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PubMed2005

Ethnic comparisons of obesity in the Asia-Pacific region: protocol for a collaborative overview of cross-sectional studies.

The prevalence of overweight and obesity has been rapidly increasing within countries of the Asia-Pacific region, with adverse consequences for health. The Obesity in Asia Collaboration (OAC) was initiated to provide reliable evidence concerning the relationships between anthropometrical markers of adiposity with cardiovascular risk factors within, and across, ethnic groups. This is to be achieved through the collection of cross-sectional studies from the Asia-Pacific region. These data will be used to examine the ethnic-specific associations of different anthropometric measures of adiposity (such as body mass index, waist circumference, waist-hip ratio and waist-height ratio) with cardiovascular risk factors (fasting blood glucose and blood pressure). Estimates of the relative risks for type 2 diabetes and hypertension with increased adiposity will be obtained using data from contributing studies in conjunction with those from the previously established Asia Pacific Cohort Studies Collaboration. To date, 12 countries and regions from the Asia-Pacific region with information on nearly 300,000 individuals, are participants in the OAC. Data from other eligible studies are sought. The findings from the OAC will provide reliable evidence concerning the association of adiposity with cardiovascular risk factors across ethnic groups. It will also provide a strong evidence base upon which to define ethnic-specific cut-points for overweight and obesity.

Anthropometry↗
PubMed2006

The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region.

BACKGROUND: Pancreatic cancer accounts for about 220,000 deaths each year. Known risk factors are smoking and type 2 diabetes. It remains to be seen whether these risk factors are equally important in Asia and whether other modifiable risk factors have important associations with pancreatic cancer. METHODS: An individual participant data analysis of 30 cohort studies was carried out, involving 420,310 Asian participants (33% female) and 99,333 from Australia/New Zealand (45% female). Cox proportional hazard models, stratified by study and sex and adjusted for age, were used to quantify risk factors for death from pancreatic cancer. RESULTS: During 3,558,733 person-years of follow-up, there were 324 deaths from pancreatic cancer (54% Asia and 33% female). Mortality rates (per 100,000 person-years) from pancreatic cancer were 10 for men and 8 for women. The following are age-adjusted hazard ratios (95% confidence interval) for death from pancreatic cancer: for current smoking, 1.61 (1.12-2.32); for diabetes, 1.76 (1.15-2.69); for a 2-cm increase in waist circumference, 1.08 (1.02-1.14). All three relationships remained significant (P < 0.05) after adjustment for other risk factors. There was no evidence of heterogeneity in the strength of these associations between either cohorts from Asia and Australia/New Zealand or between the sexes. In men, the combination of cigarette smoking and diabetes more than doubled the likelihood of pancreatic cancer (2.47; 95% confidence interval, 1.17-5.21) in both regions. CONCLUSIONS: Smoking, obesity, and diabetes are important and are potentially modifiable risk factors for pancreatic cancer in populations of the Asia-Pacific region. Activities to prevent them can be expected to lead to a major reduction in the number of deaths from this cancer, particularly in Asia with its enormous population.

Asia↗
PubMedDate not supplied

Temporal correlation between opiate seizures in East/Southeast Asia and B.C. heroin deaths: a transoceanic model of heroin death risk.

BACKGROUND: Because heroin supply changes cannot be measured directly, their impact on populations is poorly understood. British Columbia has experienced an injection drug use epidemic since the 1980s that resulted in 2,590 illicit drug deaths from 1990-1999. Since previous work indicates heroin seizures can correlate with supply and B.C. receives heroin only from Southeast Asia, this study examined B.C. heroin deaths against opiate seizures in East/Southeast Asia. METHODS: Opiate seizures in East/Southeast Asia and data from two B.C. mortality datasets containing heroin deaths were examined. The Pearson correlation coefficient for seizures against each mortality dataset was determined. RESULTS: Opiate seizures, all illicit drug deaths and all opiate deaths concurrently increased twice and decreased twice from 1989-1999, and all reached new peak values in 1993. Three B.C. sub-regions exhibited illicit drug deaths rate trends concurrent with the three principal datasets studied. The Pearson correlation coefficient for opiate-induced deaths against opiate seizures from 1980-1999 was R=0.915 (p<0.0001), and for illicit drug deaths against opiate seizures from 1987-1999 was R=0.896 (p<0.0001). CONCLUSIONS: From 1980-1999, opiate seizures in East/Southeast Asia were very strongly correlated with B.C. opiate and illicit drug deaths. The number of B.C. heroin-related deaths may be strongly linked to heroin supply. Enforcement services are not effective in preventing harm caused by heroin in B.C.; therefore, Canada should examine other methods to prevent harm. The case for harm reduction is strengthened by the ineffectiveness of enforcement and the unlikelihood of imminent eradication of heroin production in Southeast Asia.

Asia, Southeastern↗
PubMed2007

Prevalence of diabetes mellitus and population attributable fractions for coronary heart disease and stroke mortality in the WHO South-East Asia and Western Pacific regions.

The aims of this study were to obtain the most recent representative data for the prevalence of diabetes in adult populations in the World Health Organisation's South-East Asia and Western Pacific regions and to quantify the contribution of diabetes to the burden of mortality from cardiovascular diseases in these regions. Previous reports indicate that there are 83 million individuals with diabetes in the Asia-Pacific region, but since many of the country-specific estimates were not from nationally representative studies, this figure may not accurately reflect the current burden of diabetes. Information on the prevalence of diabetes was obtained by searching Medline and government health websites. Data were available from 12 countries representing 78% of the total population of the Asia-Pacific region. Six of 10 countries with complete data reported a prevalence of diabetes exceeding those estimates currently cited by the World Health Organization; three of which have also already exceeded the World Health Organization projections for 2030. In the 12 countries in the region with nationally representative data, the prevalence of diabetes ranged from 2.6% to 15.1%. Hazard ratios from the Asia Pacific Cohort Studies Collaboration were used to calculate population attributable fractions for diabetes for fatal cardiovascular diseases in the region. Population attributable fractions ranged from 2% to 12% for coronary heart disease, 1% to 6% for haemorrhagic stroke, and 2% to 11% for ischaemic stroke. Accurate estimates of the prevalence of diabetes are of great importance and standard methods are needed for periodic surveillance across the Asia-Pacific region and elsewhere.

Adolescent↗
PubMed2000

Exposure of women in general populations to lead via food and air in East and Southeast Asia.

BACKGROUND: Despite increasing public concern of the possible health effects of lead (Pb) on general populations, reports on Pb levels in blood (Pb-B) and urine (Pb-B), as well as Pb intake via foods (Pb-F) for many Asian countries are scarce. The present study was initiated to elucidate the extent of non-occupational Pb exposure among general populations in East and Southeast Asia. METHODS: In 1991-1997, peripheral blood, morning spot urine and 24-hour food duplicate samples were collected from 20 to 50 non-smoking adult women in each of four cities in Southeast Asia and five cities in Mainland China, and two cities each in Japan and Korea. The samples were wet-ashed and then analyzed by inductively coupled plasma mass spectrometry for Pb-B, Pb-U and Pb-F. Measures after logarithmic conversion were subjected to ANOVA and regression analysis. RESULTS: Geometric mean values in cities in East and Southeast Asia were in ranges of 32-65 microg/L for Pb-B, 2.1-7.5 microg/g cr for Pb-Ucr, and 7-32 microg/day for Pb-F. The values for a combination of two cities of Tokyo and Kyoto, Japan (38 microg/L for Pb-B and 9.3 microg/day for Pb-F) appeared to be lower than the values for other Asian cities, and the values for all Japan (thus including both urban and rural areas) were even lower (19 microg/L for Pb-B and 7.7 microg/day for Pb-F). Comparison of Pb uptake via respiratory and dietary routes showed that Pb via dietary route accounted for 15% of the total in Manila where Pb in air was high (ca. 650 ng/m(3)), whereas it was 54% in Tokyo+Kyoto where Pb in air was low (ca. 75 ng/m(3)). CONCLUSIONS: When compared internationally, Pb-F and Pb-B in Asia in general are similar to or somewhat higher than the levels in Europe and USA, whereas the levels in Japan are probably lower than the two latter areas. In Asia, Pb-F accounted for 15-54% of all Pb sources, the percentage being variable depending on local conditions especially Pb in atmospheric air.

Adult↗
PubMed2005

The spread of the H5N1 bird flu epidemic in Asia in 2004.

H5N1 avian influenza has spread to eight countries in eastern Asia including China, Japan, South Korea, Vietnam, Laos, Cambodia, Thailand, and Indonesia in early 2004. This H5N1 influenza A virus is extremely virulent in poultry including chickens and ducks, killing millions of birds throughout the region. Additionally this virus has transmitted to humans (mainly children) in Vietnam, Cambodia, and Thailand, killing 54 of 100 diagnosed persons. To control this epidemic hundreds of millions of chickens and ducks have been culled. One genotype of H5N1 designated "Z" has become dominant in Asia. This virus was first detected in wild birds in Hong Kong in November 2002 and was antigenically distinct from H5N1 viruses isolated from 1997 to early 2002 and lethal for aquatic birds. The H5N1 virus infecting humans and poultry in Asia in 2004 is an antigenic variant of the Z genotype. Here we consider the possible role of migrating birds in the evolution and spread of the H5N1 influenza A virus throughout Asia. We conclude that the available information is consistent with a role for migrating birds but limited information is available and that serological studies are urgently needed on migrating birds worldwide. The prospect is that this H5N1/04 influenza A virus will become endemic in poultry in eastern Asia and will be a continuing threat to animal and human health. It is also projected that a human H5N1 vaccine will eventually be needed.

Animals↗
PubMed1987

Non-A, non-B fulminant viral hepatitis in France in returnees from Asia and Africa.

Among 61 patients admitted for non-A, non-B fulminant viral hepatitis to Hôpital Beaujon, 10 had returned from Asia or Africa, and 51 had not been outside France, within the month preceding jaundice. This suggests that hepatitis might have been contracted in Asia or Africa in the former, and in France in the latter. The interval between the onset of jaundice and the onset of hepatic encephalopathy was 10 days in the former and 26 days in the latter (P less than 0.03). The serum of the patient returning from Asia contained, and the sera of the nine patients returning from Africa did not contain, antibodies to a virus isolated from the stools of patients suffering from an epidemic fecal-oral non-A, non-B viral hepatitis in Central Asia. It is concluded that infection with Asian-African non-A, non-B viruses can be the cause of fulminant hepatitis in persons returning from these countries, that the course of this type of non-A, non-B fulminant viral hepatitis is shorter than that of non-A, non-B fulminant hepatitis contracted in France, and that different viruses might be responsible for non-A, non-B hepatitis in Asia and Africa.

Adult↗
PubMed2005

Introduction: Aging in Asia--perennial concerns on support and caring for the old.

This introductory article provides background to an understanding of "Aging in Asia," focusing on the demographics of population aging in Asia. It discusses the differences in the magnitude of the aged population in different parts of Asia and highlights the perennial concerns of care and support facing the aged and their families as Asian societies grapple with the graying population. Globalization is one important factor presenting new challenges as well as opportunities to aging Asia. The introduction substantiates the discussions in this special issue, which range from an examination of broad issues of support for the aged and policy directions in East and Southeast Asia, to specific concerns relating to activity and elderly in Singapore, intergenerational relationships in Korea, and issues concerning caregiving of the old in Singapore.

Aged↗
PubMed2004

Improving cadaveric organ donation rates in kidney and liver transplantation in Asia.

In the year 2001, cadaveric kidney and liver transplant rates (CadTx) in countries with well-established transplant programs such as the United States and Spain ranged from 51 to 61.9 and 18.7 to 31.3 per million population (pmp), respectively. However, overall kidney and liver transplant rates in Asia are significantly lower at 4.3 and 0.3 pmp, respectively. Improving CadTx rates to meet the needs of organ failure patients poses several unique challenges in Asia. Across Asia, there is a wide disparity in prehospital emergency services and intensive care facilities that allow victims of cerebrovascular accident or trauma to be sent to hospitals for optimal management. Identification of the brain-dead victim in an intensive care setting, donor referral to an organ procurement coordinator/network, making the request for organ donation, and obtaining consent for organ donation from the family are other critical issues that impact on successful cadaveric donation. While affirmative legislation regarding organ donation is existent in most Asian countries, religious, ethnic, and cultural influences on concepts of death and the sanctity of the human body remain major barriers to obtaining consent for cadaveric donation. Although there are no overt objections to CadTx among the major religions of Asia, perceptions to the contrary largely limit consent for organ donation from potential donor families. Development of transportation and communication networks, public and donor hospital education programs, legislative initiatives such as presumed consent, and establishment of effective organ procurement practices are all key initiatives that will improve CadTx rates. Broadening donor criteria as with the use of expanded criteria donors, including non-heart-beating and older donors, may further improve cadaveric donation rates by as much as 20%. Finally, ethical transplant practices that prohibit trade in organs will promote an environment conducive to cadaveric donation. Together with efforts to increase living donor TX transplant rates, it is hoped that these measures will increase the supply of organs so as to meet the needs of organ failure patients in Asia.

Asia↗
PubMedDate not supplied

Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention.

Reliable statistics related to the prevalence, incidence and mortality of hypertension and stroke are not available from Asia. The data may be in national or institutional reports or journals published in the local language only. The mortality rate for stroke has been on the decline since the mid 1960s in the developed countries of Asia, such as Australia, New Zealand, and Japan, with some improvement in Singapore, Taiwan and Hong Kong, some areas of China and Malaysia about 15 years later. In India, China, Philippines, Thailand, Sri Lanka, Iran, Pakistan, Nepal, there has been a rapid increase in stroke mortality and prevalence of hypertension. The prevalence of hypertension according to new criteria (>140/90 mm Hg) varies between 15-35% in urban adult populations of Asia. In rural populations, the prevalence is two to three times lower than in urban subjects. Hypertension and stroke occur at a relatively younger age in Asians and the risk of hypertension increases at lower levels of body mass index of 23-25 kg/m2. Overweight, sedentary behaviour, alcohol, higher social class, salt intake, diabetes mellitus and smoking are risk factors for hypertension in most of the countries of Asia. In Australia, New Zealand and Japan, lower social class is a risk factor for hypertension and stroke. Population-based long-term follow-up studies are urgently needed to demonstrate the association of risk factors with hypertension in Asia. However prevention programmes should be started based on cross-sectional surveys and case studies without waiting for the cohort studies.

Antihypertensive Agents↗
PubMed1998

Mental health services in Asia: international perspective and challenge for the coming years.

In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.

Asia↗
PubMed2005

Aging in Asia: a cultural, socio-economical and historical perspective.

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no "single size fits all" solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.

Aged↗
PubMed2004

Epidemiology of depression in the Asia Pacific region.

OBJECTIVE: To summarise studies reporting rates of depression (for the general population and older samples) and suicide in the Asia Pacific region. METHODS: Information on local data was collected from the members of the SEBoD International Advisory Board on known epidemiological studies. Additionally, online searches were conducted using Medline and PsycInfo for the period 1994-2004. RESULTS: Across the Asia Pacific region, rates of current or 1-month major depression ranged from 1.3% to 5.5%, rates of major depression in the previous year ranged from 1.7% to 6.7%, and lifetime rates ranged from 1.1% to 19.9%, with a median of 3.7%. Rates of suicide in the Asia Pacific region are now similar to those in Europe and the Americas. The exceptions include China and South Korea. CONCLUSIONS: Epidemiological studies in Asian populations are rare and use various diagnostic criteria. However, studies indicate that rates of depression in Asia Pacific, whilst lower, are comparable to other western countries. As such, depression as a health issue in Asia Pacific demands greater recognition. It is important that Asian countries should have the human and financial resources to conduct large scale epidemiological surveys not only in the area of depression, but also in the broader field of mental disorders.

Adult↗
PubMed1996

Ethical and legal aspects of assisted reproduction practice in Asia.

This report describes the ethical and legal aspects of assisted reproduction technology (ART) that have been instituted in Asian countries. The data were collected by a questionnaire circulated to ART units in Asia. These are Taiwan, Singapore, Korea, Indonesia, Thailand, Japan, Iran, India, Jordan, Malaysia, China, Israel, Hong Kong, Pakistan, Lebanon, Saudi Arabia, and Persian Gulf countries. According to the survey, there are approximately 260 ART centers in Asia (half of which are in Japan). On a global basis each ART centre in Asia serves an average population of 13 million people. On the other hand, in those Asian countries where the standards of living are relatively high, the availability of ART services, including the more sophisticated and costly ART procedures like micromanipulation, is similar to that in the Western world. In most of the Asian countries practising ART, however, no state registry exists. Taiwan is the only country that has specific legislation, and in six other countries some kind of ministerial regulations are practised. We conclude that ART is now practised in 20 countries in Asia. The prevailing rules and cultural heritage in many of these Asian countries has a major influence on the implementation of ART in Asia. However, in view of the complicated and sensitive issues involved, and as no supervision on ART clinics exists in most of the Asian countries, we advocate that some kind of quality control should be urgently instituted in all centres practising ART. In this way, it is hoped that the highest standards be attained for all parties concerned.

Asia↗
PubMed1998

Need for Haemophilus influenzae type b vaccination in Asia as evidenced by epidemiology of bacterial meningitis.

OBJECTIVE: To evaluate the role of Haemophilus influenzae type b (Hib) infections in Asia by scrutinizing data on Hib meningitis. DESIGN: A comprehensive literature search was performed in English and other languages. Special attention was paid to the age group of 0 to 4 years, in which the great majority of Hib meningitis occurs. RESULTS: Twenty studies from as many countries indicated Hib to be a major pathogen in childhood meningitis. In series comprising nearly 2000 patients, Hib was responsible for at least 50% of cases in one-third of series and for at least 25% in three-fourths of series investigated and was the leading pathogen overall. The countries in South and Southeast Asia differed from the Middle East and East Asia in having a greater incidence of meningitis during the first 6 months of life; the proportions were 50 to 60% vs. 10 to 30%, respectively (P < 0.001). CONCLUSIONS: Despite lacking data from many areas, belief in a paucity of Hib disease in Asia is not supported by the existing data; and because meningitis represents only 50 to 75% of all classical Hib manifestations and some cases occur after the age of 4 years, vaccination is warranted. The cumulative age curves suggest that conjugates with good immunogenic potential should be used, especially in South and Southeast Asia.

Asia↗
PubMed2004

Ant allergy in Asia and Australia.

PURPOSE OF REVIEW: Anaphylaxis due to ant sting is increasingly being recognized as a significant problem. Severe allergic reactions to ants are well described in the south-eastern United States, but have only been recognized in recent years as being important in other parts of the world. There are many different ant species and their distribution around the world varies. The purpose of this review is to familiarize the reader with the epidemiology and clinical characteristics of ant allergy in Asia and Australia. RECENT FINDINGS: In Korea, allergy to Pachycondyla chinensis (subfamily Ponerinae) has been well described. In an ant-endemic area, sensitization was 23%, with about 1% having anaphylactic reactions. There were at least eight IgE-binding proteins in P. chinensis venom, with 1 major allergen binding 85% of patient sera. P. chinensis venom was also found to be possibly crossreactive with bee venom, but not with imported-fire-ant venom. In Australia, anaphylactic reactions to ant stings are usually caused by the 'jack jumper' ant (Myrmecia pilosula) or the bull ant (Myrmecia pyriformis). A recent study showed promising results for immunotherapy with M. pilosula venom. There have been reports of stings by other ant species in Asia and Australia, but these reports are few and sporadic. SUMMARY: The study of ant allergy in Asia is in its infancy. Clinicians in Asia need to be aware of ant stings as a cause of severe allergic reactions. Certain species that cause allergic reactions are unique to Asia and Australia and deserve further research. The allergens in the venom of the different ant species need to be identified. We should aim for improved understanding of the epidemiology of ant-sting anaphylaxis, formulation of better diagnostic tests and possibly the introduction of immunotherapeutic strategies.

Adrenergic Agonists↗
PubMed2001

Evidence-based nutrition and cardiovascular disease in the Asia-Pacific region.

The Asia-Pacific region is undergoing a major change in both food and health patterns, with a connection between the two more than likely. Evidence for certain traditional Asia-Pacific foods as protective agents against chronic non-communicable disease and cardiovascular disease (CVD), in particular, is growing at a time when their usage diminishes. The nature of the evidence to establish relevant Asia-Pacific food-health linkages will include randomised placebo-controlled clinical trials, but is much more extensive and meaningful. Okinawans have probably achieved one of the most successful food cultures from a health point of view and serve as a reference point for the Asia-Pacific region. The expert working party has produced, in November 2000, the 'Okinawan Recommendations on Nutrition and CVD in the Asia-Pacific region'.

Asia↗
PubMedDate not supplied

Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland.

Surveillance using admissions to hospital, while being useful, is a poor indicator of the real incidence of disease encountered by travelers. An alternative is self-reported illness among those who attended at a pretravel clinic prior to their travels. Estimates of incidence and risk factors were determined for attendees at a travel clinic in Scotland using a questionnaire. Analysis for risk factors was carried out for those travelers visiting countries in Africa, Asia, or South and Central America, who had traveled for 1 week or more and had returned between 1997 and 2001 (N= 4,856). Multivariate logistic regression was used to test the hypotheses that time abroad and age-group would be significant for both respiratory and diarrheal symptoms regardless of which of the three geographical areas are visited. From 2006 returned questionnaires (response rate = 41.3%), diarrhea and respiratory symptoms were reported by 44.2 and 16.8% of respondents, respectively; the incidence was significantly greater among travelers to Asia for both diarrheal (55.5%) and respiratory (23.7%) symptoms than among travelers to Africa (36.6 and 12.2%, respectively) or South and Central America (39.5 and 16.2%, respectively). For diarrhea, age was a highly significant risk factor for travelers to Asia, South and Central America, and Africa. Being a self-organized tourist/backpacker, traveling to Asia was associated with increased risk, while for Africa and South and Central America visiting family or friends was associated with a lower risk. For travelers to Asia, traveling to the Indian subcontinent was significantly associated with increased risk. The majority of travelers had an adverse event while traveling abroad, with diarrhea and respiratory conditions being especially common despite attending a travel clinic for advice prior to departure. However, the limitations of this surveillance-based strategy have highlighted the requirement for more research to understand more fully the issues of risk and incidence among travelers to high-risk destinations from Scotland.

Adolescent↗