Although health technology assessment (HTA) has been well established in all developed countries, it has not found a firm footing in many developing countries. This is especially true of the Asia Pacific region, which has much of the world population.
We report the full genome sequence of hepatitis C virus (HCV) subtype 6n from Kuala Lumpur, Malaysia. Phylogenetic analysis of the isolate 10MYKJ032 suggests that Southeast Asia might be the origin for the HCV subtype 6n and highlights the possible spread of this lineage from Southeast Asia to other regions.
Non-alcoholic fatty liver disease (NAFLD) is rapidly increasing in the Asia-Pacific and affects up to 30 % of the general population. In younger children, prevalence has been reported to be between 2.1 and 4.5 %. The prevalence of NAFLD increases with increasing age. NAFLD is more prevalent in men than women, but this trend fades in older age group. NAFLD is one of the most common causes of raised serum ALT levels and the latter is closely related to the presence of features of metabolic syndrome. NAFLD may contribute to metabolic syndrome in a similar way as visceral adiposity and can be an early predictor of metabolic disorders. NAFLD increases the risk of developing diabetes mellitus and is closely related to degree of glucose intolerance. A significant proportion of patients with NAFLD have impaired glucose tolerance or diabetes mellitus but with normal fasting blood glucose, highlighting the importance of oral glucose tolerance test in NAFLD patients with normal fasting blood glucose. Besides liver-related complications, NAFLD has been associated with cardiovascular complications, hyperuricemia, gout, chronic kidney disease, gallstone disease, colorectal adenomatous polyp, and polycystic ovarian syndrome. NAFLD seems to be related to host metabolic factors rather than viral factors and does not seem to affect severity of the liver disease in patients with chronic hepatitis B. On the other hand, hepatic steatosis may be related to both host metabolic and viral factors in patients with chronic hepatitis C and seems to adversely impact on the severity of liver disease and possibly response to antiviral therapy.
BACKGROUND AND OBJECTIVES: The family medicine training programs in the Asia Pacific (AP) are evolving. To date, there is a lack of comprehensive and systematic documentation on the status of family medicine training in the AP. This study aims to determine the status of family medicine training at both the undergraduate and postgraduate levels in medical schools (universities or colleges) in the AP.
METHODS: In 2014, the authors conducted a cross-sectional online survey to assess the undergraduate and postgraduate family medicine programs in academic family medicine departments from AP countries. A 37-item online survey questionnaire was sent to key informants from academic institutions with established family medicine departments/units. Only one response from each family medicine department/unit was included in the analysis.
RESULTS: The medical school and country response rates were 31.31% and 64.1%, respectively. The majority of the medical schools (94.7%, n=71/75) reported having a department/unit for family medicine. Family medicine is recognized as a specialist degree by the governments of 20/25 countries studied. Family medicine is included in the undergraduate program of 92% (n=69/75) of all the participating medical schools. Only slightly more than half (53.3%) (n=40/75) reported conducting a postgraduate clinical program. Less than one third (26.7%) (n=20/75) of the medical schools conducted postgraduate research programs.
CONCLUSIONS: Undergraduate training remains the focus of most family medicine departments/units in the AP. Nevertheless, the number of postgraduate programs is increasing. A more rigorous and long-term documentation of family medicine training in the AP is warranted.
There are not many studies that attempt to model intensive care unit (ICU) risk of death in developing countries, especially in South East Asia. The aim of this study was to propose and describe application of a Bayesian approach in modeling in-ICU deaths in a Malaysian ICU.
Pollution in Southeast Asia is a major public energy problem and the cause of energy losses. A significant problem with respect to this type of pollution is that it decreases energy yield. In this study, two types of photovoltaic (PV) solar arrays were used to evaluate the effect of air pollution. The performance of two types of solar arrays were analysed in this research, namely, two units of a 1 kWp tracking flat photovoltaic (TFP) and two units of a 1 kWp fixed flat photovoltaic arrays (FFP). Data analysis was conducted on 2,190 samples at 30 min intervals from 01st June 2013, when both arrays were washed, until 30th June 2013. The performance was evaluated by using environmental data (irradiation, temperature, dust thickness, and air pollution index), power output, and energy yield. Multiple regression models were predicted in view of the environmental data and PV array output. Results showed that the fixed flat system was more affected by air pollution than the tracking flat plate. The contribution of this work is that it considers two types of photovoltaic arrays under the Southeast Asian pollution 2013.
Valuing sedimentary 'blue carbon' stocks of seagrass meadows requires exclusion of allochthonous recalcitrant forms of carbon, such as black carbon (BC). Regression models constructed across a Southeast Asian tropical estuary predicted that carbon stocks within the sandy meadows of coastal embayments would support a modest but not insignificant amount of BC. We tested the prediction across three coastal meadows of the same region: one patchy meadow located close to a major urban centre and two continuous meadows contained in separate open embayments of a rural marine park; all differed in fetch and species. The BC/total organic carbon (TOC) fractions in the urban and rural meadows with small canopies were more than double the predicted amounts, 28 ± 1.6% and 36 ± 1.5% (±95% confidence intervals), respectively. The fraction in the rural large-canopy meadow remained comparable to the other two meadows, 26 ± 4.9% (±95% confidence intervals) but was half the amount predicted, likely owing to confounding of the model. The relatively high BC/TOC fractions were explained by variability across sites of BC atmospheric supply, an increase in loss of seagrass litter close to the exposed edges of meadows and sediment resuspension across the dispersed patchy meadow.
Malaysia is a tropical country in the heart of South East Asia, at the crossroads of the ancient east-west sea trade routes. Although independent from British colonial rule only in 1957, it has a recorded history dating back to at least the first century CE, when the region was already the source of valuable mineral and forest produce that found markets in China, India and further west.
Osteoporosis only became a 'disease' entity in the 20th century. After the initial observations and definitions of osteoporosis based on Caucasian populations, systematic research in Asian populations started in the 1980s. Significant variations between different ethnic groups with respect to the rate of osteoporotic fractures, bone mineral density and disease risk factors emerged from the data; this article highlights some of the earlier important findings and the dissimilarities. Osteoporosis is therefore not a homogeneous disease across the world.
Food production in the countries of South and South-East Asia has shown a general upward trend during the last decade. Despite the considerable increase in population in many of these countries, food production per capita in 1988-90 was significantly higher as compared to 1979-81 figures, the increase being specially marked in such countries as Vietnam, Cambodia, Indonesia, and Malaysia. Available daily calorie supply was adequate to meet the requirement. The overall pattern of food production however has shown little change, with cereal production continuing to account for a predominant part of food production. There is no evidence of a significant uptrend with respect to production of pulses, milk, horticultural products, poultry or meat production in most countries. A unique and unfortunate feature of the nutrition situation in South-Asian countries is that the incidence of low birth weight deliveries is as high as 34% (1990), ranging from 25% in Sri Lanka to 50% in Bangladesh (as against less than 7% in the countries of Europe and North America). Even in countries of Africa where the overall food and nutrition situation is worse than in South Asia, the incidence is well below 20%. This is a reflection of the poor state of maternal nutrition in pregnancy. Florid nutritional deficiency diseases have shown a steep decline over the last two decades, but goitre and iron deficiency anaemia continue to be major public health problems, though some headway has been made with regard to the control of the former. Severe forms of growth retardation in children have declined but the majority suffer from mild and moderate forms of growth retardation. Countries of the Region are in varying stages of developmental transition. Among the burgeoning middle classes in some of these countries there are evidences of escalation of degenerative diseases such as diabetes and coronary heart disease. With increasing life expectancy, geriatric nutritional problems will demand increasing attention.
Conference abstract:
Hypertension is the leading cause of mortality worldwide. It is highly prevalent throughout the world. Even in regions liike South-East Asia (SEA) which has been perceived to be less prone to cardiovascular diseases, the prevalence of hypertension has been reported to be around 35% (1). Awareness and control of hypertension in SEA is also low, both being less than 50% each (2).Control of hypertension is an interplay between patients, doctors and system factors. One of the reasons for poor control of hypertension is resistant hypertension. Resistant hypertension is defined as blood presure that remains above goal despite being on three concurrent anti-hypertensive medications preferbaly one of which is a diuretic (3).True resistant hypertension should be differiented from secondary hypertension and pseudo-resistant hypertension. Resistant hypertension is almost always multi-factorial in aetiology. The exact prevalence of resistant hypertenion even in developed countries is not known It has been estimated that it is as high as 20-30% in clinical trial patients (4)Not many studies about resistant hypertension have been done in SEA but one done in an outpatient clinic in Thailand found it to be 7.82% Another study also done in a primary care clinc in Malaysia on 1217 patients with hypertension found the prevalence of resistant hypertension to be 8.8%. (6) Here it was found that the presence of chronic kidney disease was more likely to be associated with resistant hypertension (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.56-5.35). Other factors like increasing age, female gender, presence of diabetes, obesity and left ventricular hypertrophyage which have been found to be predictors of resistant hypertension in other studies in the west were not seen in this study. There are various reasons for these findingsBut whatever the factors are that are associated with uncontrolled hypertension, the task is to sort out true resistant hypertension from pseudo-resistant hypertension and secondary casues of hypertension which may be treatable. A concerted effort is needed to reduce the BP in resistant hypertension. Failure to do so would mean a substantal increase in CV risk for the patient.
This study aimed at summarizing the existing health policies for stateless populations living in the 10 ASEAN countries: Brunei, Cambodia, Lao PDR, Indonesia, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam. We followed scoping review method recommended by Arksey and O'Malley. Our inclusion criteria were based on three concepts: populations (stateless and undocumented people), issues (healthcare policies and regulations), and settings (10 ASEAN countries). Our findings suggest that none of the ASEAN countries have explicit healthcare policies for stateless people except Thailand. We also observed that ratification of international human rights treaties relating to the right to health does not necessarily translate into the provision of healthcare policies for stateless population. Although Thailand seems like the only country among 10 ASIAN countries having health policies for stateless populations in the country, the question remains whether having a policy would lead to a proper implementation by ensuring right to health.
Chigger mites (Acariformes: Trombiculidae) of Southeast Asia, including Myanmar, Malaysia, Brunei, Singapore, Indonesia, Thailand, Cambodia, Vietnam, and the Philippines have been revised based on reference data and examination of type materials in European collections of chiggers. For 450 species of 49 genera synonymy, collection data on types, lists of known host species and lists of countries are given. The lists of hosts include in total 649 valid species and subspecies of mammals, birds, reptiles, amphibians, and arthropods. Two new synonyms were established: Doloisia (Doloisia) Oudemans, 1910 (= Doloisia (Trisetoisia) Vercammen-Grandjean, 1968, syn. nov.) and Gahrliepia lui Chen and Hsu, 1955 (= Gahrliepia (Gateria) octosetosa Chen, Hsu and Wang, 1956, syn. nov.). Twenty-seven new combinations were proposed: Walchia (Ripiaspichia) biliranensis (Brown, 1997), comb. nov., Walchia (Ripiaspichia) huberti (Upham and Nadchatram, 1968), comb. nov., Walchia (Ripiaspichia) parmulaseta (Brown, 1997), comb. nov., and Walchia (Ripiaspichia) serrata (Brown and Goff, 1988), comb. nov., transferred from Gahrliepia Oudemans, 1912; Farrellioides consuetum (Womersley, 1952), comb. nov. (originally in Trombicula Berlese, 1905), Farrellioides nakatae (Nadchatram and Traub, 1964), comb. nov. (originally in Leptotrombidium Nagayo, Miyagawa, Mitamura and Imamura, 1916), and Farrellioides striatum (Nadchatram and Traub, 1964), comb. nov. (originally in Leptotrombidium), transferred from Euschoengastia Ewing, 1938; Guntheria (Phyllacarus) bushlandi (Philip, 1947), comb. nov. (originally in Ascoschoengastia Ewing, 1946), transferred from Guntherana Womersley and Heaslip, 1943 (syn. of Guntheria Womersley, 1939); Kayella masta (Traub and Sundermeyer, 1950), comb. nov. (originally in Ascoschoengastia), transferred from Cordiseta Hoffmann, 1954; Neoschoengastia stekolnikovi (Kalúz, 2016), comb. nov., transferred from Hypogastia Vercammen-Grandjean, 1967; Susa chiropteraphilus (Brown, 1997), comb. nov., Susa masawanensis (Brown, 1998), comb. nov., and Susa palawanensis (Brown and Goff, 1988), comb. nov., transferred from Cheladonta Lipovsky, Crossley and Loomis, 1955; Ericotrombidium cosmetopode (Vercammen-Grandjean and Langston, 1971), comb. nov., transferred from Leptotrombidium; Eutrombicula gigarara (Brown, 1997), comb. nov., transferred from Siseca Audy, 1956; Microtrombicula eltoni (Audy, 1956), comb. nov., transferred from Eltonella Audy, 1956; Trombiculindus alethrix (Traub and Nadchatram, 1967), comb. nov., Trombiculindus cuteanum (Vercammen-Grandjean and Langston, 1976), comb. nov., Trombiculindus frondosum (Traub and Nadchatram, 1967), comb. nov., Trombiculindus hastatum (Gater, 1932), comb. nov., Trombiculindus lepismatum (Traub and Nadchatram, 1967), comb. nov., Trombiculindus limi (Traub and Nadchatram, 1967), comb. nov., Trombiculindus maxwelli (Traub and Nadchatram, 1967), comb. nov., Trombiculindus roseannleilaniae (Brown, 1992), comb. nov., Trombiculindus sarisatum (Traub and Nadchatram, 1967), comb. nov., Trombiculindus vanpeeneni (Hadi and Carney, 1977), comb. nov., and Trombiculindus yooni (Traub and Nadchatram, 1967), comb. nov., transferred from Leptotrombidium.
PREMISE: Leaf phenology is an essential developmental process in trees and an important component in understanding climate change. However, little is known about the regulation of leaf phenology in tropical trees.
METHODS: To understand the regulation by temperature of leaf phenology in tropical trees, we performed daily observations of leaf production under rainfall-independent conditions using saplings of Shorea leprosula and Neobalanocarpus heimii, both species of Dipterocarpaceae, a dominant tree family of Southeast Asia. We analyzed the time-series data obtained using empirical dynamic modeling (EDM) and conducted growth chamber experiments.
RESULTS: Leaf production by dipterocarps fluctuated in the absence of fluctuation in rainfall, and the peaks of leaf production were more frequent than those of day length, suggesting that leaf production cannot be fully explained by these environmental factors, although they have been proposed as regulators of leaf phenology in dipterocarps. Instead, EDM suggested a causal relationship between temperature and leaf production in dipterocarps. Leaf production by N. heimii saplings in chambers significantly increased when temperature was increased after long-term low-temperature treatment. This increase in leaf production was observed even when only nighttime temperature was elevated, suggesting that the effect of temperature on development is not mediated by photosynthesis.
CONCLUSIONS: Because seasonal variation in temperature in the tropics is small, effects on leaf phenology have been overlooked. However, our results suggest that temperature is a regulator of leaf phenology in dipterocarps. This information will contribute to better understanding of the effects of climate change in the tropics.
Monitoring the mutation dynamics of human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical in understanding its infectivity, virulence and pathogenicity for development of a vaccine. In an "age of mobility," the pandemic highlights the importance and vulnerability of regionalization and labor market interdependence in Southeast Asia. We intend to characterize the genetic variability of viral populations within the region to provide preliminary information for regional surveillance in the future. By analyzing 142 complete genomes from South East Asian (SEA) countries, we identified three central variants distinguished by nucleotide and amino acid changes.