Epidemiology of cervical cancer and HPV infection in Asia and Oceania

Cancer will continue to be a major source of morbidity and mortality globally during the foreseeable future. Human papillomavirus (HPV)-related cancer is now a serious problem in both women and men. The most common HPV-related cancer is cervical cancer in females and oropharyngeal cancer in males. Eastern Africa has a high age-standardized incidence of HPV-related cancers, followed in order by Southern Africa, Central Africa, and then the rest of Africa. Among Asian and Oceania countries, Fiji, Papua New Guinea, Solomon Islands, Indonesia, Maldives, and Myanmar have extremely high age-standardized incidences and mortality. Oropharyngeal cancer is less common than cervical cancer, but the age-standardized incidence, for both females and males, is higher in Western Europe, Northern Europe, North America, and Australia/New Zealand. Oropharyngeal cancer incidence rates differ significantly from the rates of cervical cancer within the same countries. In Asia and Oceania, the incidence of oropharyngeal cancer is particularly high among females in Bhutan, Bangladesh, and Australia, and it is highest among males in Bangladesh, New Caledonia, Australia, and French Polynesia. To a certain extent, cervical cancer can be reduced through the development of cervical screening programs and improvements in screening uptake. On the other hand, for oropharyngeal cancer, as of yet, no effective means of cancer screening has been established. Widespread uptake of HPV vaccine will contribute to the reduction of HPV-related cancers in Asia and Oceania, but also in the rest of the world.

Awareness of human papillomavirus infection among Indigenous males in North America and Oceania: a Scoping Review

PURPOSE

Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection. HPV infections have been on the rise among males, especially in the form of oropharyngeal cancer. Despite this, there is a gap in healthcare guidelines to increase HPV vaccine administration among males. In this study, we focus on the Indigenous population of North America and Oceania to determine existing barriers resulting in low HPV vaccination rates among the population.

METHOD

We surveyed peer-reviewed literature on the awareness of HPV infection among Indigenous males in North America and Oceania. Using keywords HPV plus male, men or boy, and ethnical filters such as Indigenous, Aboriginal or First Nations, we retrieved 54 articles based on titles, of which 15 were included after reading the abstracts.

RESULTS

Reported HPV awareness was generally low in Indigenous males in North America, with no peer-reviewed data from Oceania. The lower understanding by males compared to females was largely attributable to misconceptions about HPV-related diseases, their transmission, and prevention. Lack of awareness and concern toward the risk of contracting HPV infection in Indigenous males suggests an impediment in disseminating health information about this cancer-causing virus.

CONCLUSION

Culturally sensitive education, with emphasis on Indigenous males, is needed to improve this group's HPV knowledge. Researchers should also engage meaningfully with Indigenous communities by building rapport to achieve a positive change in attitude.

Pseudoscorpions (Arachnida, Pseudoscorpiones) from French Polynesia with first species records and description of new species

A new species Olpiumcaputisp. nov. from Tahiti is described here based on external characters. This is the first record of the family Olpiidae Banks, 1895 from French Polynesia. Additionally, the genus Paratemnoides Harvey, 1991 is recorded from French Polynesia for the first time with the full description of new-found specimens of Paratemnoidesassimilis (Beier, 1932). New localities of Geogarypuslongidigitatus (Rainbow, 1897) are added. An identification key to pseudoscorpions of French Polynesia is provided.

Rays in the Shadows: Batoid Diversity, Occurrence, and Conservation Status in Fiji

Over recent decades, elasmobranchs (sharks, rays, and skates) have been increasingly recognized among the world's most threatened marine wildlife, leading to heightened scientific attention. However, batoids (rays and skates) are relatively understudied, especially in Large Ocean States of the Pacific. This synthesis compiles insights on batoid diversity and occurrence in Fiji's waters by integrating a literature review, participatory science programs such as the Great Fiji Shark Count (GFSC) Initiative, Projects Abroad Fiji (PA), Manta Project Fiji (MPF), and iNaturalist, along with environmental DNA. Nineteen batoid species from seven families were identified: 19 species from the literature, 12 from participatory science programs, and six from eDNA analysis. Notably, this study provides the first photographic evidence for the bentfin devil ray (Mobula thurstoni, Lloyd, 1908) in Fiji. GFSC data indicated the highest species diversity in the Western Division, with spotted eagle rays (Aetobatus ocellatus, Kuhl, 1823) and maskrays (Neotrygon sp.) being observed most. In-person interviews conducted by PA provided information on the occurrence of wedgefishes and potentially sawfishes. MPF records and iNaturalist uploads were dominated by reef manta rays (M. alfredi, Krefft, 1868), while the pink whipray (Pateobatis fai, Jordan and Seale, 1906) yielded the most DNA sequences. Overall, 68.4% of the species face an elevated extinction risk based on the International Union for the Conservation of Nature Red List criteria. Although caution is warranted with older literature-based records for the giant guitarfish (Glaucostegus typus, Anonymous [Bennett], 1830), giant stingaree (Plesiobatis daviesi, Wallace, 1967), and the lack of sawfish verification, this synthesis highlights the effectiveness of a combined methodological approach in establishing a reference point for the diversity and occurrence of this understudied taxon in Fiji.

The prevalence of multiple sclerosis (MS) in Oceania, a systematic review, and meta-analysis

BACKGROUND

Oceania is a continent, covering more than 8 million km2, with a population of more than 44 million people. In different countries landing in Oceania, various prevalence of MS has been reported, so we designed this systematic review and meta-analysis to estimate the pooled prevalence of MS in Oceania.

METHODS

We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. We also searched references of included studies, and conference abstracts. The search was done on January 1, 2023, by two independent researchers. We extracted the name of the first author, country, publication year, prevalence period, number of study participants, total female and male population, disease duration, type of MS, mean duration of the disease, mean age at disease onset, mean Expanded Disability Status Scale (EDSS), and total female and male patients with MS.

RESULTS

A literature search revealed 81,044 records; after deleting duplicates, 38,260 records remained. One hundred and six full texts were evaluated, and finally, seventeen studies remained for systematic review. Most studies were done in Newcastle; eight studies were done in 1961, 8 in 1981, 2 in 1996, and 2 in 2001. In all other years, only one study was done. The pooled prevalence of MS in 1961 in Oceania was estimated as 19.85/100,000 (I2=70.3%, p=0.001). The pooled prevalence of MS in 1981 in Oceania was estimated as 39.07/100,000 (I2 =88%, p=0.001).

CONCLUSIONS

The result of this systematic review and meta-analysis shows that the prevalence of MS has increased dramatically during the timespan in Oceania.

The Epidemiology of Inflammatory Bowel Disease in Oceania: A Systematic Review and Meta-Analysis of Incidence and Prevalence

BACKGROUND

Past studies have shown high rates of inflammatory bowel disease (IBD) in Australia and New Zealand (NZ). We aimed to describe the epidemiology of IBD in Australia, NZ, and the surrounding region (collectively termed Oceania) by conducting a systematic review and meta-analysis.

METHODS

Electronic databases were searched from inception to April 2023 for studies reporting incidence or prevalence rates of IBD, Crohn's disease (CD), or ulcerative colitis (UC) in Oceania. All study designs were included. A meta-analysis calculated pooled estimates of incidence and prevalence, and a sensitivity analysis compared the pooled population-based studies with the non-population-based studies and the Australian and NZ studies separately.

RESULTS

Nineteen incidence and 11 prevalence studies were included; 2 studies were from the Pacific Islands, with the rest coming from Australia and NZ. Pooled estimates showed high incidence rates of 19.8 (95% confidence interval [CI], 15.8-23.7) for IBD, 8.3 (95% CI, 6.9-9.8) for CD, and 7.4 (95% CI, 5.7-9.1) for CD per 100 000 person-years. CD was more common than UC in most studies. The pooled estimates for the prevalence studies were 303.3 (95% CI, 128.1-478.4) for IBD, 149.8 (95% CI, 71.0-228.5) for CD, and 142.2 (95% CI, 63.1-221.4) for UC per 100 000 persons. Studies using population-based data collection methods showed higher pooled rates for both incidence and prevalence.

CONCLUSIONS

The incidence and prevalence of IBD in Oceania is high. The studies were heterogeneous and there were several geographic areas with no information, highlighting the need for more epidemiological studies of IBD.

Antimicrobial Resistance in Papua New Guinea: A Narrative Scoping Review

Antimicrobial-resistant bacterial infections are a known threat to the public health of low-income countries and are undercharacterized in Papua New Guinea. A scoping literature review of scientific peer-reviewed publications on antimicrobial resistance in Papua New Guinea was conducted, and their results were summarized. Many of the available data on resistant bacteria in Papua New Guinea have come from Port Moresby and Goroka and have been focused on Staphylococcus aureus, as well as important pediatric pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. Progressive resistance to the commonly used antibiotics penicillin and chloramphenicol among most clinically important bacterial pathogens has prompted healthcare workers to adopt expensive broad-spectrum antibiotics. There is already evidence of resistance to newly adopted antibiotics among several Gram-negative organisms. Drivers of antimicrobial resistance in Papua New Guinea include a high burden of infectious diseases, inappropriate antibiotic prescription practices, poor regulation of antibiotics, incomplete adherence, substandard drug quality, and overcrowding of healthcare facilities. There is a lack of information on antimicrobial resistance among priority pathogens and from several important regions of Papua New Guinea.

Molecular and clinical epidemiology of carbapenem resistant Acinetobacter baumannii ST2 in Oceania: a multicountry cohort study

Background

Carbapenem resistant Acinetobacter baumannii (CRAb) is categorised by the World Health Organization (WHO) as a pathogen of critical concern. However, little is known about CRAb transmission within the Oceania region. This study addresses this knowledge gap by using molecular epidemiology to characterise the phylogenetic relationships of CRAb isolated in hospitals in Fiji, Samoa, and other countries within the Oceania region including Australia and New Zealand, and India from South Asia.

Methods

In this multicountry cohort study, we analysed clinical isolates of CRAb collected from the Colonial War Memorial Hospital (CWMH) in Fiji from January through December 2019 (n = 64) and Tupua Tamasese Mea'ole Hospital (TTMH) in Samoa from November 2017 through June 2021 (n = 32). All isolates were characterised using mass spectrometry, antimicrobial susceptibility testing, and whole-genome sequencing. For CWMH, data were collected on clinical and demographic characteristics of patients with CRAb, duration of hospital stay, mortality and assessing the appropriateness of meropenem use from the treated patients who had CRAb infections. To provide a broader geographical context, CRAb strains from Fiji and Samoa were compared with CRAb sequences from Australia collected in 2016-2018 (n = 22), New Zealand in 2018-2021 (n = 13), and India in 2019 (n = 58), a country which has close medical links with Fiji. Phylogenetic relationships of all these CRAb isolates were determined using differences in core genome SNPs.

Findings

Of CRAb isolates, 49 (77%) of 64 from Fiji and all 32 (100%) from Samoa belonged to CRAb sequence type 2 (ST2). All ST2 isolates from both countries harboured blaOXA-23, blaOXA-66 and ampC-2 genes, mediating resistance to β-lactam antimicrobials, including cephalosporins and carbapenems. The blaOXA-23 gene was associated with two copies of ISAba1 insertion element, forming the composite transposon Tn2006, on the chromosome. Two distinct clusters (group 1 and group 2) of CRAb ST2 were detected in Fiji. The first group shared common ancestral linkage to all CRAb ST2 collected from Fiji's historic outbreak in 2016/2017, Samoa, Australia and 54% of total New Zealand isolates; they formed a single cluster with a median (range) SNP difference of 13 (0-102). The second group shared common ancestral linkage to 3% of the total CRAb ST2 isolated from India. Fifty eight of the 64 patients with CRAb infections at the CWMH had their first positive CRAb sample collected 72 h or more following admission. Meropenem use was deemed inappropriate in 15 (48%) of the 31 patients that received treatment with meropenem in Fiji. Other strains of CRAb ST1, ST25, ST107, and ST1112 were also detected in Fiji.

Interpretation

We identified unrecognised outbreaks of CRAb ST2 in Fiji and Samoa that linked to strains in other parts of Oceania and South Asia. The existence of Tn2006, containing the blaOXA-23 and ISAba1 insertion element, within CRAb ST2 from Fiji and Samoa indicates the potential for high mobility and dissemination. This raises concerns about unmitigated prolonged outbreaks of CRAb ST2 in the two major hospitals in Fiji and Samoa. Given the magnitude of this problem, there is a need to re-evaluate the current strategies used for infection prevention and control, antimicrobial stewardship, and public health measures locally and internationally. Moreover, a collaborative approach to AMR surveillance within the Oceania region with technical, management and budgetary support systems is required to prevent introduction and control transmission of these highly problematic strains within the island nation health systems.

Funding

This project was funded by an Otago Global Health Institute seed grant and Maurice Wilkins Centre of Research Excellence (CoREs) grant (SC0000169653, RO0000002300).

Children with palliative care needs in Papua New Guinea, and perspectives from their parents and health care workers: a qualitative study

INTRODUCTION

The World Health Organisation defines paediatric palliative care (PPC) as caring for the child's body, mind, and spirit, and giving support to the family. In life-limiting conditions it is important that palliative support can be provided even when curative attempts are being utilised. In Papua New Guinea, as in other low- and middle-income countries there is a lack of services and training on PPC. This study aims to describe the characteristics of children with palliative care needs and to assess the perspectives of their parents and health care workers.

METHODS

A descriptive qualitative study was carried out over 5 months in 2022 at the Port Moresby General Hospital children's wards. Clinical information was gathered from the admission charts of children with life threatening and life limiting conditions and a recorded interview was carried out with the children's parents. A focus group interview with 10 experienced nurses caring for these children was video recorded. The recorded interviews were subjected to thematic analysis.

RESULTS

Twenty children and their parents were included in this study. Nine had a cancer diagnosis and 11 had a chronic progressive condition. The common clinical characteristics of children with palliative care needs were pain (n = 9) and shortness of breath (n = 9), and most children had more than one symptom. Several themes were identified in the parent interviews. Most parents could not name their child's diagnosis, but they were able to correctly describe their child's condition using their own terms. Most parents felt involved in their child's management and were satisfied with the care provided. Parents were psychologically affected by their child's situation but were hopeful that God and the medicines would heal their child. Ten nurses were involved in a focus-group interview. Most nurses' understanding of palliative care was from experience not from formal training, but most felt confident in identifying the physical, emotional, and spiritual needs of the children. Understanding of analgesia was limited, as was the availability of appropriate medications included in the WHO Analgesic Ladder.

CONCLUSION

There is a need for a systematic approach to palliative care in Papua New Guinea. Palliative care can be integrated into an overall approach to quality of paediatric care. It is relevant to a broad section of children with severe chronic or malignant conditions and can be carried out with limited resources. It does require some resources, further training and education, and increased provision of basic drugs for symptom control.

Recovery of insular seabird populations years after rodent eradication

Seabirds have been particularly affected by invasive non-native species, which has led to the implementation of numerous eradication campaigns for the conservation of these keystone and highly vulnerable species. Although the benefits of eradication of invasive non-native species for seabird conservation have been demonstrated, the recovery kinetics of different seabird populations on islands after eradication remains poorly evaluated. We conducted long-term monitoring of the number of breeding pairs of seven seabird species on a small atoll, Surprise Island, New Caledonia (southwestern tropical Pacific). Marine avifauna of the island were surveyed yearly 4 years before to 4 years after rodent eradication (conducted in 2005), and we conducted multiple one-time surveys from ∼10 years before and ∼15 years after eradication. We sought to determine how different seabird species responded to the eradication of invasive rodents in an insular environment. Three species responded positively (two- to 10-fold increase in population size) to eradication with differences in lag time and sensitivity. The number of breeding pairs increased (effect sizes = 0.49-0.95 and 0.35-0.52) for two species over 4 years post-eradication due to immigration. One species had a longer (at least 5 years) response time than all others; breeding pairs increased for over 10 years after eradication. Long-term sampling was necessary to observe the responses of the seabird populations on the island because of the delayed response of a species to eradication not visible in the first years after eradication. Our results confirmed the positive effects of eradication of invasive non-native species on seabirds and emphasize the importance of mid- and long-term pre- and posteradication surveys to decipher the mechanisms of seabird recovery and confirm the benefits of eradication for conservation purposes.

Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management

Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.

Asia-Pacific consensus recommendations for application of continuous glucose monitoring in diabetes management

Glucose monitoring has evolved from self-monitoring of blood glucose to glycated hemoglobin, and the latest continuous glucose monitoring(CGM). A key challenge to adoption of CGM for management of diabetes in Asia is the lack of regional CGM recommendations. Hence, thirteen diabetes-specialists from eight Asia-Pacific(APAC) countries/regions convened to formulate evidence-based, APAC-specific CGM recommendations for individuals with diabetes. We defined CGM metrics/targets and developed 13 guiding-statements on use of CGM in- [1]people with diabetes on intensive insulin therapy, and [2]people with type 2 diabetes on basal insulin with/without glucose lowering drugs. Continual use of CGM is recommended in individuals with diabetes on intensive insulin therapy and suboptimal glycemic control, or at high risk of problematic hypoglycemia. Whilst continual/intermittent CGM may be considered in individuals with type 2 diabetes on basal insulin regimen and with suboptimal glycemic control. In this paper, we provided guidance for optimizing CGM in special populations/situations, including elderly, pregnancy, Ramadan-fasting, newly diagnosed type 1 diabetes, and comorbid renal disease. Statements on remote CGM, and stepwise interpretation of CGM data were also developed. Two Delphi surveys were conducted to rate the agreement on statements. The current APAC-specific CGM recommendations provide useful guidance for optimizing use of CGM in the region.

Incidence, treatment patterns and clinical outcomes associated with acute kidney injury in Fiji: a retrospective cohort study

AIM

This study aims to describe the incidence and outcomes of acute kidney injury at Fiji's tertiary referral hospital.

METHODS

A retrospective study of adults aged ≥ 18 years hospitalised at the Colonial War Memorial Hospital between 1 January and 30 June, 2015 was conducted. Acute kidney injury was defined using the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines by medical record review.

RESULTS

One hundred ten (2.1%) of 5140 hospitalised patients met the diagnostic criteria for acute kidney injury. Fifty-two cases (47%) of acute kidney injury were stage 1, 11 (10%) cases were stage 2, and 47 (43%) cases were stage 3. Acute sepsis (n = 68) and dehydrating illness (n = 52) were the most common causes. Thirty-nine patients had urinalysis and 36 received imaging; none underwent kidney biopsy. Treatment included antibiotics (n = 91), intravenous fluids (n = 84) and vasopressors (n = 25). Twenty-one (19%) patients were treated with intermittent haemodialysis. Forty-seven patients (43%) with acute kidney injury died including 16 (76%) dialysed patients. Crude mortality at 7 days was 19 (40%). Of the 63 patients who survived their primary illness, 29 (46%) had a follow-up assessment at 3 months.

CONCLUSION

In patients needing hospitalisation for acute kidney injury in Fiji, the most common causes were sepsis and dehydration. Mortality was high, in particular in those who received dialysis. Follow-up after acute kidney injury is incomplete.

Low birthweight newborns in Vanuatu: A longitudinal follow-up study

AIM

Medical care and technology have increased the survival of low birthweight babies (LBW), but especially in low- and middle-income settings the longer term thriving of such babies is not assured because of their fragility, limited services and difficult access after discharge from hospital. In Vanuatu, a Pacific nation of dispersed islands, improving LBW outcomes and survival remains a significant challenge. In this study, we prospectively document the survival, developmental and nutritional outcomes of a cohort of LBW over the first year of life. We also explored the mother's experiences of caring for an LBW baby in hospital and at home.

METHODS

A prospective descriptive cohort study of 49 newborns weighing less than 2.5 kg, born between April and August 2019. Data were recorded on their hospital stay, and they were followed up at 6 and 12 months post-discharge and outcomes recorded. Developmental milestones were assessed using the Denver Developmental Screening Test, using milestones appropriate for corrected age. Qualitative interviews were conducted to identify experiences and challenges the mothers faced in caring for their LBW baby.

RESULTS

The mean birthweight was 1800 g at 35 weeks gestation (between 2nd and 9th centile). At 6 months of age the median weight was 6.5 kg (9th centile) and at 12 months it was 7.8 kg (9th centile). Three infants died in the first 6 months post-discharge. By 12 months of age, the proportion of infants who had achieved milestones of social and emotional (90%), language and communication (97%), cognition (85%) and motor (69%) development. One had evidence of retinopathy, and 19 had clinical anaemia. Mothers identified several stressors that they attributed as risk factors for premature delivery and outlined the difficulties and isolation of caring for an LBW baby.

CONCLUSIONS

It is vital that all LBW babies are followed up in the years after discharge: nutritional, developmental and general health outcomes were generally good; however, post-discharge deaths are more common in this group than in the general population. Equally important is the support for mothers of LBW babies to achieve better outcomes.

Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region

It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.

An examination of procrastination in a multi-ethnic population of adolescents from New Caledonia

BACKGROUND

Although procrastination has been widely studied in adults, comparatively little work has focused on adolescent procrastination, especially in the Pacific region. As a contribution to knowledge and diversification of population sampling, therefore, we examined procrastination in a multi-ethnic sample of adolescents from New Caledonia. Specifically, we examined gender and ethnic differences in procrastination, as well as sociodemographic and ethnic identity predictors of procrastination.

METHODS

927 adolescents (474 boys, 453 girls; age M = 13.2 years) completed measures of procrastination and ethnic identity, and reported their ethnicity (Kanak vs. Polynesian vs. European). Sociodemographic data (sex, age, area of residence and socioeconomic status) were also collected.

RESULTS

An analysis of variance indicated significant ethnic (Kanak and Polynesian adolescents had higher procrastination than European adolescents) and sex differences (girls had higher procrastination than boys), but no significant interaction. Regression analysis showed that higher procrastination was significantly associated with sex, ethnicity, age, and the interaction between ethnicity and ethnic identity. Moderation analysis showed that ethnic identity moderated the relationship between ethnicity and procrastination, but only in Kanak adolescents.

CONCLUSION

Relatively high levels of procrastination were observed in Kanak and Polynesian adolescents, and in girls. These findings, while preliminary, may have important implications for academic attainment in the New Caledonian context.

Relation of blood lead levels and lead in gasoline: an updated systematic review

BACKGROUND

Millions of tons of lead were added to gasoline worldwide beginning in 1922, and leaded gasoline has been a major source of population lead exposure. In 1960s, lead began to be removed from automotive gasoline. Removal was completed in 2021.

OBJECTIVES

To determine whether removal of lead from automotive gasoline is associated with declines in population mean blood lead levels (BPb).

METHODS

We examined published studies that reported population blood leaded levels for two or more years, and we calculated average concentrations of lead in gasoline corresponding to the years and locations of the blood lead level measurements.

RESULTS

Removal of lead from gasoline is associated with declines in BPb in all countries examined. In some countries, BPb continues to fall after lead has been eliminated from gasoline. Following elimination of lead from gasoline, BPb less than 1 μg/dL have been observed in several European and North American countries, and BPb less than 3 μg/dL have been documented in several studies from South America.

DISCUSSION

There remain many countries for which no multi-year studies of populations BPb have been identified, including all of Central America, high population countries including Pakistan and Indonesia, and major lead producers including Australia and Russia.

CONCLUSION

Removal of lead from gasoline has been a public health success. Elimination of lead from gasoline has enabled many countries to achieve population mean BPb levels of 1 μg/dL or lower. These actions have saved lives, increased children's intelligence and created great economic benefit in countries worldwide.

Implications of anomalous relative sea-level rise for the peopling of Remote Oceania

Beginning ~3,500 to 3,300 y B.P., humans voyaged into Remote Oceania. Radiocarbon-dated archaeological evidence coupled with cultural, linguistic, and genetic traits indicates two primary migration routes: a Southern Hemisphere and a Northern Hemisphere route. These routes are separated by low-lying, equatorial atolls that were settled during secondary migrations ~1,000 y later after their exposure by relative sea-level fall from a mid-Holocene highstand. High volcanic islands in the Federated States of Micronesia (Pohnpei and Kosrae) also lie between the migration routes and settlement is thought to have occurred during the secondary migrations despite having been above sea level during the initial settlement of Remote Oceania. We reconstruct relative sea level on Pohnpei and Kosrae using radiocarbon-dated mangrove sediment and show that, rather than falling, there was a ~4.3-m rise over the past ~5,700 y. This rise, likely driven by subsidence, implies that evidence for early settlement could lie undiscovered below present sea level. The potential for earlier settlement invites reinterpretation of migration pathways into Remote Oceania and monument building. The UNESCO World Heritage sites of Nan Madol (Pohnpei) and Leluh (Kosrae) were constructed when relative sea level was ~0.94 m (~770 to 750 y B.P.) and ~0.77 m (~640 to 560 y B.P.) lower than present, respectively. Therefore, it is unlikely that they were originally constructed as islets separated by canals filled with ocean water, which is their prevailing interpretation. Due to subsidence, we propose that these islands and monuments are more vulnerable to future relative sea-level rise than previously identified.

Marine conservation in Vanuatu: Local conceptualisation and 'assemblage'

This article deals with the local conceptualisation of 'conservation' in the village Siviri in Vanuatu where villagers have established and maintain a small marine conservation area. Looking at villagers' motivations, the aim is to carve out the local conceptualisation and practice of 'conservation', to show what conservation is for the villagers. The theoretical framework is a combination of two approaches, namely 'assemblage' and 'world-making'. Conservation in Siviri is ontologically different from the concept of conservation used in Vanuatu national policy. It can be regarded as a creative engagement of villagers with their environment(s) to preserve the specific world-making assemblage consisting of humans and marine life for future generations.

"Draw the sea…": Children's representations of ocean connectivity in Fiji and New Caledonia

In the South Pacific region, marine territories and resources play a crucial role for local communities. Children engage with these territories and resources from an early age onwards. As the next ocean stewards, they are a stakeholder group whose understandings of ocean connectivity and fisheries should be given serious consideration in decision-making processes towards the sustainable use and management of coastal seas. This paper analyses 290 children's drawings from Fiji and New Caledonia, created in 2019 in spontaneous response to the instruction: "Draw the sea and what you and others do in the sea". Exploring the webs of connections with and within the sea revealed by these children's drawings and their own interpretations leads us to discuss children's representations of the sea: (1) beyond a land-sea compartmentation, (2) as a locus of both exploitation and conservation of marine life, and (3) as a 'place-full' space connecting human and more-than-human realms.

School food programmes in the Pacific Islands: exploring opportunities and challenges for creating healthier school food environments

OBJECTIVE

The school setting can provide an environment that supports healthy behaviours, including the provision of food. School food activities, that is, school feeding, are commonplace globally, but not well understood in the Pacific Islands region. The aim of this research is to explore learnings associated within existing school food programmes (SFP), and adoption resistors in those Pacific Island Countries and Territories (PICT) without SFP, with the intent of improving current and future SFP interventions.

DESIGN

This observational cross-sectional study utilised four facilitated workshop sessions to explore SFP within an existing framework.

SETTING

Pacific Islands region.

PARTICIPANTS

Fourteen participants representing the education and health sectors from eleven PICT, and two participants representing regional organisations.

RESULTS

Most countries reported some form of related policy, but key critical constraints to the use of SFP included local food environments, strategic alignment to organisational priorities, advocacy and organisational leadership, and community and cultural connections and collaboration. There are opportunities for integration of SFP into existing frameworks (i.e. Health Promoting Schools), increased collaboration, greater professional development and awareness activities, improved monitoring and evaluation, improved awareness of SFP and promotion of healthy eating for the wider school community.

CONCLUSIONS

Given the current health, social and economic challenges faced by countries and territories in the Pacific Islands region, SFP should be considered as an opportunity for food provision and associated nutrition education for students and their wider community. Further research is needed to understand the critical constraints of SFP in this region and how to support stakeholders to advocate for, develop and sustain SFP that are contextually and culturally appropriate.

Goals, challenges and strategies for wound and bleeding management in total knee arthroplasty: A modified Delphi method

BACKGROUND

Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available.

METHODS

Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September-October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework.

RESULTS

Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus.

CONCLUSION

Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.

Persistence of Rare Salmonella Typhi Genotypes Susceptible to First-Line Antibiotics in the Remote Islands of Samoa

For decades, the remote island nation of Samoa (population ~200,000) has faced endemic typhoid fever despite improvements in water quality, sanitation, and economic development. We recently described the epidemiology of typhoid fever in Samoa from 2008 to 2019 by person, place, and time; however, the local Salmonella enterica serovar Typhi (S. Typhi) population structure, evolutionary origins, and genomic features remained unknown. Herein, we report whole genome sequence analyses of 306 S. Typhi isolates from Samoa collected between 1983 and 2020. Phylogenetics revealed a dominant population of rare genotypes 3.5.4 and 3.5.3, together comprising 292/306 (95.4%) of Samoan versus 2/4934 (0.04%) global S. Typhi isolates. Three distinct 3.5.4 genomic sublineages were identified, and their defining polymorphisms were determined. These dominant Samoan genotypes, which likely emerged in the 1970s, share ancestry with other 3.5 clade isolates from South America, Southeast Asia, and Oceania. Additionally, a 106-kb pHCM2 phenotypically cryptic plasmid, detected in a 1992 Samoan S. Typhi isolate, was identified in 106/306 (34.6%) of Samoan isolates; this is more than double the observed proportion of pHCM2-containing isolates in the global collection. In stark contrast with global S. Typhi trends, resistance-conferring polymorphisms were detected in only 15/306 (4.9%) of Samoan S. Typhi, indicating overwhelming susceptibility to antibiotics that are no longer effective in most of South and Southeast Asia. This country-level genomic framework can help local health authorities in their ongoing typhoid surveillance and control efforts, as well as fill a critical knowledge gap in S. Typhi genomic data from Oceania. IMPORTANCE In this study, we used whole genome sequencing and comparative genomics analyses to characterize the population structure, evolutionary origins, and genomic features of S. Typhi associated with decades of endemic typhoid fever in Samoa. Our analyses of Samoan isolates from 1983 to 2020 identified a rare S. Typhi population in Samoa that likely emerged around the early 1970s and evolved into sublineages that are presently dominant. The dominance of these endemic genotypes in Samoa is not readily explained by genomic content or widespread acquisition of antimicrobial resistance. These data establish the necessary framework for future genomic surveillance of S. Typhi in Samoa for public health benefit.

A revision of Lycianthes (Solanaceae) in Australia, New Guinea, and the Pacific

The genus Lycianthes (Dunal) Hassl. (Solanaceae) has in the past been treated as a section of the large genus Solanum L., but is more closely related to Capsicum L. The eighteen species of Lycianthes occurring in Australia, New Guinea (defined as the island of New Guinea, comprising Papua New Guinea [incl. Bougainville] and the Indonesian provinces of Papua Barat and Papua, plus the surrounding islands connected during the last glacial maximum) and the Pacific Islands are here treated in full, with complete descriptions, including synonymy, typifications and synonyms, distribution maps and illustrations. The history of taxonomic treatment of the genus in the region is also discussed. These taxa occupy a diverse range of forested habitats, and are in diverse in habit, from small shrubs to large canopy lianas to epiphytic shrubs. They are for the most part rarely collected, and many are endemic (14 of the 18 species treated here). Australia has a single endemic Lycianthes species (L.shanesii (F.Muell.) A.R.Bean). Nine species are found in both Indonesia and Papua New Guinea, one in Indonesia only, four in Papua New Guinea only, and L.vitiensis (Seem). A.R.Bean is known from Bougainville (Papua New Guinea) and the south Pacific as far east as Samoa. Lyciantheslucens S.Knapp sp. nov. is described from the islands of Lihir, New Ireland and the Louisiade Archipelago of Papua New Guinea. The cultivated L.rantonnetii (Carrière) Bitter is also treated in full, in this region known currently only from Australia; it is native to southern South America. Preliminary conservation assessments are presented for all species except the cultivated L.rantonnetii.

Investigating volatiles as the secondary metabolome of Piper methysticum from root powder and water extracts using comprehensive two-dimensional gas chromatography

ETHNOPHARMACOLOGICAL RELEVANCE

Kava (Piper methysticum G. Forst) is a plant grown in the Pacific that is used in traditional medicines. The roots are macerated and powdered for consumption as a beverage in social settings as well as in ceremonies. Other types of preparations can also be used as traditional medicines. There has been an increase in demand for kava as there is continued traditional use and as it is becoming utilized more both socially and medicinally outside of Oceania. Currently, most research of this plant has focused on bioactive kavalactones and flavokawains, and there are few studies focusing on the other compounds that kava contains, such as volatile and semivolatile components.

AIM OF THE STUDY

This study investigated the kava volatile organic compound (VOC) profile from nine different commercially available samples of dried, powdered kava root sourced across the Pacific region.

MATERIALS AND METHODS

The headspace above the kava samples was analyzed, both from the root powder as originally purchased and by performing a scaled-down extraction into water mimicking traditional preparation of the beverage. The headspace of each sample was extracted using solid-phase microextraction arrow (SPME Arrow), followed by analysis using comprehensive two-dimensional gas chromatography - quadrupole mass spectrometry/flame ionization detection (GC×GC-qMS/FID). The superior peak capacity of GC×GC was invaluable in effectively separating the complex mixture of compounds found in all samples, which enabled improved monitoring of minor differences between batches.

RESULTS

Dry root powder samples contained high levels of β-caryophyllene while water extracted samples showed high levels of camphene. Many alcohols, aldehydes, ketones, terpenes, terpenoids, and aromatics were also characterized from both types of samples. All water extracted samples from the different brands followed similar trends in terms of compounds being detected or not. Additional major compounds found in water extracts included benzaldehyde, hexanal, methoxyphenyloxime, camphor, limonene, 1-hexanol, endoborneol, and copaene. While some samples could be differentiated based on brand, samples did not group by purported geographic origin.

CONCLUSIONS

This study provides foundational data about a different subset of compounds within kava than previous research has studied, and also informs the community of the compounds that transfer into the consumed beverage during the traditional means of preparing kava.

Effects of lifestyle interventions on weight amongst Pasifika communities: A systematic review and meta-analysis

BACKGROUND

Pasifika populations experience high incidence and prevalence of obesity and T2DM. However, no international review of lifestyle intervention studies amongst Pasifika communities exists. This study seeks to identify the effect and translatability of lifestyle strategies on weight amongst Pasifika populations.

METHODS

Lifestyle studies involving ≥90% adult Pasifika participants measuring weight change were eligible for inclusion. Database searching was carried out up to December 2021. Databases searched were MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and ProQuest Central. Risk of bias was assessed using RoB2 (RCTs) and the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool. Meta-analysis and meta-regression used a bivariate random-effects model. Strategies were coded against pre-identified components of the newly proposed Cultural and Sustainability Assessment of Intervention (CSAI) framework.

FINDINGS

Twenty-three studies (n = 4258 participants) met inclusion and exclusion criteria. Thirty-two lifestyle strategies targeting weight loss (WL) and 7 targeting weight maintenance (WM) were extracted. Meta-analysis estimates small but significant effect of -0.26 standard deviations (95% CI -0.51 to -0.02), with RCTs demonstrating a non-significant effect of -0.23 standard deviations (95% CI -0.49 to 0.035). Culturally relevant strategies included community and peer support facilitators and team-based activities. The CSAI identified 14 out of 23 studies with low cultural competency and sustainability scores (<60%).

INTERPRETATION

Qualitative and quantitative analysis show tailored lifestyle interventions has had an estimated small but beneficial effect on WL amongst Pasifika communities. Potential for tailored interventions design to incorporate psychosocial and behavioural considerations. The CSAI has the potential for systematically identifying cultural and sustainability components of efficacy in interventions.

FUNDING

This review was funded under Western Sydney University's Postgraduate Research Scholarship.

Darwin and the French: The species question and 'man' in Oceania

Reading Darwin with a strong sense of déjà vu, French scholars often give him a long French intellectual genealogy. So the physical anthropologist Topinard averred in 1876 that 'transformism is of French origin … the honour is entirely due to M. Lamarck' and defined Darwinism as 'Natural selection through the struggle for existence, applied to Lamarck's transformism'. Using detailed exegesis, this article traces antecedents, intersections, rebuttals, appropriations, shifts, and mutual misunderstandings in late eighteenth- and nineteenth-century transmutationist thinking in France and Britain. With specific reference to unstable concepts of evolution and species, the article samples French and francophone reception and interpretation of Darwin's writings and his responses to critics or supporters. Relative to ideas of race or civilization, human unity or diversity, and the interplay of empirical or deductive logic, I compare Darwin's work with that of the French physical anthropologist Broca in debates on racial ranking, extinction, and the 'descent of man', particularly in Australia and Oceania more widely. I conclude that, notwithstanding Darwin's personal humanitarian values, his science of man made important contributions to the theoretical underpinnings of the science of race, or raciology, which had emerged and developed mainly in France in the half century after 1800.

Formative encounters: Colonial data collection on land and law in German Micronesia

Data collections are a hallmark of nineteenth-century administrative knowledge making, and they were by no means confined to Europe. All colonial empires transferred and translated these techniques of serialised and quantified information gathering to their dominions overseas. The colonial situation affected the encounters underlying vital statistics, enquête methods and land surveying. In this paper, two of those data collections will be investigated-a survey on land and a survey on indigenous law, both conducted around 1910 on the Micronesian island of Pohnpei, which had fallen under German colonial influence a decade earlier. Strikingly, there are no enumerators or envoys of the state visiting the doorsteps of Pohnpei. To facilitate the data collection on homesteads, the whole population of the island was called upon to measure their respective plots of land themselves, without resorting to certified land surveyors. The preserved cadastral lists and spreadsheets testify to a rather peculiar contact between the colonizing administration and the colonized peoples. I argue that the production of data made encounters necessary, which are best observed though a methodological focus on data practices. I argue, furthermore, that the Pohnpeians were prompted during the surveys to define their homestead in new terms. This did not only entail new two-dimensional plots but also a new regime of private property. The change in the legal concept can be seen as a continuation of colonial violence by other means, given that it happened in the aftermath of the defeated Pohnpei Rebellion. The argument of the paper is, therefore, that data collection can have formative effects on society, and that measurement and quantified information are often, as Witold Kula argued, a scene of conflict. At its core, the installation of these metric regimes signified a change in patterns of justification, resource management and the unwritten constitution of the Pacific island.

A new Diancta species of the family Diplommatinidae (Cyclophoroidea) from Vanua Levu Island, Fiji

A new species of Diancta of the staircase snail family Diplommatinidae is described from Mt. Savusavu, Vanua Levu Island, Fiji. Due to its left coiling shell and a constriction before the last whorl, it is placed in the genus Diancta. Micro-CT imaging reveals two apertural teeth and an inner lamella that is situated at the zone of constriction. The shell abruptly changes coiling direction by 45 degrees before the last whorl. Up to now, this coiling modus had not yet been documented for any species of Diplommatinidae from the Fiji Islands.

Climate impacts on air quality and child health and wellbeing: Implications for Oceania

Despite the enormous gains in reducing child mortality resulting from the United Nations Millennium Development Goals, in some ways children's future wellbeing has never been under greater threat. Climate and environmental change, primarily driven by poor air quality, represents a major threat to child health and wellbeing, through both direct and indirect effects. Climate change has multiple environmental consequences impacting negatively on child health and wellbeing, including increases in ambient temperature, rising atmospheric carbon dioxide (CO₂₎ , altered distribution of rainfall, ocean warming, rising sea level and more frequent and severe adverse weather events. Multiple pathways link these exposures to a wide variety of adverse health outcomes. Countries in Oceania are especially likely to be subjected to the effects of increases in ambient temperature, altered distribution of rainfall, ocean warming and sea level rise. These changes pose a significant risk to children and provide a moral imperative for us to act to protect child health.

The effectiveness of legislative and voluntary strategies to prevent ocean plastic pollution: Lessons from the UK and South Pacific

The islands of the South Pacific contribute a fraction of the mis-managed plastics in the world's ocean, yet the region is one of the main recipients of its impacts. Based on expert interviews and a review of current strategies to prevent marine plastic pollution in six countries (Australia, New Zealand, Fiji, Tonga, Vanuatu, United Kingdom), this paper identifies several interventions - legislative, financial, voluntary - which governments, organisations and individuals can learn from. Both voluntary and statutory consumer-based behaviour change campaigns are well developed and somewhat successful in several countries. While sub-national policies do not inhibit progress, they are not optimal. Harmonisation across the territories of federal and devolved systems is beneficial, such as container return schemes, levies, and bans. Vanuatu has displayed high ambition, and the challenges in achieving this serve as a case study. A coordinated global strategy with associated legislation aimed at tackling plastic pollution is critical.

Indigenous knowledge around the ethics of human research from the Oceania region: A scoping literature review

BACKGROUND

Many indigenous people have died or been harmed because of inadequately monitored research. Strong regulations in Human Research Ethics (HRE) are required to address these injustices and to ensure that peoples' participation in health research is safe. Indigenous peoples advocate that research that respects indigenous principles can contribute to addressing their health inequities. This scoping literature review aims to analyze existing peer reviewed and grey literature to explore how indigenous values and principles from countries of Oceania are incorporated into HRE and the governance of research involving human participants.

METHODS

A scoping literature review framework was used for this study. A search for peer reviewed and grey literature from Google, bibliographies, and electronic databases such as SCOPUS, SPRINGER, Medline (Ovid) and JBI Database of Systematic Reviews was conducted, limited to the years 2002-2020. Sixty (60) documents that focused on indigenous knowledge from Oceania region and HRE were included, from which key findings and themes were synthesized.

RESULTS

Charting the data showed that more than half the eligible documents were peer-reviewed journal articles (54%). Other sources included: International Declarations on Human Research (8%); book chapters (8%); government documents (8%); HRE Guidelines or protocols (13%); news articles (7%) and PhD thesis (2%). The literature was from Australia, Cook Islands, Guam, New Zealand, Fiji, Samoa, Tonga and Vanuatu, some of which focused specifically on HREs in the Pacific Region. Issues emerging from the literature were grouped into five themes (i) indigenous and cultural principles of HRE; (ii) informed consent in indigenous settings in Oceania; (iii) vulnerability and minority status of indigenous populations exploited for research; (iv) research ethics governance for Oceania indigenous peoples; and (v) research ethics committees in Oceania. Respect, relationship building, and trust were priority indigenous HRE principles that encompass the principles of partnership, capacity building, reciprocity, and equality. Relationship building and trust imply the equal distribution of benefits for indigenous population and researchers.

CONCLUSION

Indigenous principles of HRE identified were interconnected and interdependent. Recommendations were to incorporate indigenous principles of research in HRE regulations and processes of all countries with indigenous populations. This is especially pertinent for emerging national research committees in LMIC countries, including Fiji and Tonga. Relationship building among researchers and indigenous populations is key to successful research with indigenous populations. HRE principles important for relationship building include respect that is reciprocal among researchers and indigenous people. Elements of the principle of respect highlighted are empathy, collaboration, sharing of benefits, reciprocity, appreciation, empowerment, protection, safety and awareness of culture and languages. Indigenous ontology from the Oceania region involves spirituality, connectedness to land, religious beliefs and a participatory approach to HRE and should be respected in research. An ethical governance mechanism of HRE is one that incorporates indigenous principles and applications for the purpose of maximizing the protection of the dignity and rights of indigenous peoples of Oceania.

Living with thalassaemia in Papua New Guinea, the experience of children, adolescents and their families

AIM

Thalassaemia, the commonest genetic blood disorder in Papua New Guinea (PNG) presents daunting challenges for the affected children, their parents and families, and the health system. We aimed to describe the quality of life of affected children and adolescents and the experience of and difficulties faced by their parents in the setting of a tertiary referral hospital in PNG.

METHODS

A mixed-methods longitudinal study involving baseline questionnaire, then serial interviews with parents, children and adolescents living with β-thalassaemia attending Port Moresby General Hospital.

RESULTS

Twenty-one patients and their families were interviewed over a 6-month period. Most families originated outside the National Capital District and had migrated to be near the Port Moresby General Hospital and its blood bank services. Thirteen patients had at least one affected sibling and four families had experienced the death of at least one other affected child. No child was receiving chelating agents, and most had clinical evidence of iron overload. There were important impacts of thalassemia on quality of life, including very poor school attendance and some aspects of children's self-perception. Families faced significant burdens and made genuine sacrifices to care for their children.

CONCLUSION

Regular blood transfusions increase the life-span of children with thalassaemia but there is a need to achieve a hyper-transfusion regimen coupled with chelation therapy. As for all chronic illness, a focused and holistic approach is needed to improve the quality of life for affected children and their families.

Childhood cancer mortality trends in the Americas and Australasia: An update to 2017

BACKGROUND

Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends.

METHODS

Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries.

RESULTS

Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia.

CONCLUSIONS

Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide.

LAY SUMMARY

Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.

COVID-19 Containment Ship Model: A Case Study for Pacific Island Response

The Republic of the Marshall Islands, American Samoa, the Federated States of Micronesia, and the Republic of Palau have been without any COVID-19 community transmission since the beginning of the global pandemic. The Commonwealth of the Northern Mariana Islands has experienced modest community transmission, and Guam has had significant COVID-19 community transmission and morbidity. Although several of these United States Affiliated Pacific Island jurisdictions made difficult strategic choices to prevent the spread of COVID-19 which have been largely successful, the built environment and the population density in the urban areas of the Pacific remain inherently conducive to rapid COVID-19 transmission. Rapid transmission could result in devastating health and economic consequences in the absence of continued vigilance and long-term strategic measures. The unique COVID-19 vulnerability of islands in the Pacific can be modeled through examination of recent outbreaks onboard several United States Naval ships and other marine vessels. The environmental characteristics that pose challenges to infection control on an isolated naval ship are analogous to the environmental characteristics of these Pacific island communities. Considering a collection of case studies of COVID-19 transmission on ships and applying to Pacific Island environments, provides a heuristic, easily accessible epidemiologic framework to identify methods for interventions that are practical and reliable towards COVID-19 containment, prevention, and control. Using accessible evidence based public health policies, infection risk can be decreased with the objective of maintaining in-country health and social stability. These case studies have also been examined for their relevance to current discussions of health care infrastructure and policy in the Pacific Islands, especially that of vaccination and repatriation of citizens marooned in other countries. The need for aggressive preparation on the parts of territories and nations not yet heavily exposed to the virus is critical to avoid a rapid "burn-through" of disease across the islands, which would likely result in catastrophic consequences.

Novel lures and COI sequences reveal cryptic new species of Bactrocera fruit flies in the Solomon Islands (Diptera, Tephritidae, Dacini)

Results from a snap-shot survey of Dacine fruit flies carried out on three of the Solomon Islands in April 2018 are reported. Using traps baited with the male lures cue-lure, methyl eugenol, and zingerone, 30 of the 48 species previously known to occur in the Solomon Islands were collected. Six species are newly described here: Bactroceraallodistincta sp. nov., B.geminosimulata sp. nov., B.kolombangarae sp. nov., B.quasienochra sp. nov., B.tsatsiai sp. nov., and B.vargasi sp. nov., all authored by Leblanc & Doorenweerd. An illustrated key to the 54 species now known to be present in the country is provided.

A method to analyze the sectoral impact of Fiscal support for COVID-19 affected economies: The case of Oceania

In this paper, we apply the method of computable general equilibrium (CGE) modeling in economics to ascertain how fiscal support measures such as wage subsidies, small business loans, and finance guarantee schemes have impacted at an economy-wide and sectoral level for 8 COVID-19 affected economies in Oceania. We model our scenarios based on IMF World economic outlook projections, combined with the fiscal stimulus packages offered to counter this global health pandemic's recessionary effect. Our study confirms that the adverse impact of COVID-19 on output is cushioned through a large fiscal stimulus package wherever offered. This package would still be inadequate to avoid unemployment and job losses in tourism and education services in Oceania, with continued support essential for their survival in 2021.•The approach entails steps (1) to (3), as outlined in the paper.•Future researchers will find this method useful in evaluating the adverse impact of not only COVID-19 but any other external shocks to the economy, either directly or indirectly, that involves fiscal support mechanisms.

Papua New Guinean genomes reveal the complex settlement of north Sahul

The settlement of Sahul, the lost continent of Oceania, remains one of the most ancient and debated human migrations. Modern New Guineans inherited a unique genetic diversity tracing back 50,000 years, and yet there is currently no model reconstructing their past population dynamics. We generated 58 new whole genome sequences from Papua New Guinea, filling geographical gaps in previous sampling, specifically to address alternative scenarios of the initial migration to Sahul and the settlement of New Guinea. Here, we present the first genomic models for the settlement of northeast Sahul considering one or two migrations from Wallacea. Both models fit our dataset, reinforcing the idea that ancestral groups to New Guinean and Indigenous Australians split early, potentially during their migration in Wallacea where the northern route could have been favored. The earliest period of human presence in Sahul was an era of interactions and gene flow between related but already differentiated groups, from whom all modern New Guineans, Bismarck islanders and Indigenous Australians descend. The settlement of New Guinea was probably initiated from its southeast region, where the oldest archaeological sites have been found. This was followed by two migrations into the south and north lowlands that ultimately reached the west and east highlands. We also identify ancient gene flows between populations in New Guinea, Australia, East Indonesia and the Bismarck Archipelago, emphasizing the fact that the anthropological landscape during the early period of Sahul settlement was highly dynamic rather than the traditional view of extensive isolation.

Multiple sclerosis epidemiology in Asia and Oceania; A systematic review and meta-analysis

BACKGROUND

Multiple sclerosis (MS) is an inflammatory demyelinating CNS disease and the most common neurological immune-mediated disorder. Due to its progressive format, it affects patients' quality of life (QoL) significantly. This study aimed to evaluate epidemiologic parameters of MS in the Asia and Oceania continents.

METHODS

A comprehensive literature search on October 1st, 2020, was performed in PubMed, Scopus, and Web of Science to retrieve original population-based studies on MS epidemiology in the Asian and Oceanian countries, published between January 1st, 1985 and October 1st, 2020. The designed search strategy was repeated for each country, and the relevant referenced articles were added to our database. A random-effect model was used to combine the epidemiological estimates, and subgroup analysis was also performed by continent, region, and country, when possible. Meta-regression analysis was done to evaluate the effects of Human Developmental Index (HDI), latitude, and study period on the epidemiologic parameters.

RESULTS

A total of 3,109 publications were found, of which 89 articles met the eligibility criteria and were included for data extraction. These articles provided data on prevalence, incidence, and mean age at disease onset in 18 countries in Asia and Oceania, including Iran, Turkey, Cyprus, Kuwait, Saudi Arabia, Qatar, UAE, Jordan, Israel, India, Malaysia, China, Hong Kong, Taiwan, Republic of Korea, Japan, Australia, and New Zealand. The pooled total prevalence, incidence, and mean age of onset in Asia and Oceania were 37.89/100000 (95% CI: 35.65 - 40.142), 2.40/100000 (95% CI: 2.22 - 2.58), and 28.21 (95% CI: 27.55 - 28.88), respectively. MS prevalence and incidence in the female gender (68.7/100000 and 4.42/100000, respectively) were infinitely higher than in the male gender (24.52/100000 and 2.06/100000, respectively). Our subgroup analysis showed that MS was much more prevalent in Australia and West Asia among the studied area. The meta-regression showed that the total incidence decreased with an increase in the HDI, and the total prevalence in Asia increased with increasing latitude gradients. Also, the study period had a positive effect on the total prevalence and incidence in Asia and Oceania.

CONCLUSION

MS prevalence and incidence have increased in recent decades. This study highlights the need for further studies to elucidate MS's geographical and temporal variations' exact etiologies.

Clinical and laboratory features associated with mortality in children with severe malnutrition in Papua New Guinea

Background: The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more.Aim: To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality.Methods: The clinical and laboratory predictors of death in a prospective cohort of 150 children with severe malnutrition admitted to a provincial hospital in Papua New Guinea were analysed. The clinical signs and electrolytes, complete blood count and liver function tests at presentation and on Days 3 and 5 were recorded.Results: The strongest independent predictors of mortality at assessment on admission were a low child Glasgow coma scale (≤12), hypoxaemia (SpO₂ <90%), prolonged capillary refill (>3 seconds) and dysnatraemia (<130 or >150 mmol/L). The area under the receiver operating characteristics curve for these four variables was 0.93.Conclusions: That three of these four criteria correspond closely to the WHO Emergency Clinical Signs reinforces the value of a system of triage and risk assessment in children with severe malnutrition. If a child has emergency signs they should be managed in an area on the ward where close monitoring and supportive care can be provided, the WHO guidelines for severe malnutrition followed, and other specific care provided. Measurements of serum sodium, particularly in children with diarrhoea and dehydration, is also important in risk assessment and management.

The Visual Politics of Maralinga: Experiences, (Re)presentations, and Vulnerabilities

Visual cultures are being increasingly discussed in the history of science literature, although relatively very little of that work concerns the nuclear age. In addition, within the discrete yet bourgeoning literature on global nuclear art and culture, Oceania is often overlooked despite its central role in the development of the American, British, and French nuclear weapon capabilities, as well as their associated colonial legacies. This article serves to redress both concerns by examining the visual politics of Maralinga in relation to settler-colonial and Aboriginal experiences, vulnerabilities and (re)presentations. I do so by surveying artworks with a connection to the Australian experience of nuclear colonialism and find that the figure of biological life has been conspicuously left absent from contemporary non-Indigenous Australian depictions of British nuclear testing in Australia.

'Eating well' in Pacific Islands countries and territories: A qualitative and normative approach to food cultures in New Caledonia

In recent decades, the food cultures of the Pacific populations have undergone a profound transition, particularly because the increasing trade exchanges with Western countries have facilitated access to a wide range of processed foods. Essentially, a new normative model of eating is now taking the place of the traditional models. The aims of this qualitative study were to explore what 'eating well', 'good food' and 'bad food' now mean in the New Caledonian family context and, more broadly, to categorise the current food practices and representations in adolescents' families. A double qualitative methodology was applied: 59 face-to-face interviews with 30 parents and 29 adolescents in both rural and urban areas and 15 collective structured discussions with middle-school classes (11- to 16-year-olds) of almost 25 students each. The main results showed various normative frames for nutrition, food quantities, local provenance, and personal taste. Food practices were related to food availability (having a home garden or involvement in family farming), socioeconomic status and community. In addition, access to nutritional information, temporal and financial constraints mostly in the urban area, and the role of food socialisation between parents and children had an impact on food practices and perceptions. The permanence of food cultures, mainly observed in families in rural areas, and the social inequalities in urban areas regarding food availability are highlighted. The positive perception of 'local food' as 'cultural', 'organic' and 'healthy' may help policymakers communicate clear messages to reach a sustainable food system.

Stroke Epidemiology in Oceania: A Review

BACKGROUND AND PURPOSE

Oceania, comprising the regions Australasia, Melanesia, Micronesia, and Polynesia, is home to 42 million living in 8.5 million square kilometres of land. This paper comprises a review of the epidemiology of stroke in countries in this region.

METHODS

Information on epidemiology of stroke in Oceania was sought from data from the Global Burden of Disease (GBD) study (incidence, mortality, incidence:mortality ratio [IMR], prevalence, disability-adjusted life-years [DALYs] lost due to stroke, and subtypes), World Health Organization (WHO) (vascular risk factors in the community), and PubMed (incidence, prevalence, and stroke subtypes). Data were analyzed by region to allow inter-country comparison within each region.

RESULTS

In 2010, age- and sex-standardized stroke mortality rates were lowest in Australasia (29.85-31.67/100,000) and highest in Melanesia and Micronesia (56.04-187.56/100,000), with wide ranges especially in Melanesia. Incidence rates were lowest in Australasia (101.36-105.54/100,000), similarly high elsewhere. Standardized IMR (0.98-3.39) was the inverse of the mortality rates and mirrored the prevalence rates (202.91-522.29/100,000). DALY rates (398.22-3,781.78/100,0000) mirrored the mortality rates. Stroke risk factors show a variable pattern - hypertension is generally the most common medical risk factor among males (18.0-26.6%), while among females, diabetes mellitus is the most common in Micronesia and Polynesia (21.5-28.4%). Among the lifestyle factors, current smoking is the most common in Melanesia among males, while obesity is generally the most common factor among females. Ischaemic stroke comprises 70% of stroke subtypes. Trend data show significant falls in standardized mortality rates and DALYs in most regions and falls in incidence in almost all countries. There is significant economic impact, particularly due to young strokes; some ethnicities are at higher risk than others, for example, Maoris and Pacific Islanders.

CONCLUSIONS

Stroke is a major healthcare problem in Oceania. Variations in stroke epidemiology are found between countries in Oceania. Data are lacking in some; more research into the burden of stroke in Oceania is needed. With the expected increase in life expectancy and vascular risk factors, the burden of stroke in Oceania will likely rise. Some of the disparities in stroke burden may be addressed by great investment in healthcare.

Three Phases of Ancient Migration Shaped the Ancestry of Human Populations in Vanuatu

The archipelago of Vanuatu has been at the crossroads of human population movements in the Pacific for the past three millennia. To help address several open questions regarding the history of these movements, we generated genome-wide data for 11 ancient individuals from the island of Efate dating from its earliest settlement to the recent past, including five associated with the Chief Roi Mata's Domain World Heritage Area, and analyzed them in conjunction with 34 published ancient individuals from Vanuatu and elsewhere in Oceania, as well as present-day populations. Our results outline three distinct periods of population transformations. First, the four earliest individuals, from the Lapita-period site of Teouma, are concordant with eight previously described Lapita-associated individuals from Vanuatu and Tonga in having almost all of their ancestry from a "First Remote Oceanian" source related to East and Southeast Asians. Second, both the Papuan ancestry predominating in Vanuatu for the past 2,500 years and the smaller component of Papuan ancestry found in Polynesians can be modeled as deriving from a single source most likely originating in New Britain, suggesting that the movement of people carrying this ancestry to Remote Oceania closely followed that of the First Remote Oceanians in time and space. Third, the Chief Roi Mata's Domain individuals descend from a mixture of Vanuatu- and Polynesian-derived ancestry and are related to Polynesian-influenced communities today in central, but not southern, Vanuatu, demonstrating Polynesian genetic input in multiple groups with independent histories.

Congenital Syphilis in Honiara, Solomon Islands

INTRODUCTION

Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis.

METHODOLOGY

All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated.

RESULTS

Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy.

CONCLUSIONS

In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.

Health and Wellness Impacts of Traditional Physical Activity Experiences on Indigenous Youth: A Systematic Review

Traditional physical activities have numerous physiological and psychosocial benefits for Indigenous youth around the world. Little is known about the positive health and wellness impacts of traditional physical activity experiences on Indigenous youths. The aim of this systematic review is to explore the holistic health and wellness impacts of traditional physical activities on Indigenous youth from certain North American and Oceania geographic areas. A systematic search of four electronic databases (PubMed, ERIC, Scopus and Web of Science) was conducted to identify peer-reviewed publications of qualitative research exploring the diverse health experiences of traditional physical activities for Indigenous youth in Canada, the United States of America, New Zealand and Australia. A qualitative synthesis of studies between 2006 and 2018 were included, and findings were synthesized using an integrated Indigenous-ecological model, which broadly captures health and wellness impacts under intrapersonal, interpersonal, organizational, community and policy level outcomes using medicine wheel teachings. In total, nine studies were identified via this search. Overall, the literature described numerous emotional, mental and spiritual benefits of traditional physical activity, and youth experiences were affected by familial and communal relationships, and systemic factors. Among Indigenous youth, this research shows the importance of including traditional physical activity in future programs and partnerships with community expertise.

The Rare Richardsitas Betsch (Collembola, Symphypleona, Sminthuridae): A New Species from Australia with Comments on the Genus and on the Sminthurinae

Richardsitas Betsch is a small genus of Sminthurinae with only two species described so far, both from Madagascar. It resembles other Sminthurinae with long antennae, especially Temeritas Richards. Here we provide the first record of Richardsitas from Australia, Richardsitas subferoleum sp. nov., which is similar to R. najtae Betsch and R. griveaudi Betsch in males' large abdomen chaetotaxy and presence of tenent-hairs on tibiotarsi II-III, but lacks mucronal chaeta and has 28 segments on the fourth antennal segment plus a unique pair of sensilla on the second. We also provide an updated genus diagnosis to Richardsitas, a key to its species, a discussion of the affinities of Temeritas and Richardsitas to other Sminthurinae, and an updated key to this subfamily.