Pub Date : 2024-08-09DOI: 10.1016/j.lanwpc.2024.101167
Wenlan Dong , Xiao Zhang , Shiwei Liu , Xian Zhang , Zhaosheng Li , Ming Gu , Yibing Yang , Yichen E. Fang , Han Li , Jing Qian , Mei Zhang , Limin Wang , Lijing L. Yan , Jing Wu
Background
The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors.
Methods
We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1–2), medium- (3–4), and long-term (6–7 years) effects.
Findings
We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (−1.78% [−4.51%, 0.96%]), passive smoking (−8.09% [−14.27%, −1.90%]), and drinking in last month (−4.04% [−8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: −1.84, −0.26), 1.15 medium-term (95% CI: −2.08, −0.22), 2.82 long-term (95% CI: −4.79, −0.85), and 1.54 overall (95% CI: −2.51, −0.56).
Interpretation
The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges.
Funding
The China National Key Research and Development Program (2018YFC1315304 and 2017YFC1310902); National Natural Science Foundation of China (81872721).
{"title":"Effect of the national integrated demonstration area for the prevention and control of noncommunicable diseases programme on behavioural risk factors in China: a synthetic difference-in-differences study","authors":"Wenlan Dong , Xiao Zhang , Shiwei Liu , Xian Zhang , Zhaosheng Li , Ming Gu , Yibing Yang , Yichen E. Fang , Han Li , Jing Qian , Mei Zhang , Limin Wang , Lijing L. Yan , Jing Wu","doi":"10.1016/j.lanwpc.2024.101167","DOIUrl":"10.1016/j.lanwpc.2024.101167","url":null,"abstract":"<div><h3>Background</h3><p>The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors.</p></div><div><h3>Methods</h3><p>We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1–2), medium- (3–4), and long-term (6–7 years) effects.</p></div><div><h3>Findings</h3><p>We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (−1.78% [−4.51%, 0.96%]), passive smoking (−8.09% [−14.27%, −1.90%]), and drinking in last month (−4.04% [−8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: −1.84, −0.26), 1.15 medium-term (95% CI: −2.08, −0.22), 2.82 long-term (95% CI: −4.79, −0.85), and 1.54 overall (95% CI: −2.51, −0.56).</p></div><div><h3>Interpretation</h3><p>The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges.</p></div><div><h3>Funding</h3><p>The China <span>National Key Research and Development Program</span> (<span><span>2018YFC1315304</span></span> and <span><span>2017YFC1310902</span></span>); <span>National Natural Science Foundation of China</span> (<span><span>81872721</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"50 ","pages":"Article 101167"},"PeriodicalIF":7.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001615/pdfft?md5=e174671e4f3400c936ab3f0ea599051d&pid=1-s2.0-S2666606524001615-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950865","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 : 2024-08-07DOI: 10.1016/j.lanwpc.2024.101164
Xiaomian Tan , Pui Yee Tan , Somphos Vicheth Som , Son Duy Nguyen , Do Thanh Tran , Nga Thuy Tran , Van Khanh Tran , J. Bernadette Moore , Yun Yun Gong
Background
Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents.
Methods
Data from 10- to 18-year-old female participants (n = 1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes.
Findings
Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16–18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p < 0.01), as was thinness (12.25 [3.47, 43.33], p < 0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p < 0.01).
Interpretation
More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam.
{"title":"Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020","authors":"Xiaomian Tan , Pui Yee Tan , Somphos Vicheth Som , Son Duy Nguyen , Do Thanh Tran , Nga Thuy Tran , Van Khanh Tran , J. Bernadette Moore , Yun Yun Gong","doi":"10.1016/j.lanwpc.2024.101164","DOIUrl":"10.1016/j.lanwpc.2024.101164","url":null,"abstract":"<div><h3>Background</h3><p>Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents.</p></div><div><h3>Methods</h3><p>Data from 10- to 18-year-old female participants (n = 1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes.</p></div><div><h3>Findings</h3><p>Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16–18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p < 0.01), as was thinness (12.25 [3.47, 43.33], p < 0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p < 0.01).</p></div><div><h3>Interpretation</h3><p>More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam.</p></div><div><h3>Funding</h3><p><span>UK BBSRC</span> <span><span>BB/T008989/1</span></span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"50 ","pages":"Article 101164"},"PeriodicalIF":7.6,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001585/pdfft?md5=6c89fc38af574dfec6a3c6db9d566f80&pid=1-s2.0-S2666606524001585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141962895","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 : 2024-08-07DOI: 10.1016/j.lanwpc.2024.101162
John Paul Caesar delos Trinos , Luc E. Coffeng , Fernando Garcia Jr. , Vicente Belizario Jr. , Virginia Wiseman , Caroline Watts , Susana Vaz Nery
Background
School-based targeted preventive chemotherapy (PC), the primary strategy for soil-transmitted helminth (STH) control, typically focusing on primary schoolchildren, was expanded to secondary school students in the Philippines in 2016. This program still excludes adults, who may also suffer from considerable morbidity and can be a significant reservoir of infection. Mass drug administration (MDA), where the entire population is treated, would bring additional health benefits but will also increase implementation costs. The incremental cost of implementing MDA for STH control compared to expanded school-based targeted PC, however, is unknown.
Methods
A cost survey was conducted in Zamboanga Peninsula region in 2021 to estimate the economic and financial cost of implementing MDA compared to the expanded school-based targeted PC from a government payer perspective. A budget impact analysis was conducted to estimate the financial cost to the government of implementing MDA over a five-year timeframe. Monte Carlo simulation accounted for uncertainty in cost estimates. Costs were reported in 2021 United States Dollars ($).
Findings
The economic cost of MDA was $809,000 per year (95% CI: $679,000–$950,000) or $0.22 per person targeted (95% CI: $0.19–$0.26), while the expanded school-based targeted PC would cost $625,000 (95% CI: $549,000–$706,000) or $0.57 per person targeted (95% CI: $0.50–$0.64). Over five years, the financial cost to the government for MDA would be $3,113,000 (95% CI: $2,475,000–$3,810,000); $740,000 (95% CI: $486,000–$1,019,000) higher than expanded school-based targeted PC.
Interpretation
Implementing MDA in the region will increase the economic and financial costs by 29% and 31%, respectively, when compared to expanded school-based targeted PC. Implementing MDA would require the Department of Health to increase their total expenditure for STH control by 0.2% and could be key in addressing the ongoing STH burden.
Funding
The project was funded by the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (NHMRC GA19028), and JPCDT was supported by a UNSW Scientia PhD Scholarship. SVN is funded by an NHMRC Investigator Grant (APP 2018220).
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Pub Date : 2024-08-05DOI: 10.1016/j.lanwpc.2024.101153
Karene Hoi Ting Yeung , Christy Ching Wun Yeung , Wing Hung Tam , King Shun Liu , Genevieve Po Gee Fung , E. Anthony S. Nelson
Background
Rotavirus vaccine has not been included in the Hong Kong Government's Childhood Immunisation Programme. This randomised controlled trial examined whether a simple intervention package can increase rotavirus vaccine uptake in Hong Kong children.
Methods
Postpartum mothers were recruited from two public hospitals in Hong Kong and randomly allocated into three groups using block randomisation, with block sizes kept unknown to investigators and research staff. Control-subjects received public rotavirus information. Subjects in intervention group 1 additionally received: key rotavirus information with a hyperlink to a webpage showing private clinics providing rotavirus vaccines and guidance on searching the clinics, and vaccination reminders. Subjects in intervention group 2 received the same intervention as group 1, plus tokens to receive free rotavirus vaccines at specific health centres. Rotavirus vaccination status was collected when children were approximately 8 months old. Maternal attitudes towards rotavirus vaccine were assessed at enrolment and at the end of the study. This trial has been registered in the Chinese Clinical Trial Register (Ref.:ChiCTR2000039791).
Findings
From 16 February to 30 July 2021, 788 eligible mothers were recruited and randomly allocated to control group (n = 263), intervention group 1 (n = 263), and intervention group 2 (n = 262). The full intervention package (intervention group 2 relative to control group) increased rotavirus vaccine uptake by 1.7 times (95% confidence interval [CI] = 1.49–1.97) or by 33 percent-points (from 48% to 81% uptake). Provision of key rotavirus information with vaccination reminders (intervention group 1 relative to control group) and removal of financial barrier (intervention group 2 relative to intervention group 1) increased uptake by 1.17 times (95% CI = 0.99–1.38) or 8 percent-points, and by 1.46 times (95% CI = 1.29–1.66) or 25 percent-points, respectively.
Interpretation
A multiple-component intervention package, and in particular providing free vaccine, could increase the uptake of rotavirus vaccine in Hong Kong children. The impact of the intervention package was greatest in low-income families, emphasising the importance of removing financial barriers to vaccination to promote equity. Incorporating rotavirus vaccine into the routine CIP could further protect more young children from rotavirus infection and improve equity.
Funding
This work was supported by the Health and Medical Research Fund by the Health Bureau, Government of Hong Kong SAR [Ref.: 19180202].
{"title":"Multiple-component interventions to increase rotavirus vaccine uptake in children: a randomised controlled trial","authors":"Karene Hoi Ting Yeung , Christy Ching Wun Yeung , Wing Hung Tam , King Shun Liu , Genevieve Po Gee Fung , E. Anthony S. Nelson","doi":"10.1016/j.lanwpc.2024.101153","DOIUrl":"10.1016/j.lanwpc.2024.101153","url":null,"abstract":"<div><h3>Background</h3><p>Rotavirus vaccine has not been included in the Hong Kong Government's Childhood Immunisation Programme. This randomised controlled trial examined whether a simple intervention package can increase rotavirus vaccine uptake in Hong Kong children.</p></div><div><h3>Methods</h3><p>Postpartum mothers were recruited from two public hospitals in Hong Kong and randomly allocated into three groups using block randomisation, with block sizes kept unknown to investigators and research staff. Control-subjects received public rotavirus information. Subjects in intervention group 1 additionally received: key rotavirus information with a hyperlink to a webpage showing private clinics providing rotavirus vaccines and guidance on searching the clinics, and vaccination reminders. Subjects in intervention group 2 received the same intervention as group 1, plus tokens to receive free rotavirus vaccines at specific health centres. Rotavirus vaccination status was collected when children were approximately 8 months old. Maternal attitudes towards rotavirus vaccine were assessed at enrolment and at the end of the study. This trial has been registered in the Chinese Clinical Trial Register (Ref.:ChiCTR2000039791).</p></div><div><h3>Findings</h3><p>From 16 February to 30 July 2021, 788 eligible mothers were recruited and randomly allocated to control group (n = 263), intervention group 1 (n = 263), and intervention group 2 (n = 262). The full intervention package (intervention group 2 relative to control group) increased rotavirus vaccine uptake by 1.7 times (95% confidence interval [CI] = 1.49–1.97) or by 33 percent-points (from 48% to 81% uptake). Provision of key rotavirus information with vaccination reminders (intervention group 1 relative to control group) and removal of financial barrier (intervention group 2 relative to intervention group 1) increased uptake by 1.17 times (95% CI = 0.99–1.38) or 8 percent-points, and by 1.46 times (95% CI = 1.29–1.66) or 25 percent-points, respectively.</p></div><div><h3>Interpretation</h3><p>A multiple-component intervention package, and in particular providing free vaccine, could increase the uptake of rotavirus vaccine in Hong Kong children. The impact of the intervention package was greatest in low-income families, emphasising the importance of removing financial barriers to vaccination to promote equity. Incorporating rotavirus vaccine into the routine CIP could further protect more young children from rotavirus infection and improve equity.</p></div><div><h3>Funding</h3><p>This work was supported by the Health and <span>Medical Research Fund</span> by the <span>Health Bureau</span>, <span>Government of Hong Kong SAR</span> [Ref.: 19180202].</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"50 ","pages":"Article 101153"},"PeriodicalIF":7.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001470/pdfft?md5=bafcd7dcbf1b5c497975d55cd35a0f1d&pid=1-s2.0-S2666606524001470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961186","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101150
Yunfei Liu , Youxin Wang , Yunfei Xing , Maike Wolters , Di Shi , Pingping Zhang , Jiajia Dang , Ziyue Chen , Shan Cai , Yaqi Wang , Jieyu Liu , Xinxin Wang , Haoyu Zhou , Miao Xu , Lipo Guo , Yuanyuan Li , Jieyun Song , Jing Li , Yanhui Dong , Yanchun Cui , Yi Song
<div><h3>Background</h3><p>The prevalence of metabolic-associated steatotic liver disease (MASLD) is rising precipitously among children, particularly in regions or countries burdened with high prevalence of obesity. However, identifying those at high risk remains a significant challenge, as the majority do not exhibit distinct symptoms of MASLD. There is an urgent need for a widely accepted non-invasive predictor to facilitate early disease diagnosis and management of the disease. Our study aims to 1) evaluate and compare existing predictors of MASLD, and 2) develop a practical screening strategy for children, tailored to local prevalence of obesity.</p></div><div><h3>Methods</h3><p>We utilized a school-based cross-sectional survey in Beijing as the training dataset to establish predictive models for screening MASLD in children. An independent school-based study in Ningbo was used to validate the models. We selected the optimal non-invasive MASLD predictor by comparing logistic regression model, random forest model, decision tree model, and support vector machine model using both the Beijing and Ningbo datasets. This was followed by serial testing using the best performance index we identified and indices from previous studies. Finally, we calculated the potential MASLD screening recommendation categories and corresponding profits based on national and subnational obesity prevalence, and applied those three categories to 200 countries according to their obesity prevalence from 1990 to 2022.</p></div><div><h3>Findings</h3><p>A total of 1018 children were included (N<sub>Beijing</sub> = 596, N<sub>Ningbo</sub> = 422). The logistic regression model demonstrated the best performance, identifying the waist-to-height ratio (WHtR, cutoff value ≥0.48) as the optimal noninvasive index for predicting MASLD, with strong performance in both training and validation set. Additionally, the combination of WHtR and lipid accumulation product (LAP) was selected as an optimal serial test to improve the positive predictive value, with a LAP cutoff value of ≥668.22 cm × mg/dL. Based on the obesity prevalence among 30 provinces, three MASLD screening recommendations were proposed: 1) “Population-screening-recommended”: For regions with an obesity prevalence ≥12.0%, where MASLD prevalence ranged from 5.0% to 21.5%; 2) “Resources-permitted”: For regions with an obesity prevalence between 8.4% and 12.0%, where MASLD prevalence ranged from 2.3% to 4.4%; 3) “Population-screening-not-recommended”: For regions with an obesity prevalence <8.4%, where MASLD prevalence is difficult to detect using our tool. Using our proposed cutoff for screening MASLD, the number of countries classified into the “Population-screening-recommended” and “Resources-permitted” categories increased from one and 11 in 1990 to 95 and 28 in 2022, respectively.</p></div><div><h3>Interpretation</h3><p>WHtR might serve as a practical and accessible index for predicting pediatric MASLD. A WHtR value ≥0
{"title":"Establish a noninvasive model to screen metabolic dysfunction-associated steatotic liver disease in children aged 6–14 years in China and its applications in high-obesity-risk countries and regions","authors":"Yunfei Liu , Youxin Wang , Yunfei Xing , Maike Wolters , Di Shi , Pingping Zhang , Jiajia Dang , Ziyue Chen , Shan Cai , Yaqi Wang , Jieyu Liu , Xinxin Wang , Haoyu Zhou , Miao Xu , Lipo Guo , Yuanyuan Li , Jieyun Song , Jing Li , Yanhui Dong , Yanchun Cui , Yi Song","doi":"10.1016/j.lanwpc.2024.101150","DOIUrl":"10.1016/j.lanwpc.2024.101150","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of metabolic-associated steatotic liver disease (MASLD) is rising precipitously among children, particularly in regions or countries burdened with high prevalence of obesity. However, identifying those at high risk remains a significant challenge, as the majority do not exhibit distinct symptoms of MASLD. There is an urgent need for a widely accepted non-invasive predictor to facilitate early disease diagnosis and management of the disease. Our study aims to 1) evaluate and compare existing predictors of MASLD, and 2) develop a practical screening strategy for children, tailored to local prevalence of obesity.</p></div><div><h3>Methods</h3><p>We utilized a school-based cross-sectional survey in Beijing as the training dataset to establish predictive models for screening MASLD in children. An independent school-based study in Ningbo was used to validate the models. We selected the optimal non-invasive MASLD predictor by comparing logistic regression model, random forest model, decision tree model, and support vector machine model using both the Beijing and Ningbo datasets. This was followed by serial testing using the best performance index we identified and indices from previous studies. Finally, we calculated the potential MASLD screening recommendation categories and corresponding profits based on national and subnational obesity prevalence, and applied those three categories to 200 countries according to their obesity prevalence from 1990 to 2022.</p></div><div><h3>Findings</h3><p>A total of 1018 children were included (N<sub>Beijing</sub> = 596, N<sub>Ningbo</sub> = 422). The logistic regression model demonstrated the best performance, identifying the waist-to-height ratio (WHtR, cutoff value ≥0.48) as the optimal noninvasive index for predicting MASLD, with strong performance in both training and validation set. Additionally, the combination of WHtR and lipid accumulation product (LAP) was selected as an optimal serial test to improve the positive predictive value, with a LAP cutoff value of ≥668.22 cm × mg/dL. Based on the obesity prevalence among 30 provinces, three MASLD screening recommendations were proposed: 1) “Population-screening-recommended”: For regions with an obesity prevalence ≥12.0%, where MASLD prevalence ranged from 5.0% to 21.5%; 2) “Resources-permitted”: For regions with an obesity prevalence between 8.4% and 12.0%, where MASLD prevalence ranged from 2.3% to 4.4%; 3) “Population-screening-not-recommended”: For regions with an obesity prevalence <8.4%, where MASLD prevalence is difficult to detect using our tool. Using our proposed cutoff for screening MASLD, the number of countries classified into the “Population-screening-recommended” and “Resources-permitted” categories increased from one and 11 in 1990 to 95 and 28 in 2022, respectively.</p></div><div><h3>Interpretation</h3><p>WHtR might serve as a practical and accessible index for predicting pediatric MASLD. A WHtR value ≥0","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101150"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001445/pdfft?md5=6a41c9baf6e0d05c574b73204ef7f919&pid=1-s2.0-S2666606524001445-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959662","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101159
Jojo Qian Hui Nah , Sharna Si Ying Seah , Lian Leng Low , Kheng Hock Lee
In 2019, SingHealth Community Hospitals (SCH) introduced Social Prescribing (SP) program to support patients in transitioning back to the community after hospitalization, which involves personalized care plans developed by Wellbeing Coordinators (WBCs) to connect patients with relevant community resources. With the recent launch of the nation-wide ‘Healthier SG’ initiative, a population health strategy in Singapore aimed at enabling individuals to prevent and manage chronic diseases, it is important to provide an update on our program's recent developments. This includes creating a living asset map, updating outcome assessment tools, organizing training sessions to enhance the skills SP practitioners, and establishing the Singapore Community of Practice in Social Prescribing (SCOMP).
{"title":"Advancing social prescribing in Singapore: an update on progress","authors":"Jojo Qian Hui Nah , Sharna Si Ying Seah , Lian Leng Low , Kheng Hock Lee","doi":"10.1016/j.lanwpc.2024.101159","DOIUrl":"10.1016/j.lanwpc.2024.101159","url":null,"abstract":"<div><p>In 2019, SingHealth Community Hospitals (SCH) introduced Social Prescribing (SP) program to support patients in transitioning back to the community after hospitalization, which involves personalized care plans developed by Wellbeing Coordinators (WBCs) to connect patients with relevant community resources. With the recent launch of the nation-wide ‘Healthier SG’ initiative, a population health strategy in Singapore aimed at enabling individuals to prevent and manage chronic diseases, it is important to provide an update on our program's recent developments. This includes creating a living asset map, updating outcome assessment tools, organizing training sessions to enhance the skills SP practitioners, and establishing the Singapore Community of Practice in Social Prescribing (SCOMP).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101159"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001536/pdfft?md5=4ad280865dad276cde1c28b120519522&pid=1-s2.0-S2666606524001536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963051","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101174
Haoliang Cui , Shijing Shen , Lin Chen , Zhiyu Fan , Qian Wen , Yiwen Xing , Zekun Wang , Jianyi Zhang , Jingyuan Chen , Bin La , Yujie Fang , Zeping Yang , Shuhan Yang , Xiangyu Yan , Shaojun Pei , Tao Li , Xiaoming Cui , Zhongwei Jia , Wuchun Cao
{"title":"Corrigendum to “Global epidemiology of severe fever with thrombocytopenia syndrome virus in human and animals: a systematic review and meta-analysis” [The Lancet Regional Health - Western Pacific, Volume: 48 (2024) 101133]","authors":"Haoliang Cui , Shijing Shen , Lin Chen , Zhiyu Fan , Qian Wen , Yiwen Xing , Zekun Wang , Jianyi Zhang , Jingyuan Chen , Bin La , Yujie Fang , Zeping Yang , Shuhan Yang , Xiangyu Yan , Shaojun Pei , Tao Li , Xiaoming Cui , Zhongwei Jia , Wuchun Cao","doi":"10.1016/j.lanwpc.2024.101174","DOIUrl":"10.1016/j.lanwpc.2024.101174","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101174"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001688/pdfft?md5=b4e77a605ed1cb436104d4be3403cc7d&pid=1-s2.0-S2666606524001688-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021234","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101190
The Lancet Regional Health – Western Pacific
{"title":"Context matters: physical activity in the Western Pacific region","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2024.101190","DOIUrl":"10.1016/j.lanwpc.2024.101190","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101190"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001846/pdfft?md5=573418bf6d4731feab650dcfa1f96135&pid=1-s2.0-S2666606524001846-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095697","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101142
Adrienne O’Neil , Joahna Perez , Lauren M. Young , Tayla John , Megan Turner , Dean Saunders , Sophie Mahoney , Marita Bryan , Deborah N. Ashtree , Felice N. Jacka , Courtney Bruscella , Megan Pilon , Mohammadreza Mohebbi , Megan Teychenne , Simon Rosenbaum , Rachelle Opie , Meghan Hockey , Lucija Peric , Samantha De Araugo , Khyati Banker , Mary Lou Chatterton
<div><h3>Background</h3><p>We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing.</p></div><div><h3>Methods</h3><p>An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021–April 2022, 182 adults with a Distress Questionnaire-5 score = ≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n = 91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n = 91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs).</p></div><div><h3>Findings</h3><p>The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n = 132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n = 70) mean difference:−3.97, 95% CIs:−5.10, −2.84; and Psychotherapy (n = 62): mean difference:−3.74, 95% CIs:−5.12, −2.37; ITT: Lifestyle (n = 91) mean difference:−4.42, 95% CIs: −4.59, −4.25; Psychotherapy (n = 91) mean difference:−3.82, 95% CIs:−4.05, −3.69) with evidence of non-inferiority (PP GEE β:−0.59; 95% CIs:−1.87, 0.70, n = 132; ITT GEE β:−0.49, 95% CIs:−1.73, 0.75, n = 182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs −$182, $611, ITT AUD$190 [95% CIs −$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:−$222, $1152] ITT AUD$ 408 [95% CIs −$139, $1157].</p></div><div><h3>Interpretation</h3><p>Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists.</p></div><div><h3>Funding</h3><p>This trial was funded by the <span>Australian Medical Research Future Fund</span> (<span><span>GA133346</span></span>) under its Covid-19 Mental Health Research Grant Sche
{"title":"Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial","authors":"Adrienne O’Neil , Joahna Perez , Lauren M. Young , Tayla John , Megan Turner , Dean Saunders , Sophie Mahoney , Marita Bryan , Deborah N. Ashtree , Felice N. Jacka , Courtney Bruscella , Megan Pilon , Mohammadreza Mohebbi , Megan Teychenne , Simon Rosenbaum , Rachelle Opie , Meghan Hockey , Lucija Peric , Samantha De Araugo , Khyati Banker , Mary Lou Chatterton","doi":"10.1016/j.lanwpc.2024.101142","DOIUrl":"10.1016/j.lanwpc.2024.101142","url":null,"abstract":"<div><h3>Background</h3><p>We conducted the first non-inferiority, randomised controlled trial to determine whether lifestyle therapy is non-inferior to psychotherapy with respect to mental health outcomes and costs when delivered via online videoconferencing.</p></div><div><h3>Methods</h3><p>An individually randomised, group treatment design with computer-generated block randomisation was used. Between May 2021–April 2022, 182 adults with a Distress Questionnaire-5 score = ≥8 (indicative depression) were recruited from a tertiary mental health service in regional Victoria, Australia and surrounds. Participants were assigned to six 90-min sessions over 8-weeks using group-based, online videoconferencing comprising: (1) lifestyle therapy (targeting nutrition, physical activity) with a dietitian and exercise physiologist (n = 91) or (2) psychotherapy (Cognitive Behavioural Therapy) with psychologists (n = 91). The primary outcome was Patient Health Questionnaire-9 (PHQ-9) depression at 8-weeks (non-inferiority margin ≤2) using Generalised Estimating Equations (GEE). Cost-minimisation analysis estimated the mean difference in total costs from health sector and societal perspectives. Outcomes were assessed by blinded research assistants using Computer Assisted Telephone Interviews. Results are presented per-protocol (PP) and Intention to Treat (ITT) using beta coefficients with 95% Confidence Intervals (CIs).</p></div><div><h3>Findings</h3><p>The sample was 80% women (mean: 45-years [SD:13.4], mean PHQ-9:10.5 [SD:5.7]. An average 4.2 of 6 sessions were completed, with complete data for n = 132. Over 8-weeks, depression reduced in both arms (PP: Lifestyle (n = 70) mean difference:−3.97, 95% CIs:−5.10, −2.84; and Psychotherapy (n = 62): mean difference:−3.74, 95% CIs:−5.12, −2.37; ITT: Lifestyle (n = 91) mean difference:−4.42, 95% CIs: −4.59, −4.25; Psychotherapy (n = 91) mean difference:−3.82, 95% CIs:−4.05, −3.69) with evidence of non-inferiority (PP GEE β:−0.59; 95% CIs:−1.87, 0.70, n = 132; ITT GEE β:−0.49, 95% CIs:−1.73, 0.75, n = 182). Three serious adverse events were recorded. While lifestyle therapy was delivered at lower cost, there were no differences in total costs (health sector adjusted mean difference: PP AUD$156 [95% CIs −$182, $611, ITT AUD$190 [95% CIs −$155, $651] ]; societal adjusted mean difference: PP AUD$350 [95% CIs:−$222, $1152] ITT AUD$ 408 [95% CIs −$139, $1157].</p></div><div><h3>Interpretation</h3><p>Remote-delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes. If replicated in a fully powered RCT, this approach could increase access to allied health professionals who, with adequate training and guidelines, can deliver mental healthcare at comparable cost to psychologists.</p></div><div><h3>Funding</h3><p>This trial was funded by the <span>Australian Medical Research Future Fund</span> (<span><span>GA133346</span></span>) under its Covid-19 Mental Health Research Grant Sche","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101142"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001366/pdfft?md5=501a59b0063a5e118bdec8721f641dea&pid=1-s2.0-S2666606524001366-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095698","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 : 2024-08-01DOI: 10.1016/j.lanwpc.2024.101155
Tania L. King , Ludmila Fleitas Alfonzo , Anthony D. LaMontagne , Humaira Maheen
{"title":"Variations in suicide rates among Australian male construction workers by country of birth","authors":"Tania L. King , Ludmila Fleitas Alfonzo , Anthony D. LaMontagne , Humaira Maheen","doi":"10.1016/j.lanwpc.2024.101155","DOIUrl":"10.1016/j.lanwpc.2024.101155","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"49 ","pages":"Article 101155"},"PeriodicalIF":7.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001494/pdfft?md5=bbd64a568bb00f3b62a142cc04bcf3f7&pid=1-s2.0-S2666606524001494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950165","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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