A Multicentre Analysis Of Employment Post-Spinal Cord Injury In Malaysia

OBJECTIVES: Employment outcome post-spinal cord injury (SCI) varies internationally due to different socioeconomic backgrounds. However, most previous studies were done in developed countries, with limited studies from developing countries like Malaysia. This research aims to study the employment rate, positive determinants of employment, and reasons for unemployment post-SCI in Malaysia. DESIGN: We conducted a cross-sectional multicentre survey study in Malaysia. This study included eight hospitals with inpatient rehabilitation services and one SCI organisation throughout Malaysia. 280 SCI individuals from 18 to 64 years old with more than one year of SCI duration participated in this study. We administered International Spinal Cord Injury (InSCI) Questionnaires to them. We extracted and analysed the relevant components like demographics, injury-related and work-related data. We identified significant positive determinants of employment by using logistic regression analyses with p-value <0.05 between categorical independent variables and employment status. We described reasons for unemployment post-SCI in frequencies of percentages. RESULTS: The employment rate post-SCI in Malaysia was 29%. Significant positive determinants of employment post-SCI in Malaysia identified from logistic regression analyses with higher odds of employment were female gender (OR [Odds Ratio]: 2.2, 95%, CI [Confidence Interval]: 1.1-4.2); being married (OR: 1.9, CI:1.1-3.4); and tertiary education (OR: 3.2, CI: 1.6-6.8. The five main reasons for unemployment post-SCI in Malaysia were health condition or disability (36.5%), inability to find suitable work (15.5%), not knowing how or where to seek work (11.5%), lack of accessibility to potential workplace (7.4%), and insufficient transportation services (6.2%) CONCLUSION: This study reported a low employment rate post-SCI in Malaysia. Tertiary education was a strong positive determinant of employment. Based on this study ’ s findings, suggested interventions focus on access to tertiary education, health condition optimisation, vocational guidance, exploration of telework options, creating a barrier-free environment, and provision of sufficient transportation services can raise the employment rate post-SCI

Effectiveness of home-based pulmonary rehabilitation:systematic review and meta-analysis

INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32–1.44; p=0.002) and HRQoL (SMD −0.62, 95% CI −0.88–−0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD −0.10, 95% CI −0.25–0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI −0.15–0.17; p=0.87). CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation

Prior Cancer Is Associated with Lower Atherosclerotic Cardiovascular Disease Risk at First Acute Myocardial Infarction

BACKGROUND: Patients with cancer are at increased risk of acute myocardial infarction (AMI). It is unclear if the Atherosclerotic Cardiovascular Disease (ASCVD) risk score at incident AMI is reflective of this higher risk in patients with prior cancer than those without. METHODS: We linked nationwide AMI and cancer registries from 2008 to 2019. A total of 18,200 eligible patients with ASCVD risk score calculated at incident AMI were identified (1086 prior cancer; 17,114 no cancer). RESULTS: At incident AMI, age-standardized mean ASCVD risk was lower in the prior cancer group (18.6%) than no cancer group (20.9%) (p &lt; 0.001). Prior to incident AMI, smoking, hypertension, hyperlipidemia and diabetes mellitus were better controlled in the prior cancer group. However post-AMI, prior cancer was associated with lower guideline-directed medical therapy usage and higher all-cause mortality (adjusted hazard ratio 1.85, 95% confidence interval 1.66-2.07). CONCLUSIONS: AMI occurred despite better control of cardiovascular risk factors and lower age-standardized estimated mean 10-year ASCVD risk among patients with prior cancer than no cancer. Prior cancer was associated with lower guideline-directed medical therapy post-AMI and higher mortality

Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases:a systematic review protocol

INTRODUCTION: Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care. METHODS AND ANALYSIS: We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for ‘Chronic Respiratory Disease’ AND ‘Pulmonary Rehabilitation’ AND ‘Home-PR’, and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR? ETHICS AND DISSEMINATION: Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences. PROSPERO REGISTRATION NUMBER: CRD42020220137

Milk drinking patterns among Malaysian urban children of different household income status

Introduction: Good oral hygiene protects against oral diseases such as caries and gum infections. Twice daily tooth brushing with fluoride pastes and flossing are recommended to keep mouth clean and reduce plaque bacterial growth. Poor access to oral cleaning material and dental care services expose children from poor backgrounds to oral diseases. Background: Milk consumption is popular in Malaysia especially among the younger ages. Nonetheless, there is a lack of quantitative data on milk consumption by children in Malaysia. Methods: A cross-sectional study was undertaken on a sample of 749 children aged 1-10 years in the metropolitan areas of Kuala Lumpur. Approximately similar proportions of children were selected from low, middle and high household income categories. Socioeconomic background, dietary intake based on 24-hour recall and food records, were obtained for each child. Results: Prevalence of milk drinking was highest among aged 1-3 years (90.6%) followed by 86.1% aged 4-6 years, and 73.7% among ages 7-10 years. The youngest age group consumed averagely 3.5 (3.1 – 3.8) cups (200ml/cup) of milk daily, exceeding the recommendation of 2-3 cups a day by the Ministry of Health, Malaysia. There were no significant differences in the mean amounts of milk consumed among ages 1-3 years from low to high income categories. Children aged 4-6 years consumed, on average, 2.2 (1.9 – 2.4) cups/day, which is within the MOH recommendation, while that for ages 7-10 years, at 1.07 (0.9–1.2) cups/day, is below the recommendation. Conclusion: Parents of young children should be advised on the nutritional importance of providing foods from a variety of sources, so that the children obtain the right balance and mix of nutrients for optimum growth