Prescribing patterns of benzodiazepine in Malaysia from 2014 to 2016

Background: Although benzodiazepines (BZDs) are often prescribed to treat wide range of psychiatric and neurological conditions, they are also associated with various harms and risks, as well as tendency of inappropriate prescribing. To date, the prescribing patterns of BZDs at outpatient tertiary hospital in Malaysia are still scarce. Objectives: To examine the patterns of BZDs prescribing at outpatient tertiary hospital in Malaysia. Methods: A cross‐sectional retrospective study was conducted from January 2014 to December 2016 using the prescriptions received by the outpatient pharmacy of tertiary hospital. Prescriptions with any seven types of BZDs (alprazolam, bromazepam, clobazam, diazepam, clonazepam, loraxepam, and midazolam) were identified and included in this study. Information on patients' age and gender, prescription date, drug name, dosage, frequency, duration, quantity supplied, and prescriber's name were extracted from the prescriptions. Only prescrip- tions for patients' age of 18 and above were included in this study. Total number of prescriptions with BZDs, total number of patients received BZDs, and total number of each type of BZDs were measured yearly and over 3 years. Data were analyzed descriptively using Stata v13. Results: A total of 5711 BZDs prescriptions were issued (n = 1959, n = 2051, and n = 1701 for year 2014, 2015, and 2016, respectively) from January 2014 to December 2016. BZDs were prescribed for 1947 patients (n = 895 in year 2014, n = 934 in 2015, and n = 782 in 2016). Alprazolam (39.7%, n = 3542) was the most frequently pre- scribed followed by lorazepam (21.1%, n = 1880), diazepam (20.7%, n = 1851), clonazepam (17.1%, n = 1530), and less than 1% to other BZDs. Sixty percent (n = 5422) of patient were prescribed with short‐acting BZDs, 21.6% (n = 1928) intermediate‐acting BZDs and 17.1% (n = 1530) long acting BZDs. Majority (90.7%, n = 5015) of BZDs prescription were for psychiatric disorders, in which, higher per- centage (82.3%) of BZDs were prescribed as anxiolytics followed by 17.1% as hypnotics. Among all BZDs, alprazolam, and lorazepam showed decreasing pattern over 3 years period. Conclusions: Short‐acting BZDs (alprazolam and lorazepam) were highly prescribed at the outpatient tertiary hospital in Malaysia. The main indication of the BZDs was as anti‐anxiety. However, data avail- able were from the prescriptions only. Thus, further research is required to examine the use of BZDs at patient‐level

Social stories to enhance communicative strategies among autism spectrum disorder (ASD) children

The use of strategies by children with developmental disabilities in repairing their communicative breakdowns has received little attention in the research literature to date. These children may also have fewer strategies available to them. By using Tarone’s Taxonomy (1980) of communicative strategies, this current study was trying to further unravel and discuss how children with autism spectrum disorder (ASD) could enhance their spoken communicative intent in conversing about moral values. Audiotaped, semi-structured conversational data was collected from four children (two low functioning autism and two Asperger Syndrome) with autism ASD. They were seven to nine years old from Sekolah Kebangsaan Desaminium, Seri Kembangan, Selangor. Two social stories were told to the subjects; Visiting atuk and nenek in Kampung and Being Kind to Animals with two moral values underpinned in each social story. Findings revealed that all four ASD children were using almost all the nine communicative strategies except for word coinage. The study concluded that Tarone’s Taxonomy (1980) of communicative strategies was really helpful in unravelling the communicative intent of a group of ASD children in talking about moral values based on the social stories told to them. Having said so, future research still needs to consider how these strategies or perhaps other communicative strategies could be used as attempts to repair communicative breakdowns among ASD children. It is hoped that the impairment in understanding others’ mind hinders the development of an intent-based moral judgment in ASD children

Ibn Fadlan's role in the Islamisation of Bulghar society

Islam is the oldest established religion among Bulghar entity, the residents along the riverbanks of the Volga-Kama triangle. This valley was famous as the first Islamic country erected in the Eastern European region. The presence of Islam in the region has raised the name of the ruler of Volga Bulgaria and was reinforced by relationship with Baghdad. The Islamisation of the Bulghar society is relevant to the role played by Ahmad ibn Fadlan, the ambassador of the Abbasid government based in Baghdad. Therefore, this article aims to examine the role played by Ibn Fadlan in the Islamization of the Bulghar society. For this study, a qualitative method using historical descriptive approach was employed, which involved compilation and evaluation of the facts of the Risalah Ibn Fadlān. Data for this study were obtained through library research. The data analyses were conducted through texts and document analyses, as well as comparison method. This study finds that Ibn Fadlan plays an important role in the islamisation of the Bulghar society, not just as an ambassador of Abbasid government but as a teacher, preacher and counselor to the Bulghar king and the whole nation

Ibn Fadlan’s Role in the Islamisation of Bulghar society

Islam is the oldest established religion among Bulghar entity, the residents along the riverbanks of the Volga-Kama triangle. This valley was famous as the first Islamic country erected in the Eastern European region. The presence of Islam in the region has raised the name of the ruler of Volga Bulgaria and was reinforced by relationship with Baghdad. The Islamisation of the Bulghar society is relevant to the role played by Ahmad ibn Fadlan, the ambassador of the Abbasid government based in Baghdad. Therefore, this article aims to examine the role played by Ibn Fadlan in the Islamization of the Bulghar society. For this study, a qualitative method using historical descriptive approach was employed, which involved compilation and evaluation of the facts of the Risalah Ibn Fadlān. Data for this study were obtained through library research. The data analyses were conducted through texts and document analyses, as well as comparison method. This study finds that Ibn Fadlan plays an important role in the islamisation of the Bulghar society, not just as an ambassador of Abbasid government but as a teacher, preacher and counselor to the Bulghar king and the whole nation

Analysis on social change among Bulghar society based on Risalah Ibn Fadlan 922 AD

The role of Islam in the forming of the society solidarity consisting of multi-ethnic backgrounds into a consistency ethno system is a great thing about the Volga Bulgaria that occupied by Bulghar society. The process of Islamization has become the main factors for social changes happened in the society. Thus, this writing is intended to analyse the social changes that occurred in the society that affected Bulghar society achievement, by referred to text analysis on Risalah Ibn Fadlan, 922 AD and some other sources related. For this study, the qualitative method using historical descriptive approach has been employed which involving compilation and evaluation of the facts of the Risalah Ibn Fadlān. Therefore, data onto this study were obtained through library research. The analyses on data study were conducted through texts and document analyses, as well as comparison method. This study finds islamization is the major factor contributing to the social change among Bulghar society. The social change in Bulghar society incorporating the changing of thinking to achieve development in education, the way of life, infrastructure, literature and the spirit of dacwah, the norms and values based on Islam, which the society adheres after becoming Muslim

Sovereignty of a nation: a lesson learnt from the case of Batu Puteh Island (Pedra Branca)

This paper discusses on the issues related to Batu Puteh Island (Pedra Branca) which is a topic of discussion in relation to the sovereignty of a country and its implications in the future. Losing territories will undermine the sovereignty of a country and is an insult to them. The reality is a bitter truth. Sovereignty is a symbol of power to many countries. The corresponding letter by the Acting Secretary of Johore dated 21st September 1953 stated that Johore does not claim ownership of Pedra Branca. The letter was seen by ICJ as a sign that Johore had handed over its sovereignty on Batu Puteh Island over to the British. Therefore, the court concluded that the letter clearly indicates that since 1953, Johore has declared that it no longer had sovereignty over Pedra Branca. Various questions arise regarding the letter. Where is the authority and sovereign of the Sultan of Johore who ruled over Johore and its territories? Can an Acting Secretary of State legitimately decide on matters of sovereignty, land and territorial rights? Or, should it be decided by the Sultan as head of a sovereign state? These are some of the questions which are yet to be answered and documentation is vital. It will determine the future and the road to success. Learn from history, learn from the administrative weaknesses and individual mistakes, and remember that history repeats itself in the future. Our own mistakes cost us an island which was originally ours for centuries. Our absent mindedness led us in losing the island’s sovereignty to other nation. Everyone knows that the island belongs to Johore with all related documents are complete and history has proven it. Always be careful when making any decisions or be sorry for life

The concept of leadership and constitution from the Islamic and Malay archipelago perspectives according to Taj Al Salatin manuscript

The aspect of leadership has existed since the dawn of time, with scholars conducting extensive studies from various angles and views, which were then produced into literary works. In the Malay Archipelago, Taj al-Salatin manuscript (1603M) is widely known as a masterpiece which highlighted leadership qualities from the Islamic perspective. This study was conducted to identify the author‟s ideas on Islamic leadership in the context of Malay Archipelago, using descriptive method by analysing the manuscript. The findings showed that leaders and leadership are considered as a mandate from Allah S.W.T. Good leaders must be qualified, with higher knowledge and morals than their subjects. Taj al-Salatin introduces the idea that leaders should practice Tasawwuf, which among its practises include constant self reminder of death, rejecting lust and desires, and prioritising remembrance to Allah. In his manuscript, Bukhari al-Jauhari presents the vision, idealism and the idea of "leaders are perfect beings", which embodies the concept of Tauhid and upholds noble character for universal humanity. A leader of a nation should always stand on the grounds of good moral values and the people are led towards creating a peaceful, prosperous and happy nation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication