Potential health and economic impacts of dexamethasone treatment for patients with COVID-19

Acknowledgements We thank all members of the COVID-19 International Modelling Consortium and their collaborative partners. This work was supported by the COVID-19 Research Response Fund, managed by the Medical Sciences Division, University of Oxford. L.J.W. is supported by the Li Ka Shing Foundation. R.A. acknowledges funding from the Bill and Melinda Gates Foundation (OPP1193472).Peer reviewedPublisher PD

Chronic pain and pattern of health care utilization among Malaysian elderly population: National health and morbidity survey III (NHMS III, 2006)

Objective: The aims of this study were to report prevalence of chronic pain and to examine whether chronic pain influence healthcare usage among elderly Malaysian population. Methods: This was a sub-population analysis of the elderly sample in the Malaysia's Third National Health and Morbidity Survey (NHMS III) 2006, a nation-wide population based survey. A subset of 4954 elderly aged 60 years and above was used in the analysis. Chronic pain, pain's interference and outcome variables of healthcare utilization (hospital admission and ambulatory care service) were all measured and determined by self-report. Results: Prevalence of chronic pain among elderly Malaysian was 15.2% (95% CI: 14.5, 16.8). Prevalence of chronic pain increased with advancing age, and the highest prevalence was seen among the old-old group category (21.5%). Across young-old and old-old groups, chronic pain was more prevalent among females, Indian ethnicity, widows/widowers, rural residency and those with no educational background. Our study showed that chronic pain alone increased hospitalization but not visits to ambulatory facilities. Presence of chronic pain was significantly associated with the frequency of hospitalization (aIRR 1.11; 95% CI 1.02, 1.38) but not ambulatory care service. Conclusions: Chronic pain is a prevalent health problem among the elderly in Malaysia and is associated with higher hospitalization rate among the elderly population. This study provides insight into the distribution of chronic pain among the elderly and its relationship with the patterns of healthcare utilization. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Preventive medicine

1st Asia Pacific Clinical Epidemiology and Evidence Based Medicine Conference. Kuala Lumpur, Malaysia. Editoria

Metabolic syndrome among non-obese adults in the teaching profession in Melaka, Malaysia

Background: Non-obese individuals could have metabolic disorders that are typically associated with elevated body mass index (BMI), placing them at elevated risk for chronic diseases. This study aimed to describe the prevalence and distribution of metabolically obese, non-obese (MONO) individuals in Malaysia. Methods: We conducted a cross-sectional study involving teachers recruited via multi-stage sampling from the state of Melaka, Malaysia. MONO was defined as individuals with BMI 18.5-29.9 kg/m2 and metabolic syndrome. Metabolic syndrome was diagnosed based on the Harmonization criteria. Participants completed self-reported questionnaires that assessed alcohol intake, sleep duration, smoking, physical activity, and fruit and vegetable consumption. Results: A total of 1168 teachers were included in the analysis. The prevalence of MONO was 17.7% (95% confidence interval [CI], 15.3-20.4). Prevalence of metabolic syndrome among the normal weight and overweight participants was 8.3% (95% CI, 5.8-11.8) and 29.9% (95% CI, 26.3-33.7), respectively. MONO prevalence was higher among males, Indians, and older participants and inversely associated with sleep duration. Metabolic syndrome was also more prevalent among those with central obesity, regardless of whether they were normal or overweight. The odds of metabolic syndrome increased exponentially from 1.9 (for those with BMI 23.0-24.9 kg/m2) to 11.5 (for those with BMI 27.5-29.9 kg/m2) compared to those with BMI 18.5-22.9 kg/m2 after adjustment for confounders. Conclusions: The prevalence of MONO was high, and participants with BMI ≥23.0 kg/m2 had significantly higher odds of metabolic syndrome. Healthcare professionals and physicians should start to screen nonobese individuals for metabolic risk factors to facilitate early targeted intervention

Role of Individual, Family, and Peers in Sexual Initiation Among Late Adolescents Attending Institutions of Higher Learning in Malaysia

This cross-sectional study aimed to determine the prevalence and the factors associated with sexual initiation among the late adolescents in 6 institutions of higher learning in Malaysia. A total of 1572 students completed self-administered questionnaires between April and September 2013. Hierarchical multivariate logistic regression analyses stratified by gender were employed to identify the correlates of sexual initiation. The analyses were further adjusted by sampling weights. The overall prevalence of sexual initiation was 9.8% (95% confidence interval [CI] = 8.3-11.6), 18.1% (95% CI = 15.1-21.5) among males, and 4.1% (95% CI = 2.9-5.9) among females. The risk factors identified in this study supported the influence of the individual, family, and peer factors in the social-ecological model on adolescents' behaviors. The findings suggest the need for risk-reduction strategies aimed at the individual, family, and peer levels as well as the importance of gender-specific focus in assuring better outcomes

Chronic diseases, depressive symptoms and functional limitation amongst older people in rural Malaysia, a middle income developing country

Objectives. To determine prevalence and prevalence ratio of functional limitation amongst older people with combined chronic diseases and co-morbid depressive symptoms compared with older people with either chronic disease or depressive symptoms alone. Methods. Data were analysed from a cross-sectional study of 765 people aged 60 years and over, conducted from 2007 to 2008 in Malaysia. Chronic diseases were self-reported, depressive symptoms were measured using the Geriatric Depression Scale and functional limitation was assessed using the Tinetti Performance Oriented Mobility Assessment Tool. Results. A higher proportion of older people with combined chronic diseases and depressive symptoms reported having functional limitation (44.7) compared with older people with chronic diseases alone (12.5) and depressive symptoms alone (18.1). Adjusting for socio-demographic characteristics, cognitive status and living arrangements, chronic diseases were associated with functional limitation (PR 2.21, 95 CI 1.31, 3.72). Depressive symptoms were also associated with functional limitation (PR 2.07,95 CI 1.56, 2.76). The prevalence ratio for functional limitation was much greater for combined chronic diseases and depressive symptoms (PR 4.09, 95 CI 2.23, 7.51). Conclusions. Older people with combined chronic diseases and depressive symptoms are more likely to have functional limitation than those with chronic disease or depressive symptoms alone. (C) 2011 Elsevier Inc. All rights reserved

Depressive symptoms, visual impairment, and its influence on physical disability and functional limitation

To the Editor: Depression and visual impairment occurs commonly in older people. Depression1,2 and visual impairment3,4 have been associated with poor physical function. There is evidence that treatment of depression improves physical function.5 Visual impairment is modifiable to a certain degree, because it may be corrected through surgery and use of optical devices. Studies have also shown that these two conditions coexist.6 It was hypothesized that older people with depression and visual impairment would have a higher prevalence of poor physical function than those with depression or visual impairment alone. The aim of this study was to determine the relationship between the combined effect of depressive symptoms and visual impairment on physical disability and functional limitation

Determinants and effects of voice disorders among secondary school teachers in peninsular Malaysia using a validated Malay version of VHI-10

10.1371/journal.pone.0141963PLoS ONE1011e014196

Predictors of death in Malaysian HIV-infected patients on anti-retroviral therapy

Objective: To determine the predictors of death in Malaysian HIV-infected patients undergoing antiretroviral therapy (ART). Methods: Data from 845 HIV-infected patients aged 20 years on ART in a large teaching hospital in Malaysia from 1989 to 2009 were analyzed using Kaplan Meier and Cox regression analyses. Results: 72.7 of the patients survived. Multivariate Cox regression showed that significant predictors of death were age 50 years (HR 1.76; 95 CI 1.18 2.64), secondary education (HR 3.57; 95 CI 1.12 11.37), tertiary education (HR 3.57; 95 CI 1.0911.70), being unemployed (HR 1.49; 95 CI 1.07 2.09), AIDS on initial presentation (HR 5.75; 95 CI 3.29 10.07), single-drug ART (HR 1.84; 95 CI 1.27, 2.66), double-drug ART (HR 1.63; 95 CI 1.19 2.25) and inability to achieve viral load 50 copies/ml (HR 10.22; 95 CI 7.26 14.37). Conclusion: Every effort needs to be made to ensure that all HIV patients have access to triple drug ART, to lower viral load to 50 copies/ml and to treat HIV patients before they progress to AIDS as these are significant modifiable predictors of death in Malaysian HIV patients

Impact of cardiac care variation on ST-elevation myocardial infarction outcomes in Malaysia

Developing countries face challenges in providing the best reperfusion strategy for patients with ST-segment elevation myocardial infarction because of limited resources. This causes wide variation in the provision of cardiac care. The aim of this study was to assess the impact of variation in cardiac care provision and reperfusion strategies on patient outcomes in Malaysia. Data from a prospective national registry of acute coronary syndromes were used. Thirty-day all-cause mortality in 4,562 patients with ST-segment elevation myocardial infarctions was assessed by (1) cardiac care provision (specialist vs nonspecialist centers), and (2) primary reperfusion therapy (thrombolysis or primary percutaneous coronary intervention P-PCI). All patients were risk adjusted by Thrombolysis In Myocardial Infarction (TIMI) risk score. Thrombolytic therapy was administered to 75% of patients with ST-segment elevation myocardial infarctions (12% prehospital and 63% in-hospital fibrinolytics), 7.6% underwent P-PCI, and the remainder received conservative management. In-hospital acute reperfusion therapy was administered to 68% and 73% of patients at specialist and nonspecialist cardiac care facilities, respectively. Timely reperfusion was low, at 24% versus 31%, respectively, for in-hospital fibrinolysis and 28% for P-PCI. Specialist centers had statistically significantly higher use of evidence-based treatments. The adjusted 30-day mortality rates for in-hospital fibrinolytics and P-PCI were 7% (95% confidence interval 5% to 9%) and 7% (95% confidence interval 3% to 11%), respectively (p = 0.75). In conclusion, variation in cardiac care provision and reperfusion strategy did not adversely affect patient outcomes. However, to further improve cardiac care, increased use of evidence-based resources, improvement in the quality of P-PCI care, and reduction in door-to-reperfusion times should be achieved