Air pollution and its association with cervical cancer: a scoping review

Kanser serviks adalah salah satu kanser wanita yang utama di dunia. Punca kanser serviks adalah 'human papillomavirus' (HPV), namun faktor risiko lain seperti faktor persekitaran turut mempunyai kaitan dengan penyakit ini. Pencemaran udara adalah penyebab utama kematian akibat kanser. Walaupun ia telah lama dikaitkan dengan kanser paru-paru, terdapat kajian-kajian yang telah membuktikan ianya merupakan faktor risiko untuk kanser lain di kalangan manusia, termasuklah kanser serviks. Kajian skop ini bertujuan untuk mengenal pasti dan meneliti literatur sedia ada yang mengkaji perkaitan antara pencemaran udara dengan perkembangan kanser serviks. Protokol 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews' (PRISMA-ScR) telah digunakan untuk membimbing kajian ini. Tujuh penerbitan yang membincangkan pencemaran udara dan kaitannya dengan kanser serviks telah dipilih berdasarkan kriteria tertentu. Huraian tentang punca pencemaran udara, jenis bahan pencemar udara, dan kesan pendedahannya terhadap kejadian kanser serviks telah dibincangkan. Beberapa bahan pencemar udara dikaitkan dengan pelbagai kesan pendedahannya yang berhubungkait dengan kanser serviks, termasuklah perkembangan pra-kanser serviks, serta peningkatan dalam kejadian dan kematian kanser serviks. Kajian ini menekankan perkaitan antara pencemar udara yang bertindak sebagai faktor risiko bersama dalam perkembangan kanser serviks. Dengan mengenalpasti bahan pencemar udara yang mempengaruhi perkembangan kanser serviks, kajian ini seterusnya dapat dijadikan panduan untuk penyelidikan berkaitan mekanisma faktor-faktor risiko pencemar udara yang menyebabkan kanser serviks di masa hadapan

Patient satisfaction on waiting time and duration of consultation at Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre

Patients are increasingly dissatisfied with the “waiting time” and “duration of consultation” at outpatient clinics. A cross sectional study was carried out to measure waiting time and duration of consultation and to examine patients’ level of satisfaction towards waiting time and duration of consultation at the Orthopedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also examined patient’s satisfaction towards the overall clinic services. Data was collected using a self-administered questionnaire. A total of 81 patients participated in this study with a response rate of 100 percent. Findings indicated a significant difference in the mean between expected waiting time level II (from the time the patient is given the calling number till the time patient is called into the doctor’s room) and the actual waiting time level II experienced. A significant difference in the mean between the expected duration of consultation and the actual duration of consultation experienced was also noted. However, no significant difference was found between the mean of expected waiting time level I (the time patient register at the counter till the patient is given the calling number) and the actual waiting time (p>0.05). Overall, patient satisfaction towards waiting time was low (29.6%) and duration of consultation was of moderate level (41.9%). The overall satisfaction towards the clinic services were of average level (56.8%). Findings also indicated that patient satisfaction was not influenced by socio-demographic factors of respondents such as age, ethnic, education level, occupation and income level. Important findings from this study may help staff managing the clinic in addressing patients’ complaint on waiting time and improve patients’ satisfaction on the overall services of the Orthopedic clinic in UKMMC

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Background: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p<0·0001), combination therapy (1·53, 1·13–2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69–2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25–1·62; p<0·0001), combination therapy (1·26, 1·08–1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00–1·28; p=0·0562) than were those unable to afford the medicines. Interpretation: A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries