Factors In Asia Research Articles

Liver Cancer Etiology: Old Issues and New Perspectives.

This review aims to synthesize the old issues and current understandings of the etiology of liver cancer, focusing on the diverse causative factors influenced by geographical, socioeconomic, and lifestyle variations across different regions. We highlight significant geographic disparities in liver cancer risk factors. While hepatitis B and C viruses, aflatoxin exposure, and alcohol consumption remain globally established contributors; metabolic dysfunction-associated steatotic liver disease and metabolic syndromes are increasingly prominent in the West. Chronic HBV and aflatoxin continue to dominate as risk factors in Asia and Africa. Dietary factors, metabolic diseases like diabetes and obesity, genetic predispositions, environmental risk factors and lifestyle choices such as smoking and alcohol use play substantial roles in specific populations. Protective factors like coffee and tea consumption, along with aspirin use, vegetables and fruits have shown potential in reducing HCC risk, although findings vary by population and dietary habits. Liver cancer etiology is influenced by various factors that differ by region. Established risk factors include hepatitis B and C, aflatoxin, and alcohol. Emerging risks, such as metabolic dysfunction-associated steatotic liver disease, are more prevalent in Western countries, while aflatoxin and HBV remains significant in Asia and Africa. Diet, metabolic conditions like diabetes and obesity, genetic predispositions, and lifestyle choices also play crucial roles. Coffee, tea, aspirin, vegetables, and fruits may reduce HCC risk, but effectiveness varies. Future research should integrate epidemiology, genetics, and nutrition, with global cooperation and data sharing essential for effective cancer control strategies.

Hepatocellular Carcinoma in Asia: Physician and Patient Perspectives on Surveillance, Diagnosis, and Treatment

PurposeIn several Asian countries, hepatocellular carcinoma (HCC) is a leading cause of cancer deaths. HCC risk factors in Asia differ from those elsewhere and are changing with the treatment landscape as systemic treatment options increase. This study was conducted to gain insight from physicians and patients into HCC screening, diagnosis, and treatment strategies in Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand, and Vietnam.MethodsTwo cross-sectional, anonymized, online surveys were completed between July and December 2022 by physicians diagnosing and treating HCC (55 questions on risk factors, surveillance, diagnosis, and treatment) and patients ≥ 18 years old diagnosed with HCC (36 questions on disease knowledge, quality of life, and experiences of diagnosis and treatment).ResultsResponses were received from 276 physicians in all 7 countries and 130 patients in Thailand, Taiwan, and Vietnam. From the physician’s perspective, surveillance programs are widespread but identify insufficient HCC cases; only 18% are early-stage HCC at diagnosis. From the patient’s perspective, knowledge of risk factors increases after diagnosis, but few seek support from patient associations; patients would benefit from better communication from their doctors. Treatment affordability and side effects are key issues for patients.ConclusionsAwareness of the risk factors for HCC should be raised in primary care and the general population, and surveillance should identify early-stage HCC. Because patients rely on their doctors for support, doctors should better understand their patients’ needs, and patients could be supported by trained nurses or case managers. Programs are needed to increase patients’ access to proven HCC treatments.

S-20-4: HYPERTENSION AND CARDIOVASCULAR DISEASE IN ASIA

Being the most populous continent in the world, consisting of around 60% of the global population, Asia shoulders a big brunt of the hypertension and cardiovascular disease (CVD) burden in the world. Just as it is in the rest of world, hypertension remains a major modifiable risk factor in Asia for stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral arterial disease; and it is a dominant risk factor implicated for cardiovascular deaths causing premature death in the region. There is generally a stronger association between elevated blood pressure (BP) and stroke than with coronary artery disease (CAD), although CAD is reported as the most dominant cause of CVD deaths in Central, Western, and Southern Asia, while stroke deaths is more common than CAD deaths in Eastern and Southeastern Asia. Of the estimated 1.13 billion people worldwide with elevated BP, around 66% live in low and middle income countries, which consist the majority of countries in Asia. In Southeast Asia (SEA), the prevalence of hypertension in the adult population is nearing 35%, and to this has been attributed the close to 1.5 million deaths in the region annually. Hypertension awareness, treatment and control remain a challenge in Asia. Awareness level is less than 50% in most countries in Asia, though it is higher (56 70%) in the higher income countries in the region. Treatment rates are generally 25% to 30% of the hypertensive population, but control rates to BP levels below 140/90 mmHg, are still dismally low. The comparatively high dietary salt intake in the region, aggravating the salt sensitive phenotype characterizing Asian hypertension is implicated as a significant risk factor leading to poor hypertension control and a relatively increased rates of strokes in the region. Salt intake ranges from 10to17 grams a day, which is 2to3 times higher compared to the 5 grams (approximately 2 grams of sodium) recommended daily salt consumption by the World Health Organization. Because of the socioeconomic, educational and cultural heterogeneity of the countries comprising Asia, the region appears to be in different transition stages of the CVD epidemic. This highlights the challenge in mapping out a one size fits all strategy in curbing hypertension and CVD in Asia. Individualized prevention and treatment strategies factoring the differing capacities for management, prevalence of unhealthy diet especially increased salt intake, smoking, obesity, hypertension, dyslipidemia, and diabetes, as well as the impact of population aging must be considered.

An evidence review and nutritional conceptual framework for pre-eclampsia prevention.

Pre-eclampsia is a serious complication of pregnancy, and maternal nutritional factors may play protective roles or exacerbate risk. The tendency to focus on single nutrients as a risk factor obscures the complexity of possible interactions, which may be important given the complex nature of pre-eclampsia. An evidence review was conducted to compile definite, probable, possible and indirect nutritional determinants of pre-eclampsia to map a nutritional conceptual framework for pre-eclampsia prevention. Determinants of pre-eclampsia were first compiled through an initial consultation with experts. Second, an expanded literature review was conducted to confirm associations, elicit additional indicators and evaluate evidence. The strength of association was evaluated as definite relative risk (RR) < 0·40 or ≥3·00, probable RR 0·40-0·69 or 1·50-2·99, possible RR 0·70-0·89 or 1·10-1·49 or not discernible RR 0·90-1·09. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation. Twenty-five nutritional factors were reported in two umbrella reviews and twenty-two meta-analyses. Of these, fourteen were significantly associated with pre-eclampsia incidence. Higher serum Fe emerged as a definite nutritional risk factors for pre-eclampsia incidence across populations, while low serum Zn was a risk factor in Asia and Africa. Maternal vitamin D deficiency was a probable risk factor and Ca and/or vitamin D supplementation were probable protective nutritional factors. Healthy maternal dietary patterns were possibly associated with lower risk of developing pre-eclampsia. Potential indirect pathways of maternal nutritional factors and pre-eclampsia may exist through obesity, maternal anaemia and gestational diabetes mellitus. Research gaps remain on the influence of household capacities and socio-cultural, economic and political contexts, as well as interactions with medical conditions.

Relationship between green tea drinking and the risk of colorectal cancer; a systematic review and meta-analysis

Introduction: Green tea drinking is one of the traditional methods to prevent colorectal cancer (CRC). The present study proposes a systematic review and meta-analysis approach to investigate the relationship between green tea drinking and CRC risk. Materials and Methods: The literature survey has been carried out using the previously published studies in the Google Scholar search engine and various electronic databases, including Scopus, Cochrane, Web of Science, Embase, and PubMed. The review process has continued until July 13, 2021. Besides, the Q test and I2 index were employed to evaluate the heterogeneity of the studies. STATA 14 software has been conducted to analyze the gathered dataset. It is essential to note that the significance level for statistical tests was set to 5% (P value &lt; 0.05). Results: The results of 18 studies accomplished on 44,992 patients aged 19-80 years have been used to compute the relative risk of green tea consumption in CRC (OR [odds ratio] = 0.99; 95% CI: 0.83-1.18), colon (OR=0.97; 95% CI: 0.85-1.10), and rectum (OR=1; 95% CI: 0.86-1.16). Although green tea consumption was a protective factor in Asia and the United States, it was considered a risk factor in Australia. The general population studies classified green tea as a risk factor for CRC, while hospital studies considered this product as a protective factor. Conclusion: The findings showed that green tea had the most significant effect on reducing the colon cancer risk, while it had the minimum influence on CRC. Additionally, it did not affect rectal cancer. It is essential to note that these relationships were not statistically significant. Registration: The current protocol was also registered on PROSPERO (#CRD42021276257, https://www.crd.york. ac.uk/prospero/display_record.php?ID=CRD42021276257).

Prognostic Outcomes in Acute Myocardial Infarction Patients Without Standard Modifiable Risk Factors: A Multiethnic Study of 8,680 Asian Patients.

BackgroundAn increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population.MethodsWe recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan–Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality.ResultsStandard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney disease, but higher rates of ventricular arrhythmias and inotropic or invasive ventilation requirement. Multivariable analysis showed higher rates of cardiovascular mortality (HR 1.48, 95% CI: 1.09–1.86, p = 0.048), cardiogenic shock (RR: 1.31, 95% CI: 1.09–1.52, p = 0.015), and stroke (RR: 2.51, 95% CI: 1.67–3.34, p = 0.030) among SMuRF-less patients. A 30-day cardiovascular mortality was raised in the SMuRF-less group, with similar trends in men, patients with ST-segment elevation myocardial infarction (STEMI), and the three Asian ethnicities. All-cause mortality remains increased in the SMuRF-less group for up to 5 years.ConclusionThere is a significant proportion of patients with AMI without standard risk factors in Asia, who have worse short-term mortality. This calls for greater focus on the management of this unexpectedly high-risk subgroup of patients.

Long-term variation of CO2 flux and the controlling factors in Asia’s largest brackish water system, Chilika Lake

Long-term variation of CO2 flux and the controlling factors in Asia’s largest brackish water system, Chilika Lake

Asian population may have a lower incidence of hip osteonecrosis in childhood acute lymphoblastic leukemia.

Osteonecrosis (ON), a long-term complication of acute lymphoblastic leukemia (ALL) treatment affects patients' quality of life. Although the incidence of any ON, including asymptomatic, was 21.7% among children with ALL in the U.S., the actual incidence and risk factors in Asia remain unknown. For over 11 years, we performed hip magnetic resonance imaging (MRI) screening to detect asymptomatic ON while initiating maintenance chemotherapy in newly diagnosed children with ALL. Overall, 164 of 175 patients underwent hip MRI screening. The incidence of symptomatic or any ON was 3.0% and 11.6%, respectively. Asymptomatic ON in patients < 10 and ≥ 10 years old was 4.0% and 35.9%, respectively (P < 0.001). In multivariate analysis, age ≥ 10 years was the only significant risk factor. Asymptomatic ON with necrosis of > 30% of the epiphyseal surface of the femoral head was detected in four patients (2.4%). All were ≥ 10 years. Three of them progressed to severe symptomatic ON. The incidence of any ON in Asia may be lower than that seen in the only screening study in the U.S. Future studies should clarify factors affecting such regional differences and develop an effective approach to avoid the progression of ON in children with ALL.

Integrated Model To Analyze FDI Role In Success of Commercialization of High-Tech Innovations in Asia

This study aims to analyze the role of FDI in the success of commercialization high tech innovation in Asia countries. The success was marked by the increasing contribution from Asia countries to the export value of high tech products in the world. &#x0D; From 49 sovereign countries in Asia, 21 countries have been selected as research samples. The result SEM analysis shows that FDI inflows to Asia countries generally pure investment from multinational companies to gain profits from the low cost of production factor in Asia, therefore increase their profit margin. &#x0D; In other words, FDI in Asia countries only increase production quantity of high tech products without increasing innovation activity in the countries, which innovation activity can be measured by R&amp;D expenditure, number of resident patent application and number of scientific journals international publication.

Exchange rate movements in emerging economies - Global vs regional factors in Asia

The aim of this article is to analyse the main determinants of emerging markets' exchange rate movements, particularly in Asia. For this purpose, we implement a dynamic latent factor model to investigate the drivers of 24 emerging countries' exchange rate movements and decompose the patterns into three components: a global common factor, a regional factor and a country-specific factor. Our results reveal that, in the whole period of 2000–2015, the common global factor is by far the most important determinant of exchange rate variations for Asian economies and, albeit to a lesser extent, for Latin America. However, after 2005, there is a strong increase in the explanatory power of the regional factor in Asia, from 5.6% to 45.1%, and to 49.7% in the period of 2011–2015, which shows that it is becoming the dominant factor in this area. Then, we use a Vector Autoregressive (VAR) model and an Autoregressive Distributed Lag (ARDL) model to show that the regional factor in Asia, estimated from the dynamic latent factor model, is mainly explained by Chinese economic variables. More particularly, our results highlight that the bilateral exchange rate of China, both the onshore and the offshore rates, and the macroeconomic climate in China greatly influence the regional factor in Asia in the long-run. These results give some evidence of a Renminbi zone in the long-run and are robust to the inclusion of two other major currencies in Asia, the Japanese Yen and the Korean Won, notably in the long run.

Second Asian Consensus on Irritable Bowel Syndrome.

Background/AimsThere has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus.MethodsKey opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method.ResultsThirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy.ConclusionsOur consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.

Diabetes, arthritis, urinary incontinence, poor self-rated health, higher body mass index and lower handgrip strength are associated with falls among community-dwelling middle-aged and older adults: Pooled analyses from two cross-sectional Malaysian datasets.

The identification of risk factors associated with comorbidities and physical fitness might provide pathways for planning therapeutic targets for future falls prevention. Results from large datasets that examined falls risk factors in Asia have been limited. The aim of the present study was to identify the risk factors for falls by pooling data consisting of medical history, physical performance and self-rated health from two large Malaysian epidemiological studies. Matching variables from the Towards Useful Aging and Malaysian Elders Longitudinal Research datasets related to falls, physical performance and determinants of falls were identified and pooled for analysis. The Timed Up and Go test and dominant handgrip strength tests were used as physical performance measures. Falls were self-reported, and functional status was assessed using activities of daily living. Data of 3935 participants, mean age 68.9 ± 6.8 years, 2127 (54.0%) women and 1807 (46.0%) men were extracted for analyses. In an adjusted model, independent risk factors for falls from this cohort studies were diabetes (OR 1.258), arthritis (OR 1.366), urinary incontinence (OR 1.346), poor self-rated health (OR 1.293), higher body mass index (OR 1.029) and lower handgrip strength (OR 1.234). Although the risk factors that emerged from our analyses were similar to available studies among older adults, the Timed Up and Go test did not appear as one of the risk factors in the present study that included middle-aged adults. Our findings will require confirmation in a prospective study. Geriatr Gerontol Int 2019; 19: 798-803.

Global Epidemiology of Mucormycosis.

Mucormycosis is an angio-invasive fungal infection, associated with high morbidity and mortality. A change in the epidemiology of mucormycosis has been observed in recent years with the rise in incidence, new causative agents and susceptible population. The rise has been perceived globally, but it is very high in the Asian continent. Though diabetes mellitus overshadow all other risk factors in Asia, post-tuberculosis and chronic renal failure have emerged as new risk groups. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis in patients with haematological malignancy and transplant recipients. In immunocompetent hosts, cutaneous mucormycosis is commonly seen following trauma. The intriguing clinical entity, isolated renal mucormycosis in immunocompetent patients is only reported from China and India. A new clinical entity, indolent mucormycosis in nasal sinuses, is recently recognized. The causative agents of mucormycosis vary across different geographic locations. Though Rhizopus arrhizus is the most common agent isolated worldwide, Apophysomyces variabilis is predominant in Asia and Lichtheimia species in Europe. The new causative agents, Rhizopus homothallicus, Mucor irregularis, and Thamnostylum lucknowense are reported from Asia. In conclusion, with the change in epidemiology of mucormycosis country-wise studies are warranted to estimate disease burden in different risk groups, analyse the clinical disease pattern and identify the new etiological agents.

Whole genome sequencing of matched tumor, adjacent non-tumor tissues and corresponding normal blood samples of hepatocellular carcinoma patients revealed dynamic changes of the mutations profiles during hepatocarcinogenesis.

Hepatocellular carcinoma (HCC) has become the third most deadly disease worldwide and HBV is the major factor in Asia and Africa. We conducted 9 WGS (whole genome sequencing) analyses for matched samples of tumor, adjacent non-tumor tissues and normal blood samples of HCC patients from three HBV positive patients. We then validated the mutations identified in a larger cohort of 177 HCC patients. We found that the number of the unique somatic mutations (average of 59,136) in tumor samples is significantly less than that in adjacent non-tumor tissues (average 83, 633). We discovered that the TP53 R249S mutation occurred in 7.7% of the HCC patients, and it was significantly associated with poor diagnosis. In addition, we found that the L104P mutation in the VCX gene (Variable charge, X-linked) was absent in white blood cell samples, but present at 11.1% frequency in the adjacent tissues and increased to 14.6% in HCC tissues, suggesting that this mutation might be a tumor driver gene driving HCC carcinogenesis. Finally, we identified a TK1-RNU7 fusion, which would result in a deletion of 103 amino acids from its C-terminal. The frequencies of this fusion event decreased from the adjacent tissues (29.2%) to the tumors (16.7%), suggesting that a truncated thymidine Kinase1 (TK1) caused by the fusion event might be deleterious and be selected against during tumor progression. The three-way comparisons allow the identification of potential driver mutations of carcinogenesis. Furthermore, our dataset provides the research community a valuable dataset for identifying dynamic changes of mutation profiles and driver mutations for HCC.

Salacia Extract Improves Post‐Prandial Glucose and Insulin Response: A Randomized Double Blind, Placebo‐Controlled, Cross‐over Study in Healthy Volunteers

Extracts of Salacia species from roots, stems, and leaves have been used for the treatment of diabetes and other associated risk factors in Asia. Studies indicate that Salacia extracts modulate multiple targets that influence carbohydrate and lipid metabolism. This study is to examine the effect of differing doses of a novel form of Salacia extract (SE) on glucose and insulin response to an oral sucrose load in healthy individuals (South Asian Population). Thirty five (N=35, 18 to 55 years of age; BMI ≥24.50 to 29.50 Kg/m2) adult healthy individuals (male and female)were randomly assigned to ingest SE at dosages of 200 mg SE, 300 mg SE and 500 mg (OmniLeanTM) or placebo (PLA) in a single center, double‐blind, randomized, placebo controlled parallel design. Plasma glucose and plasma insulin responses were measured after 0, 30, 60, 90, 120, 180 min of ingesting oral sucrose standard solution and Area under curve for glucose (AUCglucose) and insulin response (AUCinsulin) was calculated. ANOVA and paired t‐tests were used to examine differences between treatments and over baseline. Compared with PLA, SE 500 mg significantly lowered blood sugars and insulin from 60 minutes, 90 minutes and 120 minutes, SE 300 mg significantly lower at 90 min and 180 min and 200 mg at 90 min and 120 minutes. AUCglucose was not significant. Plasma insulin levels and AUCinsulin were significantly lowered after ingestion of SE. No significant adverse events were observed at any dose. Thus, in reducing the early rise in blood glucose and insulin after sucrose ingestion, Salacia extract (SE) prevents the occurrence of reactive hypoglycemia; the present study confirm that this nutritional ingredient may be of value in reducing post prandial insulin and glucose.Support or Funding InformationOmniActive Health Technologies Ltd., Mumbai, India

Modeling Asia's Child Mortality Rate: A Thinking of Human Development in Asia

Abstract Multiple linear regression model was employed to model child under age of five mortality rate and related factors in Asia of year 2010. Data analysis was carried out to find factors which influence the child mortality in Asia. Correlation analysis was done to check on the relationship among all the variables, as well as to identify the problem of multicollinearity in the data. Having fitted multiple linear regression, it was found that mortality rate of children under age of five in Asia countries are significantly influenced by percentage of case detection for all forms of tuberculosis, number of reported deaths on measles, number of population using an improved drinking water source, and number of birth trauma reported. Among those variable, it was identified that number of population using an improved drinking water source is the most important factor.

Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD.

Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003-2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/μl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31-40, 41-50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31-1.88; OR = 2.01, 95% CI 1.58-2.56; and OR = 1.69, 95% CI 1.23-2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42-3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35-0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36-0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care.

The Global Challenge to Reduce Cardiovascular Disease by 25% by 2025

This article discusses the increasing global burden of cardiovascular disease and highlights key risk factors in Asia in particular. It also discusses some important interventions that have been initiated in order to reach the World Heart Federation’s goal of a 25% reduction in premature deaths from cardiovascular disease by 2025.

Housing Demand Factors and Implications for Sustainable Housing in Asia: A Retrospective

Housing demand studies have been conducted since the 1970s. However, this research has lagged that of sustainability in housing & the standards founded to guide sustainable housing development, especially in Asia. While direct comparisons to sustainable building standards are non-existent, many studies allude to attributes highlighted in sustainable building standards as a factor influencing housing demand. This study is the first to review previous studies on housing demand factors in Asia, specifically those dealing with the characteristics of sustainable standards. It is found that sustainable structural variables have positive marginal effects on housing demand, sustainable neighbourhood variables have mixed effects, & sustainable locational variables have positive effects analogous to conventional variables. However, the exact extent to which home buyers are willing to pay for particular features in sustainable housing remains ambiguous. Therefore, to encourage the uptake of sustainable building standards in the real estate industry, it is imperative that researchers conduct studies into the specific factors determining sustainable housing demand.

ASIA: A GOLDEN FUTURE STILL?

The author considers the validity of the widespread assumptions that Asia is on the path to unending growth and success and that the 21st century, will be Asia's century. In fact this success is relatively recent and restricted to a handful of countries rather than applying to Asia as a whole. For the future the main determinants of Asia's continuing prosperity will be thorough and far-reaching economic restructuring, improved governance, operating in a way which enables change rather than stifles it and the preservation of that peace and stability in the region which has been the single most important factor in Asia's renaissance hitherto. Continuing US involvement will be required. That said, there are reasonable grounds for confidence in the abilities of Asia and the Asians.