Factors associated with HbA1c levels in poorly controlled type 2 diabetic patients in North-East Malaysia

Objective: A study was conducted at all the health centres in Kelantan in North-East Malaysia to determine the common factors associated with poor controlled of type 2 diabetic patients. Design: A cross-sectional study Materials and Methods: A total of 208 patients with poor diabetic control (HbA1c levels of more than 6.5%) were selected by stratified random sampling from all health centres in Kelantan. Socio-demographic data, physical examination, and fasting blood were taken from the patients to determine the related associated factors using multiple linear regression. Results: The levels of HbA1c in the poorly controlled diabetic patients were significantly associated with fasting blood glucose (b=0.236, 95%CI=0.189,0.283), educational level (primary education: b=-0.965, 95%CI=-1.550,-0.380; secondary and tertiary education: b=-0.625, 95%CI=-1.228,-0.021), marital status (b=0.933, 95%CI=0.426,1.440) and patients receiving their care in health centres with Family Medicine Specialist (b=-0.495, 95%CI=-0.913,-0.076). Conclusion: Fasting blood glucose and being married were associated with higher levels of HbA1c, while having had formal education and receiving diabetic care in health centres with Family Medicine Specialist were associated with lower levels of HbA1c in poorly controlled type 2 diabetic patients in Kelantan

Dumbbells and ankle-wrist weight training leads to changes in body composition and anthropometric parameters with potential cardiovascular disease risk reduction

AbstractObjectivesPromoting physical activity is a global strategy to reduce the burden of cardiovascular disease. This study aimed to determine and compare the effect of light resistance training using either dumbbells or ankle-wrist weights on the anthropometric parameters and body composition of adults in Kelantan, Malaysia.MethodsThis randomized community trial was conducted in Kelantan, Malaysia, from March through August 2012. Adults with a body mass index (BMI) of more than 23 kg/m2 were randomized into dumbbell (N = 69) and ankle-wrist (N = 69) weight groups. Participants in the dumbbell group performed structured group exercises three times per week using a pair of one-kilogram dumbbells. Participants in the ankle-wrist weight group were given one pair of 500 gm ankle weights and one pair of 500 gm wrist weights to be worn during the activities of daily living three days per week for at least 20 min. BMI, waist circumference (WC), waist-to-hip ratio (WHR), body fat percentage (BF%) and skeletal muscle percentage (SM%) were measured at baseline, week 6, month 3 and month 6.ResultsEighty-nine participants completed this study. There were significant reductions in BMI only at week six for the dumbbell group. No significant BMI changes were observed for the ankle-wrist weight group. Significant improvements of WC, WHR, BF%, and SM% were observed in both intervention groups from baseline at week 6, month 3, and month 6.ConclusionResistance exercise using either dumbbells or ankle-wrist weights produced significant improvements in certain components of body composition and anthropometric parameters

Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Objectives: Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient’s quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods: This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument’s construct validity. Cronbach’s alpha coefficients were used to determine internal consistency. Results: A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors—psychological, physical-social and spiritual wellbeing—resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450–0.718 for psychological wellbeing (12 items), 0.394–0.740 for physical-social wellbeing (14 items) and 0.449–0.727 for spiritual wellbeing (seven items). The overall Cronbach’s alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion: The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF. Keywords: Heart Failure; Quality of Life; Culturally Competent Care; Ethnic Groups; Questionnaire Design; Reliability and Validity; Malaysia

Review of energy conservation using duty cycling schemes for IEEE 802.15.4 wireless sensor network (WSN)

Energy conservation is one of the crucial issues in wireless sensor network (WSN). A significant solution to conserve energy is done by deploying duty cycle management mechanisms in the WSN applications. This paper reviews several duty cycle mechanisms in WSN such as Duty Cycle Learning Algorithm, adaptive media access control (MAC) protocol for efficient IEEE 802.15.4 (AMPE), distributed duty cycle management (DDCM), distributed duty cycle management low power broadcast (DDCM + LPB) and distributed beacon only period. These mechanisms change their parameters such as idle listening, packet accumulation and delay in the end device transmitting queue to improve the energy conservation in WSN. The performances of these different energy conservation mechanisms have been compared at the MAC layer of IEEE 802.15.4 standard. It is found that the DDCM + LPB has made approximately 100 % enhancement in terms of average energy efficiency as compared to the other mechanisms. DDCM + LPB has significant enhancements by adapting the duty cycle according to the network traffic load condition. Using this mechanism, the duty cycle is increased when the traffic load increases and vice versa. Its energy efficiency also outperforms the conventional DDCM by the average of 10 %

Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Objectives: Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient’s quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods: This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument’s construct validity. Cronbach’s alpha coefficients were used to determine internal consistency. Results: A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors—psychological, physical-social and spiritual wellbeing—resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450–0.718 for psychological wellbeing (12 items), 0.394–0.740 for physical-social wellbeing (14 items) and 0.449–0.727 for spiritual wellbeing (seven items). The overall Cronbach’s alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion: The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF

Effects of u-shaped subgrade concrete panel on subgrade deformation

California Bearing Ratio of subgrade lesser than 5% requires a treatment work either by stabilisation or strengthening method. In this study, the latter concept was chosen for the application of U-shaped Subgrade Concrete Panel as it is a method that has less disturbance to the native soil. As the name suggested, this U-shaped Subgrade Concrete Panel is a precast U-shaped concrete panel to be installed into the subgrade soil in an inverted direction. It is divided into two sections; the horizontal panel and vertical webs beneath the panel. Hence, the objective of this paper is to present the effect of applying the U-shaped Subgrade Concrete Panel into subgrade soil with a CBR value of less than 3%. There are 3 sizes of control panel used; square panel with dimension of 150 mm x 150 mm x 50 mm, 300 mm x 300 mm x 50 mm, and 600 mm x 600 mm x 70 mm, and 6 types of U-shaped Subgrade Concrete Panel; square area of 150 mm x 150 mm, 300 mm x 300 mm, and 600 mm x 600 mm. While the depth of the U-shaped Subgrade Concrete Panel varies from 100 mm, 125 mm, 150 mm, 200 mm, 270 mm, and 370 mm. The static load test was applied to centre, edge, and corner point of the panel, as to study the interlocking effect when it is subjected to a localised load. As the study was conducted in the laboratory, the condition of the subgrade soil fully controlled by monitoring the moisture content and the density of the soil in the test box. Settlement of the subgrade soil after compactions was observed and recorded as part of the initial conditions before the static load test was applied to the panel. After the compaction of the subgrade, it shows that a longer web section had caused lesser settlement compared to the control panel, indicating better resistance towards lateral movement under the U-shaped Subgrade Concrete Panel

Influence of pavement condition towards accident number on Malaysian highway

Accidents in Malaysia are alarming and have been in the rise for the past decades. Increasing numbers of road users, condition of road surface, expanded road network and weather conditions are being carefully looked into determining the contributors towards fatality. Human factors has been widely known and established as one of the main contributor to road accidents. Therefore, this study had focused more on to pavement conditions, where its relation with accidents needs to be further explored. The purpose of this study is to determine the influence of pavement condition towards accident number on Malaysian Highway. Pavement condition data which consist of Mean Texture Depth (MTD), Rutting Depth (RD) and also International Roughness Index (IRI) were measured along 265 km southern stretch of Malaysia highway, by using Multi Laser Profiler (MLP). Accident data were also collected from the accident report prepared by Southern region of Malaysian Highway Authority. Based on the results, it was found that more than 70% of the accidents happened at a good condition of road which having high MTD, low RD and minimum IRI. MTD was found as the most significance parameters that relates to accident. Other factors such as human negligence and environments (weather and lighting), might be the major cause that contribute to the accidents that happened along Malaysian highway

Anticancer activity of a sub-fraction of dichloromethane extract of Strobilanthes crispus on human breast and prostate cancer cells in vitro

<p>Abstract</p> <p>Background</p> <p>The leaves of <it>Strobilanthes crispus </it>(<it>S. crispus</it>) which is native to the regions of Madagascar to the Malay Archipelago, are used in folk medicine for their antidiabetic, diuretic, anticancer and blood pressure lowering properties. Crude extracts of this plant have been found to be cytotoxic to human cancer cell lines and protective against chemically-induced hepatocarcinogenesis in rats. In this study, the cytotoxicity of various sub-fractions of dichloromethane extract isolated from the leaves of <it>S. crispus </it>was determined and the anticancer activity of one of the bioactive sub-fractions, SC/D-F9, was further analysed in breast and prostate cancer cell lines.</p> <p>Methods</p> <p>The dichloromethane extract of <it>S. crispus </it>was chromatographed on silica gel by flash column chromatography. The ability of the various sub-fractions obtained to induce cell death of MCF-7, MDA-MB-231, PC-3 and DU-145 cell lines was determined using the LDH assay. The dose-response effect and the EC₅₀values of the active sub-fraction, SC/D-F9, were determined. Apoptosis was detected using Annexin V antibody and propidium iodide staining and analysed by fluorescence microscopy and flow cytometry, while caspase 3/7 activity was detected using FLICA caspase inhibitor and analysed by fluorescence microscopy.</p> <p>Results</p> <p>Selected sub-fractions of the dichloromethane extract induced death of MCF-7, MDA-MB-231, PC-3 and DU-145 cells. The sub-fraction SC/D-F9, consistently killed breast and prostate cancer cell lines with low EC₅₀values but is non-cytotoxic to the normal breast epithelial cell line, MCF-10A. SC/D-F9 displayed relatively higher cytotoxicity compared to tamoxifen, paclitaxel, docetaxel and doxorubicin. Cell death induced by SC/D-F9 occurred via apoptosis with the involvement of caspase 3 and/or 7.</p> <p>Conclusions</p> <p>A dichloromethane sub-fraction of <it>S. crispus </it>displayed potent anticancer activities <it>in vitro </it>that can be further exploited for the development of a potential therapeutic anticancer agent.</p

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe