Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end-organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24-hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24-hour average BP. BPV includes circadian, short-term and long-term components, and can best be documented using out-of-office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio- and cerebrovascular events, and end-organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long-acting antihypertensives that control BP throughout the 24-hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24-hour BP control particularly the EMBS and provide the best cardio- and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.
The origins of linguistic diversity remain controversial. Studies disagree on whether group features such as population size or social structure accelerate or decelerate linguistic differentiation. While some analyses of between-group factors highlight the role of geographical isolation and reduced linguistic exchange in differentiation, others suggest that linguistic divergence is driven primarily by warfare among neighbouring groups and the use of language as marker of group identity. Here we provide the first integrated test of the effects of five historical sociodemographic and geographic variables on three measures of linguistic diversification among 50 Austronesian languages: rates of word gain, loss and overall lexical turnover. We control for their shared evolutionary histories through a time-calibrated phylogenetic sister-pairs approach. Results show that languages spoken in larger communities create new words at a faster pace. Within-group conflict promotes linguistic differentiation by increasing word loss, while warfare hinders linguistic differentiation by decreasing both rates of word gain and loss. Finally, we show that geographical isolation is a strong driver of lexical evolution mainly due to a considerable drift-driven acceleration in rates of word loss. We conclude that the motor of extreme linguistic diversity in Austronesia may have been the dispersal of populations across relatively isolated islands, favouring strong cultural ties amongst societies instead of warfare and cultural group marking.
Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.
Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.
This study aimed to evaluate the association between dental students’ personality traits and stress levels in relation to dental education programs among senior dental students in University Malaya (UM) in Malaysia and National University of Singapore (NUS). A cross-sectional survey using a self-administered questionnaire was conducted on UM and NUS senior dental students. The questionnaire comprised items on demographic background, the Big Five Inventory Personality Traits (BFIPT) test and a modified Dental Environment Stress (DES) scale. Rasch analysis was used to convert raw data to interval scores. Analyses were done by t-test, Pearson correlation, and Hierarchical regression statistics. The response rate was 100% (UM=132, NUS=76). Personality trait Agreeableness (mean=0.30) was significantly more prevalent among UM than NUS students (mean=0.15, p=0.016). In NUS, Neuroticism (mean=0.36) was significantly more prevalent than in UM (mean=0.14, p=0.002). The DES mean score was higher among NUS (mean=0.23) than UM students (mean=0.07). In UM, Neuroticism was significantly correlated with stress levels (r=0.338, p<0.001). In NUS, these were Neuroticism (r=0.278, p=0.015), Agreeableness (r=0.250, p=0.029) and Conscientiousness (r=-0.242, p=0.035) personality traits. The correlation was strongest for personality trait Neuroticism in both schools. Hierarchical regression analysis showed that gender and Neuroticism were significant predictors for students’ stress levels (p<0.05) with the latter exerting a bigger effect size (R2=0.18) than gender (R2=004). This study showed that gender and Neuroticism personality trait were significant predictors for stress levels among selected groups of dental students in Southeast Asia. Information on students’ personality may be useful in new students’ intake, stress management counseling and future program reviews.
This article uses metric and nonmetric dental data to test the "two-layer" or immigration hypothesis whereby Southeast Asia was initially occupied by an "Australo-Melanesian" population that later underwent substantial genetic admixture with East Asian immigrants associated with the spread of agriculture from the Neolithic period onwards. We examined teeth from 4,002 individuals comprising 42 prehistoric and historic samples from East Asia, Southeast Asia, Australia, and Melanesia. For the odontometric analysis, dental size proportions were compared using factor analysis and Q-mode correlation coefficients, and overall tooth size was also compared between population samples. Nonmetric population affinities were estimated by Smith's distances, using the frequencies of 16 tooth traits. The results of both the metric and nonmetric analyses demonstrate close affinities between recent Australo-Melanesian samples and samples representing early Southeast Asia, such as the Early to Middle Holocene series from Vietnam, Malaysia, and Flores. In contrast, the dental characteristics of most modern Southeast Asians exhibit a mixture of traits associated with East Asians and Australo-Melanesians, suggesting that these populations were genetically influenced by immigrants from East Asia. East Asian metric and/or nonmetric traits are also found in some prehistoric samples from Southeast Asia such as Ban Kao (Thailand), implying that immigration probably began in the early Neolithic. Much clearer influence of East Asian immigration was found in Early Metal Age Vietnamese and Sulawesi samples. Although the results of this study are consistent with the immigration hypothesis, analysis of additional Neolithic samples is needed to determine the exact timing of population dispersals into Southeast Asia.
The distribution of red cell phosphoglucomutase (PGM) subtypes was determined by starch-gel electrophoresis and isoelectric focusing in a group of 2,484 unrelated individuals from ten Mongoloid populations of East Asia. The sample comprised 998 Chinese from various localities--Singapore, 325; Malaysia, 270; Taiwan, 276; Hong Kong, 67; Fouzhou, 60--as well as 342 Koreans; 252 Filipinos; 529 Thais; 336 Malays, and 27 Indonesians. Altogether 15 phenotypes controlled by four common and five rare alleles at the PGM1 locus were observed in these populations. The frequency of the most frequent allele (PGM1+) varied from 0.56 to 0.74, with the highest frequency observed in the Singapore Chinese and the lowest in the Malays. Within the Chinese from different localities a significant degree of heterogeneity was observed at the PGM1 locus. The rare allele (PGM17)6 was observed only among the Chinese, Thais, and Malays, while the PGM1 was lacking in the Filipinos. A new allele with ahigh pI (6.5) was observed in a low frequency in all the populations but the Malays.
DNA samples were extracted from six prehistoric human remains, found on the Malay Peninsula, dating to the Paleolithic and the Neolithic periods. Nucleotide sequences of mitochondrial DNA were determined by the polymerase chain reaction-direct sequencing method. A phylogenetic tree between prehistoric and present humans was constructed based on the nucleotide sequence data. Mitochondrial DNA phylogenetic relationships and ethnoarchaeological evidence suggest that there is a continuity beetween the pre-Neolithic humans and the present Semang and that the Neolithic humans in this area might be an ancestral group of the Senoi.
Anatomically modern hunter-gatherers expanded from Africa into Southeast Asia at least 50,000 years ago, where they probably encountered and interacted with populations of Homo erectus and Homo floresiensis and the recently discovered Denisovans. Simulation studies suggest that these hunter-gatherers may well have followed a coastal route that ultimately led to the settlement of Sahul, while archaeology confirms that they also crossed significant seas and explored well into the interior. They also adapted to marked environmental changes that alternated between relatively cool and dry conditions and warmer, wetter interludes. During the former, the sea fell by up to 120 m below its present level, which opened up a vast low-lying area known as Sundaland. Three principal alignments can be identified: the first involved the occupation of rock shelters in upland regions, the second has identified settlement on broad riverine floodplains, and the last concentrated on the raised beaches formed from about five millennia ago when the sea level was elevated above its present position. This cultural sequence was dislocated about 4 kya when rice and millet farmers infiltrated the lowlands of Southeast Asia ultimately from the Yangtze River valley. It is suggested that this led to two forms of interaction. In the first, the indigenous hunter-gatherers integrated with intrusive Neolithic communities and, while losing their cultural identity, contributed their genes to the present population of Southeast Asia. In the second, hunter-gatherers withdrew to rainforest refugia and, through selective pressures inherent in such an environment, survived as the small-bodied, dark-skinned humans found to this day in the Philippines, Peninsular Malaysia and Thailand, and the Andaman Islands. Beyond the impact of expansive rice farmers in Melanesia and Australia, hunter-gatherers continued to dominate until they encountered European settlement.
The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the availability of health care resources on life expectancy in Singapore, Malaysia, and Thailand. This is a cross-country study collecting annual data from 3 Southeast Asian countries from 1980 to 2008. Life expectancy is the dependent variable with demographics, socioeconomic status, and health care resources as the 3 main determinants. A structural equation model is used, and results show that the availability of more health care resources and higher levels of socioeconomic advantages are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy by way of health care resources. The authors suggest that more effort should be taken to expand and improve the coverage of health care programs to alleviate regional differences in health care use and improve the overall health status of people in these 3 Southeast Asian countries.
Men's health discourse has been around for more than 2 decades. The higher mortality rates and the shorter life expectancy in Asian men compared with their women counterparts show the disadvantaged status of men's health. Thus, discussions on men's health should address their health needs and not be confined to sex-specific male urology and reproductive health. In Asia, assessing men's health needs is challenging because of the vast differences in the socioeconomic status and the diverse culture among its member countries. Although, the epidemiology of men's health provides the focus for what to address in improving men's health, having an optimal strategy requires the understanding of men's health-seeking behaviors and the social determinants surrounding them. Thus, public health approaches addressing health behaviors and health promotion in the society should be one of the keys in improving men's health status. Locally relevant information is needed to inform effective public health approaches.
Understanding the factors influencing physical activity (PA) in the Asia-Pacific region is critical, given the high prevalence of inactivity in this area. The photovoice technique explores the types of PA and factors influencing PA among adolescents in Kuching, Sarawak. A total of 160 photographs were collected from participants (adolescents, n = 22, mean age = 14.27 ± 0.7 years, and parents, n = 8, mean age = 48 ± 6.8 years). Data analysis used constant comparison methods of a grounded theory. The Analysis Grid for Environments Linked to Obesity was used to categorize PA factors. Study findings were centered on the concept of safety, facilities, parental restriction, friends, cultural traits, media, community cohesiveness, and weather. The central theme was "feeling unsafe" when being outdoors. To promote PA behavior, provision of PA facilities needs to be supported by other programs that build on peer support, crime prevention, and traffic safety, together with other educational campaigns.
This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.
Background: The obesity rate in Malaysia is the highest in Asia. Half its population is obese or overweight. The present study aims to determine the effects of lifestyle intervention on weight loss and blood pressure among Malaysian overweight and obese housewives in Klang Valley.
Methods: A quasi-experimental study with 328 obese and overweight low socio- economic status housewives aged 18-59 years old who met the screening criteria participated in the study. They were recruited into an intervention group (N = 169) or control group (N = 159). The intervention group received a lifestyle intervention consisting of a diet, physical activity and self-monitoring behavior package. The control group (delayed intervention group) received a women's health seminar package. Both groups were followed up for six months. Weight, body mass index (BMI), and blood pressure were evaluated both pre- and post-intervention.
Results: A total of 124 participants from the intervention group and 93 participants from the control group completed the study. Mean weight loss was 1.13 ± 2.70 kg (P < 0.05) in the intervention group and 0.97 ± 2.60 kg (P < 0.05) in the control group. Systolic blood pressure (SBP) reductions in the intervention group were 5.84 ± 18.10 mmHg (P < 0.05). The control group showed reduction in SBP 6.04 ± 14.52 mmHg (P < 0.05). Both group had non-significant DBP reduction. Multivariate analysis via General Linear Model Repeated Measures observed no significant differences in terms of parameter changes with time in both groups for all parameters.
Conclusions: The results indicate that the lifestyle interventions in this study resulted in modest weight loss and thus decreased BMI and blood pressure (SBP) within six months of intervention.
Osteoporosis is highly prevalent, particularly in developing countries. However, bone turnover marker reference ranges for management of osteoporosis in Asian population are yet to be explored and established. Thus, this study aims to develop a regional bone turnover markers (BTMs) reference database by combining country-specific reference database from five ASEAN countries: Malaysia, the Philippines, Singapore, Thailand, and Vietnam. We established a healthy reference population of 746 healthy premenopausal women aged 20 to 44 years old. Serum Procollagen 1 N-Terminal Propeptide (P1NP), Osteocalcin (OC), and Beta-Crosslaps (CTX) concentrations were measured using an automated immunoassay analyzer system, the cobas® modular analyzer systems (Roche Diagnostic Gmbh). The reference interval was defined as the central 95 % range. The estimated reference interval for CTX was 128 to 811 ng/L, OC was 9.0 to 33.0 μg/L, and for P1NP, the range was 22.8 to 96.5 μg/L. Comparison across countries showed that Singaporeans had the highest levels of median CTX along with Thais and Filipinos, who had significantly higher levels of P1NP and OC. Exploratory analysis on the associations with age showed that BTMs decreased with increasing age at 20 to 29 years old and plateaued after 30 years old. When excluding participants in their 20s, the reference interval estimated were CTX: 117-678 ng/L, P1NP: 21.6-85.8 μg/L and OC: 3.5-27.0 μg/L respectively. To the best of our knowledge, this is the first study to report BTMs reference intervals based on a healthy premenopausal Southeast Asian population which will contribute to the appropriate assessment and monitoring of bone turnover rate in the evaluation and management of osteoporosis in the Southeast Asian region. LAY SUMMARY: Osteoporosis is a common health issue, especially in developing countries. However, there is a lack of information on bone health markers specific to the Southeast Asian population. This study aimed to fill this gap by creating a reference database for bone turnover markers (BTMs) in Southeast Asian countries, including Malaysia, the Philippines, Singapore, Thailand, and Vietnam. The researchers studied 746 healthy women aged 20 to 44 years and measured blood markers related to bone health. The reference interval, representing the normal range, was determined. For example, the normal range for CTX was found to be 128 to 811 ng/L, for Osteocalcin was 9.0 to 33.0 μg/L, and for P1NP, the range was 22.8 to 96.5 μg/L. When excluding participants in their 20s, the reference intervals estimated were CTX: 117-678 ng/L, P1NP: 21.6-85.8 μg/L and OC: 3.5-27.0 μg/L respectively. Comparing the results across countries, Singaporeans, Thais, and Filipinos showed variations in their biochemical bone marker levels. Additionally, the study observed changes in the levels with age, with a decrease in BTMs observed after the age of 30. This groundbreaking study provides the first-ever reference intervals for BTMs in a healthy premenopausal Southeast Asian population. These findings will help in the proper assessment and monitoring of bone health, contributing to the management of osteoporosis in the Southeast Asian region.
This article is based on the findings of the Global International Waters Assessment (GIWA) Subregion 53, Bay of Bengal. It introduces the Subregion. The wide disparity in development indicators in the Bay of Bengal Subregion (BOBSR) is presented. The large population of poor people living in South Asia is presented as a factor that needs special attention. The article focuses on the 3 geographic sites selected for detailed analysis: i) the Ganges-Brahmaputra-Meghna river systems; ii) the Merbok Estuary mangroves, Malaysia; and iii) the Sunderbans mangroves, Bangladesh. Integrated water management based upon regional cooperation among Bangladesh, India and Nepal holds opportunities for mutual benefit. Policy options are proposed. For mangrove ecosystems, the impacts of urbanization in Malaysia and the unmanaged expansion of shrimp farming in Bangladesh are analyzed. Improved governance was seen to hold promise for enhancing economic benefits from shrimp farming while safeguarding the natural ecological system. However, these measures need to be a part of national efforts to achieve the UN Millennium Development Goals.
It has recently been shown that ancestors of New Guineans and Bougainville Islanders have inherited a proportion of their ancestry from Denisovans, an archaic hominin group from Siberia. However, only a sparse sampling of populations from Southeast Asia and Oceania were analyzed. Here, we quantify Denisova admixture in 33 additional populations from Asia and Oceania. Aboriginal Australians, Near Oceanians, Polynesians, Fijians, east Indonesians, and Mamanwa (a "Negrito" group from the Philippines) have all inherited genetic material from Denisovans, but mainland East Asians, western Indonesians, Jehai (a Negrito group from Malaysia), and Onge (a Negrito group from the Andaman Islands) have not. These results indicate that Denisova gene flow occurred into the common ancestors of New Guineans, Australians, and Mamanwa but not into the ancestors of the Jehai and Onge and suggest that relatives of present-day East Asians were not in Southeast Asia when the Denisova gene flow occurred. Our finding that descendants of the earliest inhabitants of Southeast Asia do not all harbor Denisova admixture is inconsistent with a history in which the Denisova interbreeding occurred in mainland Asia and then spread over Southeast Asia, leading to all its earliest modern human inhabitants. Instead, the data can be most parsimoniously explained if the Denisova gene flow occurred in Southeast Asia itself. Thus, archaic Denisovans must have lived over an extraordinarily broad geographic and ecological range, from Siberia to tropical Asia.
The final stadium larvae of the following four species of south-east Asian Chlorocyphidae are described and compared: Aristocypha fenestrella (Rambur), Heliocypha biseriata (Selys), Libellago hyalina (Selys) and Sundacypha petiolata (Selys), including both sexes for the latter two species. Excepting one L. hyalina specimen from Brunei, identified by supposition based on habitat, all specimens were identified by comparing and matching the mitochondrial marker COI with that of known adult specimens from Sarawak, Brunei and several localities throughout tropical Asia. The specimens presented close matches with all adults in this gene. An assessment of the efficacy of this method of identification is provided, noting that in some cases close species cannot be separated by bar-code matching and ultimate determination is partially based on known distributions of adults. Some aspects of the relationships among genera revealed by the genetic analyses are also discussed. In addition, an exuvia of Libellago lineata (Burmeister) from northern Thailand, identified by supposition, is partially described for the purpose of comparison with L. hyalina. For the morphological analysis the unique features of chlorocyphid anatomy are discussed, and some new terminology is introduced. Overall, the morphological analysis revealed numerous clear differences between the four species studied, and comparisons with available literature suggest that some of these may be characteristic of their genera. It is also evident that in some cases clear interspecific differences occur within genera. It is however concluded that a generic level larval key for the Oriental region Chlorocyphidae based on morphology may never be attainable, although local generic or even species level keys addressing the fauna of limited geographic areas may be possible in many places, especially as the larvae of more species come to be known and described in detail.
A new species of Ovalona Van Damme & Dumont, 2008 (Cladocera: Anomopoda) related to the rare Australian species Ovalona archeri (Sars, 1888), is described from the Mekong Delta, South Vietnam. Ovalona garibiani sp. nov. differs from O. archeri in morphology of antenna, postabdomen, and proportions of setae on thoracic limbs II-III. Both species differ from other species of the genus Ovalona in the postabdomen with a narrow and sparsely spaced group of lateral setulae, the distance between the postanal groups being slightly greater than the width of the group. O. garibiani sp. nov. is a rare phytophilous species, known from a few localities in continental Malaysia, Southern Thailand and Vietnam.
Paraxenoacria gen. nov., a new genus belonging to the family Peleopodidae is described to accommodate a new species Paraxenoacria spinosa sp. nov. from Bangladesh. This genus is peculiar and clearly distinct from the other genera of this family and others of the related families on the basis of external morphology as well as genitalia features of males such as having downwardly curved digitiform projections in the tegumen and distinct shape of the valva. Additionally, analysis of observations from different citizen science platforms reveals that this newly described genus is distributed throughout South-East Asia up to Malaysia. The biological aspects of this new species are also provided. The genus is tentatively being placed within the subfamily Acriinae due to its close resemblance to the genus Acria Stephens, 1834 pending further comprehensive taxonomic study.