Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.

Social Work Practice with Asians and Pacific Islanders

This chapter focuses on the United Nations' classification of subregions: Central Asia, East Asia, South Asia, Southeast Asia, and Pacific Islands. Asian and Pacific Islander (API) is used as an inclusive term to refer to the diverse people with origins in countries, states, territories, and jurisdictions in the identified Asia-Pacific geographic region. APIs include immigrants, refugees, United States (U.S.)-born citizens, naturalized citizens, undocumented immigrants, asylum seekers, native communities in U.S. jurisdictions, non-immigrants. Racialization in the United States occurs along a continuum, which reflects longstanding systems of racial categorization and oppression. The COVID-19 pandemic presents sociopolitical challenges for APIs with the emergence of Sinophobia. Like other Asian American communities, the South Asian community has long been described as a model minority due to its members' increasing socioeconomic status and vast educational achievements in the United States. Heterogeneity and disparities among APIs are not fully understood due to the dearth of ethnic-specific studies. Social workers should be mindful of the diverse political, colonization, and immigration histories of API clients to fully consider the person in their environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Pediatric Cardiac Screening Data Warehouse: A National Public Health Resource

Background: Cardiac screening of youth for prevention of sudden cardiac death in the young (SCDY) has been debated due to the absence of large population-specific screening data with outcomes. Despite years of screening by US public screening groups (PSG), there is minimal coordination of effort and no standardized methods for real-world data collection. Objective(s): To understand the methods, quality, outcomes, and best practices of youth screening, the Cardiac Safety Research Consortium Pediatric Cardiology Working Group, in collaboration with FDA and PSGs, developed and enabled a scalable system to collect a uniform pediatric cardiac screening dataset including digital ECGs and post-screening electronic follow-up data. Method(s): Front end data collection (figure) was developed to include use of a universal unique ID system to align paper/digital collection of health and ECG data. PSGs use secure data transfer portals for digital ECG data upload for conversion to device-agnostic standardized FDA format to store in the national pediatric cardiac screening data warehouse. Follow-up data are obtained at designated post-screening intervals (one week, one and 3 months for pilot study) using initial text message contact followed by electronic consent (REDCap) and answering online health surveys. Result(s): Fourteen PSGs in ten states participated in the pilot study. PSG warehouse data include 33840 retrospective ECG datasets collected from 2010 to 2021 containing limited screened history/symptoms but demographics similar to US census as follows: Age 13-30y, Male/Female 57/43%, Asian 6%, Black 19%, Native American <1%, Pacific Islander <1%, White 68%, Other 4%;Hispanic/Non-Hispanic 27%/79%. Individual PSG site demographics reflected local populations. Prospective data collection since 2021 include >4000 uniform screening datasets (age, sex, race, ethnicity, ht, wt, screening H&P, COVID history, medications, digital ECG with results, screening outcome, and, if applicable, ECHO results). Follow up participation allowing initial cellular contact was high (avg 73%, range 51-91%/screening). Conclusion(s): Establishment of a national pediatric cardiac data warehouse enables large-scale aggregation of pediatric cardiac screening information to address deficits in the understanding and prevention of SCDY. This large real-world dataset will help establish normative data for pediatric ECGs which can facilitate development of new diagnostic tools such as machine learning and support pediatric drug and device development. [Formula presented]Copyright © 2023

Factors Associated with Hospitalization with Symptomatic Coronavirus Disease 2019 among Pregnant Individuals: A Multicenter Retrospective Cohort Study

Background: Pregnant individuals are at increased risk of coronavirus disease 2019 (COVID-19) hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Method(s): Among a cohort of pregnant individuals who received prenatal care at 3 healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for severe acute respiratory syndrome coronavirus 2 circulation;model covariates included site, age, race, ethnicity, insurance status, prepregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Result(s): Among 19 456 pregnant individuals with an estimated due date during 1 March 2020-28 February 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (adjusted hazard ratio [aHR], 2.7 [95% confidence interval {CI}, 1.3-5.5]), Native Hawaiian or Pacific Islander race (aHR, 12 [95% CI, 3.2-45.5]), age <25 years (aHR, 3.1 [95% CI, 1.3-7.6]), prepregnancy obesity (aHR, 2.1 [95% CI, 1.1-3.9]), diagnosis of a metabolic disorder (aHR, 2.2 [95% CI, 1.2-3.8]), lung disease excluding asthma (aHR, 49 [95% CI, 28-84]), and cardiovascular disease (aHR, 2.6 [95% CI, 1.5-4.7]). Conclusion(s): Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination. Copyright © 2022 Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Utilizing a Decentralized Clinical Study Approach for Expedited and Diverse Recruitment for Clinical Validation of a Novel Non-invasive Multitargeted Stool-based RNA Test

Introduction: Traditional clinical trials that utilize fixed sites often fail to recruit participants that are representative of the intended use population. Participants, particularly those from minority groups, cite geographical constraints, mistrust, miscommunication, and discrimination as barriers to successful recruitment. A decentralized clinical trial enrollment strategy offers reduced cost, reduced time requirements, and circumvents barriers associated with the recent pandemic outbreak. Method(s): After the mt-sRNA test system entered design-lock, a decentralized clinical trial (CRC-PREVENT) was launched through a digital campaign (https://www.colonscreeningstudy.com/;NCT04739722). Online advertisements were published on multiple social media sites, and engagement with materials directed patients to an online screener. Participants who completed the screener were eligible for enrollment if they met CRC-PREVENT inclusion and exclusion criteria and were willing to complete all clinical trial components, including providing a stool sample before an optical colonoscopy. Result(s): After 12 months of active enrollment, 276,400 individuals engaged with digital advertisements and completed pre-screener surveys to determine eligibility for the clinical trial. In total, 14,264 individuals consented to participate in the CRC-PREVENT clinical trial. Of these individuals, 58% were female (42% were male), and 65% were over 50. Regarding race and ethnicity, eligible individuals directly represented the intended use population: 16% were Black or African American, 0.2% were Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native, and 7% were Hispanic or Latinx. Regarding socioeconomic status, the decentralized approach permitted access to individuals with healthcare inequities: 25% of participants had income under $29,999, 5% of participants were from rural areas (defined as a city center , 10,000 people), and 36.7% of participants were on public insurance. Individuals were derived from 7,644 unique zip codes across all 48 continental United States. (Table) Conclusion(s): A decentralized recruitment strategy permits highly successful enrollment in the face of screening burdens heightened by COVID-19 pandemic. This approach also offered a significantly more diverse population and could mitigate selection bias and attrition bias associated with the cohorts observed in traditional clinical studies.

Covid-19 Bivalent Booster Effectiveness in People with and without Immune Dysfunction

Background: Data on the effectiveness of the bivalent booster vaccine against COVID-19 breakthrough infection and severe outcomes is limited. Method(s): Using patient-level data from 54 sites in the U.S. National COVID Cohort Collaborative (N3C), we estimated bivalent booster effectiveness against breakthrough infection and outcomes between 09/01/2022 (bivalent vaccine approval date) to 12/15/2022 (most recent data release of N3C) among patients completed 2+ doses of mRNA vaccine. Bivalent booster effectiveness was evaluated among all patients and patients with and without immunosuppressed/compromised conditions (ISC;HIV infection, solid organ/ bone marrow transplant, autoimmune diseases, and cancer). We used logistic regression models to compare the odds of breakthrough infection (COVID-19 diagnosis after the last dose of vaccine) and outcomes (hospitalization, ventilation/ECMO use, or death <=28 days after infection) in the bivalent boosted vs. non-bivalent boosted groups. Models controlled for demographics, comorbidities, geographic region, prior SARS-CoV-2 infection, months since the last dose of non-bivalent vaccine, and prior non-bivalent booster. Result(s): By 12/15/2022, 2,414,904 patients had received 2+ doses of mRNA vaccination, 75,873 of them had received a bivalent booster vaccine, and 24,046 of them had a breakthrough infection. At baseline, the median age was 52 (IQR 36-67) years, 40% male, 63% white, 10% Black, 12% Latinx, 3.5% Asian American/Pacific Islander, and 14% were patients with ISC. Patients received a bivalent booster were more likely to be female and had comorbidities. Bivalent booster was significantly associated with reduced odds of breakthrough infection and hospitalization (Figure). The adjusted odds ratios comparing bivalent vs. non-bivalent group were 0.28 (95% CI 0.25, 0.32) for all patients and 0.33 (95% CI: 0.26, 0.41) for patients with ISC. Compared to the nonbivalent group, the bivalent group had a lower incidence of COVID-19-related hospitalization (151 vs. 41 per 100,000 persons), invasive ventilation/ECMO use (7.5 vs. 1.3 per 100,000 persons), or death (11 vs. 1.3 per 100,000 persons) in all patients during the study period;the incidence of severe outcomes after bivalent boosting was similar among patients with and without ISC. Conclusion(s): A bivalent booster vaccine was highly effective against COVID-19 breakthrough infection and severe outcomes among patients received 2+ doses of mRNA vaccine and offered similar protection in patients with and without ISC. (Figure Presented).

No Place for Hate California: A Model for Community-Centered Policymaking

These are just three of more than 11,000 reports of hate against Asian Americans and Pacific Islanders (AAPIs) shared with the Stop AAPI Hate coalition during the first two years of the COVID-19 pandemic. Many more acts continue to go unreported, making the actual number much higher-potentially in the millions. Reports of anti-AAPI hate come from all fifty states and the District of Columbia, with nearly 40 percent from California. In response to the rise in hate against AAPI communities, Stop AAPI Hate introduced No Place for Hate California, a package of first-in-the-nation, state-level policy proposals. Together, these proposals take a gender-based, public health, and civil rights approach to addressing the racialized and sexualized verbal harassment experienced by AAPIs (especially AAPI women) in public, which comprise a majority of the reports submitted to Stop AAPI Hate. Stop AAPI Hate partnered with state legislators and mobilized a coalition of over fifty community-based organizations.

To Write in Unwellness: Documenting A/P/A Voices

In this collectively written essay, we write as volunteers with A/P/A Voices: A COVID-19 Public Memory Project to share and hold space for this archive's stories, images, sounds, and silences. A/P/A Voices first emerged in Spring 2020 when a group of public-facing scholars, activists, and cultural workers converging at the Asian/Pacific/American Institute at NYU recognized the critical need to document the myriad experiences of Asian Americans, Asian immigrants, and Pacific Islanders during the COVID-19 pandemic. In the past year and a half, A/P/A Voices volunteers have conducted over seventy-five oral histories with community organizers, mutual aid workers, healthcare workers, and cultural workers across the country, and over seventy-five artifacts (artwork, videos, other ephemera) have been donated by participants. Through a collective form of writing we describe as dwelling in unwellness, we consider how the A/P/A Voices project and its improvised form of curation—informed by interruption, relational co-laboring, listening, and slowness—is necessitated by prolonged crisis. We ourselves are not outside of the pandemic;rather, as scholars, cultural workers, activists, and caregivers who navigate different levels of precarity, we are entangled within and beyond its folds. Thus, our writing with, rather than about, this project begins with the following questions: How do we connect our experiences of crisis to A/P/A Voices and to one another? How is our work enacted in solidarity with other communities of color devastated by racism and carceral violence, as well as disproportionate economic violence and the uneven effects of an ongoing public health crisis? What does it mean to engage a memory project from a place of unwellness?

Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai'i during the COVID-19 Pandemic.

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.

Emergency Department-based monoclonal antibody therapy for patients with mild to moderate COVID-19

Objectives: To describe the implementation of an ED-based program to offer monoclonal antibody therapy to patients with mild-moderate COVID-19 disease. Background(s): Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Method(s): A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and healthcare utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Result(s): In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion(s): ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.Copyright © 2023

The Racial Differences in Impact and Knowledge of COVID-19 Among Patients with Psychiatric Illnesses

Introduction: COVID-19 pandemic has been associated with increased rates of de-pression, anxiety, and suicidal ideation. Individuals with mental illnesses are disproportionately affected by additional complex health issues. This study aims to examine the knowledge and impact of COVID-19 among patients with mental disorders at the Harris County Psychiatric Center (HCPC). Method(s): A retrospective review of surveys was conducted for patients with mental illness at HCPC. Participants were surveyed on demographics, COVID-19 knowledge, and COVID-19 healthcare impact. The data were analyzed with SPSS 20 for Windows at a 0.05 significance level. Result(s): A total of 46 patients were included in the study. We found that the patient population with mental disorders has different methods of obtaining information regarding COVID-19 and practices varying safety measures. To be precise, more women (52.2%) than men (21.7%) learned about COVID-19 through family and friends (p=0.032). More Hispanic (21.4%) compared to non-Hispanic (0%) patients learned about COVID-19 through resources from the World Health Organization (WHO) (p=0.032). Fewer African American (AA) patients avoided contact with people who were sick (39% vs. 81%) Caucasian (p=0.01) and (100%) Asian/Native American/Pacific Islander [ANAPI] patients (p=0.04). We found more non-Hispanic (50.0%) vs. Hispanic (7.1%) patients reported that their personal time (time outside of work) was unchanged by COVID-19 (p=0.007). More Hispanic (57.1%) vs. non-Hispanic (17.9%) patients reported increased time with family members (p=0.009). Compared to Hispanic patients, more non-Hispanic patients reported unchanged difficulty scheduling appoint-ments (46.4% vs. 7.1%) (p=0.015), obtaining prescription (71.4% vs. 35.7%) (p=0.045), and finding housing placement (53.6% vs. 21.4%) (p=0.047). Furthermore, more Caucasian compared to AA patients reported more changes in how they feel (35.7% vs. 76.2%) (p=0.033), anxiety (52.6% vs. 0%) (p=0.002), stress (47.4% vs. 7.7%) (p=0.024), and sadness (30% vs. 0%) (p=0.031). Finally, more ANAPI (67%) compared to AA patients (0%) reported increased anxiety (p=0.025). Conclusion(s): Our findings suggest that African American patients report less knowledge of COVID-19 prevention and less impact on their mental health by the pandemic compared to other racial groups. Our findings suggest that African American patients may have limited knowledge of COVID-19 prevention compared to other races, Caucasian and Asian/Native American/Pacific Islander patients may have increased mood changes, and Hispanic patients may be experiencing more healthcare inequality amidst the pandemic. However, further inves-tigation of the impending ramifications of the pandemic is warranted.Copyright © 2023 Bentham Science Publishers.

Racial and Ethnic Disparities in Screening Mammography During COVID-19

Purpose: Studies conducted prior to COVID-19 suggested that racial/ethnic disparities in breast cancer screening percentages have substantially reduced over time. COVID-19 has had devastating effects on racial/ethnic minorities and resulted in delays in preventive breast cancer screening. Our purpose was to determine if racial/ethnic minorities were less likely to receive recommended breast cancer screening after the resumption of preventive care during the COVID19 pandemic. Method(s): HIPAA-compliant, institutional review board exempt retrospective cohort study was performed at a multi-location academic medical center located in the Midwest. Patients included women aged 50-74 years old between June 2021 and May 2022, derived from the electronic medical records. Primary outcomes variables included receipt of screening mammogram within the last two years. Primary exposure variables included race (American Indian/Alaska Native, Asian/Native Hawaiian/Other Pacific Islander, Black or African American, White) and ethnicity (Hispanic/Latino, and Not Hispanic/Latino). Binary outcomes were analyzed using logistic regression, adjusted for potential confounders (insurance, age, preferred language, employment status, rural status). Result(s): 37,509 female patients without histories of mastectomies were included (mean age 63.1). 73.8% of eligible patients received a mammogram within the last two years. By race, 74.7% of White patients, 57.6% of Black patients, 67.0% of Asian/Pacific Islander patients, and 60.1% of American Indian patients received a screening mammogram within the last two years. In our unadjusted analyses, Black (OR 0.46, 95% CI 0.41 to 0.52, p < 0.001), Asian (OR 0.69, 95% CI 0.60 to 0.79, p < 0.001), and American Indian patients (OR 0.51, 95% CI 0.39 to 0.66, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Black (OR 0.54, 95% CI 0.47 to 0.61, p < 0.001), Asian (OR 0.79, 95% CI 0.68 to 0.92, p = 0.003), and American Indian patients (OR 0.63, 95% CI 0.48 to 0.82, p = 0.001) were less likely to receive recommended mammography screening. By ethnicity, 74.1% of Non-Hispanic patients and 64.2% of Hispanic patients received a screening mammogram within the last two years. In our unadjusted analyses, Hispanic patients (OR 0.62, 95% CI 0.55 to 0.71, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Hispanic patients (OR 0.92, 95% CI 0.79 to 1.08, p = 0.338) were comparably likely to receive recommended mammography screening. Patients with non-English preferred languages, uninsured or Medicaid patients, and patients living in rural areas were less likely to receive recommended mammography screening (p < 0.001). Conclusion(s): Racial/ethnic minority patients were less likely to receive recommended cancer screening after the resumption of preventive breast cancer screening during the COVID-19 pandemic. Targeted outreach efforts are required to ensure equitable access to breast cancer screening for racial/ethnic minorities, patients with non-English preferred languages, uninsured, Medicaid, and rural patients.

Cambodia in 2022: Crime and Misgovernance

The year 2022 began with a newly anointed leader-in-waiting in Hun Manet, the eldest son of prime minister Hun Sen. This formalized a process of hereditary succession underway for several years. Notwithstanding the prospect of change at the top, the authoritarian modus operandi of Cambodian politics continued in much the same way as in previous years, with government harassment of the opposition, a series of politically motivated court cases, and repression of civil society. Cambodia managed a relatively uneventful year as chair of ASEAN, but its international reputation was badly tarnished when its centrality to a surge in international criminal scamming operations and associated trafficking in persons shone a light on the corrupted nature of the country's political economy. The economy began to recover from the effects of COVID-19, due in part to investment from China, but the consequences of the pandemic continued to be felt, particularly among poorer citizens.

China in 2022: Political Power, Zero-COVID Policy, and Economic Slump

In 2022, president Xi Jinping's prolonged one-man rule was formalized, further concentrating political authority in the Communist Party of China. Unemployment increased sharply because of the continued zero-COVID policy, and the economy declined significantly, generating pain and dissatisfaction and leading to anti-government protests and demonstrations in several cities. At the end of the year, the Party recognized the crisis and eased the preventive measures. Internationally, the United States maintained its technology blockade, hampering China's economy.

Mongolia in 2022: From the COVID-19 Lockdown to Opening the Border

As in 2020, the biggest stories in Mongolia in 2021 and 2022 were elections, COVID-19, and how to cope with the contracting economy. At the end of the year, Mongolia was struggling to meet public health challenges and to recover from the economic downturn. Both the government that was elected in 2020 and the president who took office in 2021 have promised to improve corruption, which is endemic in Mongolia, but people have yet to see much change. Popular dissatisfaction led to a huge public protest in December 2022 that demanded the government ensure more transparency in the coal trade. Thirty years after a peaceful transition to democracy, Mongolia is facing its greatest challenge: how to maintain and develop a transparent democracy that truly cares about public opinion and people's livelihoods.

Indonesia in 2022: Development, Democracy, and…Delay?

After another surge in cases, COVID-19 slowly receded from Indonesia's foreground in 2022 as restrictions were lifted, schools and businesses reopened, and the economy rebounded. The Jokowi government posted several legislative victories while also testing the guardrails of democracy, for example with a public push to postpone the 2024 presidential elections. Corruption and misconduct grabbed global and national headlines and riveted the nation. In foreign policy, Indonesia chaired the G20 in a challenging year for the world economy and global politics.

North Korea in 2022: Mostly the Same, but More

North Korea's 2022 was largely a continuation of the political/economic, military, and diplomatic dynamic from 2020–21, but with different accents. Given the path dependence of military/nuclear modernization, domestic political/economic structural constraints, and the geostrategic situation in East Asia, 2023 in North Korea is likely to continue these same trends. Two big questions loom. (1) How will North Korea open up from COVID border closures, which might make better economic performance possible? (2) How will North Korea manage inter-Korean relations, and is the Korean Peninsula headed for a situation in which the security dilemma of a long-term deterrence relationship between the US–South Korea alliance and North Korea spills over into kinetic conflict?

Vietnam in 2022: Return to a Turbulent Normalcy

Vietnam in 2022 was beset with numerous dramatic political developments and diplomatic uncertainties but also recorded significant economic achievements. Changes in the top echelons of power took place in an unprecedented manner due to the intensifying anticorruption campaign, exposing the malleability of elite Vietnamese governing institutions and shrinking the space for civil society organizations. Meanwhile, Vietnam was recognized for its outstanding recovery from the COVID-19 pandemic with remarkable economic performance. The country's "bamboo diplomacy” was put under stress amid challenges caused by Russia's invasion of Ukraine and the US–China strategic rivalry. Navigating the turbulence and uncertainty of domestic and international affairs while maintaining the momentum of economic recovery will be the main challenge for Vietnam in 2023.

COVID in the islands: A comparative perspective on the Caribbean and the Pacific

Bratt reviews COVID in the islands: A comparative perspective on the Caribbean and the Pacific edited by Yonique Campbell and John Connell.