Ambulatory blood pressure monitoring profiles in Asia.

High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.

Seroprevalence and Shifting Endemicities of Hepatitis A Virus Infection in Two Different Geographical Areas in the Philippines.

INTRODUCTION: Infection with hepatitis A virus (HAV) is often asymptomatic in young children, but most adolescents and adults will have symptoms ranging from nausea and tiredness to acute liver failure and even death. The risk of severe disease is higher in older adults and people with pre-existing liver disease. Immunization is recommended in regions with low HAV endemicity levels, i.e., where people get infected later in life. In the Philippines, recent epidemiologic data on HAV infection are lacking. The objective of this study was to assess age-specific seroprevalence and evaluate risk factors associated with HAV seropositivity. METHODS: People from two geographic areas (urban and rural) were recruited/enrolled and stratified by age group. HAV-specific immunoglobulin G (IgG) antibodies were measured with a chemiluminescent microparticle immunoassay. Sociodemographic parameters, hepatitis medical history, disease knowledge, hygiene measures and sanitation were assessed via a purpose-made questionnaire. Age at midpoint of population immunity (AMPI) was estimated using Kaplan-Meier curves. Logistic regression analyses were carried out to determine factors that were statistically significantly associated (p < 0.05) with HAV seropositivity. RESULTS: Overall, 1242 participants were included in the analysis; 250/602 (41.5%) participants from urban regions and 283/640 (44.2%) participants from rural regions tested positive for HAV IgG antibodies. AMPI was 35 and 37 years for the rural and urban region, respectively. Higher education was associated with lower HAV seropositivity prevalence ratios, while not living in the same region for the last 5 years, regularly consuming street food and lack of handwashing after defecation were associated with a higher likelihood of HAV seropositivity. CONCLUSION: Results suggest that HAV endemicity is low in the Philippines. Factors associated with HAV seropositivity were traveling, consuming street food and lack of basic hygienic gestures. Immunization might be an option to protect vulnerable populations against severe hepatitis A disease.

Hepatitis A virus (HAV) is transmitted via the fecal-oral route through consumption of contaminated food or water or by close contact with an infected person. In children, HAV is usually of no concern, but in adults and people with existing liver disease, HAV infection can lead to severe symptoms and even death. In areas where most people get hepatitis during childhood (high endemicity), vaccination is not required, since people acquire life-long immunity after infection. In regions with low and intermediate HAV endemicity, people may remain at risk of infection later in life and vaccination could be considered to prevent severe HAV disease and its associated complications. In the Philippines, the current endemicity level is unknown. The goal of this study was to determine the endemicity level in the Philippines and to determine risk factors for HAV infection. We measured the proportion of people (by age group) who had previously been infected with HAV. Results showed that by age of 5 years < 20% of the study population was infected by HAV. By the age of 37 years in the urban population and 35 years in the rural population, 50% of people tested positive for HAV antibodies, indicating previous infection. This means that the Philippines has low HAV endemicity. Risk factors for HAV seropositivity were traveling, regularly eating street food and not washing hands after defecation. Vaccination against HAV might be of benefit in the Philippines, especially early in life to prevent most severe outcomes in adulthood.

Hypertension and stroke in Asia: A comprehensive review from HOPE Asia.

Stroke is the primary cause of disability and vascular death worldwide, including Asia. Asian characteristics that differ from the West lead to higher stroke incidence. Stroke epidemiology studies in Asia have shown varying levels of mortality, incidence, prevalence, and burden of disease. Hypertension is the most prevalent risk factor found in Asia. Besides ethnicity that is associated with stroke incidence, both systolic blood pressure, diastolic blood pressure, and blood pressure variability are positively correlated with stroke incidence. Post-stroke cognitive impairment is one of the sequelae that affect one-third of stroke survivors and has become a significant public health concern that is often neglected despite its increasing prevalence. Therefore, it is very important to prevent recurrence by treating stroke optimally and effectively. Increasing awareness and treatment adherence to hypertension, the leading risk factor for stroke, became the main goal in several countries in Asia.

Associations Between Quality of Life, Psychosocial Well-being and Health-Related Behaviors Among Adolescents in Chinese, Japanese, Taiwanese, Thai and the Filipino Populations: A Cross-Sectional Survey.

Health-related behaviors during adolescence have lifelong impacts. However, there are unclear areas regarding the associations between health-related quality of life and demographic characteristics, as well as physical and psychosocial indicators. The aim of this study was to examine the associations between quality of life and body weight, sleep outcome, social support by age, and cohabitants, given that income, self-esteem, lifestyle, emotional, social and behavioral problems were taken into account among adolescents in East and Southeast Asia. A cross-sectional survey was conducted in Zhengzhou of China, Hong Kong, Kansai region of Japan, Taipei of Taiwan, Bangkok of Thailand and Manila of the Philippines between 2016 and 2017 among 21,359 urban adolescents aged between 9 and 16. The results showed that adolescents who had better self-esteem and control of emotions and behaviors had much higher level of perceived quality of life. Those who were overweight or obese, sleepy in the daytime, and not living with parents had worse quality of life compared with those who were not. In conclusion, psychosocial well-being should have a higher priority in the promotion of quality of life among Asian adolescents. Nevertheless, further studies are required to explore the differences in perceived quality of life between genders and countries.

Melioidosis in the Philippines.

The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.