Western Pacific Region Research Articles

Prevalence of Chronic Obstructive Pulmonary Disease Exacerbation with Heart Failure Comorbid: A Systematic Review and Meta-Analysis

Heart Failure (HF) is one of the comorbidities in Chronic Obstructive Pulmonary Disease (COPD), associated with the incidence of respiratory tract infections which is a risk factor for COPD exacerbations. Eleven studies conducted in the meta-analysis. Pooled prevalence of COPD exacerbations with HF comorbidity was 29,43 % (95%CI:17,68%- 42,92%) and statistical heterogenity among the eleven studies was significant (I2 = 99,95%. Q = 191,96 p=<0,001). Eight studies were based in Europe, two studies in Americas and one study in Asia. Prevalence of COPD exacerbations with HF comorbidity based on WHO region subgroup analysis found European region 31,44% (95%CI: 17,87%-46,58%), America’s region 32,92% (95%CI: 12,61%-55,73%) and the Western Pacific region 10,86% (95%CI:10,03%- 13,21%) with significant statistical heterogeneity (I2 = 99,94%, Q = 191,96, p= <0,001). The age of exacerbating COPD patients with comorbid heart failure was above 70 years and there were differences in gender characteristics based on the two studies that reported. Statins reduce the incidence of COPD exacerbations. Differences in the risk of COPD exacerbation receiving Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker (ACEi/ARB) therapy. The most common comorbid cardiovascular disease apart from heart failure are atrial fibrillation and ischemic heart disease. As a conclusion, the pooled prevalence of COPD exacerbations with heart failure comorbid in this systematic review and meta-analysis was 29.43% (95% CI:17.68%-42.92%). Keywords: COPD exacerbation, Heart Failure, prevalence

Global trend of cervical cancer among women aged 55 and older from 2010 to 2019: An analysis by socio‐demographic index and geographic regions

AbstractObjectiveThis study describes the 2010–2019 trend of cervical cancer (CC) in women over 55 by socio‐demographic index (SDI) and geographical regions.MethodsWe obtained data on CC annually from 2010 to 2019 from the 2019 Global Burden of Disease Study (GBD) to analyze the incidence, death and prevalence rates, and disability‐adjusted life years (DALYs) associated with CC across different parameters such as global trend, age groups, SDI, continents, World Bank Regions, World Health Organization (WHO) regions, GBD regions, and National and territorial division. This analysis covers data from 204 countries and territories from 1990 to 2019.ResultsThere were 236,228 CC incidence cases worldwide in 2019, which is a 1.27‐fold increase from 2010. Global CC deaths also increased to 169,304 cases in 2019, reflecting a 1.24‐fold increase. CC prevalence increased to 769,925 cases in 2019, representing a 1.4‐fold rise. The number of CC DALYs globally increased to 3,835,979 cases in 2019, reflecting a 1.24‐fold increase. Incidence, death, prevalence, and DALY numbers of CC increased across all age groups females in the 65–69 years age group experienced the highest increase. Middle SDI countries had the highest incidence, death, prevalence, and DALY numbers, while low SDI countries showed increasing trends. Asia exhibited the highest incidence, death, prevalence, and DALY numbers of CC. Upper middle‐income countries had the highest incidence, death, prevalence, and DALY numbers, with the highest decreases in these rates except the prevalence rate. The Western Pacific Region showed the highest incidence, death, prevalence, and DALY numbers, with declining rate trends. The Republic of Kiribati showed the highest incidence, death, prevalence, and DALY numbers.ConclusionBased on the study results, it is clear that although the global trend of epidemiological indicators of CC is decreasing, the largest proportion of the decreasing trend is related to developing countries. But in regions of Africa and Asia that have a lower level of development, sometimes these indicators show upward trends, which shows the worsening of the problem in these regions and the need for serious policies and plans to implement comprehensive vaccination, screening, and promotion interventions. People's awareness is necessary in the field of better disease control.

8582 THE PREVALENCE OF POLYCYSTIC OVARY SYNDROME IN ADULT WOMEN: THE IMPACT OF GEOGRAPHIC REGION

Abstract Disclosure: M. Amiri: None. S. Hatoum: None. R.P. Buyalos: None. A. Sheidaei: None. R. Azziz: Consulting Fee; Self; Spruce Biosciences, May Health, Core Access Surgical Technologies, Acacia Bio, Fortress Biotech, and Rani Therapeutics. Stock Owner; Self; Martin Imaging. Background: Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age and is associated with various health complications. The reported prevalence of PCOS varies widely. However, variations in PCOS prevalence by geographic region are unclear. Objectives: This systematic review and meta-analysis aimed to compare PCOS prevalence in adults across World Health Organization (WHO) regions. Materials and methods: A search of PubMed and Embase was conducted for studies on PCOS prevalence in unselected populations published from inception to July 2023 using various diagnostic criteria. Studies were categorized according to: a) PCOS criteria (NIH 1990 [PCOS phenotypes A&B], AE-PCOS 2006 [PCOS phenotypes A-C], Rotterdam 2003 [PCOS phenotypes A-D], and ‘other/self-reported’ criteria); b) subject assessment type (direct assessment, survey/indirect assessment, or mixed assessment); and c) study quality, assessed using the PCOS Epidemiology and Phenotype (PEP) quality assessment tool. Meta-analyses were performed using fixed-effects or random-effects models depending on the heterogeneity among the studies. Publication bias was assessed using the Egger’s regression test and funnel plots. Subgroup analyses were conducted based on PCOS criteria, assessment types, study quality, and WHO region. Results: Of 6,644 records, 50 studies with including a total of 70,146 adult women (age ≥18 years) were included. The overall pooled prevalence of PCOS was 9.7% (95% CI: 8.25, 11.38) with a pooled PCOS prevalence by criteria of NIH 7.7% (95% CI: 6, 9.83), Rotterdam 11.83% (95% CI: 9.15, 15.17), AE-PCOS 11.48% (95% CI: 7.5, 17.18), and other/self-report 10.05% (95% CI: 6.63, 14.96). High-quality studies reported lower prevalences for Rotterdam and NIH criteria than low-qualities (6.99% vs 10.07% for NIH and 11.07% vs 20.97% for Rotterdam), with all studies using AE-PCOS being high-quality and all studies using other/self-report criteria being low-quality. Among high-quality studies using direct/mixed assessments, PCOS prevalence by NIH was highest in Western Pacific Region (8.19%) and lowest in Europe (6.47%), whereas by Rotterdam, it was highest in Europe (21.30%) and lowest in Western Pacific Region (7.67%). We also observed that highest PCOS prevalence based on AE-PCOS criteria was in Europe (16.09%) and lowest in Western Pacific Region (7.43%). Publication bias was not significant (Egger’s coefficient = 1.2, 95% CI: -1.49, 3.9, p = 0.38), and funnel plot showed a nearly symmetrical distribution of studies around the estimated effect size. Conclusions: This meta-analysis revealed that the reported PCOS prevalence in adults varies widely by WHO geographic region. Study quality, assessment type and diagnostic criteria for PCOS impact the assessment, with low-quality studies overestimating PCOS prevalence. Presentation: 6/2/2024

8558 Prevalence of Polycystic Ovary Syndrome in Adolescent Girls by World Health Organization Region

Abstract Disclosure: S. Hatoum: None. M. Amiri: None. R.P. Buyalos: None. A. Sheidaei: None. R. Azziz: Consulting Fee; Self; Spruce Bioscience, May Health, Core Access Surgical Technologies, Acacia Bio, Fortress Biotech, Rani Therapeutics. Stock Owner; Self; Martin Imaging. Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The use of several diagnostic criteria imposes a challenge for healthcare providers, especially in adolescents, whose PCOS symptoms may mimic normal pubertal changes. Objectives: This systematic review and meta-analysis aims to estimate the pooled prevalence of PCOS in adolescents using various diagnostic criteria in total and by WHO region. Methods: We systematically reviewed Pubmed and Embase through July 2023 to capture all studies performed in medically unbiased adolescent populations (age <18 years) reporting PCOS prevalence. Studies were categorized according to: a) PCOS criteria (NIH 1990 [PCOS phenotypes A&B], AE-PCOS 2006 [PCOS phenotypes A-C], Rotterdam 2003 [PCOS phenotypes A-D], and ‘other/self-reported’ criteria); b) subject assessment type (direct assessment, survey/indirect assessment, or mixed assessment); and c) study quality, assessed using the PCOS Epidemiology and Phenotype (PEP) quality assessment tool. We performed a meta-analysis using fixed-effects or random-effects models depending on the heterogeneity among the studies. We conducted subgroup analyses based on PCOS criteria, assessment type, study quality, and WHO region. Results: 6,644 studies were initially retrieved, of which 11 were eligible for inclusion including a total of 10,516 adolescents, yielding 15 study groups according to the diagnostic criteria. Considering all studies, PCOS prevalence was 4.98% according to the NIH 1990, 8.80% according to Rotterdam 2003, 4.74% according to the AE-PCOS 2006, and 1.69% according to other criteria/self-report, with an overall pooled PCOS prevalence of 4.57%. All studies using NIH 1990, Rotterdam 2003, and AE-PCOS 2006 were of high quality, and those using other criteria/self-report were of low quality, thus subgroup analysis based on quality resulted in the same prevalences as above. When including only high-quality studies that used direct or mixed assessment, PCOS prevalence was highest in the Western Pacific Region (WPR) at 20.69% and lowest in the Eastern Mediterranean Region at 3.43% under Rotterdam 2003, while it was highest in the South-East Asia Region at 6.20% and lowest in the WPR at 3.94% under NIH 1990. Only one high-quality study using direct or mixed assessment was available under AE-PCOS 2006. Conclusion: This meta-analysis revealed that PCOS prevalence varies according to the PCOS criteria, assessment type, and WHO region. This variability should be addressed, ideally through unifying the diagnostic criteria and using meticulous methods in PCOS epidemiologic studies. The effect of study quality alone on PCOS prevalence could not be detected because of insufficient data, further reinforcing the need for undertaking PCOS prevalence studies in all populations and regions. Presentation: 6/2/2024

Market survey of food product indicators and their credibility as a healthy food product in Klang Valley, Malaysia

IntroductionThe presence of food product indicators may facilitate consumers in making informed healthy choices. However, it may also mislead consumers. This study aims to determine the prevalence of food products...

Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990–2021: a systematic analysis of the Global Burden of Disease Study 2021

A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden. Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density. In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (r s =-0.74) and DALYs (r s =-0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians. CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden. National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).

Antimicrobial susceptibility profiles of invasive bacterial infections among children from low- and middle-income countries in the Western Pacific Region (WPRO) – a systematic review and meta-analysis

Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region. We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes. Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. Escherichia coli revealed a pooled susceptibility to ampicillin of 17% (95% CI 12-23%, n=3292), gentamicin 63% (95% CI 59-67%, n=3956), and third-generation cephalosporins 59% (95% CI 49-69%, n=3585). Susceptibility of Klebsiella spp. to gentamicin was 71% (95% CI 61-80%, n=2323), third-generation cephalosporins 35% (95% CI 22-49%, n=2076), and carbapenems 89% (95% CI 78-97%, n=2080). Pooled susceptibility of Staphylococcus aureus to flucloxacillin was 72% (95% CI 58-83%, n=1666), and susceptibility of Streptococcus pneumoniae meningitis isolates to ampicillin was 26% (95% CI 11-44%, n=375), and 63% (95% CI 40-84%, n=246) to third-generation cephalosporins. The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary. The study was supported by an Australian GovernmentNational Health and Medical Research Council Investigator Grant. This research was funded in part by the Wellcome Trust [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Megabenthic Diversity Patterns on a Seamount in the Philippine Sea: Implications for Conservation Planning on the Kyushu-Palau Ridge.

The oligotrophic tropical western Pacific region is characterized by a high density of seamounts, with the Kyushu-Palau Ridge (KPR) being the longest seamount chain here. Effective spatial management plans for seamount ecosystems necessitate an understanding of distribution patterns and key environmental factors influencing benthic communities. However, knowledge regarding deep-sea biodiversity patterns over intricate topography remains limited. In this study, we investigated a seamount with a water depth of 522 m at the summit located in the southern section of KPR. Survey transects were conducted from 522 m to 4059 m. By analyzing video-recorded data obtained by a human-occupied vehicle (HOV) during dives and environmental variables derived from bathymetry, distinct assemblages were identified through noise clustering. α- and β-diversity patterns within the seamount megabenthic community were analyzed across the depth gradient, along with investigation of their environmental drivers. A total of 10,596 megafauna individuals were documented, categorized into 88 morphospecies and statistically separated into six distinct community clusters using noise clustering analysis. Species abundance and richness were highest within the 700-800 m water depth range, declining notably beyond 2100 m, indicating a critical threshold for habitat classification in this region. The β-diversity of megabenthic communities was high (0.836). Although β-diversity patterns along the depth gradient were mostly dominated by differences in species richness, the contribution of species replacement increased with depth, becoming dominant at depths greater than 3000 m. Depth emerged as the primary driver of spatial variation in community structure, while near-bottom current velocity, topographic parameters (bathymetric position index, slope), and substrate type also influenced the formation of microhabitats. The study highlights the depth gradients, thresholds, and other intricate environmental factors shaping the spatial heterogeneity of these communities. It provides valuable insights for the future development of effective survey and conservation strategies for benthic biodiversity on the KPR.

Prevalence and accurate diagnosis of polycystic ovary syndrome in adolescents across world regions: a systematic review and meta-analysis.

To examine the global prevalence of polycystic ovary syndrome (PCOS) among adolescents across world regions, comparing the 2003 Rotterdam consensus criteria with the current International Evidence-based PCOS Guideline criteria which omits polycystic ovarian morphology (PCOM). Systematic review and meta-analysis, Prospero CRD42022372029. OVID MEDLINE, All EBM, PsycInfo, EMBASE, and CINAHL were searched from 1990 to November 2023 for studies assessing the prevalence of PCOS in unselected adolescent populations. Overall, 15 708 articles were identified. After removal of duplicates, 11 868 titles and abstracts and 445 full texts were assessed. Of these, 24 articles reporting on 23 studies from five world regions were included. In meta-analysis of 20 studies (n = 14 010 adolescents), global prevalence was 9.8% (95% CI 7.2, 12.3) according to original Rotterdam criteria, and 6.3% (95% CI 3.9, 8.8) according to International Evidence-based Guideline criteria. Global PCOS prevalence based on self-report was 9.8% (95% CI 5.5, 14.1). Grouped by WHO region, prevalence ranged from 2.9% (95% CI 2.0, 3.9) in the Western Pacific region to 11.4% (95% CI 7.1, 15.7) in the South-East Asia region according to guideline criteria. This paramount global meta-analysis on adolescent PCOS diagnosis directly informed the 2023 International PCOS Guideline. Guideline criteria generated a global PCOS prevalence of 6.3%, compared with 9.8% on Rotterdam criteria (including PCOM). Excluding PCOM, which overlaps with normal pubertal transition, is expected to deter over-diagnosis. To avoid under-diagnosis, the Guideline recommends identifying those with either irregular cycles or hyperandrogenism as being "at risk"; this group should undergo longitudinal serial evaluations until adulthood.

Harnessing the power of mobile and messaging apps for risk communication and intervention during the COVID-19 pandemic: lessons from the Western Pacific.

The spread of mis- and disinformation on mobile and messaging apps during the COVID-19 pandemic not only fuelled anxieties and mistrust in health authorities but also undermined the effectiveness of the overall public health response. Mobile and messaging apps help users stay informed and connected to their families, friends, colleagues and communities. However, during the COVID-19 pandemic, these apps were also one of the primary channels where mis- and disinformation were circulated. Recognizing the importance of including mobile and messaging apps in risk communication and emergency response strategies, the World Health Organization (WHO) and some countries in the WHO Western Pacific Region independently piloted initiatives to reach messaging app users, meet their evolving information needs, and streamline health ministry communication. The enhanced use of mobile and messaging apps enabled consistent and timely communication and improved coordination during the COVID-19 pandemic. Leveraging their features also helped identify and potentially fill crucial information gaps, mitigating the harms of mis- and disinformation and fostering stronger trust in health authorities. The findings from the work carried out by WHO and countries in the Western Pacific Region identified some promising innovative communication interventions using mobile and messaging apps. While these interventions should be further explored and evaluated, they have demonstrated that interventions need to be proactive, flexible, and able to adapt to changes in mis- and disinformation content being shared through messaging apps.

Adolescent Suicides in the Western Pacific Region Have Become a More Serious Public Health Problem than in Other Regions

Adolescent Suicides in the Western Pacific Region Have Become a More Serious Public Health Problem than in Other Regions

Impact of Cloud Vertical Overlap on Cloud Radiative Effect in the Korean Integrated Model (KIM) Seasonal Simulations during Boreal Summer and Winter

AbstractExponential-random vertical overlap of clouds is applied for radiative processes in a research version of the Korean Integrated Model (KIM) to replace the maximum-random vertical overlap of clouds. The cloud radiative effect (CRE) increases overall when the exponential-random overlap is used. This is because vertically continuous clouds, which are assumed to overlap maximally under the maximum-random overlap assumption, can be relaxed to random overlap depending on the vertical distance between cloud layers and the specified decorrelation length of clouds. CRE is more enhanced by considering the latitudinal dependency of cloud decorrelation length based on previous observational studies. This alleviates biases in CRE, which is underestimated overall, except in the low latitudes where the CRE is overestimated in the present simulations. The interaction between radiative and convective processes plays a role in decreasing CRE over the tropical western Pacific region, where strong convections develop, although the direct impact of applying the exponential-random overlap is to decrease the vertical overlap between ice clouds. The simulation of temperature in the lower troposphere is improved owing to the changes in cloud overlap. The warm bias over the Eurasian continent, in particular, is alleviated as more shortwave fluxes are reflected due to increased CRE.

Associations of tobacco and alcohol use with sexual behaviors among adolescents in 59 countries: a population-based study

BackgroundSexual behaviors, particularly risky sexual behavior, has become a serious public health concern among adolescents worldwide, presenting a substantial obstacle to the prevention of sexually transmitted infections, including human immunodeficiency virus (HIV). However, there is limited research using consistent and standardized methodology to examine associations between tobacco and alcohol use frequency and both total and risky sexual behaviors among adolescents. We aimed to examine the association between tobacco and/or alcohol use with both total and risky sexual behaviors among adolescents worldwide.MethodsData were collected from the Global School-based Student Health Survey, which comprised 211,847 adolescents aged 12–17 years from 59 countries. The frequency of tobacco or alcohol use during the past 30 days was categorized as 0, 1–2, 3–5, 6–9, or ≥ 10 days. Tobacco and alcohol use were also categorized as non-use, tobacco use alone, alcohol use alone, and combined use. Multi-variable logistic regression analysis was used to examine both the independent and combined associations of tobacco and alcohol use with total and risky sexual behaviors.ResultsCompared with no tobacco use, the odds ratio of engaging in sexual intercourse increased with the frequency of tobacco use from 1 to 2 days to ≥ 10 days (total: 2.03 [95% confidence interval 1.47–2.81] to 3.98[2.63–6.03]; risky: 2.43[1.75–3.38] to 4.21[3.26–5.42]), as well as with the frequency of alcohol use. Overall, combined users had greater likelihood of both total and risky sexual behaviors than tobacco users alone, alcohol users alone, and non-users. Similarly, the association between risky sexual behaviors and tobacco use alone was more pronounced among adolescent girls (vs. adolescent boys), as were those of risky sexual behaviors with alcohol use alone among younger adolescents aged 12–14 years (vs. aged 15–17 years) and with tobacco and/or alcohol use among adolescents in the Western Pacific region (vs. Regions of Africa and Americas).ConclusionsOur findings suggest independent and combined associations between tobacco and/or alcohol use with sexual behaviors among adolescents, with variations across age, sex, and WHO region.

Relation extraction using large language models: a case study on acupuncture point locations.

In acupuncture therapy, the accurate location of acupoints is essential for its effectiveness. The advanced language understanding capabilities of large language models (LLMs) like Generative Pre-trained Transformers (GPTs) and Llama present a significant opportunity for extracting relations related to acupoint locations from textual knowledge sources. This study aims to explore the performance of LLMs in extracting acupoint-related location relations and assess the impact of fine-tuning on GPT's performance. We utilized the World Health Organization Standard Acupuncture Point Locations in the Western Pacific Region (WHO Standard) as our corpus, which consists of descriptions of 361 acupoints. Five types of relations ("direction_of", "distance_of", "part_of", "near_acupoint", and "located_near") (n = 3174) between acupoints were annotated. Four models were compared: pre-trained GPT-3.5, fine-tuned GPT-3.5, pre-trained GPT-4, as well as pretrained Llama 3. Performance metrics included micro-average exact match precision, recall, and F1 scores. Our results demonstrate that fine-tuned GPT-3.5 consistently outperformed other models in F1 scores across all relation types. Overall, it achieved the highest micro-average F1 score of 0.92. The superior performance of the fine-tuned GPT-3.5 model, as shown by its F1 scores, underscores the importance of domain-specific fine-tuning in enhancing relation extraction capabilities for acupuncture-related tasks. In light of the findings from this study, it offers valuable insights into leveraging LLMs for developing clinical decision support and creating educational modules in acupuncture. This study underscores the effectiveness of LLMs like GPT and Llama in extracting relations related to acupoint locations, with implications for accurately modeling acupuncture knowledge and promoting standard implementation in acupuncture training and practice. The findings also contribute to advancing informatics applications in traditional and complementary medicine, showcasing the potential of LLMs in natural language processing.

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

IntroductionThis study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income...

Changes in the epidemiological trends of primary liver cancer in the Asia–Pacific region

Primary liver cancer is the third leading cause of cancer-related mortality. The increasing prevalence of metabolic syndrome and alcohol consumption, along with the existing burden of viral hepatitis, could significantly heighten the impact of primary liver cancer. However, the specific effects of these factors in the Asia–Pacific region, which comprises more than half of the global population, remain largely unexplored. This study aims to analyze the epidemiology of primary liver cancer in the Asia–Pacific region. We evaluated regional and national data from the Global Burden of Disease study spanning 2010 to 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years associated with primary liver cancer in the Asia–Pacific region. During the study period, there were an estimated 364,700 new cases of primary liver cancer and 324,100 deaths, accounting for 68 and 67% of the global totals, respectively. Upward trends were observed in the age-standardized incidence rates of primary liver cancer due to metabolic dysfunction-associated fatty liver disease (MASLD) and alcohol-associated liver disease (ALD) in the Asia–Pacific region, as well as an increase in primary liver cancer from Hepatitis B virus infection in the Western Pacific region. Notably, approximately 17% of new cases occurred in individuals aged 15–49 years. Despite an overall decline in the burden of primary liver cancer in the Asia–Pacific region over the past decade, increases in incidence were noted for several etiologies, including MASLD and ALD. However, viral hepatitis remains the leading cause, responsible for over 60% of the total burden. These findings underscore the urgent need for comprehensive strategies to address the rising burden of primary liver cancer in the Asia–Pacific region.

Human Papillomavirus Vaccination Coverage Among Adolescent Girls Aged 13-17 Years - U.S.-Affiliated Pacific Islands, 2013-2023.

Worldwide, cervical cancer is the fourth most common cancer among women, and the World Health Organization (WHO) Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines are recommended at age 11-12 years to prevent most cervical cancers. HPV vaccines were introduced across USAPI during 2007-2016, predominantly provided through school-located vaccination programs. Retrospective analysis using data from jurisdictional immunization information systems was used to estimate vaccination coverage among adolescent girls as of the last day of each calendar year during 2013-2023. This analysis measured progress toward the WHO 2030 vaccination coverage goal of ≥90% completion of the HPV vaccination series among girls by age 15 years. As of December 2023, initiation of the HPV vaccination series among adolescent girls aged 13-17 years ranged from 58.0% in Palau to 97.2% in the Northern Mariana Islands, and HPV vaccination series completion coverage ranged from 43.4% in Palau to 91.8% in the Northern Mariana Islands. HPV vaccination series completion coverage is >90% in the Northern Mariana Islands and is on track to meet WHO goals by 2030 in American Samoa. Assessment of adolescent vaccination coverage can help immunization programs monitor progress toward regional goals and identify populations and areas with low coverage. Implementing evidence-based strategies to increase vaccine access and coverage would benefit jurisdictions with lagging coverage.

The Fiji Dragonplum Dracontomelon vitiense Engl. (Anacardiaceae): a locally important but neglected fruit and timber tree endemic to the western Pacific region

The Fiji Dragonplum Dracontomelon vitiense Engl. (Anacardiaceae): a locally important but neglected fruit and timber tree endemic to the western Pacific region

Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1·97 million adults with 100 000 incident cases from 31 cohorts in 20 countries

Meat consumption could increase the risk of type 2 diabetes. However, evidence is largely based on studies of European and North American populations, with heterogeneous analysis strategies and a greater focus on red meat than on poultry. We aimed to investigate the associations of unprocessed red meat, processed meat, and poultry consumption with type 2 diabetes using data from worldwide cohorts and harmonised analytical approaches. This individual-participant federated meta-analysis involved data from 31 cohorts participating in the InterConnect project. Cohorts were from the region of the Americas (n=12) and the Eastern Mediterranean (n=2), European (n=9), South-East Asia (n=1), and Western Pacific (n=7) regions. Access to individual-participant data was provided by each cohort; participants were eligible for inclusion if they were aged 18 years or older and had available data on dietary consumption and incident type 2 diabetes and were excluded if they had a diagnosis of any type of diabetes at baseline or missing data. Cohort-specific hazard ratios (HRs) and 95% CIs were estimated for each meat type, adjusted for potential confounders (including BMI), and pooled using a random-effects meta-analysis, with meta-regression to investigate potential sources of heterogeneity. Among 1 966 444 adults eligible for participation, 107 271 incident cases of type 2 diabetes were identified during a median follow-up of 10 (IQR 7-15) years. Median meat consumption across cohorts was 0-110 g/day for unprocessed red meat, 0-49 g/day for processed meat, and 0-72 g/day for poultry. Greater consumption of each of the three types of meat was associated with increased incidence of type 2 diabetes, with HRs of 1·10 (95% CI 1·06-1·15) per 100 g/day of unprocessed red meat (I2=61%), 1·15 (1·11-1·20) per 50 g/day of processed meat (I2=59%), and 1·08 (1·02-1·14) per 100 g/day of poultry (I2=68%). Positive associations between meat consumption and type 2 diabetes were observed in North America and in the European and Western Pacific regions; the CIs were wide in other regions. We found no evidence that the heterogeneity was explained by age, sex, or BMI. The findings for poultry consumption were weaker under alternative modelling assumptions. Replacing processed meat with unprocessed red meat or poultry was associated with a lower incidence of type 2 diabetes. The consumption of meat, particularly processed meat and unprocessed red meat, is a risk factor for developing type 2 diabetes across populations. These findings highlight the importance of reducing meat consumption for public health and should inform dietary guidelines. The EU, the Medical Research Council, and the National Institute of Health Research Cambridge Biomedical Research Centre.

Sequence typing of Haemophilus ducreyi isolated from patients in the Namatanai region of Papua New Guinea: Infections by Class I and Class II strain types differ in ulcer duration and resurgence of infection after azithromycin treatment.

Haemophilus ducreyi (HD) is an important cause of cutaneous ulcers in several endemic regions, including the Western Pacific Region, especially among children. An HD sequence typing on swab samples taken from 1,081 ulcers in the Namatanai district of Papua New Guinea, during the pilot study for treatment of yaws, has been performed using the Grant typing system. Of the 363 samples that tested positive for the 16S rDNA of HD, the dsrA sequences of 270 samples were determined. Altogether they revealed 8 HD strain types circulating in Namatanai, including seven strain types of Class I (I.3, I.4, I.5, I.9, I.10, I.11, I.12) and one strain of Class II (II.3); four Class I types (I.9, I.10, I.11, I.12) were novel. The southern region of Namatanai (Matalai Rural) was identified as the region with the lowest genotype diversity and with most infections caused by HD Class II. The middle and northern subdistricts were affected mainly by HD Class I. Analysis of patient characteristics revealed that Class II HD infections were more often represented by longer-lasting ulcers than Class I HD infections. An increase in the prevalence of the I.10 strain was found after azithromycin administration compared to the untreated population at baseline likely reflecting higher infectivity of HD Class I, and more specifically strain type I.10.