Pub Date : 2024-09-01DOI: 10.1016/j.lanwpc.2024.101210
{"title":"Dementia in the Western Pacific region: address inequalities and invest on research","authors":"","doi":"10.1016/j.lanwpc.2024.101210","DOIUrl":"10.1016/j.lanwpc.2024.101210","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358077","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.2024.101183
Here we first review the limited available literature addressing the current landscape of specialist assessment services for dementia and cognitive decline and the preparedness for new amyloid-targeting therapies for Alzheimer's disease across the Western Pacific region. Considering the scarcity of literature, as national representatives of Western Pacific nations we were then guided by the World Health Organization's Global Action Plan on Dementia to provide country-specific reviews. As a whole, we highlight that the existing diverse socioeconomic and cultural landscape across the region poses unique challenges, including varying access to services and marked differences among countries in their preparedness for upcoming amyloid-targeting therapies for Alzheimer's disease. Therefore, there is an urgent call for intergovernmental collaboration and investment across the Western Pacific to ensure that for all nations, citizens living with dementia and cognitive decline have access to effective and equitable methods of diagnosis, treatment and care.
{"title":"Dementia diagnostic and treatment services in the Western Pacific: challenges, preparedness and opportunities in the face of amyloid-targeting therapies","authors":"","doi":"10.1016/j.lanwpc.2024.101183","DOIUrl":"10.1016/j.lanwpc.2024.101183","url":null,"abstract":"<div><div>Here we first review the limited available literature addressing the current landscape of specialist assessment services for dementia and cognitive decline and the preparedness for new amyloid-targeting therapies for Alzheimer's disease across the Western Pacific region. Considering the scarcity of literature, as national representatives of Western Pacific nations we were then guided by the World Health Organization's Global Action Plan on Dementia to provide country-specific reviews. As a whole, we highlight that the existing diverse socioeconomic and cultural landscape across the region poses unique challenges, including varying access to services and marked differences among countries in their preparedness for upcoming amyloid-targeting therapies for Alzheimer's disease. Therefore, there is an urgent call for intergovernmental collaboration and investment across the Western Pacific to ensure that for all nations, citizens living with dementia and cognitive decline have access to effective and equitable methods of diagnosis, treatment and care.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358056","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.2024.101154
Background
Community attitudes influence health outcomes especially for racially diverse and minority groups exposed to the detrimental effects of racism and discrimination. Using the results from Australia's national referendum to establish an Aboriginal and Torres Strait Islander Voice to Parliament (‘the Voice’) as a proxy for attitudes to Indigenous Australians, this study examined health outcomes for Indigenous and non-Indigenous Australians according to levels of opposition to the Voice.
Methods
The regional share of votes against the Voice was linked to 2021 data from the Household, Income and Labour Dynamics in Australia survey, a large, national probability sample (n∽17,000) of Australian adults. Adjusting for regional-level confounders, we used logistic regression analyses to predict health outcomes, healthcare use, and risk-taking behaviours among Indigenous and non-Indigenous Australians for different levels (quartiles) of opposition to the Voice.
Findings
Greater opposition to the Voice was associated with widening Indigenous disparities in health, healthcare use, and health behaviours. Indigenous Australians living in regions with the highest opposition to the Voice (top quartile: 72% community voting ‘No’) were more likely to report fair/poor health [OR 2.28 (95% CI 1.45–3.58)] and poor mental health [OR 2.24 (95% CI 1.48–3.39)], were less likely to have visited any healthcare provider [OR 0.52 (95% CI 0.36–0.75)], and were more likely to smoke [OR 4.21 (95% CI 2.78–6.38)] or engage in risky drinking [OR 2.66 (95% CI 1.60–4.43)] relative to non-Indigenous Australians.
Interpretation
Indigenous Australians living in communities with greater opposition to the Voice experience poorer health relative to non-Indigenous Australians. Disparities in health may be partially due to poorer healthcare access and increased risk-taking behaviours, which may be associated with racism. These findings align with discrimination-related stress processes and potentially reduced availability of culturally inclusive healthcare. Health and social policy should consider how broader societal level conditions shape Indigenous health disparities in Australia.
Funding
This work is supported by the Australian Research Council (project ID FT200100630), the University of Melbourne Faculty Research Grant, and the National Health and Medical Research Council of Australia Investigator Grant (project ID 1201937).
背景社区态度会影响健康结果，尤其是对受到种族主义和歧视有害影响的种族多样性和少数群体而言。本研究以澳大利亚关于在议会中设立土著居民和托雷斯海峡岛民之声（"之声"）的全国公民投票结果作为对澳大利亚土著居民态度的代表，根据反对 "之声 "的程度研究了澳大利亚土著居民和非土著居民的健康结果。在对地区层面的混杂因素进行调整后，我们使用逻辑回归分析预测了不同程度（四分位数）反对 "声音 "的土著和非土著澳大利亚人的健康结果、医疗保健使用情况和冒险行为。生活在 "声音 "反对率最高地区（最高四分位数：≥72%的社区投 "反对 "票）的土著澳大利亚人更有可能报告健康状况一般/较差[OR 2.28 (95% CI 1.45-3.58)]和精神健康状况较差[OR 2.24 (95% CI 1.48-3.39)]，更不可能去看任何医疗机构[OR 0.52 (95% CI 0.与非土著澳大利亚人相比，他们更有可能吸烟[OR 4.21 (95% CI 2.78-6.38)]或酗酒[OR 2.66 (95% CI 1.60-4.43)]。健康差异的部分原因可能是医疗保健服务较差和冒险行为增多，这可能与种族主义有关。这些研究结果与与歧视有关的压力过程以及具有文化包容性的医疗保健服务可能减少的情况相吻合。健康和社会政策应考虑更广泛的社会层面条件如何影响澳大利亚土著人的健康差异。基金资助这项工作得到了澳大利亚研究理事会（项目编号：FT200100630）、墨尔本大学学院研究基金和澳大利亚国家健康与医学研究理事会研究员基金（项目编号：1201937）的支持。
{"title":"Community attitudes and Indigenous health disparities: evidence from Australia's Voice referendum","authors":"","doi":"10.1016/j.lanwpc.2024.101154","DOIUrl":"10.1016/j.lanwpc.2024.101154","url":null,"abstract":"<div><h3>Background</h3><div>Community attitudes influence health outcomes especially for racially diverse and minority groups exposed to the detrimental effects of racism and discrimination. Using the results from Australia's national referendum to establish an Aboriginal and Torres Strait Islander Voice to Parliament (‘the Voice’) as a proxy for attitudes to Indigenous Australians, this study examined health outcomes for Indigenous and non-Indigenous Australians according to levels of opposition to the Voice.</div></div><div><h3>Methods</h3><div>The regional share of votes against the Voice was linked to 2021 data from the Household, Income and Labour Dynamics in Australia survey, a large, national probability sample (n∽17,000) of Australian adults. Adjusting for regional-level confounders, we used logistic regression analyses to predict health outcomes, healthcare use, and risk-taking behaviours among Indigenous and non-Indigenous Australians for different levels (quartiles) of opposition to the Voice.</div></div><div><h3>Findings</h3><div>Greater opposition to the Voice was associated with widening Indigenous disparities in health, healthcare use, and health behaviours. Indigenous Australians living in regions with the highest opposition to the Voice (top quartile: <span><math><mrow><mo>≥</mo></mrow></math></span>72% community voting ‘No’) were more likely to report fair/poor health [OR 2.28 (95% CI 1.45–3.58)] and poor mental health [OR 2.24 (95% CI 1.48–3.39)], were less likely to have visited any healthcare provider [OR 0.52 (95% CI 0.36–0.75)], and were more likely to smoke [OR 4.21 (95% CI 2.78–6.38)] or engage in risky drinking [OR 2.66 (95% CI 1.60–4.43)] relative to non-Indigenous Australians.</div></div><div><h3>Interpretation</h3><div>Indigenous Australians living in communities with greater opposition to the Voice experience poorer health relative to non-Indigenous Australians. Disparities in health may be partially due to poorer healthcare access and increased risk-taking behaviours, which may be associated with racism. These findings align with discrimination-related stress processes and potentially reduced availability of culturally inclusive healthcare. Health and social policy should consider how broader societal level conditions shape Indigenous health disparities in Australia.</div></div><div><h3>Funding</h3><div>This work is supported by the <span>Australian Research Council</span> (project ID FT200100630), the <span>University of Melbourne Faculty Research</span> Grant, and the <span>National Health and Medical Research Council</span> of Australia Investigator Grant (project ID 1201937).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358079","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.2024.101051
The Western Pacific Region (WPR) is characterized by a group of socioeconomically, culturally, and geopolitically heterogenous countries and represents a microcosm of the global endemic of neurodegeneration. This review will chart the known risk factors for dementia across the WPR. We explore the intersection between the established risk factors for dementia including the biomedical and lifestyle (cardiovascular and metabolic disease, sleep, hearing loss, depression, alcohol, smoking, traumatic brain injury, genetics) and social determinants (social disadvantage, limited education, systemic racism) as well as incorporate neuroimaging data, where available, to predict disease progression in the WPR. In doing so, we highlight core risk factors for dementia in the WPR, as well as geographical epicentres at heightened risk for dementia, to orient future research towards addressing these disparities.
{"title":"Risk factors for the neurodegenerative dementias in the Western Pacific region","authors":"","doi":"10.1016/j.lanwpc.2024.101051","DOIUrl":"10.1016/j.lanwpc.2024.101051","url":null,"abstract":"<div><div>The Western Pacific Region (WPR) is characterized by a group of socioeconomically, culturally, and geopolitically heterogenous countries and represents a microcosm of the global endemic of neurodegeneration. This review will chart the known risk factors for dementia across the WPR. We explore the intersection between the established risk factors for dementia including the <em>biomedical and lifestyle</em> (cardiovascular and metabolic disease, sleep, hearing loss, depression, alcohol, smoking, traumatic brain injury, genetics) and <em>social determinants</em> (social disadvantage, limited education, systemic racism) as well as incorporate neuroimaging data, where available, to predict disease progression in the WPR. In doing so, we highlight core risk factors for dementia in the WPR, as well as geographical epicentres at heightened risk for dementia, to orient future research towards addressing these disparities.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358055","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.2024.101192
Dementia is a leading public health crisis that is projected to affect 152.8 million individuals by 2050, over half of whom will be living in the Western Pacific region. To determine the challenges and opportunities for capacity building in the region, this scoping review searched databases. Our findings reveal national and ethnoracial differences in the prevalence, literacy and genetic risk factors associated with dementia syndromes, underscoring the need to identify and mitigate relevant risk factors in this region. Importantly, ∼80% of research was derived from higher income countries, where the establishment of patient registries and biobanks reflect increased efforts and allocation of resources towards understanding the pathogenesis of dementia. We discuss the need for increased public awareness through culturally-relevant policies, the potential to support patients and caregivers through digital strategies and development of regional networks to mitigate the growing social impact and economic burden of dementia in this region.
{"title":"A scoping review of the unique landscape and challenges associated with dementia in the Western Pacific region","authors":"","doi":"10.1016/j.lanwpc.2024.101192","DOIUrl":"10.1016/j.lanwpc.2024.101192","url":null,"abstract":"<div><div>Dementia is a leading public health crisis that is projected to affect 152.8 million individuals by 2050, over half of whom will be living in the Western Pacific region. To determine the challenges and opportunities for capacity building in the region, this scoping review searched databases. Our findings reveal national and ethnoracial differences in the prevalence, literacy and genetic risk factors associated with dementia syndromes, underscoring the need to identify and mitigate relevant risk factors in this region. Importantly, ∼80% of research was derived from higher income countries, where the establishment of patient registries and biobanks reflect increased efforts and allocation of resources towards understanding the pathogenesis of dementia. We discuss the need for increased public awareness through culturally-relevant policies, the potential to support patients and caregivers through digital strategies and development of regional networks to mitigate the growing social impact and economic burden of dementia in this region.</div></div><div><h3>Funding</h3><div><span>FightMND</span> Mid-Career Fellowship, <span>NHMRC</span> EL1 Fellowship, <span>NHMRC</span> Practitioner Fellowship (1156093), <span>NHMRC</span> Postgraduate scholarship (2022387).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358054","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 : 2024-08-31DOI: 10.1016/j.lanwpc.2024.101185
Background
Monitoring hepatitis B virus (HBV) and hepatitis C virus (HCV) liver-related morbidity and mortality is key to evaluate progress towards elimination targets.
Methods
HBV and HCV notifications in NSW, Australia (1995–2022) were linked to hospital and mortality records. Temporal trends in decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and mortality were evaluated among people notified for HBV and HCV. Segmented Poisson regression models were used to assess the impact of the viral hepatitis elimination era (1 January 2015–31 December 2022) on advanced liver disease and mortality.
Findings
During 1995–2022, there were 64,865 people with an HBV notification and 112,277 people with an HCV notification in NSW. Between 2002 and 2022, there were significant reductions in age-adjusted HBV- and HCV-related DC, HCC, and liver-related mortality. Among those with HBV, age-standardised incidence per 1000 person-years (py) in 2002, 2015, and 2022 was 3.08, 1.47, and 1.16 for DC (p < 0.001); 2.97, 1.45, and 0.75 for HCC (p < 0.001); and 2.84, 1.93, and 1.40 for liver-related mortality (p < 0.001). Among those with HCV, age-standardised incidence per 1000 py in 2002, 2015, and 2022, was 5.53, 4.57, and 2.31 for DC (p < 0.001); 2.22, 2.59, and 1.87 for HCC (p < 0.001); and 3.89, 4.73, and 3.16 for liver-related mortality (p < 0.001). In 2022, absolute liver-related mortality per 100,000 population was 0.95 for HBV and 3.56 for HCV. In adjusted analyses, older age, comorbidity, and a history of alcohol use disorder were associated with increased liver-related mortality among those with HBV and HCV.
Interpretation
This population-level study demonstrated declining risks of DC, HCC, and mortality, with HBV-related declines commencing well before elimination era while HCV-related declines were mostly during elimination era. Population liver mortality indicates elimination target achieved for combined viral hepatitis and HBV, but not HCV.
Funding
The Kirby Institute, UNSW Sydney, and New South Wales Ministry of Health, Australia.
{"title":"Trends in viral hepatitis liver-related morbidity and mortality in New South Wales, Australia","authors":"","doi":"10.1016/j.lanwpc.2024.101185","DOIUrl":"10.1016/j.lanwpc.2024.101185","url":null,"abstract":"<div><h3>Background</h3><p>Monitoring hepatitis B virus (HBV) and hepatitis C virus (HCV) liver-related morbidity and mortality is key to evaluate progress towards elimination targets.</p></div><div><h3>Methods</h3><p>HBV and HCV notifications in NSW, Australia (1995–2022) were linked to hospital and mortality records. Temporal trends in decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and mortality were evaluated among people notified for HBV and HCV. Segmented Poisson regression models were used to assess the impact of the viral hepatitis elimination era (1 January 2015–31 December 2022) on advanced liver disease and mortality.</p></div><div><h3>Findings</h3><p>During 1995–2022, there were 64,865 people with an HBV notification and 112,277 people with an HCV notification in NSW. Between 2002 and 2022, there were significant reductions in age-adjusted HBV- and HCV-related DC, HCC, and liver-related mortality. Among those with HBV, age-standardised incidence per 1000 person-years (py) in 2002, 2015, and 2022 was 3.08, 1.47, and 1.16 for DC (p < 0.001); 2.97, 1.45, and 0.75 for HCC (p < 0.001); and 2.84, 1.93, and 1.40 for liver-related mortality (p < 0.001). Among those with HCV, age-standardised incidence per 1000 py in 2002, 2015, and 2022, was 5.53, 4.57, and 2.31 for DC (p < 0.001); 2.22, 2.59, and 1.87 for HCC (p < 0.001); and 3.89, 4.73, and 3.16 for liver-related mortality (p < 0.001). In 2022, absolute liver-related mortality per 100,000 population was 0.95 for HBV and 3.56 for HCV. In adjusted analyses, older age, comorbidity, and a history of alcohol use disorder were associated with increased liver-related mortality among those with HBV and HCV.</p></div><div><h3>Interpretation</h3><p>This population-level study demonstrated declining risks of DC, HCC, and mortality, with HBV-related declines commencing well before elimination era while HCV-related declines were mostly during elimination era. Population liver mortality indicates elimination target achieved for combined viral hepatitis and HBV, but not HCV.</p></div><div><h3>Funding</h3><p>The <span>Kirby Institute</span>, <span>UNSW Sydney</span>, and <span>New South Wales Ministry of Health</span>, Australia.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001792/pdfft?md5=bad7a496147a0a09cbabfafc95bfe6df&pid=1-s2.0-S2666606524001792-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096737","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 : 2024-08-31DOI: 10.1016/j.lanwpc.2024.101177
Background
Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region.
Methods
We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes.
Findings
Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. Escherichia coli revealed a pooled susceptibility to ampicillin of 17% (95% CI 12–23%, n = 3292), gentamicin 63% (95% CI 59–67%, n = 3956), and third-generation cephalosporins 59% (95% CI 49–69%, n = 3585). Susceptibility of Klebsiella spp. to gentamicin was 71% (95% CI 61–80%, n = 2323), third-generation cephalosporins 35% (95% CI 22–49%, n = 2076), and carbapenems 89% (95% CI 78–97%, n = 2080). Pooled susceptibility of Staphylococcus aureus to flucloxacillin was 72% (95% CI 58–83%, n = 1666), and susceptibility of Streptococcus pneumoniae meningitis isolates to ampicillin was 26% (95% CI 11–44%, n = 375), and 63% (95% CI 40–84%, n = 246) to third-generation cephalosporins.
Interpretation
The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary.
Funding
The study was supported by an Australian GovernmentNational Health and Medical Research Council Investigator Grant. This research was funded in part by the Wellcome Trust [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
背景抗菌药耐药性对儿科死亡率的影响越来越大，尤其是在资源有限的环境中。我们旨在评估引起西太平洋地区儿童感染的细菌的敏感性概况。方法我们对引起儿童常见感染的细菌进行了系统回顾和荟萃分析。我们纳入了 2011 年 1 月至 2023 年 12 月期间发表的研究（PROSPERO CRD42021248722）。研究结果51篇论文符合纳入标准，共纳入18,330株细菌分离物。在已发表的数据中，该地区仅有 6 个国家有代表性。大肠埃希菌对氨苄西林的总敏感率为 17%（95% CI 12-23%，n = 3292），对庆大霉素的敏感率为 63%（95% CI 59-67%，n = 3956），对第三代头孢菌素的敏感率为 59%（95% CI 49-69%，n = 3585）。克雷伯菌属对庆大霉素的敏感率为 71%（95% CI 61-80%，n = 2323），对第三代头孢菌素的敏感率为 35%（95% CI 22-49%，n = 2076），对碳青霉烯类的敏感率为 89%（95% CI 78-97%，n = 2080）。金黄色葡萄球菌对氟氯西林的总敏感率为72%（95% CI 58-83%，n = 1666），肺炎链球菌脑膜炎分离株对氨苄西林的敏感率为26%（95% CI 11-44%，n = 375），对第三代头孢菌素的敏感率为63%（95% CI 40-84%，n = 246）。解释：西太平洋地区儿童常见感染病菌的抗菌药耐药性负担沉重，目前世界卫生组织推荐的治疗这些感染的抗生素可能无效。有必要制定战略，改善高质量数据的可用性，以了解该地区的抗菌药耐药性负担。本研究的部分资金来自威康信托基金[220211/Z/20/Z]。出于开放存取的目的，作者已对本论文的任何作者接受稿件版本申请了 CC BY 公共版权许可。
{"title":"Antimicrobial susceptibility profiles of invasive bacterial infections among children from low- and middle-income countries in the Western Pacific Region (WPRO) – a systematic review and meta-analysis","authors":"","doi":"10.1016/j.lanwpc.2024.101177","DOIUrl":"10.1016/j.lanwpc.2024.101177","url":null,"abstract":"<div><h3>Background</h3><p>Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region.</p></div><div><h3>Methods</h3><p>We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes.</p></div><div><h3>Findings</h3><p>Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. <em>Escherichia coli</em> revealed a pooled susceptibility to ampicillin of 17% (95% CI 12–23%, <em>n</em> = 3292), gentamicin 63% (95% CI 59–67%, <em>n</em> = 3956), and third-generation cephalosporins 59% (95% CI 49–69%, <em>n</em> = 3585). Susceptibility of <em>Klebsiella</em> spp. to gentamicin was 71% (95% CI 61–80%, <em>n</em> = 2323), third-generation cephalosporins 35% (95% CI 22–49%, <em>n</em> = 2076), and carbapenems 89% (95% CI 78–97%, <em>n</em> = 2080). Pooled susceptibility of <em>Staphylococcus aureus</em> to flucloxacillin was 72% (95% CI 58–83%, <em>n</em> = 1666), and susceptibility of <em>Streptococcus pneumoniae</em> meningitis isolates to ampicillin was 26% (95% CI 11–44%, <em>n</em> = 375), and 63% (95% CI 40–84%, <em>n</em> = 246) to third-generation cephalosporins.</p></div><div><h3>Interpretation</h3><p>The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary.</p></div><div><h3>Funding</h3><p>The study was supported by an <span>Australian Government</span> <span>National Health and Medical Research Council</span> Investigator Grant. This research was funded in part by the <span>Wellcome Trust</span> [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001718/pdfft?md5=6908bd95081e6d3dfc284138156e102f&pid=1-s2.0-S2666606524001718-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096736","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 : 2024-08-28DOI: 10.1016/j.lanwpc.2024.101186
{"title":"Approaching a cure for nasopharyngeal carcinoma: how close are we from there?","authors":"","doi":"10.1016/j.lanwpc.2024.101186","DOIUrl":"10.1016/j.lanwpc.2024.101186","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001809/pdfft?md5=b226bd3aa791a9d1a49b8452706bfe05&pid=1-s2.0-S2666606524001809-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087099","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 : 2024-08-27DOI: 10.1016/j.lanwpc.2024.101181
{"title":"Challenges or opportunities in developing clinical research in resource-limited regions? Insights from a province-wide survey of Chinese health professionals","authors":"","doi":"10.1016/j.lanwpc.2024.101181","DOIUrl":"10.1016/j.lanwpc.2024.101181","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001755/pdfft?md5=5ed6ccd1f31dbc2fa426840f69709f91&pid=1-s2.0-S2666606524001755-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083641","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 : 2024-08-24DOI: 10.1016/j.lanwpc.2024.101187
{"title":"A call to action in improving access to diabetes care in lower- and middle-income countries","authors":"","doi":"10.1016/j.lanwpc.2024.101187","DOIUrl":"10.1016/j.lanwpc.2024.101187","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001810/pdfft?md5=8768bc8cb40ccf5c71035d45499da8c7&pid=1-s2.0-S2666606524001810-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142058258","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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