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PubMed1995

Pesticide poisoning in the Asia-Pacific Region and the role of a regional information network.

Pesticide poisoning is an important cause of morbidity and mortality in many countries in the world. It has been estimated that 95% of fatal pesticide poisonings occur in developing countries, many of which are in the Asia-Pacific region. Agriculture based economies, easy availability of pesticides, poverty related socioeconomic problems, lack of adequate protective clothing, and limited treatment facilities are some of the factors contributing to the high morbidity and mortality. There is a lack of easily accessible information on pesticide related ill health in the countries of Asia-Pacific Region. Although Poison Centers are active in some countries, lack of resources is a major constraint on the provision of an efficient service. There are several intercountry projects and information networks in the region dealing with agriculture and environment but no such information facilities are available concerning pesticide poisoning. A Regional Pesticide Poisoning Information Network for the Asia-Pacific Region could disseminate information on pesticide related illness to any individual or institution via print and electronic media. Such a network could work towards close cooperation between all poisons centers and toxicologists in the region to reduce the rising morbidity and mortality from pesticide poisoning.

Adolescent↗
PubMed1975

[The epidemiology of cancer in Central Asia].

The author reports the data characterizing the incidence of cancer, as a whole, and its main localizations in the Republics of Central Asia. According to these findings the cancer incidence indices the Central Asia are more low, as compared with the All-Union data and the data from other Socialist Republics. The main localizations of cancer, except esophageal cancer, are recorded more seldom than in other Republics. Especially low indices of the morbidity were noted in relation to cancer of the skin, lower lip, mammary gland, uterine cervix. In some Republics of Central Asia (Uzbek SSR, Turkmen SSR) the incidence of esophageal cancer was found to be high, exceeding several times the corresponding indices in the USSR and other Socialist Republics.

Female↗
PubMed2006

Improvement of diabetic care at Maharat Nakhon Ratchasima Hospital (the study of Diabcare-Asia from 1997 to 2003).

Diabcare-Asia, the largest, multicenter observational study in Asia, surveyed the status of diabetic control among Asian diabetics, including Thais. Maharat Nakhon Ratchasima Hospital is a regional hospital in Northeast Thailand that participated in Diabcare-Asia. In 1997, 1998 and 2003, the authors recruited 200, 100, 204 diabetic patients for analysis, respectively. Most (93 per cent) of the patients had type 2 diabetes. In the present study, patients with a BMI > or = 25 kg/m2 increased from 38, 45 and 47 percent in 1997, 1998 and 2003, respectively. Annual check-ups for diabetic complications increased to nearly 100 per cent by 2003; however, only 72 per cent were examined for diabetic retinopathy, but that number is up from the 33 per cent in 1997. In the present study, diabetic retinopathy was detected in 8, 16 and 25 per cent of patients, respectively. Diabetic nephropathy (urine albumin > or = 1 + by urine strip) decreased from approximately 50 per cent in 1997/98 to 19 per cent in 2003. Patients were able to achieve the target blood sugar better than in the past. The number of patients with HbA1c < 7 per cent and FPG < or = 130 mg/dL was 8, 21, 38 and 30, 39 and 40 per cent in 1997, 1998 and 2003, respectively. The proportion of patients who achieved the American Diabetic Association blood pressure, total cholesterol and LDL-C targets in 2004 was < 50 per cent. In conclusion, the present study showed the improvement of diabetic control at Maharat Nakhon Ratchasima Hospital between 1997 and 2003. A similar hospital-based diabetic care system should be implemented at other Thai hospitals for the early identification and prevention of diabetic complications in the future.

Chronic Disease↗
PubMed1991

Historical review and current status of gnathostomiasis in Asia.

The genus Gnathostoma contains at least twelve distinctive species. Among these, 6 species, namely G. spinigerum, G. hispidum, G. doloresi, G. vietnamicum, G. malaysiae and G. nipponicum, are found in wild animals in Asia. Related to human gnathostomiasis, G. spinigerum has long been believed as the only causative species. Until the early 1980s, all gnathostomiasis cases found in major endemic areas in Asia, such as Thailand, China and Japan, were caused by infection with G. spinigerum. In the early 1980s in Japan, new gnathostomiasis cases appeared in urban areas and these cases were shown to be caused by G. hispidum, of which larvae were found in loaches imported from Taiwan, Korea, or mainland China. Recently infections with G. nipponicum caused by eating locally obtained loaches raw, were found in 2 humans in Mie Prefecture, and 14 cases of infection with G. doloresi, probably caused by eating raw slices of freshwater fishes, were found in Miyazaki Prefecture. So far four Gnathostoma species are responsible for zoonotic infections in humans. Since G. hispidum and G. doloresi, like G. spinigerum, are widely distributed in Asia, care should be taken with the identification of species causing gnathostomiasis.

Animals↗
PubMed1990

Epidemiology of diabetes mellitus in the Asia-Pacific region.

The complex interaction between genetic and environmental factors in the causation of diabetes mellitus is well illustrated by the epidemiology of diabetes in the Asia-Pacific region. Among the Chinese, the prevalence of diabetes is uniformly higher among Chinese living outside China than in the Chinese in The People's Republic of China. Similarly among the Indians, the prevalence of diabetes is universally higher in those who have settled outside India than in Indians in India. In the Pacific populations, diabetes is much commoner among the Nauruans and Fiji Indians. Throughout the Asia-Pacific countries, economic progress and urbanisation have a uniformly deleterious effect on diabetes. A better understanding of the hereditary and environmental factors in the causation of diabetes is required to halt and reverse the rising prevalence of diabetes in the Asia-Pacific region.

Australia↗
PubMed2005

Diverse origins of waxy foxtail millet crops in East and Southeast Asia mediated by multiple transposable element insertions.

The naturally occurring waxy and low-amylose variants of foxtail millet and other cereals, like rice and barley, originated in East and Southeast Asia under human selection for sticky foods. Mutations in the GBSS1 gene for granule-bound starch synthase 1 are known to be associated with these traits. We have analyzed the gene in foxtail millet, and found that, in this species, these traits were originated by multiple independent insertions of transposable elements and by subsequent secondary insertions into these elements or deletion of parts of the elements. The structural analysis of transposable elements inserted in the GBSS1 gene revealed that the non-waxy was converted to the low-amylose phenotype once, while shifts from non-waxy to waxy occurred three times, from low amylose to waxy once and from waxy to low amylose once. The present results, and the geographical distribution of different waxy molecular types, strongly suggest that these types originated independently and were dispersed into their current distribution areas. The patterns of GBSS1 variation revealed here suggest that foxtail millet may serve as a key to solving the mystery of the origin of waxy-type cereals in Asia. The GBSS1 gene in foxtail millet provides a new example of the evolution of a gene involved in the processes of domestication and its post-domestication fate under the influence of human selection.

Asia, Southeastern↗
PubMed2001

Three major lineages of Asian Y chromosomes: implications for the peopling of east and southeast Asia.

DNA variation on the non-recombining portion of the Y chromosome was examined in 610 male samples from 14 global populations in north, east, and southeast Asia, and other regions of the world. Eight haplotypes were observed by analyses of seven biallelic polymorphic markers ( DYS257(108), DYS287, SRY(4064), SRY(10831), RPS4Y(711), M9, and M15) and were unevenly distributed among the populations. Maximum parsimony tree for the eight haplotypes showed that these haplotypes could be classified into four distinct lineages characterized by three key mutations: an insertion of the Y Alu polymorphic (YAP) element at DYS287, a C-to-G transversion at M9, and a C-to-T transition at RPS4Y(711). Of the four lineages, three major lineages (defined by the allele of YAP(+), M9-G, and RPS4Y-T, respectively) accounted for 98.6% of the Asian populations studied, indicating that these three paternal lineages have contributed to the formation of modern Asian populations. Moreover, phylogenetic analysis revealed three monophyletic Asian clusters, which consisted of north Asian, Japanese, and Han Chinese/southeast Asian populations, respectively. Coalescence analysis in the haplotype tree showed that the estimated ages for three key mutations ranged from 53,000 to 95,000 years, suggesting that the three lineages were separated from one another during early stages of human evolutionary history. The distribution patterns of the Y-haplotypes and mutational ages for the key markers suggest that three major groups with different paternal ancestries separately migrated to prehistoric east and southeast Asia.

Asia↗
PubMed2005

Aging in Southeast and East Asia: issues and policy directions.

Population aging is unique in Asia given the speed at which it is occurring and the immense social and economic changes that the region is experiencing at the same time. Compared to their Western counterparts, Asian governments have much less time to prepare for population aging. Asian countries that have traditionally relied on family-based support for older family members are worried that increased numbers of older adults may stress these family systems. At the same time, information concerning the effectiveness of formal programs for older adults is scarce. This paper reviews current research on informal support versus formal support of older adults in Southeast and East Asia, with a larger aim of assessing the current well-being of older Asians and suggesting areas of policy concern. Current research reveals that formal programs in the majority of Southeast and East Asian countries have very low coverage of today's older adults, and the figures for future generations are not that much higher. However, family support of older persons may not be deteriorating as predicted by modernization theory. Asian families continue to play a major role in supporting older members, thus policies should focus on enabling Asian families to provide this support.

Aging↗
PubMed2005

Regional variation in the prevalence of extended-spectrum beta-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002).

We examined the prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Proteus mirabilis, Citrobacter koseri, and Salmonella spp. that were isolated as part of the SENTRY Asia-Pacific Surveillance Program between 1998 and 2002. During the study period, a total of 6,388 strains were gathered from 17 medical centers in 7 countries and examined for ESBL production and hyperproduction of K. oxytoca chromosomal K1 beta-lactamase enzyme. High rates of confirmed ESBL-producing isolates were found in K. pneumoniae strains from Singapore (35.6%), followed by those from mainland China (30.7%), South Africa (28.1%), and the Philippines (21.9%), whereas the rates were less than 10% in Japan and Australia. ESBL-producing E. coli strains were also prominent in mainland China (24.5%), Hong Kong (14.3%), and Singapore (11.3%). ESBL-producing K. oxytoca were common in the Philippines (38.5%), Singapore (33.3%), and China (30.0%). Hyperproduction of K. oxytoca chromosomal K1 beta-lactamase enzyme was common in Australia and Japan. P. mirabilis strains from Singapore produced ESBL (17.9%) despite the low prevalence (0-8.1%) in other countries. Few ESBL-producing C. koseri and Salmonella spp. strains were found in Japan, Singapore, Taiwan, and South Africa. Although there was variation among countries in substrate preference, ceftazidime was more likely to detect presumptive ESBL phenotype in K. pneumoniae and aztreonam more likely in E. coli, whereas ceftriaxone was the best substrate for the confirmation of ESBL production. ESBL-producing strains showed high levels of co-resistance to aminoglycosides, tetracycline, trimethoprim-sulfamethoxazole, and ciprofloxacin. Imipenem retained activity against all ESBL-producing strains. Organisms expressing ESBLs are widely distributed in the Asia-Pacific region, although prevalence rates vary significantly.

Anti-Bacterial Agents↗
PubMed2006

In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends).

In the 2004 Study for Monitoring Antimicrobial Resistance Trends (SMART), 14 centres from six countries in Asia-Pacific collected 1198 unique aerobic and facultative Gram-negative bacilli from intra-abdominal infections for susceptibility testing to 12 antimicrobial agents. Enterobacteriaceae comprised 82% of the total isolates. Escherichia coli was the most commonly isolated species (43%). Resistance rates were generally higher in Enterobacteriaceae isolated from Asian centres than those isolated from Oceania centres. There was little difference in susceptibility rates between community- and hospital-acquired Enterobacteriaceae for carbapenems. Extended-spectrum beta-lactamase (ESBL)-producers typically had a more resistant profile than non-ESBL-producers, but were usually susceptible to carbapenems. Of the antimicrobial agents tested, carbapenems were the most reliably active in vitro against Enterobacteriaceae recovered from patients in Asia-Pacific with intra-abdominal infections.

Abdomen↗
PubMed2003

Lipids and coronary heart disease in Asia.

In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.

Asia, Southeastern↗
PubMed2002

The status of diabetes control in Asia--a cross-sectional survey of 24 317 patients with diabetes mellitus in 1998.

AIMS: To establish the status of diabetes control in Asia, the Diabcare-Asia 198 study collected data from 230 diabetes centres in Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998. METHODS: Data were obtained either by patient interview during the enrolment visit or by reviewing medical records for the most recent laboratory assessment and clinical examinations. Blood samples were also collected during patients'. visits for central assessments of HbA1c (normal range 4.7-6.4%). RESULTS: The mean of centrally measured HbA1c was 8.6 +/- 2.0% for 18 211 patients (82% of the analysis population). Of the patients with central HbA1c measurements, the majority (55%) had values exceeding 8%, indicative of poor glycaemic control. The prevalence of retinopathy, microalbuminuria and neuropathy was also higher in the group of patients with higher HbA1c. Based on the findings from central HbA1c measurements and reported local HbA1c assessments, it also appears that more patients with poor glycaemic control did not have access to glycated haemoglobin measurements. Mean HbA1c of thediabetic populations in Bangladesh, Indonesia, Korea, Malaysia and Taiwan were significantly lower (all P = 0.0001, except P = 0.0007 for Malaysia), while that of China, India, Philippines and Vietnam was significantly higher (all P = 0.0001) than the grand mean. CONCLUSIONS: In our study population of the Asian diabetes patients treated at diabetes centres, more than half were not well controlled. The prevalence of diabetic microvascular complications was higher in the group of patients with higher HbA1c. Further therapeutic actions to improve glycaemic control are required to prevent chronic diabetic complications.

Adolescent↗
PubMed2005

Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region.

BACKGROUND: Although smoking is a major risk factor for cardiovascular disease, it has been suggested that Asians may be less susceptible to the adverse effects of smoking than Caucasians. This may have contributed to the high prevalence of smoking, and the low quitting rates, in Asian men. Worldwide, smoking rates are increasing for women, amongst whom cardiovascular awareness is relatively poor. METHODS: An individual participant data analysis of 40 cohort studies was carried out, involving 463 674 Asians (33% female) and 98 664 Australasians (45% female). Cox proportional hazard models, stratified by study and sex where appropriate, were employed. RESULTS: The HR [95% confidence interval (CI)], comparing current smokers with non-smokers, for coronary heart disease (CHD) was 1.60 (1.49-1.72); haemorrhagic stroke 1.19 (1.06-1.33); ischaemic stroke 1.38 (1.24-1.54). There was a clear dose-response relationship between the number of cigarettes smoked per day and both CHD and stroke, with no significant difference (P >/= 0.20) between populations from Asia and Australia/New Zealand. Although there was no sex difference for stroke in the effect of amount smoked (P = 0.16), for CHD, women tended to have higher hazard ratios than men (P = 0.011). Quitting gave a clear benefit, which was not significantly different between the sexes or regions (P > 0.63). The HR (CI) for ex-smokers compared with current smokers was 0.71 (0.64-0.78) for CHD and 0.84 (0.76-0.92) for stroke. CONCLUSIONS: Unless urgent public health measures are put into place, the impact of the smoking epidemic in Asia, and among women, will be enormous. Tobacco control policies that specifically target these populations are essential.

Adult↗
PubMedDate not supplied

Asia-Pacific Consensus Statement on dementia.

The 12 national Alzheimer's Associations that contributed to this Consensus Statement will continue to network with one another regionally and will continue to share relevant expertise and practical resources. It is expected that regional consensus on dementia will evolve in individual member countries and in the Asia-Pacific region as a whole. It is the hope of the participating members of these two consensus conferences that this document will provide the inspiration, direction, and practical ideas to further advance the goals of national Alzheimer's Associations and to further advance dementia-related medical and service activities within the Asia-Pacific region.

Aged↗
PubMed2003

Blood pressure and cardiovascular disease in the Asia Pacific region.

OBJECTIVES: To estimate age-, sex- and region-specific associations of blood pressure with cardiovascular diseases. DESIGN: Relative risk estimates and 95% confidence intervals were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk on individual participant data from 37 cohort studies. Repeat measurements of blood pressure were used to adjust for regression dilution bias. SETTING: Studies included in the Asia Pacific Cohort Studies Collaboration from Australia, mainland China, Hong Kong, Japan, New Zealand, Singapore, South Korea, and Taiwan. PARTICIPANTS: A total of 425 325 study participants. MAIN OUTCOMES MEASURES: Stroke, ischaemic heart disease, total cardiovascular death. RESULTS: During over 3 million person-years of follow-up, 5178 strokes, 3047 ischaemic heart disease events and 6899 cardiovascular deaths were observed. Continuous log-linear associations were seen between systolic blood pressure and the risks of all three endpoints down to at least 115 mmHg. In the age groups < 60, 60-69, and > or = 70 years, a 10 mmHg lower usual systolic blood pressure was associated with 54% (95% CI 53-56%), 36% (34-38%) and 25% (22-28%) lower stroke risk, and 46% (43-49%), 24% (21-28%) and 16% (13-20%) lower ischaemic heart disease risk, respectively. All associations were similar in men and women. Blood pressure was at least as strongly associated with cardiovascular events in Asian populations compared to Australasian populations. CONCLUSIONS: About half of the world's cardiovascular burden is predicted to occur in the Asia Pacific region. Blood pressure is an important determinant of this burden, with considerable potential benefit of blood pressure lowering down to levels of at least 115 mmHg systolic blood pressure.

Aged↗
PubMed2004

Serum triglycerides as a risk factor for cardiovascular diseases in the Asia-Pacific region.

BACKGROUND: The importance of serum triglyceride levels as a risk factor for cardiovascular diseases is uncertain. METHODS AND RESULTS: We performed an individual participant data meta-analysis of prospective studies conducted in the Asia-Pacific region. Cox models were applied to the combined data from 26 studies to estimate the overall and region-, sex-, and age-specific hazard ratios for major cardiovascular diseases by fifths of triglyceride values. During 796,671 person-years of follow-up among 96,224 individuals, 670 and 667 deaths as a result of coronary heart disease (CHD) and stroke, respectively, were recorded. After adjustment for major cardiovascular risk factors, participants grouped in the highest fifth of triglyceride levels had a 70% (95% CI, 47 to 96) greater risk of CHD death, an 80% (95% CI, 49 to 119) higher risk of fatal or nonfatal CHD, and a 50% (95% CI, 29% to 76%) increased risk of fatal or nonfatal stroke compared with those belonging to the lowest fifth. The association between triglycerides and CHD death was similar across subgroups defined by ethnicity, age, and sex. CONCLUSIONS: Serum triglycerides are an important and independent predictor of CHD and stroke risk in the Asia-Pacific region. These results may have clinical implications for cardiovascular risk prediction and the use of lipid-lowering therapy.

Aged↗
PubMed2005

Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants.

BACKGROUND AND PURPOSE: The cause of subarachnoid hemorrhage (SAH) is poorly understood and there are few large cohort studies of risk factors for SAH. We investigated the risk of SAH mortality and morbidity associated with common cardiovascular risk factors in the Asia-Pacific region and examined whether the strengths of these associations were different in Asian and Australasian (predominantly white) populations. METHODS: Cohort studies were identified from Internet electronic databases, searches of proceedings of meetings, and personal communication. Hazard ratios (HRs) for systolic blood pressure (SBP), current smoking, total serum cholesterol, body mass index (BMI), and alcohol drinking were calculated from Cox models that were stratified by sex and cohort and adjusted for age at risk. RESULTS: Individual participant data from 26 prospective cohort studies (total number of participants 306,620) that reported incident cases of SAH (fatal and/or nonfatal) were available for analysis. During the median follow-up period of 8.2 years, a total of 236 incident cases of SAH were observed. Current smoking (HR, 2.4; 95% CI, 1.8 to 3.4) and SBP >140 mm Hg (HR, 2.0; 95% CI, 1.5 to 2.7) were significant and independent risk factors for SAH. Attributable risks of SAH associated with current smoking and elevated SBP (> or =140 mm Hg) were 29% and 19%, respectively. There were no significant associations between the risk of SAH and cholesterol, BMI, or drinking alcohol. The strength of the associations of the common cardiovascular risk factors with the risk of SAH did not differ much between Asian and Australasian regions. CONCLUSIONS: Cigarette smoking and SBP are the most important risk factors for SAH in the Asia-Pacific region.

Adult↗
PubMed2005

Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region.

BACKGROUND: Although interest in multifactorial interventions for cardiovascular disease is increasing, data on the strength and shape of the joint effects of blood pressure and cholesterol levels on the risk of cardiovascular disease are scarce, confined primarily to coronary heart disease (CHD) mortality in early middle-aged Western populations. METHODS AND RESULTS: This analysis included 29 cohorts from Asia (78% of the total 380,216 participants) and 7 from Australia and New Zealand, with a total of 2,547,447 person-years of observation. Stratified time-dependent Cox proportional-hazards analyses were used to regress time until first event against baseline systolic blood pressure (SBP) and total cholesterol levels. A total of 3079 CHD and 4247 stroke events occurred; stroke subtypes were confirmed by CT, MRI, or necropsy in 1471 (35%) stroke events. Usual values of SBP were strongly linearly associated with ischemic stroke, hemorrhagic stroke, and CHD. The slope of the association with SBP became steeper with decreasing levels of cholesterol for ischemic stroke (P=0.007) and CHD (P< or =0.0001). For example, for the cholesterol groups of <4.75, 4.75 to 5.49, 5.50 to 6.24, and > or =6.25 mmol/L, each 10-mm Hg-higher systolic pressure was associated with 34% (95% CI, 30% to 37%), 28% (95% CI, 21% to 35%), 25% (95% CI, 18% to 32%), and 21% (95% CI, 13% to 27%) higher CHD risk, respectively. Adjustments for other leading cardiovascular risk factors made no appreciable differences in these results. CONCLUSIONS: In Asia-Pacific populations, there are hazards of increasing SBP at all cholesterol levels and hazards of increasing cholesterol at all levels of SBP, but the associations of SBP with CHD risk and ischemic stroke risk are slightly steeper among those with low cholesterol levels. The joint effects of SBP and total cholesterol on cardiovascular disease seem consistent across various Western and Asian populations.

Age Factors↗