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Background: Around 0.4 million cases of multidrug-resistant tuberculosis (MDR-TB) occur each year. Only a small fraction of these cases are treated according to international guidelines. Evidence relevant to decisions about whether to scale-up treatment for MDR-TB includes cost and cost-effectiveness data. Up to 2010, no systematic review of this evidence has been available. Objective: Our objective was to conduct a systematic review of the cost and cost effectiveness of treatment for MDR-TB and synthesize the available data. Methods: We searched for papers published or prepared for publication in peer-review journals and grey literature using search terms in five languages: English, French, Portuguese, Russian and Spanish. From an initial set of 420 studies, four were included, from Peru, the Philippines, Estonia and Tomsk Oblast in the Russian Federation. Results on costs, effectiveness and cost effectiveness were extracted. Assessment of the quality of each economic evaluation was guided by two existing checklists around which there is broad consensus. Costs were adjusted to a common year of value (2005) to remove distortions caused by inflation, and calculated in two common currencies: $US and international dollars (I$), to standardize for purchasing power parity. Data from the four identified studies were then synthesized using probabilistic sensitivity analysis, to appraise the likely cost and cost effectiveness of MDR-TB treatment in other settings, relative to WHO benchmarks for assessing whether or not an intervention is cost effective. Best estimates are provided as means, with 5th and 95th percentiles of the distributions. Results: The cost per patient for MDR-TB treatment in Estonia, Peru, the Philippines and Tomsk was $US10 880, $US2423, $US3613 and $US14 657, respectively. Best estimates of the cost per disability-adjusted life-year (DALY) averted were $US598 (I$960), $US163 (I$291), $US143 (I$255) and $US745 (I$1059), respectively. The main influences on costs were (i) the model of care chosen (the extent to which hospitalization or ambulatory care were relied upon) and (ii) the second-line drugs included in the treatment regimen. When extrapolated to other settings, the best estimate of the cost of treatment varied from $US3401 to $US195 078, depending on the region and model of care The cost per DALY averted was lower than GDP per capita in all 14 WHO sub-regions considered, with better cost effectiveness for outpatient versus inpatient models of care. Conclusions: Treatment for MDR-TB can be cost effective in low- and middle-income countries. Evidence about the relative cost effectiveness of outpatient versus inpatient models of care is limited and more data are needed from Africa and Asia - especially India and China, which have the largest number of cases. Unless there is strong evidence that hospitalization is necessary to achieve high rates of adherence to treatment, patients with MDR-TB should be treated using mainly ambulatory care [ABSTRACT FROM AUTHOR]

Suicide rates are higher at high altitudes, and some hypothesize that hypoxia is the cause. There may be a significant correlation between rates of depression and altitude, but little data exist outside the United States. The purpose of the present study is to conduct a survey of depression among the elderly highlanders in Asia. We enrolled 114 persons aged 60 years or older (mean, 69.2 ± 6.7 years; women, 58.8%) in Domkhar (altitude, 3800 m), Ladakh, India and 173 ethnic Tibetans (mean, 66.5 ± 6.1 years; women, 61.3%) in Yushu (altitude, 3700 m), Qinghai Province, China. The two-item Patient Health Questionnaire (PHQ-2) and the geriatric depression scale were administered. A psychiatrist interviewed the subjects who had a positive score on the PHQ-2. The results of the interview with the residents conducted by the specialist showed that two cases (1.8%) from Domkhar and four (2.3%) from Qinghai had depression. Despite the high altitude, the probability of depression was low in elderly highlander in Ladakh and Qinghai. Our finding seems to indicate that cultural factors such as religious outlook and social/family relationship inhibit the development of depression. [ABSTRACT FROM AUTHOR]

The Asian summer monsoon (ASM) begins firstly over the Indo-China Peninsula in early May and over the South China Sea (SCS) in mid-May. The different monsoon onset dates can exert distinct effects on the summer rainfall in Asia. Statistical results indicate that the Antarctic Oscillation (AAO) in the boreal winter has a significant precursory influence on the ASM onset dates. In stronger AAO years, both the Mascarene high and the Australia high in March are stronger owing to the 'see-saw' structure of atmospheric circulation over the subtropics and higher latitudes in the Southern Hemisphere, and the tropical intertropical convergence zone (ITCZ) is deeper. Thus, the pressure gradient between the subtropical and tropical regions increases in spring. As a result, the Somalia cross-equatorial flow (SCEF) occurs earlier, strengthens, and enhances the westerlies over the tropical Indian Ocean. The enhanced westerlies impel an eastward withdrawal of the western Pacific subtropical high and intensify the convergence and rising motion at the lower troposphere, accelerating the burst of ASM. Differently, weaker AAO weakens the pressure gradient between the tropical and subtropical regions and delays the establishment of SCEF, resulting in a delayed onset of ASM. This study extends the leading time of seasonal forecast of ASM onset from the previous spring to winter and provides useful information about precursory signals in climate prediction operation. [ABSTRACT FROM AUTHOR]

Institutional regionalization has come very late to East Asia compared with Europe, but its pace has dramatically increased since the mid-1990s. Many agreements, including bilateral ones such as those signed between Japan and Singapore, or pluri-lateral ones such as those between ASEAN countries, cover an ever increasing number of countries of the East Asian region, including Japan, India, and China. We first analyze Asian integration as a de facto, spontaneous, development of trade. Trade specialization in Asia has often been described as guided by the different levels of development of the countries participating in the regional integration. It constitutes a vertical division of labor between poor countries exporting natural resources and/or labor-intensive products to developed countries exporting machinery, sophisticated parts and components, and high-tech products. This trade structure is radically different from the European horizontal division of labor (exchange of different varieties of similar goods). Then we look at the micro-economic level how Japanese firms tend to integrate Asia into their international network, with Japanese partners being used as relays for Japanese export of semi-manufactured products. Last we present a simulation with the MIRAGE model of a scenario of general regionalization in which all the regions of the world develop preferential treatment for neighboring countries. These agreements are limited to industrial products with particular attention to the automotive sector. The main results are that Asia is the main winner in such a scenario, and within Asia it is Japan and Korea that will be the main winners. In fact, because developing Asia is one of the most protected regions of the world, the impact of liberalization is also the highest. Second, Japan and Korea are best placed to profit from these regional agreements, because other developed countries are excluded from the market of developing Asia. They also have superiority in manufacturing goods whereas countries like China might have problems upscaling their industrial production. Nevertheless our model did not take into account the voluntary pace of development chosen by China and that she will use her powerful state system to avoid being locked into low-tech, low-value-added products. [ABSTRACT FROM AUTHOR]