METHOD: We undertook a comprehensive literature search across 5 electronic databases (PubMed, Scopus, Web of Science, The Cochrane Library, clinicaltrials.gov, and EMBASE) from inception through February 2024. Three reviewers screened all randomized controlled trials (RCTs) and assessed quality, and two reviewers extracted data. The meta-analysis used standardized mean difference (SMD) with Hedges' g method, a random effects model adjusted by Hartung-Knapp, and assessed heterogeneity (I² statistic), weighted studies (inverse variance), and evaluated publication bias (Begg's funnel plot and linear regression test).
RESULT: We located 13 RCTs for inclusion in the meta-analysis. Tele-exercise interventions demonstrated significant improvements across all outcomes: depression (SMD=-0.51, p < 0.001), fatigue (SMD=-0.58, p = 0.01), physical health (SMD=0.62, p = 0.001), QoL (SMD=0.38, p = 0.02), and mental health (SMD=-0.48, p = 0.001). Mind-Body Training consistently had larger effects than Combination Training.
CONCLUSION: Tele-exercise can improve fatigue, depression, mental and physical health, and overall QoL in MS patients. Further research is necessary to optimize tele-exercise protocols, assess long-term effects, and explore potential synergies with other intervention modalities such as telemedicine.
METHODS: This study was carried out in urban and rural communities with adults aged between 35 and 70 years using purposive sampling. Standardized questionnaires were used to assess the smoking status and sociodemographic data of the participants. Bivariate analysis and multiple logistic regression were done to determine the association between smoking status and demographic characteristics among Malaysian adults.
RESULTS: The prevalence of smoking among adults is 23.2%. The sociodemographic factors significantly associated with active smoking status were being a younger adult (adjusted odds ratio [AOR] = 1.26, 95% CI: 1.06-1.50), being male (AOR = 24.16, 95% CI: 20.58-28.36), being Malay (AOR = 1.72, 95% CI: 1.49-1.98), being a blue-collar worker (AOR = 1.75, 95% CI: 1.48-2.06), having no formal education (AOR = 1.99, 95% CI: 1.56-2.53), being unmarried (AOR = 1.22, 95% CI: 1.02-1.48) and being of low socioeconomic status (AOR = 1.45, 95% CI: 1.14-1.84).
CONCLUSION: Public health policies and actions on smoking reduction should emphasize those identified as high-risk sub-populations, particularly younger adults, males and those who are not yet married, have no formal education and are of low socioeconomic status.
METHODS: In 35,815 patients from the VISION cohort study and 9219 patients from the POISE-2 trial who were ≥45 yr old and underwent nonurgent inpatient noncardiac surgery, we examined (by age and sex) the association between continuous nonlinear preoperative estimated glomerular filtration rate (eGFR) and the composite of myocardial injury after noncardiac surgery, nonfatal cardiac arrest, or death owing to a cardiac cause within 30 days after surgery. We estimated contributions of predictive information, C-statistic, and net benefit from eGFR and other common patient and surgical characteristics to large multivariable models.
RESULTS: The primary composite occurred in 4725 (13.2%) patients in VISION and 1903 (20.6%) in POISE-2; in both studies cardiac events had a strong, graded association with lower preoperative eGFR that was attenuated by older age (Pinteraction<0.001 for VISION; Pinteraction=0.008 for POISE-2). For eGFR of 30 compared with 90 ml min-1 1.73 m-2, relative risk was 1.49 (95% confidence interval 1.26-1.78) at age 80 yr but 4.50 (2.84-7.13) at age 50 yr in female patients in VISION. This differed modestly (but not meaningfully) in men in VISION (Pinteraction=0.02) but not in POISE-2 (Pinteraction=0.79). eGFR contributed the most predictive information and mean net benefit of all predictors in both studies, most C-statistic in VISION, and third most C-statistic in POISE-2.
CONCLUSIONS: Continuous preoperative eGFR is among the best cardiac risk predictors in noncardiac surgery of the large set examined. Along with its interaction with age, preoperative eGFR would improve risk calculators.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00512109 (VISION) and NCT01082874 (POISE-2).
METHOD: The phospholipid nanocarrier dispersion showed significantly enhanced in-vitro release, porcine skin/ intestine permeation, and retention. When the ratio of the MGR versus partially hydrogenated ginsenoside reached 1:1 w/w in the nanocarrier composition, the in-vitro release increased 54.8-fold compared to the MGR powder suspended in the release media.
RESULTS: Permeation of the nanocarrier dispersion through the porcine skin and intestine increased 160-fold and 42-fold, respectively, compared to permeation of the MGR powder suspension. Furthermore, the nanocarrier dispersion reduced NO production and iNOS mRNA expression in the LPS-stimulated RAW264.7 cells. MIC and MBC of the nanocarrier dispersion against P. gingivalis were 4.11 ± 1.17 and 8.22 ± 2.35 μg/mL, respectively.
CONCLUSION: In conclusion, the anti-inflammatory and antibacterial activities of MGR were remarkably enhanced when the MGR was loaded into the nanocarrier with partially hydrolyzed ginsenoside.
METHODS: We collected responses to an online and physical survey from people living with T2D through a quantitative cross-sectional study. First, we tested the contextual validity and cultural preciseness of ASQ-DM-EX prototype through a preliminary pilot testing phase. These processes culminated in the development of a 91-item version of the questionnaire which was disseminated widely to evaluate the predictive strength of the ASQ-DM-EX.
RESULTS: All constructs within ASQ-DM-EX showed internal consistencies within good to excellent range (Cronbach's ⍺ = 0.70-0.94), except for the Influence construct (Cronbach's ⍺ = 0.33). An increase in ASQ-DM-EX scores was associated with a reduction in HbA1c control (r = -0.17, P
METHODS: Melt emulsification followed by ultrasonication was used as a method of preparation and Quality-by-Design (QbD) was utilized to optimize ABE-SLNs.
RESULTS: The optimized ABE-SLNs consist of Precirol-ATO5 as a lipid and Brij-58 as a surfactant. The particle size, PDI value, and zeta potential of the optimized formulation were 170.4 ± 0.49 nm, 0.25 ± 0.014, and -26.4 ± 0.1 mV, respectively. It also showed sustained release behavior and a high entrapment efficiency of 79.96%. ABE-SLNs exhibited enhanced anticancer activity in the MDA-MB-231 and T47D breast cancer cell lines compared to pure ABE. In Caco-2 human colonic cell lines, ABE-SLNs also showed increased cellular uptake.
CONCLUSION: The use of QbD to achieve high entrapment efficiency and sustained release in ABE-SLNs, coupled with enhanced cellular uptake and cytotoxicity, represents a novel approach that could set a new standard for nanoparticle-based drug delivery systems.
METHODS: Social Cognitive Theory (SCT) was used as a guide in developing the PEB framework. Specifically, three factors were identified-Self-awareness (Personal), Attitude (Personal and Environment) and Safe Practice (Behavior) as the potential predictors for online fraud victimization. A self-reporting questionnaire was developed based on the PEB framework and used to collect data targeting Malaysian adults. The study reports result from two separate datasets collected across two separate timelines. Study I involved data collection in January 2023 (n = 820) whereas Study II was conducted with a modified questionnaire from November 2023 -January 2024 (n = 629). Study I identified the online fraud victimization predictors through an Exploratory Factor Analysis (EFA) and a hierarchical binary logistic regression. The dataset from Study II was used to validate the online fraud victimization model derived from Study I by executing another round of hierarchical binary logistic regression.
RESULTS: Results from both the samples show that most of the respondents are aware of digital privacy. EFA from Study I yielded a five-factor solution with a total variance of 60.6%, namely, Self-awareness, Safe Practice, Bank Trust, Overconfidence and Social Influence. Hierarchical binary logistic regression results from both the studies were found to be consistent. Specifically, Overconfidence (β = 0.374; OR = 1.453; 95% CI [1.119, 1.887]; p = 0.005) and Social Influence (β = 0.332; OR = 1.225; 95% CI [1.077, 1.512]; p = 0.006) were found to significantly predict online fraud victimization as well as gender (β = 0.364; OR = 1.440; 95% CI [1.008, 2.016]; p = 0.045) with females exhibiting higher risks to victimization.
IMPLICATIONS: The emergence of Overconfidence and Social Influence as significant predictors can guide the development of targeted online fraud awareness campaigns and/or tools emphasizing critical thinking and skepticism. Policymakers can leverage this knowledge to implement regulations that reduce deceptive practices online, promote digital literacy programs, and mandate clearer consumer protections to mitigate the impact of social manipulation and overconfidence on fraud victimization.
CONCLUSION: This study identifies online fraud victimization predictors, hence improving our understanding of the factors behind this phenomenon-allowing for the development of effective preventive measures and policies to safeguard individuals and improve digital security. For instance, gender- specific educational campaigns can be developed to enhance awareness and equip women with strategies to detect and avoid scams. Additionally, addressing systemic factors like social norms and digital literacy gaps is crucial for creating equitable and effective solutions to reduce online fraud victimization.
OBJECTIVE: This study aimed to develop, test the reliability of, and validate the Tele-Primary Care Oral Health Clinical Information System (TPC-OHCIS) questionnaire for evaluating the implementation of maternal and child digital health information systems.
METHODS: A cross-sectional study was conducted in 2 phases. The first phase focused on content item development and was validated by a group of 10 experts using the content validity index. The second phase was to assess its psychometric testing for reliability and validity.
RESULTS: A structured questionnaire of 65 items was constructed to assess the TPC-OHCIS delivery for primary health care use based on literature and has been validated by 10 experts, and 319 respondents answered the 65-item TPC-OHCIS questionnaire, with mean item scores ranging from 1.99 (SD 0.67) to 2.85 (SD 1.019). The content validity, reliability, and face validity showed a scale-level content validity index of 0.90, scale-level content validation ratio of 0.90, and item-level face validity index of 0.76, respectively. The internal reliability was calculated as a Cronbach α value of 0.90, with an intraclass correlation coefficient of 0.91. Scales were determined by the scree plot with eigenvalues >1, and 13 subscales were identified based on principal component analysis. The Kaiser-Meyer-Olkin value was 0.90 (P0.7. The Bartlett test of sphericity, determining construct validity, was found to be significant (P
METHODS: From August 2023 to September 2024, semi-structured interviews were conducted with sixteen Palliative Care, 12 Geriatrics and 13 Emergency physicians from various hospitals in Malaysia. Interview transcripts were analyzed using both inductive and deductive qualitative analyses.
RESULTS: Data analysis revealed three key domains: (1) living and dying well, (2) definition of suffering, and (3) impact of patient suffering on physicians.
CONCLUSION: Physicians' concepts of a good life and death frame their notions of suffering beyond the antithesis of a good life. Suffering is found to be distress at a loss of control, independence and dignity, alongside the presence of physical, emotional and existential distress. Witnessing patient suffering predisposes to physician suffering as they question their goals and roles in patient care. Our findings underscore the need for host organizations, hospitals and clinical departments to invest more in the care of their physicians. We believe these findings ought to be applicable to many resource-limited nations and other health care professionals beyond Malaysian shores.
SETTING: All glyphosate-related data of the Malaysia National Poison Centre from 2006 to 2023.
PARTICIPANTS: Telephone inquiries of incidents involving glyphosate made by healthcare professionals across Malaysia. Information received was recorded according to WHO guidelines.
OUTCOMES: The outcome is to provide an overview of national glyphosate poisoning epidemiology, including identifying risk factors and high-risk groups to strategise appropriate measures.
RESULTS: A total of 4548 glyphosate poisoning cases were reported, with males comprising 67.3% of cases. The most affected age groups were 21-30 years (25.5%) and 31-40 years (23.5%). Ingestion was the primary exposure route (93.0%). Intentional poisonings, mainly suicides, accounted for 68.4% (n=3078) of cases. Among the 1420 unintentional cases, 78.2% resulted from ingestion exposures. The incidence rate declined from 1.17 per 100 000 in 2011 to 0.61 in 2023. Significant associations were found between intentional ingestion and sociodemographic factors. From 2013 to 2023, 73.7% of cases were minor, 11.5% moderate, 0.8% severe and 0.1% fatal.
CONCLUSIONS: In Malaysia, the reported intentional glyphosate poisoning most commonly affects young adults, resulting in generally minor to moderate symptoms. The study highlights the need for stricter regulations on glyphosate use and improved mental health support, to mitigate poisoning risks. Continued surveillance and public education are essential to address this public health issue.
METHODS: Electronic health records were linked to echocardiography data between 2015 and 2021 from patients in Tayside, Scotland (population~450 000). Incident HF diagnosis was classified into inpatient or outpatient and stratified by ejection fraction (EF). A non-HF comparator group with normal left ventricular function was also defined. The primary outcome was time to cardiovascular death or hHF within 12 months of diagnosis.
RESULTS: In total, 5223 individuals were identified, 4231 with HF (1115 heart failure with reduced ejection fraction (HFrEF), 666 heart failure with mildly reduced ejection fraction, 1402 heart failure with preserved ejection fraction and 1048 HF with unknown EF) and 992 with non-HF comparators. Of the 4231 HF patients, 2169 (51.3%) were diagnosed as inpatients. The primary outcome was observed in 1193 individuals with HF (28.1%) and 32 (3.2%) non-HF comparators and was significantly more likely to occur in individuals diagnosed as inpatients than outpatients (809 vs 384 events; adjusted HR: 1.62 (1.39-1.89), p<0.001), and this was consistent regardless of EF. For HFrEF patients first diagnosed as inpatients, those discharged on ≥2 GDMT had a reduced incidence of the primary outcome compared with those discharged on <2 GDMT (303 vs 175 events; adjusted HR: 0.72 (0.55-0.94), p=0.016).
CONCLUSIONS: Individuals whose first presentation was a HF hospitalisation had a significantly worse outcome than those who were diagnosed in the community. Among hospitalised individuals, higher use of GDMT was associated with improved outcomes. Our results highlight the importance of improving diagnostic pathways to allow for earlier identification and treatment of HF.