Search

Background: The presence of sleep-disordered breathing (SDB) in congestive heart failure (CHF) is associated with poor prognosis and is underdiagnosed despite advances in CHF management. The prevalence of SDB in CHF remains understudied in South East Asia., Methods: A prospective, observational single-centre study was conducted where 116 consecutive patients in a specialised heart failure clinic underwent level 1, attended polysomnography (PSG)., Results: The prevalence of SDB was 78% using the apnoea-hypopnea index (AHI), AHI ⩾ 5/h threshold, and 59% with the AHI ⩾ 15/h threshold. Obstructive sleep apnoea (OSA) was the predominant type of SDB and was associated with increased body mass index and neck circumference. STOP-BANG was predictive of SDB, especially in men. Central sleep apnoea (CSA) patients had worse sleep indexes and lower awake arterial carbon dioxide. SDB was also homogenously present in preserved ejection fraction (EF) CHF., Conclusion: Most of the CHF patients were found to have SDB with the utility of PSG. Local CHF guidelines should include sleep testing for all patients with CHF.The study is registered on ClinicalTrials.gov (NCT05332223) as 'The Epidemiological Characteristics of SDB in Patients with Reduced or Preserved EF CHF'., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Tobacco use among youth in the South-East Asian region is quite prevalent. This study aims to examine if psychosocial factors (perceived loneliness, peer, and parental relationships) were associated with adolescent smoking, and whether the effects were different according to sex and age. Data came from the Global School-based Student Health Surveys collected between 2012 and 2015 in Brunei, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, Timor-Leste, and Vietnam. 64 578 (males = 48.5%) adolescents aged 13-18 completed the survey. Prevalence of past-month cigarette use was 10.6%. Adolescent smoking was associated with loneliness (OR = 1.75), lack of close friends (OR = 1.43), and lack of parental understanding (OR = 1.35). There was significant interactions between sex with loneliness, close friends, and parental understanding ( p < .001). Interactions indicated having no close friends is associated with smoking and is stronger for females than males. Conversely, loneliness was associated with smoking more strongly in males than females. Results indicate that psychosocial factors are linked to adolescent smoking in South-East Asia, suggesting a further need for research on the relation of psychosocial factors with smoking, and their underlying factors.

Mental health in young people is a public health challenge worldwide, with around one-fifth of university students suffering from a 12-month mental disorder. In low- and middle-income countries (LMICs) of Southeastern Asia, resources for mental health are limited and counseling services are not regularly established at universities. This review aims to determine the prevalence of mental health problems among university students in six ASEAN (Association of Southeast Asian Nations) countries (Cambodia, Laos, Malaysia, Myanmar, Thailand, and Vietnam) and to identify the determinants of mental health. A systematic database search (PubMed, CINAHL, PsycINFO, PubPsych, and Scopus) for peer-reviewed, English language articles, published 2010-2020, reporting prevalence data based on standardized screening instruments resulted in 335 articles; 108 were eligible for full-text analysis, of which 34 could be included in the review. Median point prevalence was 29.4% for depression, 42.4% for anxiety, 16.4% for stress, and 13.9% for disordered eating. Current suicidality was present in 7% to 8% of students. There was a high rate of psychiatric comorbidity. Despite the high prevalence of mental health problems, the willingness to seek professional help was comparatively low. Implications for mental health promotion and prevention in university settings are discussed.

Objective: We compare population aging in Europe and Asia using a measure that is both consistent over time and appropriate for cross-country comparison. Method: Sanderson and Scherbov proposed to estimate the old-age threshold by the age at which the remaining life expectancy (RLE) equals 15 years. We propose an adjustment of this measure, taking into account cross-national differences in the exceptionality of reaching that age. Results: Our old-age threshold was lower than 65 years in 2012 in Central Asia, Southern Asia, Southeastern Asia, and many Eastern European countries. These populations also experienced a higher share of elderly compared with the RLE15 method. Our method revealed more geographical diversity in the shares of elderly. Both methods exhibited similar time trends for the old-age thresholds and the shares of elderly. Discussion: Our prospective and comparative measure reveals higher population aging estimates in most Asian and Eastern European countries and more diversity in aging.

We conducted a systematic review research and meta-analysis to reveal the relationship between the risk of chronic diarrhea and Cryptosporidium infection in people living with HIV in Southeast Asia. We performed online peer-reviewed literature research from January 2005 to December 2017, which included PubMed, Science Direct, ProQuest, EBSCO, Cochrane, and Web of Science databases. Calculation of size effects in the meta-analysis was performed by STATA 13.0 software to estimate relative risks (RRs) with 95% confidence intervals (CIs) for any associations. Seven cross-sectional research articles were recruited in this study based on the inclusion and exclusion criteria. Our analysis revealed a significant relationship between cryptosporidiosis and the risk of chronic diarrhea in people living with HIV, with RR = 1.325; 95% CI = 1.157 to 1.517; and P < .000. Our results suggested that cryptosporidiosis increases the risk of chronic diarrhea, and low CD4 + lymphocyte cell counts aggravate the degree of diarrhea. Therefore, clinicians should be more aware in treating HIV-positive people, especially those with low CD4 + cell counts, and we suggest that Cryptosporidium laboratory examinations be conducted immediately.

Southeast Asia is one of the most dynamic regions in the world. It is experiencing rapid socioeconomic change that may influence the level of sexual aggression, but data on the scale of sexual aggression in the region remain sparse. The aim of the present article was to systematically review the findings of studies available in English on the prevalence of self-reported sexual aggression and victimization among women and men above the age of 12 years in the 11 countries of Southeast Asia (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam). Based on four scientific databases, the search engine Google, Opengrey database, and reference checking, 49 studies were found on sexual victimization. Of those, 32 included only women. Self-reported perpetration was assessed by only three studies and included all-male samples. Prevalence rates varied widely across studies but showed that sexual victimization was widespread among different social groups, irrespective of sex and sexual orientation. Methodological heterogeneity, lack of representativeness of samples, imbalance of information available by country, missing information within studies, and cultural differences hampered the comparability between and within countries. There is a need for operationalizations that specifically address sexual aggression occurring after the age of consent, based on detailed behavioral descriptions of unwanted sexual experiences and allied to a qualitative approach with cultural sensitivity. Data on sexual aggression in conflict settings and in human trafficking are also limited. Recommendations for future research are presented in the discussion.

Background: Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions., Aims: This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015., Methods: Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate., Results: Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30-34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from -4.2% to -44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years., Conclusions: Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.

Aims: Following the 2004 Southeast Asian tsunami, Swedish authorities received public criticism for slow implementation of rescue work. Meanwhile, data are scarce on survivors' perspectives and potential mental health symptoms associated with timing of evacuation. Therefore, the aim of this study was to investigate survivors' contentment with evacuation time and whether duration at disaster site following the 2004 tsunami was associated with post-traumatic stress symptoms (PTSS) and psychological morbidity., Methods: Of 10,116 Swedish tsunami survivors who returned to Sweden in the first 3 weeks post tsunami, 4910 (49%) answered a questionnaire 14 months later including questions on evacuation time, contentment with evacuation time and PTSS (Impact of Event Scale). We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) of PTSS by timing of evacuation adjusting for gender, age, education, various indicators of trauma exposure and pre-tsunami psychiatric diagnoses., Results: More than half of the survivors (53%) were content with evacuation time while 33% wanted later evacuation and 13% earlier evacuation. Compared with those evacuated 14-21 days post tsunami, individuals evacuated at day 1-4 presented with increased odds of PTSS (crude OR 3.0, 95% CI 2.0-4.5; and multivariable adjusted OR 2.0, 95% CI 1.3-3.0) and impaired mental health (crude OR 1.7, 95% CI 1.2-2.4; and multivariable adjusted OR 1.4 95% CI 1.0-2.0)., Conclusions: One-third of Swedish tsunami survivors preferred a later evacuation from disaster sites. These findings call for further studies, with prospective designs, to disentangle the causal direction of the association between evacuation time and PTSS.

We described and quantified epidemiologic trends in dengue disease burden in 5 Asian countries (Indonesia, Thailand, Malaysia, Philippines, and Vietnam) and identified and estimated outbreaks impact over the last 3 decades. Dengue surveillance data from 1980 to 2010 were retrieved from DengueNet and from World Health Organization sources. Trends in incidence, mortality, and case fatality rate (CFR) were systematically analyzed using annual average percent change (AAPC), and the contribution of epidemic years identified over the observation period was quantified. Over the 30-year period, incidence increased in all countries (AAPC 1980-2010: 6.7% in Thailand, 10.4% in Vietnam, 12.0% in Indonesia, 18.1% in Malaysia, 24.4% in Philippines). Mortality also increased in Indonesia, Malaysia, and Philippines (AAPC: 6.8%, 7.0%, and 29.2%, respectively), but slightly decreased in Thailand and Vietnam (AAPC: -1.3% and -2.5%), and CFR decreased in all countries (AAPC: -4.2% to -8.3%). Epidemic years, despite representing less than a third of the observation period, contributed from 1 to 3 times more cases versus nonepidemic years. Implementation of more sensitive surveillance methods over the study period may have contributed to a reporting or ascertainment bias in some countries. Nonetheless, these data support the urgent need for novel, integrated, or otherwise effective dengue prevention and control tools and approaches.

Recent scholarship offers different theories on how macrosocial determinants affect the population health of East and Southeast Asian nations. Dominant theories emphasize the effects of welfare regimes, welfare generosity, and labor market institutions. In this article, we conduct exploratory time-series cross-sectional analyses to generate new evidence on these theories while advancing a political explanation. Using unbalanced data of 7 East Asian countries and 11 Southeast Asian nations from 1960 to 2012, primary findings are 3-fold. First, welfare generosity measured as education and health spending has a positive impact on life expectancy, net of GDP. Second, life expectancy varies significantly by labor markets; however, these differences are explained by differences in welfare generosity. Third, as East and Southeast Asian countries become more democratic, welfare generosity increases, and population health improves. This study provides new evidence on the value of considering politics, welfare states, and labor markets within the same conceptual framework., (© 2016 APJPH.)

Mekong Delta Basin (MDB) is vulnerable to extreme climate and hydrological events. The objectives of this review are to understand of water related health effects exacerbated by climate change and the gaps of knowledge on the relationships between climate conditions, water quality, and water-related diseases in the MDB. The findings indicate that a few studies with qualitative emphases on the relationships between climate and water quality have been conducted in MDB, and they are insufficient to describe the pattern of climate-disease relationship. The diseases caused by chemical contaminants in relation to changes of climate conditions are neglected in MDB. We suggest further studies to examine the influence of short-term variation of climate conditions on water quality and water-related diseases for the purpose of public health and medical prevention, and due to the trans-boundary nature of MDB, developing partnership in data sharing and research collaboration among MDBs countries should be prioritized., (© 2015 APJPH.)

This study aimed to examine the impact of health care resources, socioeconomic status, and demographic changes on life expectancy in Indonesia, Philippines, and Vietnam. This was a cross-country study to collect annual data (1980-2008) from each target country. Life expectancy was the dependent variable and health care resources, socioeconomic status, and demographics were the 3 main determinants. Structural equation modeling was employed, and the results indicate that the availability of more health care resources (Indonesia: coefficient = .47, P = .008; Philippines: coefficient = .48, P = .017; Vietnam: coefficient = .48, P = .004) and higher levels of socioeconomic advantages (Indonesia: coefficient = .41, P = .014; Vietnam: coefficient = .34, P = .026) are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy because of the wide range of health care resources. These findings suggest that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to health care services and increasing preventive care for the population that currently has less access to health care in communities where there is a shortage of medical resources., (© 2013 APJPH.)

Background: Stroke is a leading cause of death in Asia; however, many estimates of stroke mortality are based on epidemiological models rather than empirical data. Since 2005, initiatives have been undertaken in a number of Asian countries to strengthen and analyse vital registration data. This has increased the availability of empirical data on stroke mortality., Aims: The aim of this paper is to present estimates of stroke mortality for Indonesia, Myanmar, Viet Nam, Thailand, and Malaysia, which have been derived using these empirical data., Methods: Age-specific stroke mortality rates were calculated in each of the five countries, and adjusted for data completeness or misclassification where feasible. All data were age-standardized and the resulting rates were compared with World Health Organization estimates, which are largely based on epidemiological models., Results: Using empirical data, stroke ranked as the leading cause of death in all countries except Malaysia, where it ranked as the second leading cause. Age-standardized rates for males ranged from 94 per 100,000 in Thailand, to over 300 per 100,000 in Indonesia. In all countries, rates were higher for males than for females, and those compiled from empirical data were generally higher than modelled estimates published by World Health Organization., Conclusions: This study highlights the extent of stroke mortality in selected Asian countries, and provides important baseline information to investigate the aetiology of stroke in Asia and design appropriate public health strategies to address the rapidly growing burden from stroke., (© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.)

Objective: This study described the prevalence of and risk factors for sensory deficits, cognitive and physical functional limitations, and disability among older Southeast Asian refugees in the United States., Methods: Data for the regression analyses were drawn from the 2003-2007 American Community Surveys. The sample included foreign-born persons aged 55 and older who were classified as Hmong, Cambodian, Laotian, and Vietnamese., Results: Hmong, Cambodian, and Laotian persons were more likely to report a sensory deficit, functional limitation and disability than Vietnamese persons. Year of arrival, English language proficiency and education were important risk factors. Hmong and Cambodian groups had the most negative health profiles., Discussion: Previous studies found that Vietnamese were the most health disadvantaged when compared to other Asian American groups and Whites. When compared to other refugee populations, the Vietnamese were actually the advantaged group. Our results indicated additional research on the disablement process among Southeast Asians is warranted.

This study aimed to examine individual-, household-, and community-level characteristics associated with nonexclusive breastfeeding (non-EBF) in infants younger than 6 months of age using Demographic and Health Surveys data collected between 2002 and 2005 in East and Southeast Asia. Multilevel logistic regression was used to estimate the odds ratios for factors associated with non-EBF. Exclusive breastfeeding rates in infants younger than 6 months were as follows: Vietnam, 15.5%; Timor-Leste, 30.7%; the Philippines, 33.7%; Indonesia, 38.9%; and Cambodia, 60.1%. The significant individual factors associated with non-EBF included first-born infants, working mothers, and higher maternal age. Communities with a higher proportion of wealthier households in Indonesia, trained delivery assistance in the Philippines, and poor maternal education in Vietnam and Cambodia were at greater risk for non-EBF. All countries need effort to improve EBF, specifically targeting working mothers, less educated women, rich households, and first-time mothers. Health institutions and care providers should be appropriately guided to support EBF.

The use of tobacco by adolescents is a major public health concern worldwide. There are 1.2 billion smokers globally, of which more than 50% are young people. The Southeast Asian countries have about 600 million tobacco smokers within the global burden of tobacco users. Most smokers begin at early stage of life and persist through adulthood. Malaysia alone has about 5 million smokers, 20% of whom are younger than 18 years old. Many factors are implicated in the continuous rising trend of tobacco use among adolescents in Southeast Asia. A triad of family, environmental, and individual factors synergistically acts to motivate adolescents toward smoking. This article discusses the current trends of tobacco use and implications of increasing rise in adolescent smoking in the Southeast Asia region.

Throughout Southeast Asia, the number of people living with chronic conditions and degenerative disease has increased proportionately and absolutely. Public health interventions and effective medical treatment and surgeries have increased life expectancy. Concurrently, social and economic conditions have led to the rapid escalation of lifelong illnesses, characterized as "lifestyle" conditions. Drawing on ethnographic and survey research conducted in Southeast Asia, the authors illustrate the multiple factors contributing to people's health. Changes in food production; the organization, nature, and conditions of work; living conditions; and other factors affecting contemporary living increase vulnerability to noncommunicable diseases. These factors are largely beyond the control of most people. Efforts to reduce chronic illnesses predominantly focus on individual interventions, overlooking the lack of individual capacity to address the structural and institutional factors that compromise people's health.

An audit of the incidence, causes and outcome of perioperative cardiac arrest was conducted in a university hospital in Pakistan. All perioperative cardiac arrests from induction of anaesthesia to post anaesthesia care unit discharge or intensive care unit admission during noncardiac surgery, from January 1992 to December 2006 were included. Patients' demographic information, physical status and type of surgery and anaesthesia were noted. Outcome variables were noted as immediate survival and survival to discharge. Anaesthesia-related cardiac arrests were identified and their causes analysed. Forty-two cardiac arrests occurred among 140,384 patients. Overall frequency was 2.99 per 10,000 (95% confidence interval: 2.90 to 3.08). Twenty-four (3.77/10,000) were females. Thirty-four (13.59/10,000) patients were ASA physical status III to V, 10 (4.95/10,000) were children and 14 (4.28/10,000) above 60 years. Sixteen patients (6.48/10,000) were undergoing emergency surgery. Anaesthesia was deemed primarily responsible in nine cases (0.64/10,000). The causes of anaesthesia-related arrests were medication related (4), airway related (3), massive air embolism (1) and under-replacement of fluids (1). The event was considered to be avoidable in 26 cases. Seventeen patients died during the arrest, 15 survived more than one hour and 10 were discharged home. The number of perioperative cardiac arrests and their mortality was higher in patients with poor physical status and in emergency surgery. The number was also higher in infants, patients above 60 and females. The majority of the cases were considered avoidable, indicating the importance of prevention strategies.

Data on the prevalence of Hypertension (HTN) among elderly Asians is limited. We investigated the prevalence of elevated blood pressure (EBP) and its risk factors in a multiracial Southeast Asian elderly population who participated in the National Kidney Foundation Singapore nationwide screening programme. Among 19,848 subjects > or =65 years (approximately 6% of the total Singapore population), the mean age was 70.6 +/- 5.26 yrs. After excluding 36.6% with known HTN, analysis revealed that 5,889 (46.8%) of the remaining population had previously undetected EBP > 140/90. Increasing age, male gender, BMI > or =23 kg/m2 and pre-existing diabetes were significantly associated with previously undetected EBP on multivariate analysis. 6% of cases with undetected EBP had proteinuria suggestive of longstanding EBP and renal damage. We conclude that there is a high prevalence of undetected EBP in elderly Asians, suggesting the need for increased efforts in screening in the elderly population.

The paper will review a representative selection of health systems reforms throughout the Asia-Pacific region to summarise the regional experience, identify the key lessons learnt from innovative health reforms and propose policy recommendations for sustainable health systems development. Broad descriptive trends of health systems reforms will be compared across the Asia-Pacific region within the context of rapid demographic, health and socio-economic development. More specifically, the study will address the following questions: 1. What are the main features of innovative health systems reforms? 2. How have these reforms affected the health systems? 3. Are there lessons and other implications from these reforms? A common conceptual framework to compare health systems reforms is adopted, using a standardised format to report data of national health systems. A classification of health systems is constructed by categorising them according to the level of development of their respective economies: 1) Developed 2 )High Performing 3) Newly Industrialising 4) Transitional, and 5) Developing. A typology of common issues, challenges and responses are generalised for these health systems at different stages of socio-economic development of individual countries. Evaluative criteria are proposed to compare the long-term effects of these reforms on national health systems in terms of efficiency, equity, quality and sustainability.

WHO's Declaration of the "Health for All" (HFA) goal was pronounced in 1978 in Alma Ata, and it was planned that HFA would be achieved through primary health care programmes and approaches by 2000. However, it is now 2002 and despite the technological advancements in medicine, science, and ICT, Health for All is far from reality. Instead, more and more conflicts are emerging with lethal consequences, such as, bioterrorism, biological agent abuse, global-terrorism, and environmental destruction is occurring at a greater scale that we have witnessed before. We may have the latest technology and knowledge today, but ironically, we are using them to inflict more suffering and pain in the world. In the Asia-Pacific, the past 30 years has seen dramatic advancement and lifestyle changes. We are now paying a high price for such progress in terms of risk factors to the health of the population, such as, ageing diseases, obesity, smoking, diabetes, hypertension, and related conditions. The social, political, economic and environmental factors appeared to have deterred and negated WHO's HFA goal to attain basic human rights and health care for all. The HFA will not be achieved in the future if we do not learn from history and start taking measures now.

There has been rapid development in the Asia-Pacific region, leading to improvements in the food supply and nutrition. The high prevalence of low birth weight has been a problem in many countries and continues to be a problem in some parts of the region. In the past few years an epidemic of obesity and chronic disease has emerged. The fetal origins hypothesis links the high prevalence of low birth weight and recent increasing obesity to explain the emerging epidemic of chronic disease. One public health strategy to challenge this epidemic is the promotion of breastfeeding of all infants. Breastfeeding has been shown to protect against childhood obesity, and is "dose related", that is, the longer an infant is breastfed, the lower the risk of obesity.

Recently, discussion among academics and practitioners has focused on the potential roles, strategies, and functions of universities in the Asia-Pacific region in the next ten to fifteen years in the global initiative commonly referred to as the Child Survival and Development Revolution toward Health for All. (1) The purpose of this paper is to capture the practical key elements of recent discussions and to extend the current thinking into potentially useful guidelines or frameworks for universities of the region. Universities may then be better prepared to move forward in ways which promote the goals and interests of the Health For All movement and the well-being of particularly the world's children.