Income Inequality in Quality of Life among Rural Communities in Malaysia: A Case for Immediate Policy Consideration

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Quality of life (QOL) is a proxy of health and social well-being. Hence, it is vital to assess QOL as it informs the strategies of policymakers to enhance the living conditions in communities. Rural areas in emerging economies are underserved in terms of modern facilities and technologies, which impact QOL. To address this, this study investigated whether income played a role in the QOL of rural residents within emerging economies using a large survey of Malaysian adults above 18 years old. The study extracted data from a sample of 18,607 respondents of a health and demographic surveillance system survey. A generalized linear model was used to estimate the impact of three income groups, the bottom 40%, middle 40% and top 20%, on perceived QOL, controlling for sociodemographic, chronic disease co-morbidities and mental health status. Results of the study showed a statistically significant association between income and the physical, psychological, social and environmental QOL domains. Using the bottom 40% as a reference category, the middle 40% and top 20% income groups showed a significant and positive association across the four domains of QOL. Hence, intervention programs are necessary to escalate the income levels of rural communities, especially the bottom 40%, to uplift perceived QOL among rural residents.https://doi.org/10.3390/ijerph1723873117pubpub2

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.https://doi.org/10.3390/ijerph1911660419pubpub1

Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia

INTRODUCTION This study aimed to determine the prevalence of metabolic syndrome and risk of coronary heart disease (CHD) in patients with schizophrenia receiving antipsychotics in Malaysia. METHODS This cross-sectional study, conducted at multiple centres, involved 270 patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR diagnostic criteria for schizophrenia, were on antipsychotic medications for at least one year, and were screened for metabolic syndrome. Patients receiving mood stabilisers were excluded. Metabolic syndrome was defined according to the National Cholesterol Education Program ATP III criteria modified for Asian waist circumference. Risk for cardiovascular disease was assessed by using Framingham function (all ten-year CHD events). RESULTS The prevalence of metabolic syndrome was 46.7 (126/270). Among all the antipsychotics used, atypical antipsychotics (monotherapy) were most commonly used in both the metabolic and non-metabolic syndrome groups (50.8 vs. 58.3). The ten-year risk for CHD was significantly higher in patients with metabolic syndrome. The proportion of patients with high/very high risk for CHD (Framingham >= 10) was greater in patients with metabolic syndrome than in those with non-metabolic syndrome (31.5 vs. 11.0, odds ratio 3.9, 95 confidence interval 2.0-7.6; p < 0.001). The mean body mass index was higher in patients with metabolic syndrome than in those without (29.4 +/- 5.1 kg/m(2) vs. 25.0 +/- 5.6 kg/m(2); p < 0.001). CONCLUSION Patients with schizophrenia receiving antipsychotics in Malaysia have a very high incidence of metabolic syndrome and increased cardiovascular risk. Urgent interventions are needed to combat these problems in patients

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

Efficacy of switching to aripiprazole and ziprasidone on clinical and metabolic profile among schizophrenic patients with metabolic syndrome / Mas Ayu Binti Said

Introduction: Schizophrenia is a devastating mental illness that impairs mental and social functioning and often leads to the development of co-morbid diseases. They are at greater risk for metabolic dysfunctions than other individuals due to a number of reasons, including inactive lifestyle, poor dietary choices, and side effects of antipsychotic medications. Atypical antipsychotics were reported to be associated with increased risk of hyperglycaemia and hyperlipidemia, and subsequently increase the risk of metabolic syndrome. However, ziprasidone and aripiprazole have a favourable metabolic profile. Objectives: i) To determine the prevalence of metabolic syndrome and its components among schizophrenia patients. ii) To determine the improvement and reversibility of metabolic syndrome, its components and lipid profiles after switching to aripiprazole or ziprasidone. iii) To determine the safety and efficacy of aripiprazole and ziprasidone in the treatment of schizophrenia patients with metabolic syndrome. Methodology:Screening -The study was conducted at four mental institutions and four general hospitals. Study population were schizophrenia patients aged between 18 and 65 years old, who met the DSM-IV TR criteria for schizophrenia. Patients should receive antipsychotic treatment for at least 1 year and were not on mood stabilizer. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria-modified for Asian waist circumference. Randomized double-blind controlled trial was conducted for 6-month after screening.The dose of aripiprazole and ziprasidone, can be either increased or reduced based on clinical assessment. The total daily dosage of ziprasidone ranges from 80mg - 160mg.The total daily dosage of aripiprazole ranges from 10mg - 30 mg. The outcome measures included body mass index (BMI), waist circumference, blood v pressure(BP), fasting blood sugar (FBS) and lipid profile, adverse effects monitoring and clinical rating scale such as Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Scale (CGI), Abnormal Involuntary Movement Scale (AIMS), Barnes Akathasia Scale (BAS) and Simpson Angus Scale (SAS).Intention-to-treat analysis and mixed-effects model with repeated measures (MMRM) for statistical analysis were done. Results: A total of 527 patients were screened but only 270 schizophrenia patients fulfil all inclusion and did not have any exclusion criteria. The prevalence of metabolic syndrome was 46.7%. There was improvement in the prevalence of all metabolic syndrome component from baseline to 6-month after switching to aripiprazole or ziprasidone; waist circumference (aripiprazole 84.4% vs. 44.4%, ziprasizone 87.1% vs. 35.3%), HDL cholesterol (aripiprazole 54.4% vs. 33.3%, ziprasizone 52.9% vs. 23.5%), triglycerides (aripiprazole 50.0% vs. 21.1%, ziprasizone 37.6% vs. 12.9%), BP (aripiprazole 41.1% vs. 25.6%, ziprasizone 32.9% vs. 20.0%), FBS (aripiprazole 42.2% vs. 20.0%, ziprasizone 25.9% vs. 8.2%, p<0.05). Switching to either aripiprazole or ziprasidone cause statistically significant reduction in prevalence of metabolic syndrome after 6 month of treatment (aripiprazole 58.9% vs. 30.0%, ziprasizone 51.8% vs. 15.3%, p<0.05). There was statistically significant improvement in PANSS, CGI, BARS and SAS after switching to aripiprazole or ziprasidone. Conclusion: The prevalence of metabolic syndrome in schizophrenia patients receiving antipsychotic in Malaysia was very high. Switching to aripiprazole or ziprazidone was effective in reversing the metabolic syndrome and its components among schizophrenia patients who had metabolic syndrome

Wpływ czasu spędzanego przed ekranem na rozwój społeczno-emocjonalny we wczesnym dzieciństwie

Background. The World Health Organization calls for avoidance of screen-based media usage for children below the age of one and for limitation of screen time to not more than an hour per day for children under the age of five due to public health concerns. This study is aimed to determine the prevalence of excessive screen time and its association with early childhood social-emotional development among Malaysian children. Material and methods. Self-administered questionnaires were distributed to 600 Malaysian parents of children aged 18 and 36 months old. Child’s social-emotional development was measured using the “Ages and Stages Questionnaire: Social Emotional-2”. Multivariate logistic regression method was utilized for data analysis. Results. A total of 82.2% of children did not adhere to screen time recommendations. Mean screen time recorded was 141.7 (SD 131.6) minutes per day. The odds of children with excessive screen time having poor mastery of social-emotional development is 2.5 times higher than children adhering to screen time recommendations, with this association persisting after adjustment to confounders (AOR: 2.50, 95% CI: 1.07-5.86). Conclusions. Excessive screen time among children is linked to paucity in active parent-child interaction and hindrance in the process of learning and development which consequently leads to a delayed attainment of social-emotional milestones.Wprowadzenie. Światowa Organizacja Zdrowia wzywa do unikania korzystania z urządzeń z ekranem przez dzieci poniżej pierwszego roku życia oraz do ograniczenia czasu spędzanego przed ekranem do nie więcej niż godziny dziennie w przypadku dzieci poniżej piątego roku życia ze względu na obawy dotyczące zdrowia publicznego. Niniejsze badanie ma na celu określenie rozpowszechnienia nadmiernego czasu spędzanego przed ekranem i jego związku z wczesnodziecięcym rozwojem społeczno-emocjonalnym wśród malezyjskich dzieci. Materiał i metody. Kwestionariusze do samodzielnego wypełnienia rozdano 600 malezyjskim rodzicom dzieci w wieku 18 i 36 miesięcy. Rozwój społeczno-emocjonalny dziecka mierzony był za pomocą kwestionariusza „Ages and Stages Questionnaire: Social Emotional-2”. Do analizy danych zastosowano metodę wieloczynnikowej regresji logistycznej. Wyniki. Łącznie 82,2% dzieci nie stosowało się do zaleceń dotyczących czasu spędzanego przed ekranem. Średni czas przed ekranem wynosił 141,7 (SD 131,6) minut dziennie. Prawdopodobieństwo, że dzieci spędzające nadmiernie dużo czasu przed ekranem będą wykazywały słabe opanowanie rozwoju społeczno-emocjonalnego jest 2,5 razy większe niż u dzieci przestrzegających zaleceń dotyczących czasu przed ekranem, przy czym związek ten utrzymuje się po dostosowaniu do czynników zakłócających (AOR: 2,50, 95% CI: 1,07-5,86). Wnioski. Nadmierny czas spędzany przez dzieci przed ekranem wiąże się z niedostatkiem aktywnej interakcji rodzic-dziecko i utrudnieniem procesu uczenia się i rozwoju, co w konsekwencji prowadzi do opóźnionego osiągnięcia kamieni milowych w sferze społeczno-emocjonalnej

Income inequality in quality of life among rural communities in Malaysia:a case for immediate policy consideration

Quality of life (QOL) is a proxy of health and social well-being. Hence, it is vital to assess QOL as it informs the strategies of policymakers to enhance the living conditions in communities. Rural areas in emerging economies are underserved in terms of modern facilities and technologies, which impact QOL. To address this, this study investigated whether income played a role in the QOL of rural residents within emerging economies using a large survey of Malaysian adults above 18 years old. The study extracted data from a sample of 18,607 respondents of a health and demographic surveillance system survey. A generalized linear model was used to estimate the impact of three income groups, the bottom 40%, middle 40% and top 20%, on perceived QOL, controlling for sociodemographic, chronic disease co-morbidities and mental health status. Results of the study showed a statistically significant association between income and the physical, psychological, social and environmental QOL domains. Using the bottom 40% as a reference category, the middle 40% and top 20% income groups showed a significant and positive association across the four domains of QOL. Hence, intervention programs are necessary to escalate the income levels of rural communities, especially the bottom 40%, to uplift perceived QOL among rural residents

Sexual behaviour among male methamphetamine and heroin dependents in selected areas in Malaysia

This study aims to describe the pattern of sexual behaviour among methamphetamine and heroin users. It describes the pattern of sexual behaviour based on aspects of sex such as desire, interest, drive and obsession in relation to the drug use. A cross-sectional study was carried out among attendees of drug rehabilitation programmes in Kota Kinabalu, Kota Bharu and Kuala Lumpur. All subjects were living in the community with satisfactory psychosocial functioning. This study was primarily based on a validated sexual behaviour self-rated questionnaire followed by face-to-face interview. A total of 227 subjects were included with 124 (54.6%) using methamphetamine while 103 (45.4%) using heroin. Majority (218; 96%) were heterosexuals with 104 (45.8%) reported having been involved in high risk sexual behaviour. More methamphetamine than heroin subjects agreed that their sexual thoughts, feelings and behaviours were often associated with the drug (p<0.05). Methamphetamine subjects agreed that the use of methamphetamine caused them to be more obsessed with sex and they found themselves to be preoccupied with sexual thoughts while being under the influence of the drug (p<0.05). Heroin subjects mainly reported on negative effects of the drug on their sexual behaviour. Methamphetamine subjects reported that the use of drug had positively affected their sexual interest and drive (p<0.05). Methamphetamine subjects were also 1.97 times more likely than heroin subjects to be involved in risky sexual behaviour. The results of this study can be utilized to improve the drug treatment and rehabilitation programme. Methamphetamine subjects were more likely than heroin subjects to be involved in risky sexual behaviour