Pub Date : 2025-12-01Epub Date: 2025-11-12DOI: 10.1016/j.lanwpc.2025.101748
Michael Jefford , Fiona Crawford-Williams , Carolyn Taylor , Miyako Takahashi , Wendy W.T. Lam , Alexandre Chan , Bogda Koczwara , Yan Lou , Raymond J. Chan
The Western Pacific region faces a significant cancer burden with over 12.8 million cancer survivors. Cancer survivorship care remains inconsistent across the region but is important regardless of diversity in healthcare systems and resources within countries. Cultural factors deeply influence survivorship experiences; thus, recognition of the importance of traditional medicine and the role of community-based support in survivorship care is needed. In this viewpoint, we highlight opportunities for regional collaboration to improve cancer survivorship outcomes, and advocate for incorporation of survivorship priorities into national cancer control plans. We call for coordinated action involving international organizations, local governments, and cancer survivor voices to deliver responsive, equitable survivorship care. Education, policy reform, and multinational partnerships are essential to address disparities and improve outcomes across the region.
{"title":"Global need, regional action: opportunities to improve cancer survivorship care in the Western Pacific","authors":"Michael Jefford , Fiona Crawford-Williams , Carolyn Taylor , Miyako Takahashi , Wendy W.T. Lam , Alexandre Chan , Bogda Koczwara , Yan Lou , Raymond J. Chan","doi":"10.1016/j.lanwpc.2025.101748","DOIUrl":"10.1016/j.lanwpc.2025.101748","url":null,"abstract":"<div><div>The Western Pacific region faces a significant cancer burden with over 12.8 million cancer survivors. Cancer survivorship care remains inconsistent across the region but is important regardless of diversity in healthcare systems and resources within countries. Cultural factors deeply influence survivorship experiences; thus, recognition of the importance of traditional medicine and the role of community-based support in survivorship care is needed. In this viewpoint, we highlight opportunities for regional collaboration to improve cancer survivorship outcomes, and advocate for incorporation of survivorship priorities into national cancer control plans. We call for coordinated action involving international organizations, local governments, and cancer survivor voices to deliver responsive, equitable survivorship care. Education, policy reform, and multinational partnerships are essential to address disparities and improve outcomes across the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101748"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486314","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 : 2025-12-01Epub Date: 2025-11-28DOI: 10.1016/j.lanwpc.2025.101762
Mengji Chen , Clive Tan , Muhamad Noor Alfarizal Kamarudin , Vivek Jason Jayaraj , Premikha M , Muhammad Taufeeq Wahab , Anthony Li , Kidong Park
{"title":"Building AI readiness for health in Southeast Asia","authors":"Mengji Chen , Clive Tan , Muhamad Noor Alfarizal Kamarudin , Vivek Jason Jayaraj , Premikha M , Muhammad Taufeeq Wahab , Anthony Li , Kidong Park","doi":"10.1016/j.lanwpc.2025.101762","DOIUrl":"10.1016/j.lanwpc.2025.101762","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101762"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615709","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}
Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care–led HCV programme in 2024.
Methods
We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.
Findings
HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5–4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1–5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5–60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05–1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October–December (Q4; aOR 1·79) versus January–March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).
Interpretation
A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.
Funding
ANRS MIE (ANRS0689b).
现实世界中关于西太平洋地区丙型肝炎病毒（HCV）分散初级保健服务的证据有限。我们评估了柬埔寨2024年以初级保健为主导的国家HCV规划。方法我们分析了来自15个业务区256个卫生机构的设施级数据，以评估6个HCV级联步骤：筛查、抗HCV阳性、RNA检测、病毒血症、开始治疗和完成治疗。使用基于设计的调查估计器以95%置信区间（ci）估计比例。为了考虑多阶段设计（在操作区域内聚集），采用基于设计的广义线性模型来评估与病毒血症、治疗开始和完成相关的因素。发现成人（≥18岁；分母2,196,351）的shcv检测覆盖率为3.5% （95% CI 2.5 - 4.4）。在接受检测的76,512名成人中，3213名（4.2%;95% CI 3.1 - 5.6）为抗hcv阳性；2628/3213例（81.8%）接受了RNA检测，1446/2628例（55.0%;95% CI 49.5 - 60.03）为病毒血症（占所有检测的1.9%）。在rna阳性个体中，1345/1446（93.0%）开始使用直接抗病毒药物，1289/1345（95.8%）完成治疗。男性病毒血症较高（校正优势比[aOR] 1.40; 95% CI 1.05 - 1.86），因省而异（武夫比值为2.79，磅湛比值为2.11，马德望比值为2.11），10 - 12月（Q4； aOR为1.79）高于1 - 3月。所有设施的治疗启动和完成率超过90%。主要的差距是确认性检测（18.2%的抗hcv阳性个体缺乏RNA检测）。解释：一种分散的初级保健模式在第一年实现了高度的联系和治疗完成。消除确认性检测差距（来自相同遭遇的反射RNA/核心抗原），优先考虑低覆盖率/高负担地区，并建立患者层面的联系，以在第12周捕获持续的病毒学反应，是加速消除的优先事项。基金编号：anrs MIE （ANRS0689b）。
{"title":"Early performance of a decentralised, primary-care hepatitis C programme in Cambodia: a retrospective programme evaluation, 2024","authors":"Chansovannara Soputhy , Florian Girond , Samley Keo , Kolveasna Kim , Luis Sagaon-Teyssier , Capucine Penicaud , Sovann Ly , Emilie Mosnier","doi":"10.1016/j.lanwpc.2025.101758","DOIUrl":"10.1016/j.lanwpc.2025.101758","url":null,"abstract":"<div><h3>Background</h3><div>Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care–led HCV programme in 2024.</div></div><div><h3>Methods</h3><div>We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion.</div></div><div><h3>Findings</h3><div>HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5–4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1–5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5–60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05–1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October–December (Q4; aOR 1·79) versus January–March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing).</div></div><div><h3>Interpretation</h3><div>A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination.</div></div><div><h3>Funding</h3><div><span>ANRS MIE</span> (<span><span>ANRS0689b</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101758"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615785","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 : 2025-12-01Epub Date: 2025-11-28DOI: 10.1016/j.lanwpc.2025.101761
Huong Le , Christopher C. Blyth , Clement Schlegel , Jo-Anne Morgan , Francis Mitrou , Ha Nguyen , Rachel Foong , Samantha Carlson , Catherine Hughes , Bette Liu , Hannah C. Moore
Background
Socio-economic inequality and vaccination inequity have long been critical issues. However, no studies have explored the gap in influenza vaccination uptake between public and private schools. Importantly, the extent to which socio-economic inequality translates into vaccination uptake inequity has not been quantified. We investigate influenza vaccination uptake among school-aged Australian children in 2023, compare uptake between public and private schools, and assess the role of socio-economic inequality in vaccination uptake inequity.
Methods
We analysed whole-of-population linked immunisation, census, and administrative data. Multivariable logistic regression was used to identify key uptake predictors, and the Oaxaca-Blinder decomposition was used to identify factors driving uptake inequity between public and private schools.
Findings
Of 9.5 million influenza vaccination doses administered, only 0.7 million (7%) were given to school-aged children (5–<18 years), who represent 16% of the population. Coverage among school-aged children was low. Secondary school-aged children had the lowest uptake, with a significant gap between public and private schools. Children in private secondary schools, who demonstrate greater socio-economic advantage, had higher uptake than their public peers (unadjusted OR = 1.47; 95% CI: 1.45–1.57). Two-thirds of the uptake gap is driven by differences in cultural, linguistic, and socio-economic characteristics, with parental education, parental income, and socio-economic characteristics of residential area being the strongest contributors.
Interpretation
Addressing socio-economic inequality among parents could reduce vaccination uptake inequity for children. Future influenza vaccination campaigns should consider tailored strategies for specific cultural, linguistic, and socio-economic groups.
Funding
Wesfarmers Centre of Vaccines and Infectious Diseases; Western Australian’s Future Health Research and Innovation Fund.
{"title":"Socio-economic inequality underpins inequity in influenza vaccination uptake between public and private secondary schools: an Australian population-based study","authors":"Huong Le , Christopher C. Blyth , Clement Schlegel , Jo-Anne Morgan , Francis Mitrou , Ha Nguyen , Rachel Foong , Samantha Carlson , Catherine Hughes , Bette Liu , Hannah C. Moore","doi":"10.1016/j.lanwpc.2025.101761","DOIUrl":"10.1016/j.lanwpc.2025.101761","url":null,"abstract":"<div><h3>Background</h3><div>Socio-economic inequality and vaccination inequity have long been critical issues. However, no studies have explored the gap in influenza vaccination uptake between public and private schools. Importantly, the extent to which socio-economic inequality translates into vaccination uptake inequity has not been quantified. We investigate influenza vaccination uptake among school-aged Australian children in 2023, compare uptake between public and private schools, and assess the role of socio-economic inequality in vaccination uptake inequity.</div></div><div><h3>Methods</h3><div>We analysed whole-of-population linked immunisation, census, and administrative data. Multivariable logistic regression was used to identify key uptake predictors, and the Oaxaca-Blinder decomposition was used to identify factors driving uptake inequity between public and private schools.</div></div><div><h3>Findings</h3><div>Of 9.5 million influenza vaccination doses administered, only 0.7 million (7%) were given to school-aged children (5–<18 years), who represent 16% of the population. Coverage among school-aged children was low. Secondary school-aged children had the lowest uptake, with a significant gap between public and private schools. Children in private secondary schools, who demonstrate greater socio-economic advantage, had higher uptake than their public peers (unadjusted OR = 1.47; 95% CI: 1.45–1.57). Two-thirds of the uptake gap is driven by differences in cultural, linguistic, and socio-economic characteristics, with parental education, parental income, and socio-economic characteristics of residential area being the strongest contributors.</div></div><div><h3>Interpretation</h3><div>Addressing socio-economic inequality among parents could reduce vaccination uptake inequity for children. Future influenza vaccination campaigns should consider tailored strategies for specific cultural, linguistic, and socio-economic groups.</div></div><div><h3>Funding</h3><div><span>Wesfarmers Centre of Vaccines and Infectious Diseases</span>; <span>Western Australian’s Future Health Research and Innovation Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101761"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615786","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 : 2025-12-01Epub Date: 2025-12-05DOI: 10.1016/j.lanwpc.2025.101769
Yuanshi Jiao , Zonglin Dai , Jiangnan Zhu , Manuel A. Espinoza , Xue Li
{"title":"Leveraging managed access with life-cycle reassessment in Asia-Pacific: advancing the learning of health system matters for innovative medicines in oncology","authors":"Yuanshi Jiao , Zonglin Dai , Jiangnan Zhu , Manuel A. Espinoza , Xue Li","doi":"10.1016/j.lanwpc.2025.101769","DOIUrl":"10.1016/j.lanwpc.2025.101769","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101769"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681864","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 : 2025-12-01Epub Date: 2025-12-26DOI: 10.1016/j.lanwpc.2025.101785
The Lancet Regional Health – Western Pacific
{"title":"Heterogeneous determinants of falling birth rates in the Western Pacific","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2025.101785","DOIUrl":"10.1016/j.lanwpc.2025.101785","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101785"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839288","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 : 2025-12-01Epub Date: 2025-11-27DOI: 10.1016/j.lanwpc.2025.101753
Kristie Watego , Morgan Brodhurst-Hill , Cherilda Murray , Clare Mangoyana , Alynta Emery , Jayde Woon , Kara Williams , Natasha Reid , Teyl Engstrom , Carmel Nelson , Clair Sullivan , Jenny Setchell
Background
With healthcare's accelerating digital transformation and expanding data-sharing capabilities, it is essential to uphold Indigenous Data Sovereignty (IDSov)—which affirms Indigenous ownership and authority over health data relating to Indigenous communities. Indigenous Data Governance (IDGov) provides the mechanisms through which IDSov is enacted, ensuring Indigenous Peoples lead decisions about how data are collected, accessed, and used. Our research investigates a local enactment of IDGov, discussing how custodial stewardship is enacted in data-sharing arrangements between an Aboriginal and Torres Strait Islander community-controlled health organisation and a government birthing facility. The research aimed to understand Aboriginal and Torres Strait Islander service users' and health workers' perspectives on how/whether to share data between services.
Methods
Led by a community-controlled organisation, the study used Indigenous methodologies, including ‘yarning’—a traditional knowledge-sharing practice. An Aboriginal researcher conducted yarns with Aboriginal and/or Torres Strait Islander staff and perinatal service users. Collaborative analysis was undertaken using an adapted ‘Thought Ritual’, an Indigenous analytical framework.
Findings
Analysis identified four domains: 1) Power and Control in Data Sharing—Data sharing can shift power dynamics, affecting sovereignty and community control, 2) Safety Concerns—Participants cited legal, cultural, and psychosocial risks tied to stigma and systemic racism, 3) Ability to Do My Job—Limited data access can hinder effective service delivery, and 4) Not Everything Should Be Shared—There is a clear preference for consent-based, selective data sharing.
Interpretation
Honouring Indigenous perspectives in data-sharing arrangements is an ethical obligation. In perinatal settings, upholding custodial stewardship helps safeguard sovereignty, safety, and equitable outcomes.
Funding
Funding was received from the Australian Government through the Medical Research Future Fund.
{"title":"Indigenous people's perspectives on sharing health data for service delivery purposes: an inquiry using Indigenous methodologies","authors":"Kristie Watego , Morgan Brodhurst-Hill , Cherilda Murray , Clare Mangoyana , Alynta Emery , Jayde Woon , Kara Williams , Natasha Reid , Teyl Engstrom , Carmel Nelson , Clair Sullivan , Jenny Setchell","doi":"10.1016/j.lanwpc.2025.101753","DOIUrl":"10.1016/j.lanwpc.2025.101753","url":null,"abstract":"<div><h3>Background</h3><div>With healthcare's accelerating digital transformation and expanding data-sharing capabilities, it is essential to uphold Indigenous Data Sovereignty (IDSov)—which affirms Indigenous ownership and authority over health data relating to Indigenous communities. Indigenous Data Governance (IDGov) provides the mechanisms through which IDSov is enacted, ensuring Indigenous Peoples lead decisions about how data are collected, accessed, and used. Our research investigates a local enactment of IDGov, discussing how custodial stewardship is enacted in data-sharing arrangements between an Aboriginal and Torres Strait Islander community-controlled health organisation and a government birthing facility. The research aimed to understand Aboriginal and Torres Strait Islander service users' and health workers' perspectives on how/whether to share data between services.</div></div><div><h3>Methods</h3><div>Led by a community-controlled organisation, the study used Indigenous methodologies, including ‘yarning’—a traditional knowledge-sharing practice. An Aboriginal researcher conducted yarns with Aboriginal and/or Torres Strait Islander staff and perinatal service users. Collaborative analysis was undertaken using an adapted ‘Thought Ritual’, an Indigenous analytical framework.</div></div><div><h3>Findings</h3><div>Analysis identified four domains: 1) Power and Control in Data Sharing—Data sharing can shift power dynamics, affecting sovereignty and community control, 2) Safety Concerns—Participants cited legal, cultural, and psychosocial risks tied to stigma and systemic racism, 3) Ability to Do My Job—Limited data access can hinder effective service delivery, and 4) Not Everything Should Be Shared—There is a clear preference for consent-based, selective data sharing.</div></div><div><h3>Interpretation</h3><div>Honouring Indigenous perspectives in data-sharing arrangements is an ethical obligation. In perinatal settings, upholding custodial stewardship helps safeguard sovereignty, safety, and equitable outcomes.</div></div><div><h3>Funding</h3><div>Funding was received from the Australian Government through the <span>Medical Research Future Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101753"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615706","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 : 2025-12-01Epub Date: 2025-12-08DOI: 10.1016/j.lanwpc.2025.101710
Jiaxi Yang , Wei Wei Pang , Guoqi Yu , Juliana Antero , Ling-Jun Li , Zhongwei Huang , Cuilin Zhang
In the face of declining global birth rates, women's health status remains a critical yet often overlooked determinant. This review summarises evidence on how various aspects of women's health, including nutrition and lifestyle, socioeconomic status, environmental pollutants, and metabolic and reproductive health are related to birth rates and female fertility. A healthy lifestyle, including a balanced, nutrient-rich diet, regular physical activity, adequate sleep, and mental wellbeing along with optimal metabolic and reproductive health, supports women's health. Meanwhile, broader determinants, such as socioeconomic status and environmental pollutants, also shape women's health and reproductive wellbeing. Collectively, these individual and systemic factors influence female fertility and birth outcomes, and subsequently, population-level birth rates. However, most existing evidence is based on White populations, underscoring the need for more inclusive research, particularly in the Asia–Pacific region. Improving women's health and fertility outcomes requires a holistic approach, with coordinated efforts across research, education, and policy domains.
{"title":"Women's health and female fertility: current evidence and knowledge gaps in the Asia–Pacific region","authors":"Jiaxi Yang , Wei Wei Pang , Guoqi Yu , Juliana Antero , Ling-Jun Li , Zhongwei Huang , Cuilin Zhang","doi":"10.1016/j.lanwpc.2025.101710","DOIUrl":"10.1016/j.lanwpc.2025.101710","url":null,"abstract":"<div><div>In the face of declining global birth rates, women's health status remains a critical yet often overlooked determinant. This review summarises evidence on how various aspects of women's health, including nutrition and lifestyle, socioeconomic status, environmental pollutants, and metabolic and reproductive health are related to birth rates and female fertility. A healthy lifestyle, including a balanced, nutrient-rich diet, regular physical activity, adequate sleep, and mental wellbeing along with optimal metabolic and reproductive health, supports women's health. Meanwhile, broader determinants, such as socioeconomic status and environmental pollutants, also shape women's health and reproductive wellbeing. Collectively, these individual and systemic factors influence female fertility and birth outcomes, and subsequently, population-level birth rates. However, most existing evidence is based on White populations, underscoring the need for more inclusive research, particularly in the Asia–Pacific region. Improving women's health and fertility outcomes requires a holistic approach, with coordinated efforts across research, education, and policy domains.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101710"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839287","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}
Device-detected atrial fibrillation (DDAF), including atrial high-rate episodes recorded at a cardiovascular implantable electronic device and subclinical atrial fibrillation detected by insertable cardiac monitor and smart wearables, poses an increasing challenge in stroke prevention. Although oral anticoagulants (OACs) are effective in clinical AF, their benefit-risk balance in DDAF remains uncertain. In response, the Asia Pacific Heart Rhythm Society (APHRS) proposes the 4S-DDAF approach (Strip documentation and longest AF duration, Symptoms, Stroke [ischemic] history, and Score) to guide anticoagulation decisions. This approach integrates electrogram review, symptom assessment, history of ischemic stroke or transient ischemic attack (TIA), and CHA2DS2-VASc scoring, emphasizing individualized care. OACs are recommended for patients with AF episodes ≥24 h, prior stroke/TIA, CHA2DS2-VASc score ≥4, or vascular disease. In patients not meeting these thresholds, close monitoring and risk factor management are advised. The 4S-DDAF approach provides a practical and evidence-informed strategy for clinical decision-making in the management of DDAF.
{"title":"Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach","authors":"Tze-Fan Chao , Chu-Pak Lau , Eue-Keun Choi , Chi-Keong Ching , Ngai-Yin Chan , Chung-Lieh Hung , Boyoung Joung , Rungroj Krittayaphong , Hung-Fat Tse , Gregory Y.H. Lip","doi":"10.1016/j.lanwpc.2025.101770","DOIUrl":"10.1016/j.lanwpc.2025.101770","url":null,"abstract":"<div><div>Device-detected atrial fibrillation (DDAF), including atrial high-rate episodes recorded at a cardiovascular implantable electronic device and subclinical atrial fibrillation detected by insertable cardiac monitor and smart wearables, poses an increasing challenge in stroke prevention. Although oral anticoagulants (OACs) are effective in clinical AF, their benefit-risk balance in DDAF remains uncertain. In response, the Asia Pacific Heart Rhythm Society (APHRS) proposes the 4S-DDAF approach (Strip documentation and longest AF duration, Symptoms, Stroke [ischemic] history, and Score) to guide anticoagulation decisions. This approach integrates electrogram review, symptom assessment, history of ischemic stroke or transient ischemic attack (TIA), and CHA<sub>2</sub>DS<sub>2</sub>-VASc scoring, emphasizing individualized care. OACs are recommended for patients with AF episodes ≥24 h, prior stroke/TIA, CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥4, or vascular disease. In patients not meeting these thresholds, close monitoring and risk factor management are advised. The 4S-DDAF approach provides a practical and evidence-informed strategy for clinical decision-making in the management of DDAF.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101770"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736759","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 : 2025-12-01Epub Date: 2025-11-13DOI: 10.1016/j.lanwpc.2025.101745
Yi Yang , Jiani Jiang , Can Chen , Rongrong Qu , Yi Liu , Chen Xu , Xiangkun Zeng , Xiaofan Li , Yi Li , Weili Lin , Lili Huang , Mi Zhou , Mengsha Chen , Rong Zhang , Shigui Yang , Ning Dong
Background
Antimicrobial resistance (AMR) represents an escalating global health challenge, with socioeconomic status (SES) being a significant influencing factor. This study aimed to quantify area-level SES and assess its association with drug-resistant bacteria in China.
Methods
AMR data were collected from China Antimicrobial Resistance Surveillance System (CARSS, 2014–2023). Area-level SES across China was captured by County-level Area Deprivation Index (CADI) and Townsend Deprivation Index (TDI). Spatiotemporal distributions of drug-resistant bacteria were explored by spatial autocorrelation and spatiotemporal scan analyses. Key AMR risk factors were identified by GeoDetector analysis. Six Bayesian models were established through the Bayesian spatiotemporal modelling analysis. The Bayesian Spatiotemporal Interaction Hierarchy Model (BSTIHM), demonstrating superior estimative accuracy, was selected to forecast nationwide AMR patterns.
Findings
AMR profiles were obtained for totally 34,442,268 isolates of thirteen types of drug-resistant bacteria. The distributions of these bacteria exhibited manifest spatiotemporal heterogeneity nationwide. Both CADI and TDI consistently revealed a distinct socioeconomic gradient, with low area-level SES in western regions, medium in central regions, and high in eastern regions. Spatiotemporal clusters of drug-resistant bacteria were mainly observed in low SES regions. Lower area-level SES (odds ratio (OR) range: 1.054–1.254) and higher antimicrobial usage intensity (OR range: 1.022–1.174) contributed to higher risk of all thirteen types of drug-resistant bacteria. Meanwhile, total wastewater discharge (OR range: 1.064–1.280), PM2.5 (OR range: 1.031–1.135), and number of healthcare technicians per 10,000 people (OR range: 1.035–1.310) were correlated with risks of most drug-resistant bacteria. Estimated risks for all thirteen types of drug-resistant bacteria were increased in low and middle area-level SES regions based on the BSTIHM.
Interpretation
Area-level SES is a pivotal driver of AMR risk, which might be caused by antibiotic overuse and environmental pollution. Targeted investments in healthcare and environmental systems in lower area-level SES regions are essential to effectively reduce AMR burden.
Funding
National Key R&D Program of China, National Natural Science Foundation of China, Natural Science Foundation of Zhejiang Province, and Natural Science Foundation of Jiangsu Province.
{"title":"Area-level socioeconomic status inequalities shape patterns of antimicrobial resistance in China, 2014–2023: a Bayesian spatiotemporal modelling analysis","authors":"Yi Yang , Jiani Jiang , Can Chen , Rongrong Qu , Yi Liu , Chen Xu , Xiangkun Zeng , Xiaofan Li , Yi Li , Weili Lin , Lili Huang , Mi Zhou , Mengsha Chen , Rong Zhang , Shigui Yang , Ning Dong","doi":"10.1016/j.lanwpc.2025.101745","DOIUrl":"10.1016/j.lanwpc.2025.101745","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) represents an escalating global health challenge, with socioeconomic status (SES) being a significant influencing factor. This study aimed to quantify area-level SES and assess its association with drug-resistant bacteria in China.</div></div><div><h3>Methods</h3><div>AMR data were collected from China Antimicrobial Resistance Surveillance System (CARSS, 2014–2023). Area-level SES across China was captured by County-level Area Deprivation Index (CADI) and Townsend Deprivation Index (TDI). Spatiotemporal distributions of drug-resistant bacteria were explored by spatial autocorrelation and spatiotemporal scan analyses. Key AMR risk factors were identified by GeoDetector analysis. Six Bayesian models were established through the Bayesian spatiotemporal modelling analysis. The Bayesian Spatiotemporal Interaction Hierarchy Model (BSTIHM), demonstrating superior estimative accuracy, was selected to forecast nationwide AMR patterns.</div></div><div><h3>Findings</h3><div>AMR profiles were obtained for totally 34,442,268 isolates of thirteen types of drug-resistant bacteria. The distributions of these bacteria exhibited manifest spatiotemporal heterogeneity nationwide. Both CADI and TDI consistently revealed a distinct socioeconomic gradient, with low area-level SES in western regions, medium in central regions, and high in eastern regions. Spatiotemporal clusters of drug-resistant bacteria were mainly observed in low SES regions. Lower area-level SES (odds ratio (OR) range: 1.054–1.254) and higher antimicrobial usage intensity (OR range: 1.022–1.174) contributed to higher risk of all thirteen types of drug-resistant bacteria. Meanwhile, total wastewater discharge (OR range: 1.064–1.280), PM<sub>2.5</sub> (OR range: 1.031–1.135), and number of healthcare technicians per 10,000 people (OR range: 1.035–1.310) were correlated with risks of most drug-resistant bacteria. Estimated risks for all thirteen types of drug-resistant bacteria were increased in low and middle area-level SES regions based on the BSTIHM.</div></div><div><h3>Interpretation</h3><div>Area-level SES is a pivotal driver of AMR risk, which might be caused by antibiotic overuse and environmental pollution. Targeted investments in healthcare and environmental systems in lower area-level SES regions are essential to effectively reduce AMR burden.</div></div><div><h3>Funding</h3><div>National Key R&D Program of China, National Natural Science Foundation of China, Natural Science Foundation of Zhejiang Province, and Natural Science Foundation of Jiangsu Province.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101745"},"PeriodicalIF":8.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519338","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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