The Lancet Regional Health: Western Pacific最新文献

{"title":"Pan-Asian consortium for treatment and research in ALS (PACTALS) guidelines for management of amyotrophic lateral sclerosis","authors":"Steve Vucic ,&nbsp;Nortina Shahrizaila ,&nbsp;Osamu Kano ,&nbsp;Parvathi Menon ,&nbsp;Sheila Agustini ,&nbsp;Kongkiat Kulkantrakorn ,&nbsp;Nalini Atchayaram ,&nbsp;Yi-Chung Lee ,&nbsp;Mario B. Prado Jr. ,&nbsp;Kay W.P. Ng ,&nbsp;Josiah Chai ,&nbsp;Bugyeong Son ,&nbsp;Paul Talman ,&nbsp;Hoang Tien Trong Nghia ,&nbsp;Le Tu Quoc Tuan ,&nbsp;Kazumoto Shibuya ,&nbsp;Yuishin Izumi ,&nbsp;Naoki Atsuta ,&nbsp;Robert D. Henderson ,&nbsp;Liying Cui ,&nbsp;Matthew C. Kiernan","doi":"10.1016/j.lanwpc.2025.101684","DOIUrl":"10.1016/j.lanwpc.2025.101684","url":null,"abstract":"<div><div>The Pan-Asian Consortium for Treatment and Research in ALS (PACTALS) guidelines were developed for the management of amyotrophic lateral sclerosis (ALS) patients living in the Asia–Pacific countries, taking into consideration the ethnic, racial and economic diversity of the region. The majority of patients reside in low-income (limited-resource setting) and middle-income countries. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was utilised for development of the PACTALS management guidelines. Nine broad research questions, divided into sections, were addressed. Evidence was derived from existing Cochrane reviews, systematic reviews, meta-analysis, and randomized controlled trials (RCT) along with consensus when evidence was limited. Recommendations were provided for diagnostic pathways, use of disease modifying therapies, appropriateness of multidisciplinary care models, management of respiratory dysfunction, communication and nutrition, addressing symptoms that affect the quality of life, managing cognitive, behavioural and emotional symptoms as well as appropriate implementation of palliative care services and addressing end-of-life issues. The PACTALS guidelines provide a much-needed framework for the management of ALS patients living in the Asia–Pacific region. The management guidelines will be updated as the treatment landscape evolves and evidence of novel management approaches becomes available.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101684"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity and polluted air: implications for COPD prevention and policy","authors":"Omar Hahad ,&nbsp;Karsten Keller ,&nbsp;Jos Lelieveld","doi":"10.1016/j.lanwpc.2025.101693","DOIUrl":"10.1016/j.lanwpc.2025.101693","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101693"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of mature T-cell and NK-cell neoplasms: east and west","authors":"Yok-Lam Kwong ,&nbsp;Huilai Zhang ,&nbsp;Xianhuo Wang ,&nbsp;Eric Tse","doi":"10.1016/j.lanwpc.2025.101646","DOIUrl":"10.1016/j.lanwpc.2025.101646","url":null,"abstract":"<div><div>Mature T-cell and natural killer (NK) cell lymphomas are uncommon. Their epidemiological data are mainly derived from Western and Eastern countries, some with significant variations. These differences may be related to genetic susceptibilities, prevalence of oncogenic viruses and other environmental factors. Nodal mature T-cell lymphomas are most common, with their incidences varying ethnically/geographically. Extranodal T-cell lymphomas have very different epidemiologic features. Adult T-cell leukaemia/lymphoma, due to human T-cell leukaemia virus type-1 (HTLV-1) infection, is found mainly in HTLV-1 endemic areas. Mycosis fungoides, the most common cutaneous T-cell lymphoma in the West, accounts for &lt;2% of T-cell lymphomas in Asia. Epstein–Barr virus (EBV) related T-cell lymphomas are common in Asia and Central/South America but exceptional in the West. Germline polymorphisms of <em>HLA-DPB1</em>, <em>IL18RAP</em> and <em>HLA-DRB1</em> genes have been defined in Chinese NK/T-cell lymphoma patients, potentially affecting susceptibility to EBV-related lymphomagenesis. This review explores these epidemiological differences and how they may impact on management.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101646"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policies, resource allocation, and interventions for child and adolescent mental health in low- and middle-income countries in the Western Pacific Region: a scoping review","authors":"Jiang Long ,&nbsp;Stephanie Zhang ,&nbsp;Lingjun Chu ,&nbsp;Juliet Balkian ,&nbsp;Isabel Giovannucci ,&nbsp;Cody Mui ,&nbsp;Yiqun Luan ,&nbsp;Odille Chang ,&nbsp;Phetsavanh Chanthavilay ,&nbsp;Kartika Goundar ,&nbsp;Munkh-Erdene Luvsan ,&nbsp;Elissa Kennedy ,&nbsp;Dang Nguyen ,&nbsp;Picholas Kian Ann Phoa ,&nbsp;Caroline Mae Ramirez ,&nbsp;Bach Xuan Tran ,&nbsp;Siyan Yi ,&nbsp;Paula Melizza Valera ,&nbsp;Sovanvorleak Tep ,&nbsp;Mengieng Ung ,&nbsp;Chunling Lu","doi":"10.1016/j.lanwpc.2025.101674","DOIUrl":"10.1016/j.lanwpc.2025.101674","url":null,"abstract":"<div><div>Child and adolescent mental health (CAMH) has become an increasingly important public health issue worldwide and particularly in low- and middle-income countries (LMICs) in the Western Pacific Region (WPR), where access to quality mental health care remains limited. The existing evidence on CAMH in the region is fragmented and insufficient for guiding further development and improvements in CAMH services. Against this background, we conducted a scoping review to provide the most recent evidence of the resources (legal, financial, human, infrastructural) allocated to CAMH and the effectiveness of CAMH interventions in the 15 LMICs of the region, consisting of Cambodia, China, Fiji, Kiribati, Laos, Malaysia, the Marshall Islands, Mongolia, Papua New Guinea, the Philippines, the Solomon Islands, Tonga, Tuvalu, Vanuatu, and Viet Nam. Data were gathered from peer-reviewed publications and grey literature in both English and local language published since 2016, yielding a total of 16,869 publications in the initial search, including 15,708 peer-reviewed studies and 1161 grey literature publications, of which 260 English publications (118 peer-reviewed and 142 grey literature) and 384 local languages publications (124 peer-reviewed and 260 grey literature publications) were included in the review. China had the most included articles (53.7%), whereas the Pacific Island Countries (PICs), aside from Papua New Guinea, had the least. Legislation and policies on CAMH are underdeveloped in most PICs. Information on CAMH spending was available only in China, where 0.04% of total health spending was allocated to curative care for adolescent mental health. Countries with available data spent 1% or less of their total health spending on mental health overall (including CAMH), with CAMH beds ranging from 1.83% to 4.19% of total mental health beds and CAMH psychiatrists ranging from 0 to 34.2 per 100,000. Service utilization was low: children and adolescents made up 1.5%–5.4% of all mental health admissions. Effectiveness studies were found in only four countries: China, Malaysia, the Philippines, and Viet Nam. The review highlights significant knowledge gaps and challenges in CAMH resources in the WPR's LMICs, underscoring the need for stronger political commitment, financial investment, multisectoral collaboration, service delivery capacity, and research efforts. Given the predominance of evidence from China compared to other LMICs, this paper focuses on the latter, with China discussed in a separate paper in this Series.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101674"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extranodal NK/T-cell lymphoma: an update of the molecular characterization of the tumor and microenvironment, and its clinical implications","authors":"Wee Lee Chan ,&nbsp;Susan Swee-Shan Hue ,&nbsp;Lichang Deng ,&nbsp;Sai Mun Leong ,&nbsp;Wee Joo Chng ,&nbsp;Siok-Bian Ng","doi":"10.1016/j.lanwpc.2025.101550","DOIUrl":"10.1016/j.lanwpc.2025.101550","url":null,"abstract":"<div><div>Extranodal NK/T-cell lymphoma (ENKTL) is an aggressive lymphoma associated with Epstein–Barr virus which does not respond to conventional anthracycline-based chemotherapy. Recent multi-omics studies have identified genetic and epigenetic alterations involved in the tumor pathogenesis and enabled the characterisation of distinct molecular subtypes with therapeutic and prognostic implications. Similarly, genomic and transcriptomic studies have shed new light on the tumor microenvironment (TME) and potential interactions with the EBV-infected malignant cells, as well as their potential influence on tumor development and progression. This review provides an update on the key genetic alterations and analysis of the recurrent mutations of ENKTL, the role of EBV, epigenetic modifications and emerging molecular classifications of both the tumor and the TME. We also explore the prognostic and therapeutic applications of these new insights, and how they are beginning to reshape the current understanding and future clinical management of this difficult-to-treat disease.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101550"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public understanding and misuse of antibiotics in China: insights from a comprehensive national survey","authors":"Zhixin Fan ,&nbsp;Yuting Zhang ,&nbsp;Yibo Wu ,&nbsp;Jia Yin ,&nbsp;Qiang Sun","doi":"10.1016/j.lanwpc.2025.101682","DOIUrl":"10.1016/j.lanwpc.2025.101682","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) is a major global health threat, with antibiotic misuse as a key driver. This study assessed public understanding and misuse of antibiotics in China to inform targeted interventions.</div></div><div><h3>Methods</h3><div>Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2024), including 25,047 respondents over the age of 18 years. The study evaluated antibiotic knowledge, use practices, and associated factors using validated electronic health literacy scales.</div></div><div><h3>Findings</h3><div>Of the 25,047 respondents, 59.1% (14,806/25,047) reported having heard about antibiotics, with 34.8% (5154/14,806) correctly identifying their function. Regarding antibiotic use, 49.3% (7292/14,806) reported purchasing antibiotics without prescription at least once; 36.8% (5454/14,806) did not follow physicians’ instructions specifically, 15.1% (2235/14,806) discontinued their medication independently, 9.4% (1391/14,806) adjusted their doses, and 16.6% (2457/14,806) stopped taking the antibiotic immediately after their symptoms disappeared during the treatment. Female (OR = 0.843, 95% CI: 0.790–0.900), minority (OR = 0.786, 95% CI: 0.674–0.917) and rural respondents (OR = 0.812, 95% CI: 0.743–0.887) were less likely to have a correct knowledge of antibiotics. Minority respondents and those with children were likelier to purchase antibiotics without prescription, whereas those without companion animals (OR = 0.680, 95% CI: 0.631–0.733) were less so. Higher educated respondents were less likely to follow medication instructions (OR = 0.848, 95% CI: 0.765–0.941), so were those with children or companion animals.</div></div><div><h3>Interpretation</h3><div>Public understanding and use of antibiotics in China fall short of national targets. The study reveals complex relationships between demographic factors and antibiotic practices, suggesting the need for targeted interventions to address AMR effectively.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>National Natural Science Foundation of China</span> (NO. <span><span>72474119</span></span>) and <span>National Health Commission Key Lab of Health Economics and Policy Research</span> (NO. <span><span>NHC-HEPR202401</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101682"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect modification of long-term air pollution exposure on the association of physical activity with COPD hospitalization: a prospective cohort study of 0.5 million Chinese adults","authors":"Xi Xia ,&nbsp;Cong Liu ,&nbsp;Yue Niu ,&nbsp;Xia Meng ,&nbsp;Neil Wright ,&nbsp;Christiana Kartsonaki ,&nbsp;Yiping Chen ,&nbsp;Ling Yang ,&nbsp;Huaidong Du ,&nbsp;Canqing Yu ,&nbsp;Dianjianyi Sun ,&nbsp;Jun Lv ,&nbsp;Junshi Chen ,&nbsp;Liming Li ,&nbsp;Maxim Barnard ,&nbsp;Kai Kang ,&nbsp;Shaowei Wu ,&nbsp;Ka Hung Chan ,&nbsp;Kin Bong Hubert Lam ,&nbsp;Haidong Kan ,&nbsp;Zhengming Chen","doi":"10.1016/j.lanwpc.2025.101676","DOIUrl":"10.1016/j.lanwpc.2025.101676","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about how long-term ambient air pollution exposure modifies the potential benefits of physical activity against chronic obstructive pulmonary disease (COPD). We aimed to examine the interaction between ambient air pollution and physical activity in relation to risk of COPD hospitalization.</div></div><div><h3>Methods</h3><div>In a prospective cohort study of 467,944 adults recruited from 10 areas of China and without spirometry-defined airflow obstruction at baseline in 2004–2008, we examined the exposure-response relationships of total physical activity levels (metabolic-equivalent of task-hour/day; MET-h/d) with COPD hospitalization, stratified by long-term exposure to ambient PM_2.5 (median: 58.7 μg/m³), NO₂ (33.3 μg/m³), and O₃ (87.8 μg/m³), respectively, using multivariable Cox regression.</div></div><div><h3>Findings</h3><div>In 467,944 adults (mean [SD] age = 51.8 [10.6] years; 280,590 females, 187,354 males), 14,688 incidents of COPD were recorded during 5.9 million person-years of follow-up. Physical activity was inversely associated with COPD in participants exposed to low air pollution but showed weak or no association in those exposed to high air pollution (all p-interaction &lt; 0.001). Comparing participants at the highest (≥29.8 MET-h/d) versus lowest quartile (&lt;10.7 MET-h/d) of physical activity, there were 18–23% statistically significant lower risks among those with low air pollution exposure, but marginally significant elevated risks among those with high air pollution exposure (for PM_2.5 and NO₂). The effect modification strengthened when stratifying participants by higher cut-offs of air pollution exposure.</div></div><div><h3>Interpretation</h3><div>Long-term exposure to ambient air pollution is associated with attenuation of the potential benefits of physical activity against COPD in Chinese adults.</div></div><div><h3>Funding</h3><div><span>Sino-British Fellowship Trust</span>, <span>National Key Research and Development Program of China</span>, <span>Kadoorie Charitable Foundation</span>, <span>Wellcome</span>, <span>Noncommunicable Chronic Diseases-National Science and Technology Major Project</span>, <span>National Natural Science Foundation of China</span>, <span>UK Medical Research Council</span>, <span>Cancer Research UK</span>, <span>British Heart Foundation</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101676"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the safety and immunogenicity of a 9-valent human papillomavirus vaccine produced in Saccharomyces cerevisiae using a heating–chilling process for virus-like particle antigen assembly: a double-blind, randomized, placebo-controlled phase 1 clinical trial","authors":"Jae Hoon Kim ,&nbsp;Yoo Kyung Lee ,&nbsp;Han Byul Cho ,&nbsp;Jae Woong Choi ,&nbsp;Gil-Im Mun ,&nbsp;Oak-Gi Song ,&nbsp;Joonheon Hong ,&nbsp;Hyoung Jin Kim ,&nbsp;Anna Lee ,&nbsp;Sunghwi Choo ,&nbsp;Hong-Jin Kim","doi":"10.1016/j.lanwpc.2025.101686","DOIUrl":"10.1016/j.lanwpc.2025.101686","url":null,"abstract":"<div><h3>Background</h3><div>It is challenging to secure the tertiary structure of virus-like particles (VLPs) during manufacturing process development. In this study, we evaluated the safety and immunogenicity of PV-001, a 9-valent human papillomavirus (HPV) vaccine candidate manufactured in <em>Saccharomyces cerevisiae</em> using a new heating–chilling process designed to yield L1 VLPs with high purity and homogeneity.</div></div><div><h3>Methods</h3><div>The 9-valent vaccine formulation contained L1 VLPs for HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. A double-blind, randomized clinical trial was conducted in which participants were assigned in a 1:1 ratio to receive either the investigation vaccine or a placebo consisting solely of aluminum phosphate (AP) gel, used as an adjuvant. A total of 41 healthy women aged 19–45 years were enrolled in South Korea and administered the assigned intervention via intramuscular injection at 0, 2, and 6 months. Safety assessments included immediate adverse events (AEs), solicited local and systemic AEs, and unsolicited AEs. Immunogenicity was evaluated by measuring serum anti-HPV L1 VLP IgG and neutralizing antibody titers pre- and post-vaccination (ClinicalTrials.gov: <span><span>NCT07081334</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>No serious adverse events (AEs) were reported following administration of PV-001, and the overall safety profile was consistent with expected findings, supporting the favorable clinical safety of PV-001. Robust increases in both anti-HPV L1 VLP IgG and neutralizing antibody titers were observed for all nine HPV types following the second and third vaccine doses, relative to baseline.</div></div><div><h3>Interpretation</h3><div>PV-001 was well tolerated and elicited strong immunogenic responses, supporting its potential for further clinical development and the evaluation of broader target populations and age groups.</div></div><div><h3>Funding</h3><div>This research was supported by a grant of the <span>Korea Health Technology R&amp;D Project</span> through the <span>Korea Health Industry Development Institute</span> (KHIDI), funded by the <span>Ministry of Health &amp; Welfare</span>, Republic of Korea (grant number: <span><span>RS-2023-KH134909</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101686"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogen distribution and antimicrobial resistance among neonatal bloodstream infections in Southeast Asia: results from NeoSEAP, a multicentre retrospective study","authors":"Benjamin F.R. Dickson ,&nbsp;Michelle Harrison ,&nbsp;Maria Esterlita T. Villanueva-Uy ,&nbsp;Nina Dwi Putri ,&nbsp;Riyadi Adrizain ,&nbsp;Leny Kartina ,&nbsp;Gayana P.S. Gunaratna ,&nbsp;Hoang T. Tran ,&nbsp;Nguyen X. Huong ,&nbsp;Siew M. Fong ,&nbsp;Erena S. Kasahara ,&nbsp;Distyayu Sukarja ,&nbsp;Tetty Yuniati ,&nbsp;Martono Utomo ,&nbsp;Nambage S. Chandrasiri ,&nbsp;Chau H.M. Le ,&nbsp;Nguyen T.K. Trinh ,&nbsp;Ng Boon Hong ,&nbsp;Hoang N.T. Thuy ,&nbsp;Tran T.C. Tu ,&nbsp;Phoebe C.M. Williams","doi":"10.1016/j.lanwpc.2025.101617","DOIUrl":"10.1016/j.lanwpc.2025.101617","url":null,"abstract":"<div><h3>Background</h3><div>Progress in reducing morbidity and mortality due to neonatal sepsis has slowed in recent decades and is threatened by the global rise of antimicrobial resistance. The populous Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance (AMR). Despite this, there remains a lack of robust data on the epidemiology of neonatal sepsis and the prevalence of AMR within the region.</div></div><div><h3>Methods</h3><div>We evaluated positive blood cultures and susceptibility profiles responsible for neonatal sepsis across 10 clinical sites in five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia, and Vietnam). Retrospective data on all blood cultures collected from neonates over two years (1st January 2019–31st December 2020) were extracted from laboratory records. Data were also collected on the availability and implementation of infection prevention and control resources, and antimicrobial prescribing practices. Pooled estimates across sites and pathogens were generated, with adjustment for clustering.</div></div><div><h3>Findings</h3><div>Of 14,804 blood cultures collected over the study period, a total of 2131 positive isolates (including 1483 significant pathogens) were identified. Gram-negative bacteria predominated as causative of neonatal sepsis (78·4%; 1163/1483) with <em>Klebsiella</em> spp. (408/1483; 27·5%) and <em>Acinetobacter</em> spp. (261/1483; 17·6%) most frequently isolated overall. Adjusted pooled non-susceptibility for <em>Klebsiella</em> spp. was 86·7% (95% CI 54·0–98·5) for third-generation cephalosporins (ceftriaxone and/or cefotaxime; 3GC) and 17·1% (95% CI 8·1–24·7) for carbapenems; while non-susceptibility for <em>Escherichia coli</em> was 46·4% (95% CI 20·0–72·0) for 3GC and 15·4% (95% CI 2·7–31·0) for carbapenems. Carbapenem non-susceptibility for <em>Acinetobacter</em> spp. was 76·5% (95% CI 59·4–84·5). Gram-positive bacteria accounted for 13·2% (196/1483) of pathogens causative of neonatal sepsis, whilst <em>Candida</em> spp. accounted for 8·3% (123/1483) of culture-positive sepsis episodes.</div></div><div><h3>Interpretation</h3><div>Neonatal sepsis in tertiary hospitals in Southeast Asia is predominantly caused by gram-negative bacteria, with high rates of non-susceptibility to commonly prescribed antibiotics.</div></div><div><h3>Funding</h3><div>This study was supported by an <span>Australian National Health and Medical Research Council (NHMRC)</span> grant. The NHMRC was not involved in the design or conduct of the research.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101617"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child and adolescent mental health burden, policies, and services in high-income countries and areas in the Western Pacific Region","authors":"Yi-An Hung ,&nbsp;Minjae Choi ,&nbsp;Yi-An Liao ,&nbsp;Michael Bowden ,&nbsp;Say How Ong ,&nbsp;Tae-Yeon Hwang ,&nbsp;Machi Kakimoto ,&nbsp;Michael Y. Ni ,&nbsp;Akihiro Nishio ,&nbsp;Juan Garcia-Quiroga ,&nbsp;Corine Sau Man Wong ,&nbsp;Chunling Lu ,&nbsp;Shu-Sen Chang","doi":"10.1016/j.lanwpc.2025.101678","DOIUrl":"10.1016/j.lanwpc.2025.101678","url":null,"abstract":"<div><div>This study examined recent trends in the burden of mental disorders, substance use disorders, and suicide among children and adolescents, and reviewed child and adolescent mental health (CAMH) policies and services in eight high-income jurisdictions (Australia, Hong Kong, Japan, Macao, New Zealand, Singapore, South Korea, and Taiwan) in the Western Pacific Region. Data on disability-adjusted life years (DALYs) of mental and substance use disorders and suicide were extracted from global and national datasets. A narrative review on CAMH policies and services was conducted using English and local language sources. Mental and substance use disorders accounted for 14.9%–24.2% of total DALYs among individuals under 20 years, with suicide rates of 10–19-year-olds increasing in several jurisdictions since the early 2010s. While all jurisdictions had mental health laws addressing minors and legislated protections against harms, only Australia had a stand-alone CAMH policy, and large gaps in workforce and service data remained. Strengthening suicide prevention efforts, improving CAMH data systems, enhancing CAMH-focused legislation, and learning from best practices on youth engagement and cross-sector collaboration are recommended to advance CAMH systems in the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101678"},"PeriodicalIF":8.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}