</h3><p>The <span>National Health</span> and <span>Medical Research Council</span> (NHMRC) investigator grant—LR and the <span>Macquarie Group Foundation</span> 50th Celebration Awards–AS.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101194"},"PeriodicalIF":7.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001883/pdfft?md5=303e22bedb7e223428e87bd210877d60&pid=1-s2.0-S2666606524001883-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1016/j.lanwpc.2024.101195
Huan Wang , Xiaoran Yu , Jianhui Guo , Sheng Ma , Yunfei Liu , Yifei Hu , Jing Li , Yi Song , Zhiyong Zou
Background
A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden.
Methods
Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density.
Findings
In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (rs = −0.74) and DALYs (rs = −0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians.
Interpretation
CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden.
Funding
National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).
{"title":"Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990–2021: a systematic analysis of the Global Burden of Disease Study 2021","authors":"Huan Wang , Xiaoran Yu , Jianhui Guo , Sheng Ma , Yunfei Liu , Yifei Hu , Jing Li , Yi Song , Zhiyong Zou","doi":"10.1016/j.lanwpc.2024.101195","DOIUrl":"10.1016/j.lanwpc.2024.101195","url":null,"abstract":"<div><h3>Background</h3><p>A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden.</p></div><div><h3>Methods</h3><p>Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density.</p></div><div><h3>Findings</h3><p>In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (<em>r</em><sub><em>s</em></sub> = −0.74) and DALYs (<em>r</em><sub><em>s</em></sub> = −0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians.</p></div><div><h3>Interpretation</h3><p>CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden.</p></div><div><h3>Funding</h3><p><span>National Natural Science Foundation of China</span> (82073573 to ZZ; 82273654 to YS).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"51 ","pages":"Article 101195"},"PeriodicalIF":7.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001895/pdfft?md5=6ce83c95676fa659f7287ab12f3ea232&pid=1-s2.0-S2666606524001895-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.lanwpc.2024.101179
Hannah C. Timmins , Vincent C.T. Mok , Seung Hyun Kim , Nortina Shahrizaila , Jia-Ying Sung , Gen Sobue , Sheila Agustini , Stephanie Ward , Kaarin J. Anstey , Dayna-Lee Talbot , Srestha Mazumder , Sicong Tu , Rachel H. Tan , Cindy Shin-Yi Lin , Claire O’Callaghan , Johannes C. Michaelian , Yun-Hee Jeon , David Foxe , Sharon L. Naismith , Olivier Piguet , Matthew C. Kiernan
In the Western Pacific Region, the prevalence of dementia is expected to increase, however, the diversity of the region is expected to present unique challenges. The region has varying levels of preparedness, with a limited number of countries having a specific national dementia plan and awareness campaigns. Diversity of risk and healthcare services within the region is exerting impact on diagnosis, treatment, care, and support, with most countries being under resourced. Similarly, the ability to monitor dementia-related indicators and progress research, particularly relating to treatment and clinical trial access needs to be addressed. Countries require comprehensive national plans that lay out how resources will be allocated to improve dementia literacy, train, and support carers, mobilise resources to reduce risk factors and improve research capabilities. These plans need to be informed by consumers and tailored to the region to develop an inclusive society for people living with dementia and their families.
{"title":"Regional health priorities for dementia: a roadmap for the Western Pacific","authors":"Hannah C. Timmins , Vincent C.T. Mok , Seung Hyun Kim , Nortina Shahrizaila , Jia-Ying Sung , Gen Sobue , Sheila Agustini , Stephanie Ward , Kaarin J. Anstey , Dayna-Lee Talbot , Srestha Mazumder , Sicong Tu , Rachel H. Tan , Cindy Shin-Yi Lin , Claire O’Callaghan , Johannes C. Michaelian , Yun-Hee Jeon , David Foxe , Sharon L. Naismith , Olivier Piguet , Matthew C. Kiernan","doi":"10.1016/j.lanwpc.2024.101179","DOIUrl":"10.1016/j.lanwpc.2024.101179","url":null,"abstract":"<div><div>In the Western Pacific Region, the prevalence of dementia is expected to increase, however, the diversity of the region is expected to present unique challenges. The region has varying levels of preparedness, with a limited number of countries having a specific national dementia plan and awareness campaigns. Diversity of risk and healthcare services within the region is exerting impact on diagnosis, treatment, care, and support, with most countries being under resourced. Similarly, the ability to monitor dementia-related indicators and progress research, particularly relating to treatment and clinical trial access needs to be addressed. Countries require comprehensive national plans that lay out how resources will be allocated to improve dementia literacy, train, and support carers, mobilise resources to reduce risk factors and improve research capabilities. These plans need to be informed by consumers and tailored to the region to develop an inclusive society for people living with dementia and their families.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"50 ","pages":"Article 101179"},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.lanwpc.2024.101202
Jessica Gong
{"title":"Understanding dementia in the Western Pacific: a region-specific approach to prevention","authors":"Jessica Gong","doi":"10.1016/j.lanwpc.2024.101202","DOIUrl":"10.1016/j.lanwpc.2024.101202","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"50 ","pages":"Article 101202"},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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