Knowledge, attitude, and practice toward herpes zoster (HZ) and HZ vaccination: Concept elicitation findings from a multi-country study in the Asia Pacific

Herpes zoster (HZ) is a prevalent disease characterized by a painful rash. A multi‑country study was conducted to elicit public and physician knowledge, attitude, and practice (KAP) toward HZ disease and vaccination for the assessment of local factors influencing HZ vaccine perceptions in four Asian-Pacific countries/territories One-to-one qualitative interviews were conducted in 2022, among the public (people aged ≥ 50 years, adults with parents aged ≥ 50 years, zoster vaccine live-vaccinated individuals aged ≥ 50 years in Republic of Korea, and HZ patients; n = 78) and physicians (general practitioners and specialists; n = 24). Themes surrounding KAP toward HZ and HZ vaccination were summarized using a thematic analysis. A substantial knowledge gap related to HZ was observed among the public, including its causes, long-term impacts, and the at-risk population. There was a low perceived risk of HZ and low general awareness of HZ vaccine availability, although country/territory-specific differences existed. Fear of HZ-associated pain contributed toward vaccination intent among HZ patients and adults with parents aged ≥ 50 years. HZ-naïve adults who were encouraged to receive the vaccine by others were not motivated to do so due to optimism bias. Physicians were perceived to be a reliable source of information. However, physicians did not always proactively discuss HZ vaccination due to time constraints and a perceived need to prioritize other vaccinations including influenza and pneumococcal vaccines. Initiatives are needed to improve public awareness of HZ and its complications, in terms of overall impact on individuals and society, and highlight the important role of physicians in recommending vaccination.

Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study

Background

Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals.

Methods

We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries.

Results

Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy.

Conclusion

While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.

Climate Change, Air Pollution, and Biodiversity in Asia Pacific and Impact on Respiratory Allergies

Allergic diseases are increasing globally. Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on chronic noncommunicable diseases. Outdoor and indoor air pollution and climate change are increasing. Asia has experienced rapid economic growth, a deteriorating environment, and an increase in allergic diseases to epidemic proportions. Air pollutant levels in Asian countries are substantially higher than in developed countries. Moreover, industrial, traffic-related, and household biomass combustion and indoor pollutants from chemicals and tobacco are major sources of air pollutants. We highlight the major components of pollutants and their impacts on respiratory allergies.

Emergency medical dispatch services across Pan-Asian countries: a web-based survey

Background

Dispatch services (DS’s) form an integral part of emergency medical service (EMS) systems. The role of a dispatcher has also evolved into a crucial link in patient care delivery, particularly in dispatcher assisted cardio-pulmonary resuscitation (DACPR) during out-of-hospital cardiac arrest (OHCA). Yet, there has been a paucity of research into the emerging area of dispatch science in Asia. This paper compares the characteristics of DS’s, and state of implementation of DACPR within the Pan-Asian Resuscitation Outcomes (PAROS) network.

Methods

A cross-sectional descriptive survey addressing population characteristics, DS structures and levels of service, state of DACPR implementation (including protocols and quality improvement programs) among PAROS DS’s.

Results

9 DS’s responded, representing a total of 23 dispatch centres from 9 countries that serve over 80 million people. Most PAROS DS’s operate a tiered dispatch response, have implemented medical oversight, and tend to be staffed by dispatchers with a predominantly medical background. Almost all PAROS DS’s have begun tracking key EMS indicators. 77.8% (n = 7) of PAROS DS’s have introduced DACPR. Of the DS’s that have rolled out DACPR, 71.4% (n = 5) provided instructions in over one language. All DS’s that implemented DACPR and provided feedback to dispatchers offered feedback on missed OHCA recognition. The majority of DS’s (83.3%; n = 5) that offered DACPR and provided feedback to dispatchers also implemented corrective feedback, while 66.7% (n = 4) offered positive feedback. Compression-only CPR was the standard instruction for PAROS DS’s. OHCA recognition sensitivity varied widely in PAROS DS’s, ranging from 32.6% (95% CI: 29.9–35.5%) to 79.2% (95% CI: 72.9–84.4%). Median time to first compression ranged from 120 s to 220 s.

Conclusions

We found notable variations in characteristics and state of DACPR implementation between PAROS DS’s. These findings will lay the groundwork for future DS and DACPR studies in the PAROS network.

Burden of oral diseases and noncommunicable diseases: An asia-pacific perspective

Background

At a population level, there are no systematic data to correlate the pattern of prevalence of noncommunicable diseases (NCD) with oral disease burden in South Asian countries. The influence of the age, gender, and geographical distribution on these diseases is not reported. We attempt to provide a population level correlation of occurrence using the Global Burden of Disease approach.

Materials and Methods

Using the data from the Global Burden of Diseases, 2016, the occurrence of oral diseases (dental caries of permanent teeth, edentulism (including severe tooth loss), and periodontal diseases) and various NCDs, based on geographical region, gender and age groups were collected and subjected to correlation statistics. Statistical Package for Social Services (Version 23) was used to analyze the results. P ≤ 0.05 was considered as statistically significant.

Results

Geographical location and age had a significant role in the occurrence of dental diseases. There was a considerable difference in rates of dental diseases and NCD prevalence in the various regions of Asia-Pacific. It was observed that for most of the NCDs, there was a linear significant relationship for edentulism as well as periodontal diseases with high statistical significance.

Discussion

The factors that contribute to the discrepancies, phenomenon, and relationship between the oral diseases and NCDs are discussed. The current state of the importance of oral health, in maintaining overall health is discussed. Methods by which policymakers could bring about a change by utilizing the principles of "Overton window" for mobilizing the support of people are presented.

Definition of treatment-resistant depression - Asia Pacific perspectives

BACKGROUND

The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries.

METHODS

A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition.

RESULTS

Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode.

LIMITATIONS

Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel.

CONCLUSION

Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life.