Public Debt Sustainability in Developing Asia: An Update

Our previous assessment of debt sustainability in developing Asia, conducted in 2011, found that the region's fiscal outlook was mostly benign. In this study we update the debt sustainability assessment, taking stock of the latest data and including a larger number of countries. With the benefit of hindsight, we assess the accuracy of our earlier debt ratio forecasts and the underlying macroeconomic assumptions. By and large, we find that standard debt sustainability analysis (DSA) represents a valid forecasting tool, able to predict debt ratios fairly accurately under reasonable assumptions and circumstances. Further, our fan chart analysis confirms the importance for stochastic analysis to integrate standard DSA, in order to capture heightened macroeconomic volatility, which we observe for some countries in the region. Looking forward to 2020, debt ratio projections confirm that the outlook remains benign for the region as a whole, country heterogeneity notwithstanding. On the issue of DSA methods and implementation, we emphasize the importance of macroeconomic forecast accuracy and suggest that volatility be captured by risk analysis tools that would optimally flank the standard DSA framework

Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis

Presence of BB-specific antibodies in the cerebrospinal fluid (CSF) with evidence of their intrathecal production in conjunction with the white cell count in the CSF and typical clinical symptoms is the traditional diagnostic gold standard of Lyme neuroborreliosis (LNB). Few data are available on the CSF lactate concentration in European adults with the diagnosis of acute LNB. The objective of the study was to investigate the CSF changes during acute LNB. Routine CSF parameters [leukocyte count, protein, lactate and albumin concentrations, CSF/serum quotients of albumin (QAlb), IgG, IgA and IgM, and oligoclonal IgG bands] and the Borrelia burgdorferi (BB)-specific antibody index were retrospectively studied in relation to the clinical presentation in patients diagnosed with acute LNB. A total of 118 patients with LNB were categorized into the following groups according to their symptoms at presentation; group 1: polyradiculoneuritis (Bannwarth’s syndrome), group 2: isolated facial palsy and group 3: predominantly meningitic course of the disease. In addition to the CSF of patients with acute LNB, CSF of 19 patients with viral meningitis (VM) and 3 with neurolues (NL) were analyzed. There were 97 patients classified with definite LNB, and 21 as probable LNB. Neck stiffness and fever were reported by 15.3% of patients. Most of these patients were younger than 50 years. Polyradiculoneuritis was frequently found in patients older than 50 years. Lymphopleocytosis was found in all patients. Only 5 patients had a CSF lactate ≥3.5 mmol/l, and the mean CSF lactate level was not elevated (2.1 ± 0.6 mmol/l). The patients with definite LNB had significantly higher lactate levels than patients with probable LNB. Elevated lactate levels were accompanied by fever and headache. In the Reiber nomograms, intrathecal immunoglobulin synthesis was found for IgM in 70.2% followed by IgG in 19.5%. Isoelectric focussing detected an intrathecal IgG synthesis in 83 patients (70.3%). Elevated BB AIs in the CSF were found in 97 patients (82.2%). Patients with VM showed lower CSF protein concentration and CSF/serum quotients of albumin than LNB patients. In acute LNB, all patients had elevated cerebrospinal fluid (CSF) leukocyte counts. In contrast to infections by other bacteria, CSF lactate was lower than 3.5 mmol/l in all but 5 patients. The CSF findings did not differ between polyradiculoneuritis, facial palsy, and meningitis. The CSF in LNB patients strongly differed from CSF in VM patients with respect to protein concentration and the CSF/serum albumin quotient

Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports

<p>Abstract</p> <p>Background</p> <p>Adolescent pregnancy has significant health and socio-economic consequences for women, their families and communities. Efforts to prevent too-early pregnancy rely on accurate information about adolescents' knowledge, behaviours and access to family planning, however available data are limited in some settings. Demographic and Health Survey (DHS) reports are recognised as providing nationally representative data that are accessible to policymakers and programmers. This paper reviews DHS reports for low and lower middle income countries in East Asia and the Pacific to determine what information regarding adolescent fertility and family planning is available, and summarises key findings.</p> <p>Methods</p> <p>The most recent DHS reports were sought for the 33 low and lower middle income countries in the East Asia and Pacific region as defined by UNICEF and World Bank. Age-disaggregated data for all indicators relevant to fertility and current use, knowledge and access to family planning information and services were sought to identify accessible information. Reported data were analysed using an Excel database to determine outcomes for adolescents and compare with adult women.</p> <p>Results</p> <p>DHS reports were available for eleven countries: Cambodia, Indonesia, Marshall Islands, Nauru, Papua New Guinea, Philippines, Samoa, Solomon Islands, Timor-Leste, Tuvalu and Vietnam. Twenty seven of 40 relevant DHS indicators reported outcomes for adolescent women aged 15-19 years. There were limited data for unmarried adolescents. A significant proportion of women commence sexual activity and childbearing during adolescence in the context of low contraceptive prevalence and high unmet need for contraception. Adolescent women have lower use of contraception, poorer knowledge of family planning and less access to information and services than adult women.</p> <p>Conclusion</p> <p>DHS reports provide useful and accessible data, however, they are limited by the failure to report data for unmarried adolescents and report age-disaggregated data for some indicators. Further research is required to better understand the barriers that both married and unmarried adolescents face accessing reproductive health information and services, and their information and service delivery preferences.</p

Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

BackgroundThere is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.Methods/DesignIntervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.DiscussionSalt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.<br /

A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region

Background: Physical activity (PA) surveillance is an important component of non-communicable disease risk factor monitoring, and occurs through national and international surveillance systems. This review identifies population PA estimates for adults in the Asia-Pacific region, and examines variation in trends and prevalence rates obtained using different PA measures.Methods: Data were obtained from a MEDLINE search; World Health Organization&rsquo;s Global Health Infobase; Government websites and reference lists of relevant papers. Inclusion criteria included: national studies or those reporting large scale population-level data; data published from 2000 to 2010 and trend data prior; sample sizes over n = 1000, or fewer subjects in small nations.Results: In total, 56 population surveys from 29 Asia-Pacific countries were identified. Data on &lsquo;sufficient physical activity&rsquo; amongst adults were available from 45 studies (80%), with estimates ranging from 7% to 93% (median 62%, inter-quartile range 40%-85%). For 14 countries, estimates of &lsquo;sufficient activity&rsquo; were documented in multiple surveys using different methods, with the largest variation from 18% to 92% in Nepal. Median or mean METminutes/ day, reported in 20 studies, ranged from 6 to 1356. Serial trend data were available for 11 countries (22%), for periods spanning 2-10 years. Of these, five countries demonstrated increases in physical activity over time, four demonstrated decreases and three showed no changes.Conclusions: Many countries in the Asia-Pacific region collect population-level PA data. This review highlights differences in estimates within and between countries. Some differences may be real, others due to variation in the PA questions asked and survey methods used. Use of standardized protocols and measures, and combined reporting of data are essential goals of improved international PA surveillance.<br /

Kortikale Repräsentation mimischer Muskulatur im funktionellen MRT (fMRT) bei Normalpersonen und bei Patienten mit Synkinesien nach Fazialisdefektheilung

Einleitung: Nach Lähmungen des N. VII kommt es nicht selten zu Defektheilungen mit sog.pathologischen Mitbewegungen (Synkinesien). Bei der Reorganisation spielen auch Areale des Zentralnervensystems eine Rolle, die oberhalb der Kernebene lokalisiert sind. Hier werden die Repräsentation der mimischen Muskulatur im fMRT bei gesunden Probanden und corticale Veränderungen bei Patienten mitFazialisdefektheilungen dargestellt.Methodik: In einem 3 Tesla Siemens MRT wurden 8 Patienten mit Synkinesien unterschiedlicher Genese, Lokalisation und Ausprägung und 16 gesundeProbanden untersucht. Alle Versuchspersonen erhielten über eine LCD-Brille optische Signale, die einen Zeitraum vorgaben in dem repetitiv Standardbewegungsmuster (Augen zukneifen, Nase rümpfen, Lippen spitzen, mit Zunge über Schneidezähne fahren, Fingertapping) ausgeführt wurden. Die Daten wurden mit BrainVoyager QX 2.2® weiterverarbeitet. Es wurden die maximalent-Werte in zuvor festgelegten Arealen des primär motorischen Cortex ermittelt, graphisch dargestellt und anschließend verglichen.Ergebnisse: Die t-Wert-Maxima liegen bei den meisten der gesunden Probanden je nachBewegung in einem Cortexareal gruppiert vor. Größe und Lage der t-Wert-Maxima variieren je nach Bewegung und betrachteter Hirnhälfte. Im untersuchten Patientenkollektiv folgen die corticalen Repräsentationen keiner eindeutigen somatotopen Gliederung. Es zeigt sich eine breite Streuung der t-Wert-Maxima.Schlussfolgerung: Bei gesunden Probanden werden im fMRT Gesichtsbewegungen auf dem Cortexsomatotopisch gegliedert repräsentiert.Entgegen der erwarteten somatotopen Gliederung ergab sich bei der Patientengruppe eine breite Streuung der maximalen t-Werte, die keinemerkennbaren Muster folgte. Möglicherweise kann dies als "corticale Reaktion" auf die neue periphere Situation nach Fazialisdefektheilung interpretiert werden

Policy environment for the tourism sector's adaptation to climate change in the South Pacific - the case of Samoa

Samoa and its neighbouring Pacific Island Countries are highly vulnerable to climate change risks because their population and infrastructure are mostly located on low-lying coastal areas. Impacts of climate change are potentially disastrous to tourism, the major economic sector in the region. This research examines the conduciveness of the policy environment in Samoa for the tourism sector to adapt to climate change along three dimensions: stakeholders’ will and commitment, resources available, and policy-making mechanisms [Wong, E.P.Y., Mistilis, N., & Dwyer, L. (2011). A framework for analyzing intergovernmental collaboration – the case of ASEAN tourism. Tourism Management, 32, 367–376]. Samoa is used as an exemplar case study to understand how the Pacific island tourism sector can best adapt to climate change. It was found that the policy environment in Samoa is generally conducive. However, there is a strong need for closer public–private cooperation