Displaying publications 1 - 20 of 612 in total

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  1. Azmoude E, Aradmehr M, Dehghani F
    Malays J Med Sci, 2018 May;25(3):120-128.
    PMID: 30899193 DOI: 10.21315/mjms2018.25.3.12
    Objectives: Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.

    Methods: In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.

    Results: The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.

    Conclusion: Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

  2. Baharuddin IH, Arifin WN, Kueh YC, Rahman NA
    Malays J Med Sci, 2018 May;25(3):111-119.
    PMID: 30899192 DOI: 10.21315/mjms2018.25.3.11
    Background: Many questionnaires have been developed to measure dental anxiety and fear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of a dental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module (IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.

    Methods: This was a cross-sectional validation study. The original English version of the IDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via an expert validation and face validation by the target student population. Three hundred and seventy questionnaires were then distributed among 16-year-old school children. Confirmatory factor analysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihood estimator. Spearman's rank correlation was used to assess the relationship between the IDAF-S and IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of the IDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.

    Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed the existence of only one factor with a reliability estimate of 0.921, obtained via Raykov's procedure. All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P < 0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed model with absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showed satisfactory stability, as assessed via kappa values.

    Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dental anxiety and fear among Malaysian secondary school children.

  3. Zolkefli Y
    Malays J Med Sci, 2018 May;25(3):135-139.
    PMID: 30899195 DOI: 10.21315/mjms2018.25.3.14
    Can a lie be justified if it saves a human life or a community, or if another great evil is avoided? The article proposes that health professionals need not always tell the truth, depending on situation; but, this does not refute the significance of telling the truth. It also elucidates the value of telling the truth, and the challenges for telling the whole truth. Two prominent theories of ethics, Deontological and Consequentialism are deliberated, together with the integration of examples to illustrate main areas of interest.
  4. Tewari R, Chopra D, Wazahat R, Dhingra S, Dudeja M
    Malays J Med Sci, 2018 May;25(3):129-134.
    PMID: 30899194 DOI: 10.21315/mjms2018.25.3.13
    Multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) bacterium, a nosocomial pathogen associated with a high mortality rate and limited therapeutic options have emerged as a serious problem throughout the world. The present study aimed to assess the current levels of antibiotic susceptibility among the isolates of Acinetobacter species. The sensitivity patterns were analysed from various clinical specimens obtained from both in-patients and outpatients of a teaching hospital. Isolation was performed on 5% sheep blood agar and MacConkey agar. Urine samples were inoculated into CLED agar. Antibiotic susceptibility was performed by the disc diffusion method. A total of 16,452 samples were collected. The total number of samples positive for Acinetobacter species was 67 (0.4%). The highest number of isolates 26 (38.8%) were obtained from urine. Majority 80.3% of the isolates exhibited resistance to three or more classes of antibiotics. All isolates were susceptible to colistin (100%). The susceptibility rate of A. baumannii isolates was 80% for tigecycline and 53.3% for carbapenem. Combination therapies including colistin and tigecycline seem to be the rational treatment for MDR A. baumannii until new alternatives come forward.
  5. Yusoff N, Anuar NN, Reza MF
    Malays J Med Sci, 2018 May;25(3):103-110.
    PMID: 30899191 DOI: 10.21315/mjms2018.25.3.10
    Background: Sex is a psychobiological factor that is important in the process of emotion. This study determines the effect of sex on the electropsychological process of various intensities of emotional arousal.

    Methods: In the Event-related Potential (ERP) session, electroencephalographic (EEG) data was recorded for 90 participants, 60% of whom were females. The participants responded to 30 universal emotional pictures, randomly chosen from the International Affective Picture System (IAPS), which were classified as invoking high, moderate, and low intensity of emotional arousal.

    Results: From the analysis of variance of two-way mixed design, the interaction between sex and emotional intensity was observed in the occipital regions (O2), indexed by the amplitude of P300 and N200 components. Males exhibited higher amplitude of P300 and N200 components (in the occipital region) as responded to high and low emotional arousal stimuli than females.

    Conclusion: Sex is a fundamental factor that modulates psychological states in reaction to emotional stimuli.

  6. Yau CK, Rahim FF, Sheng CJ, Ling CX, Weng LK, Chia TC, et al.
    Malays J Med Sci, 2018 May;25(3):78-87.
    PMID: 30899189 DOI: 10.21315/mjms2018.25.3.8
    Background: Many smokers have undiagnosed chronic obstructive pulmonary disease (COPD), and yet screening for COPD is not recommended. Smokers who know that they have airflow limitation are more likely to quit smoking. This study aims to identify the prevalence and predictors of airflow limitation among smokers in primary care.

    Methods: Current smokers ≥ 40 years old who were asymptomatic clinic attendees in a primary care setting were recruited consecutively for two months. We used a two-step strategy. Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using a pocket spirometer. Multiple logistic regression was utilised to determine the best risk predictors for airflow limitation.

    Results: Three hundred participants were recruited. Mean age was 58.35 (SD 10.30) years old and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found to have airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year history and Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness of COPD were low.

    Conclusions: The high prevalence of airflow limitation and low readiness to quit smoking imply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additional motivator for smoking cessation intervention may be considered. A two-step case-finding method is potentially feasible.

  7. Kong CC, Kandasamy R, Haspani S, Idris Z, Abdullah JM
    Malays J Med Sci, 2018 May;25(3):88-102.
    PMID: 30899190 DOI: 10.21315/mjms2018.25.3.9
    Background: Meningiomas are the most common intracranial tumours; they account for 13%-26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of all meningiomas and are one of the most difficult intracranial tumours to be managed surgically. This is due to the fact that it is difficult to approach the lesions which are also close to vital structures such as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia, local data on meningiomas is scarce.

    Methods: This is a retrospective study consisting of 199 patients with meningiomas who have been operated at the Kuala Lumpur General Hospital from January 2010-December 2014. They were categorised into skull base and non-skull base groups. Demography, tumour characteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well as Cox hazard univariable and multivariable regressions for the possible predictors of survival were analysed.

    Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only five patients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), with a male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skull base meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), in addition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazard regressions showed that the skull base meningioma group had four times the risk of death of the non-skull base group.

    Conclusions: Symptomatic meningiomas can be curative if the tumour is completely removed. Our study has revealed that skull base meningiomas which were operated locally had higher rates of incomplete resection and poorer surgical outcomes as compared to the non-skull base group. Patients with skull base meningiomas had four times the risk of death vis-à-vis non-skull base ones. More local studies are needed to look into skull base meningiomas for the improvement of its surgical outcomes.

  8. Kalim H, Pratama MZ, Nugraha AS, Prihartini M, Chandra A, Sholihah AI, et al.
    Malays J Med Sci, 2018 May;25(3):17-26.
    PMID: 30899184 DOI: 10.21315/mjms2018.25.3.3
    Introduction: Regulatory T cells' (Tregs') role remains unclear in the pathogenesis of systemic lupus erythematosus (SLE). This study was aimed at monitoring the percentage of Tregs within 32 weeks and monitoring its relationship with the percentage of other T helper (Th) cell subsets and the levels of autoantibodies and pro-inflammatory cytokines in a murine SLE model induced by pristane.

    Methods: Forty-eight female BALB/c mice were divided into a healthy control (HC) and a pristine-induced (PI) group. SLE was induced by a single 0.5 cc pristane intraperitoneal injection. Six from each group were sacrificed every eight weeks until 32 weeks post-pristane injection. Treg, Th1, Th2 and Th17 percentages from the spleen were measured using flowcytometry. ANA, IL-6 and IFN-α levels were measured from serum using ELISA.

    Results: The Treg percentage from the PI group increased significantly at 16 weeks compared to the HC group, while Th1, Th2 and Th17 percentages decreased. Tregs in the PI group began to reduce from the 24th to 32nd weeks, followed by an elevation of the Th1, Th2 and Th17 percentages. Tregs were negatively correlated with Th1 and Th2. Tregs in the PI group had a negative correlation with ANA and IFN-α levels from serum, whereas Tregs had a positive correlation with IL-6 levels.

    Conclusion: The compensation of Tregs observed at 16 weeks after pristane injection failed, marked by a decreasing number of Tregs, followed by an increase of Th subsets, pro-inflammatory cytokines and autoantibodies. This compensatory failure of Tregs could be affected by pro-inflammatory cytokines, such as IFN-α and IL-6.

  9. Yun TC, Ahmad SR, Quee DKS
    Malays J Med Sci, 2018 May;25(3):56-66.
    PMID: 30899187 DOI: 10.21315/mjms2018.25.3.6
    Background: Young adults are at risk of developing obesity, especially when transitioning into university life as they become responsible for their daily eating and lifestyles. This study estimates the prevalence of overweight/obesity and explores the eating patterns and lifestyle practices of university students.

    Methods: A cross-sectional study was conducted at Universiti Brunei Darussalam (UBD). A total of 303 students participated. Data was collected from January to April 2016. Self-designed questionnaires comprised questions pertaining to current weight, self-reported height data, information on eating habits, exercise and knowledge of the food pyramid. The collected data were used to compare and contrast eating habits and lifestyle practices among overweight/obese students with those of non-overweight/obese students.

    Results: The prevalence of overweight/obesity was 28.8% (95% CI: 24.0%, 34.0%). The majority ate regular daily meals, but more than half skipped breakfast. Frequent snacking, fried food consumption at least three times per week and low intake of daily fruits and vegetables were common. The frequency of visits to fast food restaurants was significantly higher in the overweight/obese. 25.4% of the students exercised at least three times per week. Almost all students are aware of balanced nutrition and the food pyramid.

    Conclusions: Most university students had poor eating habits, although the majority had good nutrition knowledge. By way of recommendation, the university is encouraged to provide a multi-disciplinary team specialising in health promotion that includes nutrition and physical activity programmes to increase the awareness among the university students.

  10. Lari H, Noroozi A, Tahmasebi R
    Malays J Med Sci, 2018 May;25(3):67-77.
    PMID: 30899188 DOI: 10.21315/mjms2018.25.3.7
    Introduction: Physical activity is the most important self-management behaviour in diabetes. The aim of this study was to evaluate the impact of a short message service (SMS) based on a health promotion model (HPM) on the physical activity of diabetic patients.

    Methods: This quasi-experimental study consisted of 37 type II diabetes patients in an SMS group and 36 type II diabetes patients in a control group. The patients in both groups completed written consent forms and questionnaires at the beginning of the study. The patients in the SMS group received training messages within two weeks (two or three messages daily) in the field of physical activity based on HPM constructs. Both groups completed questionnaires in three stages (at the beginning of the study, four weeks after the first visit, and three months later) comprising demographic factors, questions regarding the constructs, and 7-day physical activity recall. After data collection, statistical analysis was conducted using an independent t-test, a Chi-square test, and a repeated measures analysis of variance (ANOVA).

    Results: As compared with the control group, changes in mean scores of perceived self-efficacy (P = 0.001) and family support (P = 0.046) of physical activity in the training group were significantly greater and perceived barriers (P < 0.001) were significantly lower over time. The physical activity performance of the SMS group was better three months after training as compared with that of the control group (P < 0.001).

    Conclusion: The results demonstrated the efficacy of training messages in changing the beliefs and physical activity behaviours of diabetic patients.

  11. Wanandi SI, Ningsih SS, Asikin H, Hosea R, Neolaka GMG
    Malays J Med Sci, 2018 May;25(3):7-16.
    PMID: 30899183 DOI: 10.21315/mjms2018.25.3.2
    The growth of tumour cells is closely related to cancer-associated fibroblasts (CAFs) present within their microenvironment. CAFs, the most abundant cells in tumour stroma, secrete growth factors that play pivotal roles in tumour cell proliferation, metabolism, angiogenesis and metastasis. Tumour cells adapt to rapid environmental changes from normoxia to hypoxia through metabolic interplay with CAFs. In this mini review, we discuss the role of lactate dehydrogenases (LDHs) and monocarboxylate transporters (MCTs) on the metabolic interplay between tumour cells and CAFs under hypoxia compared to normoxia. The LDHs catalyse the interchange of lactate and pyruvate, whereas MCTs facilitate the influx and efflux of monocarboxylates, especially lactate and pyruvate. To sum up, tumour cells switch their metabolic state between glycolysis and oxidative phosphorylation through metabolic interplay with CAFs, which exhibit the Warburg effect under hypoxia and reverse Warburg effect under normoxia.
  12. López-Muñoz F, Povedano-Montero FJ, Chee KY, Shen WW, Fernández-Martín P, García-Pacios J, et al.
    Malays J Med Sci, 2018 May;25(3):40-55.
    PMID: 30899186 DOI: 10.21315/mjms2018.25.3.5
    Objective: We carried out a bibliometric study on the scientific papers related to second-generation antipsychotic drugs (SGAs) in Malaysia.

    Methods: With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price's law and Bradford's law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D).

    Results: We found 105 original documents published between 2004 and 2016. Our results fulfilled Price's law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3.

    Conclusion: The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.

  13. Lah MHC, Reza F, Begum T, Abdullah JM
    Malays J Med Sci, 2018 May;25(3):27-39.
    PMID: 30899185 DOI: 10.21315/mjms2018.25.3.4
    Background: Previous studies from animal models have shown that pre-synaptic NMDA receptors (preNMDARs) are present in the cortex, but the role of inhibition mediated by preNMDARs during epileptogenesis remains unclear. In this study, we wanted to observe the changes in GABAergic inhibition through preNMDARs in sensory-motor and visual cortical pyramidal neurons after pilocarpine-induced status epilepticus.

    Methods: Using a pilocarpine-induced epileptic mouse model, sensory-motor and visual cortical slices were prepared, and the whole-cell patch clamp technique was used to record spontaneous inhibitory post-synaptic currents (sIPSCs).

    Results: The primary finding was that the mean amplitude of sIPSC from the sensory-motor cortex increased significantly in epileptic mice when the recording pipette contained MK-801 compared to control mice, whereas the mean sIPSC frequency was not significantly different, indicating that post-synaptic mechanisms are involved. However, there was no significant pre-synaptic inhibition through preNMDARs in the acute brain slices from pilocarpine-induced epileptic mice.

    Conclusion: In the acute case of epilepsy, a compensatory mechanism of post-synaptic inhibition, possibly from ambient GABA, was observed through changes in the amplitude without significant changes in the frequency of sIPSC compared to control mice. The role of preNMDAR-mediated inhibition in epileptogenesis during the chronic condition or in the juvenile stage warrants further investigation.

  14. Hoe TW
    Malays J Med Sci, 2018 May;25(3):1-6.
    PMID: 30899182 DOI: 10.21315/mjms2018.25.3.1
    The use of serious games as digital medicine started in recent years as the United States Food and Drug Administration granted Class 1 or 2 device clearance to serious games or game-like technologies. This encouraging trend motivates interdisciplinary cooperation between experts in the medical sciences and the game industry because the Northern American pharmaceutical revenues have exceeded USD1 trillion globally since 2014. The potential of this lucrative business opportunity may attract fund providers and venture capitalists to support game-related research and development projects. The author elaborates his activities and experiences in the United States in FY2017/2018 as a Humphrey fellow from Malaysia. Specifically, the research and development trend of serious games for cognitive function in the academic and the game industry has positive impact on how medical doctors and practitioners in low- and middle-income countries may use or develop games as digital medicine.
  15. Moslehi A, Farahabadi M, Chavoshzadeh SA, Barati A, Ababzadeh S, Mohammadbeigi A
    Malays J Med Sci, 2018 Feb;25(1):16-23.
    PMID: 29599631 DOI: 10.21315/mjms2018.25.1.3
    Background: Endoplasmic reticulum (ER) stress creates abnormalities in the insulin action, inflammatory responses, lipoprotein B100 degradation, and hepatic lipogenesis. Hepatic steatosis leads to a broad spectrum of hepatic disorders such as nonalcoholic fatty liver disease (NAFLD) and NASH. Amygdalin has beneficial effects on asthma, bronchitis, diabetes, and atherosclerosis. We designed this study to evaluate the effect of amygdalin on the ER stress induced hepatic steatosis.

    Methods: Inbred mice received saline, DMSO and amygdalin, as control groups. ER stress was induced by tunicamycin (TM) injection. Amygdalin was administered 1 h before the TM challenge (Amy + TM group). Mice body and liver weights were measured. Hematoxylin and eosin (H&E) and oil red O staining from liver tissue, were performed. Alanin aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride and cholesterol levels were measured.

    Results: Histological evaluation revealed that amygdalin was unable to decrease the TM induced liver steatosis; however, ALT and AST levels decreased [ALT: 35.33(2.15) U/L versus 92.33(6.66) U/L; (57.000, (50.63, 63.36),P< 0.001) and AST: 93(5.09) U/L versus 345(97.3) U/L, (252, (163.37, 340.62),P< 0.001)]. Amygdalin also decreased triglyceride and cholesterol plasma levels in the Amy + TM group [TG: 42.66(2.15) versus 53.33(7.24) mg/dL; (10.67, (3.80, 17.54),P= 0.006) and TC: 9.33(3.55) versus 112.66(4.31) mg/dL, (103.33, (98.25, 108.40)P< 0.001)].

    Conclusion: Amygdalin improved the ALT, AST, and lipid serum levels after the TM challenge; however, it could not attenuate hepatic steatosis.

  16. Yajid AI, Ab Rahman HS, Wong MPK, Wan Zain WZ
    Malays J Med Sci, 2018 Feb;25(1):5-15.
    PMID: 29599630 DOI: 10.21315/mjms2018.25.1.2
    The incidence of cancer is increasing each year, which generates concerns regarding the efficacy of the current treatment options. This has caused patients to seek alternatives to complement or to replace surgery, chemotherapy and radiotherapy.Annona muricataand other plants have been shown to have promising compounds that can be utilised in the treatment of cancer. Native to the tropical and subtropical parts of the world,A. muricataplant extracts contain compounds that are particularly effective against cancer cells. In light of increasing concerns regarding the limitations of cancer treatment in hospitals, this review attempts to highlight the benefits ofA. muricataand its potential to be integrated as one of the treatment options against cancer.
  17. Idris Z, Kandasamy R, Neoh YY, Abdullah JM, Wan Hassan WMN, Mat Hassan ME
    Malays J Med Sci, 2018 Feb;25(1):1-4.
    PMID: 29599629 DOI: 10.21315/mjms2018.25.1.1
    World-renowned neurosurgeon, Professor Saleem Abdulrauf, has been featured in several medical journals for his successful "Awake Brain Aneurysm Surgery". Regarded as a "world first", this surgery, involves clipping un-ruptured brain aneurysms while patients are awake. Only one or two neurosurgery centres worldwide are capable of this. Performing the surgery while the patient is awake lowers risks of brain ischemia with neurological deficits and ventilator associated morbidities. The technique has been viewed as the start of a new era in brain surgery. Physicians from the Universiti Sains Malaysia (USM) School of Medical Sciences, at the Health Campus in Kelantan, headed by Professor Dr Zamzuri Idris (neurosurgeon) and Dr Wan Mohd Nazaruddin Wan Hassan (neuroanaesthetist), recently performed a similar procedure, the first such surgery in Malaysia and Southeast Asia. The USM team can therefore be considered to be among the first few to have done this brain surgery and achieved successful patient outcomes.
  18. Oktaria D, Soemantri D
    Malays J Med Sci, 2018 Feb;25(1):75-83.
    PMID: 29599637 DOI: 10.21315/mjms2018.25.1.9
    Background: The concept of feedback-seeking behaviour has been widely studied, but there is still a lack of understanding of this phenomenon, specifically in an Indonesian medical education setting. The aim of this research was to investigate medical students' feedback-seeking behaviour in depth in one Indonesian medical school.

    Methods: A qualitative method was employed to explore the feedback-seeking behaviour of undergraduate medical students in the Faculty of Medicine at Universitas Lampung. Focus group discussions (FGDs) were conducted with four student groups and each group consisted of 7-10 students from the years 2012, 2013 and 2014. Data triangulation was carried out through FGDs with teaching staff, and an interview with the Head of the Medical Education Unit.

    Results: Study findings indicated that the motivation of students to seek feedback was underlain by the desire to obtain useful information and to control the impressions of others. Students will tend to seek feedback from someone to whom they have either a close relationship or whose credibility they value. The most common obstacle for students to seek feedback is the reluctance and fearfulness of receiving negative comments.

    Conclusions: Through the identification of factors promoting and inhibiting feedback-seeking behaviour, medical education institutions are enabled to implement the appropriate and necessary measures to create a supportive feedback atmosphere in the learning process.

  19. Kaewkaen K, Wongsamud P, Ngaothanyaphat J, Supawarapong P, Uthama S, Ruengsirarak W, et al.
    Malays J Med Sci, 2018 Feb;25(1):67-74.
    PMID: 29599636 DOI: 10.21315/mjms2018.25.1.8
    Background: The walking gait of older adults with balance impairment is affected by dual tasking. Several studies have shown that external cues can stimulate improvement in older adults' performance. There is, however, no current evidence to support the usefulness of external cues, such as audio-visual cueing, in dual task walking in older adults. Thus, the aim of this study was to investigate the influence of an audio-visual cue (simulated traffic light) on dual task walking in healthy older adults and in older adults with balance impairments.

    Methods: A two-way repeated measures study was conducted on 14 healthy older adults and 14 older adults with balance impairment, who were recruited from the community in Chiang Rai, Thailand. Their walking performance was assessed using a four-metre walking test at their preferred gait speed and while walking under two further gait conditions, in randomised order: dual task walking and dual task walking with a simulated traffic light. Each participant was tested individually, with the testing taking between 15 and 20 minutes to perform, including two-minute rest periods between walking conditions. Two Kinect cameras recorded the spatio-temporal parameters using MFU gait analysis software. Each participant was tested for each condition twice. The mean parameters for each condition were analysed using a two-way repeated measures analysis of variance (ANOVA) with participant group and gait condition as factors.

    Result: There was no significant between-group effect for walking speed, stride length and cadence. There were also no significant effects between gait condition and stride length or cadence. However, the effect between gait condition and walking speed was found to be significant [F(1.557, 40.485) = 4.568,P= 0.024, [Formula: see text]].

    Conclusion: An audio-visual cue (simulated traffic light) was found to influence walking speed in both healthy older adults and in older adults with balance impairment. The results suggest that audio-visual cues could be incorporated into healthy lifestyle promotion in older adults with balance impairment.

  20. Norsa'adah B, Che-Muzaini CM
    Malays J Med Sci, 2018 Feb;25(1):42-52.
    PMID: 29599634 MyJurnal DOI: 10.21315/mjms2018.25.1.6
    Background: Approximately 5%-10% of acute coronary syndrome (ACS) cases occur in people younger than 45 years of age. This study aimed to identify complications of ACS and the associated factors in young patients.

    Methods: In this cross-sectional study, data from 147 ACS patients aged less than 45 years were analysed.

    Results: The mean age was 39.1 (4.9) years, the male to female ratio was 3:1; 21.2% of patients presented with unstable angina, 58.5% had non-ST elevation myocardial infarction and 20.4% had ST elevation myocardial infarction. The most frequent risk factor of ACS was dyslipidaemia (65.3%), followed by hypertension (43.5%). In total, 49.7% of patients had inpatient complication(s), with the most common being heart failure (35.4%), followed by arrhythmia (20.4%). The significant factors associated with ACS complications were current smoking [adjusted odds ratio (AOR) 4.03; 95% confidence interval (CI): 1.33, 12.23;P-value = 0.014], diabetic mellitus [AOR 3.03; 95% CI: 1.19, 7.71;P-value = 0.020], treatments of fondaparinux [AOR 0.18; 95% CI: 0.08, 0.39;P-value < 0.001] and oral nitrates [AOR 0.18; 95% CI: 0.08, 0.42;P-value < 0.001].

    Conclusions: Smoking status and diabetes mellitus were modifiable risk factors while pharmacological treatment was an important protective factor for ACS complications in young patients.

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