METHODS: Data for adults undergoing fURS in 25 centers worldwide were prospectively collected (August 2023 to January 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. All patients had computed tomography scans before and within 30 d after fURS with a FANS ureteral access sheath. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments >4 mm. Data for continuous variables are presented as the median and interquartile range (IQR). Multivariable logistic regression was performed to evaluate predictors of grade A SFS.
KEY FINDINGS AND LIMITATIONS: The study enrolled 394 patients (59.1% male) with a median age of 49 yr (IQR 36-61). The median stone volume was 1260 mm3 (IQR 706-1800). Thulium fiber laser (TFL) was used in 45.9% of cases and holmium laser in the rest. The median lasing time was 18 min (IQR 11-28) and the median operative time was 49 min (IQR 37-70). One patient required a blood transfusion and 3.3% of patients had low-grade fever. No patient developed sepsis. Low-grade ureteral injury occurred in eight patients (2%). The grade A SFS rate was 57.4% and the grade A + B SFS rate was 97.2%, while 2.8% of patients had grade C or D SFS. Eleven patients underwent repeat fURS. Multivariable analysis revealed that a stone volume of 1501-3000 mm3 (odds ratio 0.50) and of >3000 mm3 (odds ratio 0.29) were significantly associated with lower probability of grade A SFS, while TFL use was associated with higher SFS probability (odds ratio 1.83). Limitations include the lack of a comparative group.
CONCLUSIONS AND CLINICAL IMPLICATIONS: fURS using a FANS ureteral access sheath resulted in a high SFS rate with negligible serious adverse event and reintervention rates.
PATIENT SUMMARY: We looked at 30-day results for patients undergoing telescopic laser treatment for kidney stones using a special type of vacuum-assisted sheath to remove stone fragments. We found a high stone-free rate with minimal complications.
METHOD: This is a cross-sectional market survey conducted from February to May 2023 on 3428 products sold in Malaysian supermarkets. Product information including the brand, name, nutrition information panel, food product indicator (front-of-pack nutrition labelling, NHC, other claims), ingredients list and manufacturer or importer were collected. Compliance of products carrying NHC and HCL is evaluated against local guidelines. Credibility as a healthy product is evaluated against the WHO Nutrient Profile Model for the Western Pacific Region on a subsample (products with HCL and/or NHC).
RESULTS: 53% of food products surveyed had food product indicators (n=1809). A total of 32% carried at least one NHC (n=1101), of which 47% had excellent overall compliance (n=522). Only 4% carried Malaysia's HCL (n=138), of which 48% had excellent nutrient compliance (n=66). Only 13% of the products carrying Malaysia's HCL and NHC could be identified as absolute healthy food products as defined by the WHO standard (n=147).
CONCLUSION: Although half of the products surveyed had food product indicators, merely half of them had excellent compliance towards the standards. Only 13% of the subsample qualified as healthy food products. Voluntary application of the local HCL was low among food industries. Ensuring high standards of compliance and credibility of food products in the Malaysian market is crucial for food companies and government authorities.
METHODS: This study employed a two-arm, single-blind cluster randomized controlled trial in a community setting within Union Council Kuri Dolal, Tehsil Gujjar Khan, District Rawalpindi-Pakistan. It compared an Active Treatment group, receiving five sessions of the IA-PM+ intervention, against a Delayed Treatment Control group. A total of 148 participants were randomized. Randomization occurred at the village level, with clusters assigned to either the intervention or control group. The intervention's effectiveness and participant satisfaction were assessed using a variety of measures, including the GHQ-12, WHODAS 2.0, DASS-21, and the Client Satisfaction Questionnaire, at baseline, the 8th week, and during a 3-month follow-up. Qualitative feedback was gathered at the end of the study to assess the intervention's acceptability among the participants.
RESULTS: The study achieved a 100% retention rate. Baseline demographics showed a majority male participation with a variety of disabilities predominantly lower limb. Significant improvements were noted in the intervention group across WHODAS scores (Cohen's d= 0.66), PTSD symptoms (d= 0.75), and DASS scores for depression (d= 0.46), anxiety (d=0.65), and stress (d= 0.47). Similar trends were noted during the follow-up phases. However, life satisfaction scores initially higher in the control group evened out by follow-up, and perceived social support was consistently lower in the intervention group. High levels of client satisfaction were reported in the intervention group, with most participants finding the sessions beneficial and expressing willingness to recommend the service to others. The qualitative interviews revealed that the integration of religious practices, such as associating stress management techniques with Adhan, significantly enhanced the acceptability of the culturally adapted PM+ intervention. Participants reported that this cultural alignment made the coping strategies more relatable and easier to adopt, contributing to improvements in both their mental health and somatic symptoms.
CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04981522, identifier NCT04981522.
METHODS: Frailty and fall publications were retrieved from Scopus and Web of Science databases without date restrictions. Data was analyzed using ScientoPy, and VOSviewer to generate statistics, visualizations, and maps based on temporality, productive countries, institutions, citations, subject categories, and keyword occurrences.
RESULTS: After pre-processing, 345 publications remained (84.6% Web of Science, 15.4% Scopus). The literature has grown steadily since 1990, led by the United States, China, and Japan. Prolific institutions were identified, including Pittsburgh University. Highly cited impactful studies were published across journals like the Journal of the American Geriatrics Society. Geriatrics/gerontology was the dominant subject category. Keyword co-occurrence analysis revealed clusters focusing on geriatric physical health, cardiovascular health, cognition, interventions, and mortality.
CONCLUSIONS: This bibliometric analysis synthesizes a comprehensive overview of frailty and fall research, identifying rising publication and citation trends, leading global contributors, impactful studies, and thematic focuses. The findings can inform resource allocation, international collaboration, impactful evidence utilization, and future research planning to advance frailty science and clinical care for older populations. Ongoing investigation is warranted into frailty mechanisms, assessment, management, and multidomain interventions.
METHODS: In 2021, a customized 6-item online survey on resuscitation practices of infants born at <29 weeks gestation (or birth weight <1,200 g) was sent by the representative of each country's neonatal network to all the Neonatal Intensive Care Units (NICUs) participating in AsianNeo network. At the time of the survey, there were 446 participating hospitals in eight countries: four high-income countries (Japan, Singapore, South Korea, and Taiwan) and four low-middle-income countries (Malaysia, Indonesia, Philippines, and Thailand).
RESULTS: The study included 446 hospitals, with a response rate of 72.6% (ranging from 62.7% to 100%), with 179 (55.2%) in HICs and 145 (44.7%) in LMICs. Routine attendance of experienced NICU physicians during resuscitations is reported to be higher in HICs than LMICs, both during daytime (79% vs. 40%) and nighttime (62% vs. 23%). The NRP guidelines in each country were varied, with 4 out of 8 countries using indigenously developed guidelines. Equipment availability during resuscitation was also variable; saturation monitors, radiant warmers, and plastic wraps were available in almost all hospitals, whereas oxygen and air blenders, heated humidified gas, and end-tidal CO2 detectors were more available in HICs. The most common device for Positive Pressure Ventilation (PPV) was the T-piece resuscitator (52.3%).
CONCLUSION: The neonatal resuscitation practices for extremely preterm infants, encompassing staff, equipment, and guidelines, exhibited variance between HICs and LMICs in the AsianNeo region. Further enhancements are imperative to narrow this gap and optimize neonatal outcomes.
OBJECTIVE: We characterized the DBS cohort and outcomes at a Malaysian quaternary medical center.
METHODS: A retrospective chart review was done on DBS-related surgery at the University of Malaya, including clinico-demographic, genetics, and outcomes data focusing on post-operative medication reduction and complications.
RESULTS: 149 Parkinson's disease (PD) patients underwent DBS targeting the subthalamic nucleus. Six had globus pallidus internus DBS (primarily for dystonia). Only 16.1% of patients were government-funded. Of the 133 PD patients operated in the past decade (2013-2022), 25 (18.8%) had disease duration <5 years. At 6-12 months post-DBS, median levodopa-equivalent daily dose (LEDD) reduction was 440.5 [418.9] mg/day, corresponding to a reduction of ≥50% and ≥30% in 42.2% and 69.8% of patients, respectively. LEDD reductions were larger in the early-onset and short-duration subgroups. Three patients (1.9% of 155) had symptomatic intracranial hemorrhage, resulting in stroke in two. Pathogenic monogenic or GBA1 variants were detected in 12/76 (16%) of patients tested, mostly comprising the "severe" GBA1 variant p.L483P (12%).
CONCLUSIONS: This is the largest report on DBS from Southeast Asia. The procedures were effective, and complication rates on par with international norms. Our study found a high frequency of GBA1-PD; and included a substantial number of patients with short-duration PD, who had good outcomes. It also highlights regional inequities in access to device-aided therapy.
PLAIN LANGUAGE SUMMARY: Deep brain stimulation (DBS) is a highly effective treatment for several movement disorders, including Parkinson's disease (PD). However, there is very limited published information about DBS in developing countries, and on "real-life" outcomes when DBS is performed earlier in the course of PD. Here, we describe a relatively large cohort of patients who underwent DBS at a major hospital in Kuala Lumpur, Malaysia. DBS was effective with low complication rates, and at 6-12 months after surgery, the PD medication dosage was reduced by at least one-half in 4 out of 10 patients and by at least one-third in 7 out of 10 patients. Patients with PD who underwent DBS early in their disease course (within 5 years from diagnosis, comprising one-fifth of the patients), and those diagnosed at age 50 years or younger (comprising one-half of the patients), appeared to have larger reductions in their PD medications. A significant proportion of patients with PD (16%) who had genetic testing done were found to harbor monogenic (causative) gene variants or GBA1 risk gene variants, which have been associated with worse disease progression, and these patients had lesser medication reduction compared to GBA1 variant-negative patients. Less than two out of 10 patients (16%) had their DBS funded via the public health system. To our knowledge, this is the largest report on DBS from Southeast Asia and documents good outcomes overall, including in PD patients operated on early in their disease course, but highlights limited government funding for this potentially life-changing therapy as a significant barrier in developing countries.
OBJECTIVE: This study aimed to evaluate the ergonomic risk factors contributing to MSDs among traffic police in Putrajaya.
METHODS: A questionnaire encompassing socio-demographic variables, work tasks, ergonomic hazards, and the Body Symptom Survey (BOSS) was administered to 40 traffic police officers stationed at the Putrajaya District Police Headquarters. Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) software.
RESULTS: Results revealed a predominantly male (87.5%), Malay (90%) population, aged between 31 and 40, with a majority serving as corporals (42.5%) within operational task units (82.5%). Primary duties among the respondents were traffic control (45%) and police escort (30%). Extreme temperatures emerged as the most prevalent ergonomic risk factor (82.5%), with the neck being the most affected body part (50%). Significant correlations were found between MSDs and various ergonomic risk factors, including awkward posture (p ≤ 0.001), static motion (p
OBJECTIVE: This paper addresses this gap by investigating the relationship between employees and firms' environmental performance in the manufacturing sector operating in a developing country, Pakistan-where the environmental focus is sparse and organizational structures rarely follow cross-functional systems.
METHODS: Quantitative research was employed and SmartPLS technique was used to test the theoretical model with a valid response rate of 77 percent of senior and middle-level managers of manufacturing firms.
RESULTS: Results revealed the significance of green HRM as direct effect with all constructs. And internal environment management mediates the relationship (β = 0.158; t--value = 3.458; p
METHODS: This study employed a quantitative design, disseminating surveys via Sina Weibo and the Douyin platform. We collected a total of 525 valid responses. This study aims to deeply explore the social and psychological factors generated by digital religious activities on social media platforms, particularly how they stimulate Chinese Generation Z youth to participate in digital religious activities.
RESULTS: The results show that attitudes toward digital religion, perceived behavioral control, social identity, and empathetic willingness are predictors of intentions, while social norms are not. Intentions significantly predict users'behavior on social media platforms such as Weibo and Douyin. Moreover, empathetic willingness and social identity fully mediate the effects of subjective norms, perceived behavioral control, and attitudes on intentions. Consequently, these behaviors generate impact, indicating the presence of multiple mediation effects.
DISCUSSION: Unlike the societal context of theistic nations, there is a pronounced atheistic inclination within Chinese society. Consequently, subjective norms do not influence the digital religious behaviors of Chinese youth. Among contemporary Chinese youth, participation in digital religious practices is a temporary, secular activity undertaken only as a comforting behavior when anxiety becomes unmanageable or surpasses their threshold of tolerance. In contemporary China, young people face immense pressures stemming from workplace competition, social interactions, and economic burdens. Social media offers these young individuals broader opportunities for connection, community formation, and identity construction, as well as various possibilities for organizing their social lives. Consequently, on one hand, they turn to online religious avenues, seeking understanding from others through shared experiences, thereby obtaining emotional solace and comfort. On the other hand, they look to spiritual beliefs to alleviate anxiety, resolve confusion, and gain psychological comfort through emotional exchanges. Therefore, digital religion can, to some extent, be viewed as a form of social-technological empowerment, providing contemporary youth with a new "pressure valve" to facilitate emotional relief, comfort, and tension alleviation.
METHODS: This study presents cross-sectional survey data collected as part of the Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project, a longitudinal observational study in low-income communities. The study participants were 1191 randomly selected adults aged 35-70 years with a self-reported history of hypertension or identified as hypertensive through blood pressure screening.
RESULTS: While most low-income individuals with hypertension in both countries were diagnosed and receiving medication, Malaysians demonstrated higher self-reported medication adherence. Urban areas in the Philippines showed better hypertension management outcomes compared to rural areas. The study also provides insights into the care seeking pathways followed by low-income adults diagnosed with hypertension. Nearly half of these individuals in Malaysia and a third in the Philippines were following pathways where they had never changed or stopped treatment without professional advice, and where they were using and adhering to their prescribed medication. Following such pathways was strongly associated with a greater likelihood blood pressure control in the Philippines, but less so in Malayisa.
CONCLUSIONS: These findings highlight the need for a contextualised understanding of care seeking choices and the importance of person-centred solutions. They offer a typology of hypertension care seeking pathways and a foundation for similar research in other settings.
METHODS: Systematic searches were conducted in 6 databases/web search engines (MEDLINE, SPORTDiscus, Embase, Web of Science, CINAHL, and Google Scholar) up to December 1, 2023. We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age. Pseudo data were generated using Monte Carlo simulation following harmonization for methodological variation. Population-weighted Generalized Additive Models for Location, Scale, and Shape were used to develop sex- and age-specific norms for absolute HGS (kg) and HGS normalized by height (Ht, m) squared (i.e., HGS/Ht2 in kg/m2). Norms were tabulated as percentile values (5th to 95th) and visualized as smoothed percentile curves.
RESULTS: We included data from 100 unique observational studies representing 2,405,863 adults (51.9% female) aged 20 to 100+ years from 69 countries and regions tested from the year 2000 onward. On average, absolute and normalized HGS values negligibly improved throughout early adulthood, peaked from age 30-39 years (at 49.7 kg (males) and 29.7 kg (females) for absolute HGS or 16.3 kg/m2 (males) and 11.3 kg/m2 (females) for HGS/Ht2), and declined afterwards. The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.
CONCLUSION: This study provides the world's largest and most geographically comprehensive international norms for adult HGS by sex and age. These norms have utility for global peer-comparisons, health screening, and surveillance.