Displaying publications 1 - 20 of 104 in total

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  1. Choo WY, Hairi NN, Sooryanarayana R, Yunus RM, Hairi FM, Ismail N, et al.
    BMJ Open, 2016 05 25;6(5):e011057.
    PMID: 27225651 DOI: 10.1136/bmjopen-2016-011057
    INTRODUCTION: Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

    METHODS AND ANALYSIS: This is a community-based prospective cohort study using randomly selected households from the national census. A multistage sampling method was employed to obtain a total of 2496 older adults living in the rural Kuala Pilah district. The study is divided into two phases: cross-sectional study (baseline), and a longitudinal follow-up study at the third and fifth years. Elder mistreatment was measured using instrument derived from the previous literature and modified Conflict Tactic Scales. Outcomes of elder mistreatment include mortality, physical function, mental health, quality of life and health utilisation. Logistic regression models are used to examine the relationship between risk factors and abuse estimates. Cox proportional hazard regression will be used to estimate risk of mortality associated with abuse. Associated annual rate of hospitalisation and health visit frequency, and reporting of abuse, will be estimated using Poisson regression.

    ETHICS AND DISSEMINATION: The study has been approved by the Medical Ethics Committee of the University of Malaya Medical Center (MEC Ref 902.2) and the Malaysian National Medical Research Register (NMRR-12-1444-11726). Written consent was obtained from all respondents prior to baseline assessment and subsequent follow-up. Findings will be disseminated to local stakeholders via forums with community leaders, and health and social welfare departments, and published in appropriate scientific journals and presented at conferences.

  2. Loh DA, Choo WY, Hairi NN, Othman S, Mohd Hairi F, Mohd Mydin FH, et al.
    J Adv Nurs, 2015 Nov;71(11):2661-72.
    PMID: 26031344 DOI: 10.1111/jan.12699
    The aim of this study was to describe a trial protocol of an educational intervention for nurses to improve their awareness and practice in detecting and managing elder abuse and neglect.
  3. Yunus RM, Hairi NN, Choo WY, Tan MP, Hairi F, Sooryanarayana R, et al.
    J Am Geriatr Soc, 2018 07;66(6):1165-1171.
    PMID: 29601084 DOI: 10.1111/jgs.15370
    OBJECTIVES: To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians.

    DESIGN: Two-year prospective cohort study.

    SETTING: Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur.

    PARTICIPANTS: Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later.

    MEASURES: EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions.

    RESULTS: The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain-age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03-2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81-1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data.

    CONCLUSION: Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes.

  4. Yunus RM, Hairi NN, Yuen C, Sooryanarayana R, Hairi F, Ismail N, et al.
    Int J Geriatr Psychiatry, 2019 01;34(1):60-66.
    PMID: 30230023 DOI: 10.1002/gps.4986
    BACKGROUND: Elder abuse and neglect (EAN) is a growing public health problem, and numerous adverse health effects of abuse in late life have been documented. Little is known, however, about the impact of elder abuse on sleep quality. This study examines the longitudinal relationship between EAN and sleep quality.

    METHODS: This was a 2-year prospective cohort study involving 1927 older adults in a rural Malaysian district, Kuala Pilah. A multi-stage cluster sampling strategy was employed. After 2 years, 1189 respondents were re-assessed. EAN was determined using the modified Conflict Tactic Scale, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).

    RESULTS: The prevalence of elder abuse was 8.1% (95% CI:6.9,9.3). Longitudinal analysis using generalized estimating equations showed that elder abuse contributed to higher PSQI scores (B:0.49, 95% CI:0.17,0.58). Sub-analyses demonstrated that psychological abuse and neglect had significant longitudinal relationships with increase of PSQI scores, while other subtypes did not.

    CONCLUSION: Abuse in late life, particularly psychological abuse and neglect, result in greater PSQI scores. Even though this may imply decline in sleep quality, our findings were not considered clinically significant as they did not exceed the clinical cut-off score of five. Nevertheless, sleep quality is an important determinant of health and a predictor of mortality among older adults; thus, understanding its relationship with abuse is useful to health care providers and policy-makers in improving health services and upgrading preventive measures.
  5. Mat S, Jaafar MH, Ng CT, Sockalingam S, Raja J, Kamaruzzaman SB, et al.
    PLoS One, 2019;14(11):e0225075.
    PMID: 31751378 DOI: 10.1371/journal.pone.0225075
    Knee pain is often underreported, underestimated and undertreated. This study was conducted to estimate the prevalence, burden and further identify socioeconomic factors influencing ethnic differences in knee pain and symptoms of OA among older adults aged 55 years and over in Greater Kuala Lumpur (the capital city of Malaysia). The sample for the Malaysian Elders Longitudinal Research (MELoR) was selected using stratified random sampling, by age and ethnicity from the electoral rolls of three parliamentary constituencies. Information on knee pain was available in 1226 participants, mean age (SD) 68.96 (1.57) years (409 Malay, 416 Chinese, 401 Indian). The crude and weighted prevalence of knee pain and self-reported knee OA symptoms were 33.3% and 30.8% respectively. There were significant ethnic differences in knee pain (crude prevalence: Malays 44.6%, Chinese 23.5% and Indians 31.9%, p<0.001). The presence of two or more non-communicable diseases (NCD) attenuated the increased risk of knee pain among the ethnic Indians compared to the ethnic Chinese. The prevalence of knee pain remained significantly higher among the ethnic Malays after adjustment for confounders. While the prevalence of knee pain in our older population appears similar to that reported in other published studies in Asia, the higher prevalence among the ethnic Malays has not previously been reported. Further research to determine potential genetic susceptibility to knee pain among the ethnic Malays is recommended.
  6. Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.
    J Elder Abuse Negl, 2020 02 21;32(1):72-83.
    PMID: 32085693 DOI: 10.1080/08946566.2020.1731640
    This study aimed to determine the primary care doctors' ability to recognize elder maltreatment and their intentions to report on such conditions. About 358 primary care doctors participated in this study. Outcomes were assessed using a validated five context-relevant clinical vignettes. Primary care doctor's recognition of sexual abuse was highest (91.0%); while the lowest (70.2%) in case signifying physical abuse. Despite being able to ascertain elder maltreatment, the intention to report the event is generally low even for cases exemplifying physical abuse, emotional abuse and neglect. However, intentions to report cases of sexual and financial abuse are 86.9% and 73.5% respectively. Findings highlighted the uncertainties of primary care doctors in distinguishing the clinical findings of non-accidental injuries and injuries due to acts of maltreatment. This provides support for educational intervention and guidelines or policies to improve the knowledge and skills of primary care doctors to intervene in elder maltreatment.
  7. Mat S, Jaafar MH, Razack AHA, Lim J, Ong TA, Khong SY, et al.
    Neurourol Urodyn, 2023 Mar;42(3):641-649.
    PMID: 36728321 DOI: 10.1002/nau.25136
    INTRODUCTION: The common assumption that urinary incontinence occurs in osteoarthritis (OA) due to poor mobility is supported by limited evidence. The influence of gender in such associations is also yet to be elucidated.

    OBJECTIVE: This study, therefore, identified any potential associations between knee OA symptoms and urinary incontinence and further explore sex differences in the associations.

    DESIGN: Cross-sectional study.

    SETTING: University Hospital.

    PARTICIPANTS: This was a cross-sectional study from a longitudinal research study comprising 1221 community-dwelling older persons (57% women), mean age (SD) 68.95 (7.49) years.

    MAIN OUTCOME MEASURE(S): Presence of urinary incontinence: mixed, stress and urge symptoms. Physical performance and C-reactive protein levels were also assessed.

    RESULTS: Two hundred and seventy-seven (22.83%) individuals reported the presence of urinary incontinence: mixed (41.5%), stress (30%), and urge (28.5%) symptoms. In an unadjusted analysis, stratified by gender, the association between knee pain and urinary incontinence was only present in women with mixed symptoms. After further adjustment of demographics differences and body mass index, the association between knee pain with any urinary incontinence and mixed symptoms remained significant with the odds ratios (95% confidence interval): 1.48 (1.02-2.15) and 1.73 (1.06-2.83), respectively. This relationship was attenuated after further adjustment for waist circumference and impaired lower limb mobility.

    CONCLUSION: Our study refutes previous assumptions that urinary incontinence in individuals with OA is attributed to impaired mobility alone, but introduces the role of abdominal obesity in this relationship, particularly in women. Future studies should assess the temporal relationship between body fat distribution and OA with urinary incontinence.

  8. Eng-Chong T, Yean-Kee L, Chin-Fei C, Choon-Han H, Sher-Ming W, Li-Ping CT, et al.
    PMID: 23243448 DOI: 10.1155/2012/473637
    Boesenbergia rotunda is a herb from the Boesenbergia genera under the Zingiberaceae family. B. rotunda is widely found in Asian countries where it is commonly used as a food ingredient and in ethnomedicinal preparations. The popularity of its ethnomedicinal usage has drawn the attention of scientists worldwide to further investigate its medicinal properties. Advancement in drug design and discovery research has led to the development of synthetic drugs from B. rotunda metabolites via bioinformatics and medicinal chemistry studies. Furthermore, with the advent of genomics, transcriptomics, proteomics, and metabolomics, new insights on the biosynthetic pathways of B. rotunda metabolites can be elucidated, enabling researchers to predict the potential bioactive compounds responsible for the medicinal properties of the plant. The vast biological activities exhibited by the compounds obtained from B. rotunda warrant further investigation through studies such as drug discovery, polypharmacology, and drug delivery using nanotechnology.
  9. Kapitonova MY, Kuznetsov SL, Salim N, Othman S, Kamauzaman TM, Ali AM, et al.
    Bull. Exp. Biol. Med., 2014 Jan;156(3):393-8.
    PMID: 24771384 DOI: 10.1007/s10517-014-2357-8
    Morphological and phenotypical signs of cultured readaptation osteoblasts were studied after a short-term space mission. The ultrastructure and phenotype of human osteoblasts after Soyuz TMA-11 space flight (2007) were evaluated by scanning electron microscopy, laser confocal microscopy, and ELISA. The morphofunctional changes in cell cultures persisted after 12 passages. Osteoblasts retained the drastic changes in their shape and size, contour deformation, disorganization of the microtubular network, redistribution of organelles and specialized structures of the plasmalemma in comparison with the ground control cells. On the other hand, the expression of osteoprotegerin and osteocalcin (bone metabolism markers) increased; the expression of bone resorption markers ICAM-1 and IL-6 also increased, while the expression of VCAM-1 decreased. Hence, space flight led to the development of persistent shifts in cultured osteoblasts indicating injuries to the cytoskeleton and the phenotype changes, indicating modulation of bone metabolism biomarkers.
  10. Abdullah I, Chee CF, Lee YK, Thunuguntla SSR, Satish Reddy K, Nellore K, et al.
    Bioorg Med Chem, 2015 Aug 01;23(15):4669-4680.
    PMID: 26088338 DOI: 10.1016/j.bmc.2015.05.051
    Poly (ADP-ribose) polymerases (PARPs) play diverse roles in various cellular processes that involve DNA repair and programmed cell death. Amongst these polymerases is PARP-1 which is the key DNA damage-sensing enzyme that acts as an initiator for the DNA repair mechanism. Dihydroorotate dehydrogenase (DHODH) is an enzyme in the pyrimidine biosynthetic pathway which is an important target for anti-hyperproliferative and anti-inflammatory drug design. Since these enzymes share a common role in the DNA replication and repair mechanisms, it may be beneficial to target both PARP-1 and DHODH in attempts to design new anti-cancer agents. Benzimidazole derivatives have shown a wide variety of pharmacological activities including PARP and DHODH inhibition. We hereby report the design, synthesis and bioactivities of a series of benzimidazole derivatives as inhibitors of both the PARP-1 and DHODH enzymes.
  11. Hariono M, Choi SB, Roslim RF, Nawi MS, Tan ML, Kamarulzaman EE, et al.
    PLoS One, 2019;14(1):e0210869.
    PMID: 30677071 DOI: 10.1371/journal.pone.0210869
    Dengue virus Type 2 (DENV-2) is predominant serotype causing major dengue epidemics. There are a number of studies carried out to find its effective antiviral, however to date, there is still no molecule either from peptide or small molecules released as a drug. The present study aims to identify small molecules inhibitor from National Cancer Institute database through virtual screening. One of the hits, D0713 (IC50 = 62 μM) bearing thioguanine scaffold was derivatised into 21 compounds and evaluated for DENV-2 NS2B/NS3 protease inhibitory activity. Compounds 18 and 21 demonstrated the most potent activity with IC50 of 0.38 μM and 16 μM, respectively. Molecular dynamics and MM/PBSA free energy of binding calculation were conducted to study the interaction mechanism of these compounds with the protease. The free energy of binding of 18 calculated by MM/PBSA is -16.10 kcal/mol compared to the known inhibitor, panduratin A (-11.27 kcal/mol), which corroborates well with the experimental observation. Results from molecular dynamics simulations also showed that both 18 and 21 bind in the active site and stabilised by the formation of hydrogen bonds with Asn174.
  12. Harith AA, Ahmad NA, Sahril N, Wahab NA, Kassim NA, Othman S, et al.
    Geriatr Gerontol Int, 2020 Dec;20 Suppl 2:43-48.
    PMID: 33370862 DOI: 10.1111/ggi.14039
    AIM: An aging population is a potential burden for unprepared developing countries. Malaysia is foreseen to be an aging country by 2035. Thus, this study aimed to determine the prevalence and factors associated with hearing disability among older persons in Malaysia.

    METHODS: Data from a nationwide survey implemented using a stratified cluster sampling design were analyzed. This study was carried out through face-to-face interviews and guided questionnaires. The questions were based on the Washington Group of Disability (WG) questionnaires, which produce multiple disability identifiers. Hearing disability is defined as at least one domain or question out of four questions coded as "A lot of difficulty" or "Cannot hear at all".

    RESULTS: The prevalence of hearing disability among older persons aged ≥60 years was 6.4% (95% CI 5.0-8.3), whereas 1.5% (95% CI 0.90, 2.50) older persons were reported to be using a hearing aid. The determinants of hearing disability are being male (aOR 2.67, 95% CI 1.94-3.66), being unemployed (retired, homemaker, unemployed; aOR 1.86, 95% CI 1.86-4.14) and had no formal education (aOR 18.25, 95% CI 4.18-79.55).

    CONCLUSIONS: Promoting healthy aging is important and crucial for Malaysia, in preparation toward an aging nation, as it could reduce the country's financial burden in the long term. Health-related agencies should promote health awareness and treatment centers in relation to hearing disability among older persons, as they should be educated and informed about healthcare choices availability, which is aligned with the Global Disability Action Plan 2014-2021. Geriatr Gerontol Int 2020; 20: 43-48.

  13. Tan MP, Ho YY, Chin AV, Saedon N, Abidin IZ, Chee KH, et al.
    Clin Auton Res, 2020 04;30(2):121-128.
    PMID: 31079241 DOI: 10.1007/s10286-019-00610-2
    PURPOSE: To determine the lifetime cumulative incidence of syncope, potential ethnic differences and factors associated with syncope using the Malaysian elders longitudinal research (MELoR) study first wave dataset.

    METHODS: The MELoR study recruited community-dwelling adults aged 55 years and over, selected through stratified random sampling from three parliamentary constituencies. The baseline data collected during the first wave was obtained through face-to-face interviews in participants' homes using computer-assisted questionnaires. During their baseline assessments, participants were asked whether they had ever experienced a blackout in their lifetime and if they had experienced a blackout in the preceding 12 months.

    RESULTS: Information on blackouts and ethnicity were available for 1530 participants. The weight-adjusted lifetime cumulative incidence of syncope for the overall population aged 55 years and above was 27.7%. The estimated lifetime cumulative incidence according to ethnic groups was 34.6% for Malays, 27.8% for Indians and 23.7% for Chinese. The estimated 12-month incidence of syncope was 6.1% overall, equating to 11.7% for Malays, 8.7 % for Indians and 2.3% for Chinese. Both Malay [odds ratio (OR) 1.46; 95% confidence interval (CI) 1.10-1.95 and OR 3.62, 95% CI 1.96-6.68] and Indian (OR 1.34; 95% CI 1.01-1.80 and OR 3.31, 1.78-6.15) ethnicities were independently associated with lifetime and 12-month cumulative incidence of syncope, respectively, together with falls, dizziness and myocardial infarction.

    CONCLUSION: Ethnic differences exist for lifetime cumulative incidence of syncope in community-dwelling individuals aged 55 years and over in an urban area in Southeast Asia. Future studies should now seek to determine potential genetic, cultural and lifestyle differences which may predispose to syncope.

  14. Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.
    J Elder Abuse Negl, 2021 04 25;33(2):151-167.
    PMID: 33899705 DOI: 10.1080/08946566.2021.1919272
    This quasi-experimental study examined the effect of Supporting Family Doctors to Address Elder Abuse (SAFE) educational intervention among family doctors practicing at public primary care clinics in Malaysia. SAFE is an intensive, multimodal, locally tailored, and culturally sensitive face-to-face educational intervention on elder abuse. A significant mean score improvement of knowledge [Baseline: 5.33 (SD:1.33) to 6-month post-intervention: 6.45 (SD: 1.35); p<0.001] and perceived behavioral control [Baseline: 50.83 (SD: 8.87) to six-month post-intervention: 56.16 (SD: 9.56); p<0.001] observed in the intervention group compared to the control group. No significant difference in attitude, subjective norm, and practice scores between the two groups over time. SAFE educational intervention for family doctors was effective to improve but not sustainable knowledge and perceived behavioral control toward elder abuse identification and management. We recommend SAFE educational intervention as part of the continuous medical education for family doctors supplemented with a change in organization and national policy.
  15. Mat S, Jaafar MH, Sockalingam S, Raja J, Kamaruzzaman SB, Chin AV, et al.
    Int J Rheum Dis, 2018 May;21(5):930-936.
    PMID: 29611292 DOI: 10.1111/1756-185X.13279
    AIM: To determine the association between vitamin D and knee pain among participants of the Malaysian Elders Longitudinal Research (MELoR) study.

    METHOD: This was a cross-sectional study from the MELoR study consisting of a representative group of 1011 community-dwelling older persons (57% female), mean age 86.5 (54-94) years; 313 were Malays, 367 Chinese and 330 Indians. Participants were asked if they had knee pain. Levels of serum 25-hydroxy cholecalciferol (25-[OH]D), an indicator of vitamin D status, were measured using routine laboratory techniques.

    RESULTS: In unadjusted analysis, presence of knee pain was significantly associated with vitamin D deficiency (odds ratio [OR] 1.42; 95% confidence interval (CI) 1.08-1.85, P 0.011). Vitamin D levels were significantly associated with ethnicity differences where Malays (OR 7.08; 95% CI 4.94-10.15) and Indians (OR 6.10; 95% CI 4.28-9.71) have lower levels of vitamin D compared to Chinese. Subsequent multivariate analysis revealed that the association between vitamin D deficiency and knee pain was confounded by ethnic differences.

    CONCLUSION: A previous study suggested that vitamin D deficiency was associated with knee pain. This relationship was reproduced in our study, but we further established that the association was explained by ethnic variations. As vitamin D status is dependent on skin tone, diet and sunlight exposure, which are all effected by ethnicity, future studies are now required to determine whether a true relationship exists between vitamin D and knee pain.
  16. Hisham R, Ng CJ, Liew SM, Lai PSM, Chia YC, Khoo EM, et al.
    BMC Fam Pract, 2018 06 23;19(1):98.
    PMID: 29935527 DOI: 10.1186/s12875-018-0779-5
    BACKGROUND: Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients' values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.

    METHODS: The EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.

    RESULTS: The final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: "EBM websites", "evidence-based journals", "types of studies", "terms related to EBM", "practice", "access", "patient preferences" and "support". Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657-0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.

    CONCLUSIONS: The EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

  17. Ahmad NS, Hairi NN, Said MA, Kamaruzzaman SB, Choo WY, Hairi F, et al.
    PLoS One, 2018;13(11):e0206445.
    PMID: 30395649 DOI: 10.1371/journal.pone.0206445
    OBJECTIVES: This study aims to describe the prevalence and transitions of frailty among rural-community dwelling older adults in Malaysia and to analyse factors associated with different states of frailty transition. Frailty was conceptualized using modified Fried phenotype from the Cardiovascular Health Study.

    DESIGN: This is a prospective longitudinal study with 12-months follow up among older adults in Malaysia.

    SETTING: Kuala Pilah, a district in Negeri Sembilan, which is one of the fourteen states in Malaysia.

    PARTICIPANTS: 2,324 community-dwelling older Malaysians aged 60 years and older.

    RESULTS: The overall prevalence of frailty in this study was 9.4% (95% CI 7.8-11.2). The prevalence increased at least three-fold with every 10 years of age. This increase was seen higher in women compared to men. Being frail was significantly associated with older age, women, and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (p<0.05). During the 12-months follow-up, our study showed that the transition towards greater frailty states were more likely (22.9%) than transition toward lesser frailty states (19.9%) while majority (57.2%) remained unchanged. Multivariate logistic regression analysis showed that presence of low physical activity increased the likelihood of worsening transition towards greater frailty states by three times (OR 2.9, 95% CI 2.2-3.7) and lowered the likelihood of transition towards lesser frailty states (OR 0.3, 95% CI 0.2-0.4).

    CONCLUSION: Frailty is reported among one in every eleven older adults in this study. The prevalence increased across age groups and was higher among women than men. Frailty possesses a dynamic status due to its potential reversibility. This reversibility makes it a cornerstone to delay frailty progression. Our study noted that physical activity conferred the greatest benefit as a modifiable factor in frailty prevention.

  18. Tan W, Liew JWK, Selvarajoo S, Lim XY, Foo CJ, Refai WF, et al.
    Acta Trop, 2020 Apr;204:105330.
    PMID: 31917959 DOI: 10.1016/j.actatropica.2020.105330
    The public health burden of dengue is most likely under reported. Current dengue control measures only considered symptomatic dengue transmission. Hence, there is a paucity of information on the epidemiology of inapparent dengue. This study reports that many people have been unknowingly exposed to dengue infection. Almost 10% and 70% of individuals without any history of dengue infection and living in a dengue hotspot, in Selangor, Malaysia, were dengue IgM and IgG positive respectively. When dengue-positive mosquitoes were detected in the hotspot, 11 (6.3%) of the 174 individuals tested were found to have dengue viremia, of which 10 were asymptomatic. Besides, upon detection of a dengue-infected mosquito, transmission was already widespread. In a clinical setting, it appears that people living with dengue patients have been exposed to dengue, whether asymptomatic or symptomatic. They can either have circulating viral RNA and/or presence of NS1 antigen. It is also possible that they are dengue seropositive. Collectively, the results indicate that actions taken to control dengue transmission after the first report of dengue cases may be already too late. The current study also revealed challenges in diagnosing clinically inapparent dengue in hyperendemic settings. There is no one best method for diagnosing inapparent dengue. This study demonstrates empirical evidence of inapparent dengue in different settings. Early dengue surveillance in the mosquito population and active serological/virological surveillance in humans can go hand in hand. More studies are required to investigate the epidemiology, seroprevalence, diagnostics, and control of inapparent dengue. It is also crucial to educate the public, health staff and medical professionals on asymptomatic dengue and to propagate awareness, which is important for controlling transmission.
  19. Jackson AA, Lai PSM, Alias AM, Atiya N, Ramdzan SN, Abdul Malik TF, et al.
    J Infect Dev Ctries, 2019 03 31;13(3):219-226.
    PMID: 32040451 DOI: 10.3855/jidc.11089
    INTRODUCTION: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting.

    METHODOLOGY: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist.

    RESULTS: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available.

    CONCLUSION: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

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