A study on compliance to epileptic drug among epileptic patient attending physician clinic HUSM

Method: This is a cross sectional study involving 297 epilepsy patients attended Neurology Clinic, HUSM from January until November 2008 using self-administered validated questionnaires which consist of compliance, psychosocial evaluation and satisfaction with health care which has I 0, 39 and 23 items respectively. Result: The prevalence of non-compliant to epileptic drugs was 52.2% and the factors that contribute to non-compliant were patients' understanding about their illness (p= 0.002), complexity of the drug regime (p= 0.001) and cost and physical changes of the medication (p=0.004). There were no associations between sociodemographic, patient satisfaction with health care and other psychosocial factors with drug compliance. Conclusion: The drug non compliant is high among epilepsy patients attending Neurology Clinic, HUSM. Factors associated with drug compliance include duration of epilepsy, patient understanding about the illness, complexity of the drug regime and cost and physical of the medication. Assessment of drug compliance should be a routine part in managing epilepsy patients. Recognization of factors that contribute to non compliant will help the health care provider to plan an intervention programme to improve drug compliance and consequently reduces the cost of managing epilepsy patient

Study on Knowledge, Decision Making and Acceptance of Human Papilloma Virus Vaccination among Parents of Primary School Students in Kota Bharu

NTRODUCTION: Cervical cancer is the third most common cancer in women and fifth most common cancer in the entire general population in Malaysia 1. The primary prevention, HPV vaccine is only approved for use in females in Malaysia2. Children rely on parents not only for the consent even for the guidance and information about the vaccines3. OBJECTIVES: The study to determine the level of parental knowledge, decision making and acceptance of HPV vaccination, and association between knowledge and acceptance. METHODS: This cross sectional study was conducted among 280 parents of primary school students in Kota Bharu for 12 months duration. Systemic random sampling and a validated self administered questionnaire was used to assess knowledge of HPV vaccination. Data was analysed using SPSS ver 22. RESULTS: Parents with good knowledge in Kota Bharu was 38% and 62% was poor. Most decision regarding vaccination was a shared decision, 72%. The proportion of acceptance of HPV vaccine for girls was 63%. Level of knowledge (good) has significant association with acceptance of HPV vaccine (95% CI 7.319,36.403, p<0.001). CONCLUSION :Parent’s level of knowledge is low despite the implementation of the HPV vaccine since 2010. Vaccine acceptance is dependent on the level of knowledge. Parents play an important role in determining the success of HPV vaccine program4. The trend of decision making has changed in Malaysian family as most couples make joint decisions in allowing vaccinations on their child as compared to traditionally decision making by father5. KEYWORDS: HPV vaccine, knowledge, decision making, acceptance, parent

Metabolic, inflammatory, and oxidative stress markers in women exposed to secondhand smoke

Background Secondhand smoke (SHS) exposure has adverse effects on the cardiovascular system. This study aimed to determine the effects of SHS on the cardiovascular disease biomarkers, namely the metabolic, inflammatory, and oxidative stress markers in healthy adult women. Methods This comparative cross-sectional study was conducted among healthy women. The cases included those women exposed to SHS, and the controls included those women not exposed to SHS. SHS exposure was defined as being exposed to SHS for at least 15 min for 2 days per week. Venous blood was taken to measure the metabolic markers (high molecular weight adiponectin, insulin level, insulin resistance, and nonesterified fatty acids), oxidative stress markers (oxidized low density lipoprotein cholesterol and 8-isoprostane), and inflammatory markers (high-sensitivity C-reactive protein and interleukin-6). A hair nicotine analysis was also performed. An analysis of covariance and a simple linear regression analysis were conducted. Results There were 101 women in the SHS exposure group and 91 women in the non-SHS exposure group. The mean (with standard deviation) of the hair nicotine levels was significantly higher in the SHS exposure group when compared to the non-SHS exposure group [0.22 (0.62) vs. 0.04 (0.11) ng/mg; P = 0.009]. No significant differences were observed in the high molecular weight adiponectin, insulin and insulin resistance, nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, interleukin-6, and high-sensitivity C-reactive protein between the two groups. The serum high molecular weight adiponectin was negatively associated with the insulin level and insulin resistance in the women exposed to SHS. However, no significant relationships were seen between the high molecular weight adiponectin and nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, high-sensitivity C-reactive protein in the SHS group. Discussion There were no significant differences in the metabolic, oxidative stress, and inflammatory markers between the SHS exposure and non-SHS exposure healthy women. A low serum level of high molecular weight adiponectin was associated with an increased insulin level and resistance in the women exposed to SHS

Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Objective: To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design: Individual participant data meta-analysis. Data sources: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria: Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results: Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions: PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration: PROSPERO CRD42014010673

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Catamenial epilepsy: A missed cause of refractory seizure in young women

Catamenial epilepsy refers to changes in the frequency of seizures over the course of the menstrual cycle. A thorough history and detailed review of the patient’s seizure diary are imperative to classify the seizures accurately and select the most appropriate antiepileptic treatment. As catamenial epilepsy rarely responds to antiepileptic medications, the physician should regularly revise the treatment plan of the women with epilepsy that is refractory to the current treatment. We describe the case of a 34-year-old single woman who presented with refractory seizures

Underestimation of cardiovascular risk among peri and post-menopausal women

Backgrounds Peri- and postmenopausal women are among the high risk group to develop cardiovascular diseases, yet most of this group of women have inaccurate perception regarding their risk of getting the cardiovascular diseases. The aim of this study is to determine accuracy of self-perception on cardiovascular risk and its associated factor among these women attending primary care clinic. Methodology This study is a cross sectional study involving 292 peri and post- menopausal women who attended outpatient clinic in Universiti Sains Malaysia Hospital from May to August 2015. A Bahasa Malaysia version of Perception of Risk of Heart Disease Scale was used to assess participants’ perception on their cardiovascular risk. Framingham Risk Score 2008 was used to calculate cardiovascular risk. Results A total of 265 patients responded. Mean age of the participants were 57.4 ± 7. 87.5% perceived themselves in moderate cardiovascular risk group. 81.9% inaccurately perceived their cardiovascular risk with 48.7% underestimate their risk . Diabetes mellitus, age and systolic blood pressure were associated with underestimation of cardiovascular risk Conclusion A significant proportion of participants inaccurately perceived their cardiovascular risk and almost half underestimated their risk. More health education need to be done among this group of patients