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The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair

Ahmad S, Haber M, Bokor DJ

J Shoulder Elbow Surg, 2015 Feb;24(2):229-35.
PMID: 25240808 DOI: 10.1016/j.jse.2014.06.050

The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative period and to investigate the clinical factors that might predispose to an early cuff re-tear.

Matched MeSH terms: Risk Factors
Fulltext Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population

Selvarajah S, Kaur G, Haniff J, Cheong KC, Hiong TG, van der Graaf Y, et al.

Int J Cardiol, 2014 Sep;176(1):211-8.
PMID: 25070380 DOI: 10.1016/j.ijcard.2014.07.066

BACKGROUND:Cardiovascular risk-prediction models are used in clinical practice to identify and treat high-risk populations, and to communicate risk effectively. We assessed the validity and utility of four cardiovascular risk-prediction models in an Asian population of a middle-income country.
METHODS:Data from a national population-based survey of 14,863 participants aged 40 to 65 years, with a follow-up duration of 73,277 person-years was used. The Framingham Risk Score (FRS), SCORE (Systematic COronary Risk Evaluation)-high and -low cardiovascular-risk regions and the World Health Organization/International Society of Hypertension (WHO/ISH) models were assessed. The outcome of interest was 5-year cardiovascular mortality. Discrimination was assessed for all models and calibration for the SCORE models.
RESULTS:Cardiovascular risk factors were highly prevalent; smoking 20%, obesity 32%, hypertension 55%, diabetes mellitus 18% and hypercholesterolemia 34%. The FRS and SCORE models showed good agreement in risk stratification. The FRS, SCORE-high and -low models showed good discrimination for cardiovascular mortality, areas under the ROC curve (AUC) were 0.768, 0.774 and 0.775 respectively. The WHO/ISH model showed poor discrimination, AUC=0.613. Calibration of the SCORE-high model was graphically and statistically acceptable for men (χ(2) goodness-of-fit, p=0.097). The SCORE-low model was statistically acceptable for men (χ(2) goodness-of-fit, p=0.067). Both SCORE-models underestimated risk in women (p<0.001).
CONCLUSIONS:The FRS and SCORE-high models, but not the WHO/ISH model can be used to identify high cardiovascular risk in the Malaysian population. The SCORE-high model predicts risk accurately in men but underestimated it in women.
KEYWORDS:Cardiovascular disease prevention; Mortality; Risk prediction; Risk score; Validation

Matched MeSH terms: Risk Factors
Prevalence and correlates of depression among adolescents in Malaysia

Kaur J, Cheong SM, Mahadir Naidu B, Kaur G, Manickam MA, Mat Noor M, et al.

Asia Pac J Public Health, 2014 Sep;26(5 Suppl):53S-62S.
PMID: 25070697 DOI: 10.1177/1010539514544356

Depression among adolescents has been recognized as a major public health issue. The objective of this study was to determine the prevalence and correlates of depression among school-going adolescents in Malaysia. Data from the Malaysia Global School-based Health Survey (GSHS) 2012 were analyzed with additional data from the validated DASS21 (Depression, Anxiety, and Stress) questionnaire. The study revealed that 17.7% of respondents had depressive symptoms. Multivariate analysis further showed that feeling lonely (adjusted odds ratio [aOR] = 2.99; 95% CI = 2.57-3.47), Indian ethnicity (aOR = 2.00; 95% CI = 1.63-2.44), using drugs (aOR = 1.85; 95% CI = 1.21-2.82), and being bullied (aOR = 1.79; 95% CI = 1.60-1.99) were significantly associated with depressive symptoms. Lack of parental supervision, alcohol use, and tobacco use were also significant risk factors. Addressing depressive symptoms among adolescents may have implications for managing their risks of being bullied and substance use. This study also highlights the need to further investigate depressive symptoms among adolescents of Indian ethnicity.
Study name: Global School-Based Student Health Survey (GSHS)

Matched MeSH terms: Risk Factors
Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery

Park JH, Lee J, Hakim NA, Kim HY, Kang SW, Jeong JJ, et al.

Head Neck, 2015 Dec;37(12):1705-11.
PMID: 24986508 DOI: 10.1002/hed.23824

This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.

Matched MeSH terms: Risk Factors
Fulltext The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study

Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R

BMC Emerg Med, 2014;14:17.
PMID: 25086638 DOI: 10.1186/1471-227X-14-17

The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.

Matched MeSH terms: Risk Factors
Determinants of mortality among older adults with pressure ulcers

Khor HM, Tan J, Saedon NI, Kamaruzzaman SB, Chin AV, Poi PJ, et al.

Arch Gerontol Geriatr, 2014 Nov-Dec;59(3):536-41.
PMID: 25091603 DOI: 10.1016/j.archger.2014.07.011

The presence of pressure ulcers imposes a huge burden on the older person's quality of life and significantly increases their risk of dying. The objective of this study was to determine patient characteristics associated with the presence of pressure ulcers and to evaluate the risk factors associated with mortality among older patients with pressure ulcers. A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. There were 68 (66%) deaths by the end of the median follow-up period of 12 (IQR 2.5-14) weeks. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR=2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization, concurrent infection and high neutrophil counts.

Matched MeSH terms: Risk Factors
Characterization of risk factors for DNA damage among paddy farm worker exposed to mixtures of organophosphates

How V, Hashim Z, Ismail P, Omar D, Said SM, Tamrin SB

Arch Environ Occup Health, 2015;70(2):102-9.
PMID: 24965330 DOI: 10.1080/19338244.2013.823905

This is a cross-sectional study conducted among paddy farmers to characterize potential risk factors that influence levels of DNA damage from exposure to mixtures of organophosphates. Comet assay was used to determine the level of DNA damage by measuring the comet tail length from the exfoliated buccal mucosa. The result suggests that farmers who chronically exposure to a mixture of organophosphates has at least 2-fold significant increase of DNA damage as compared with control group. Factor analysis and linear regression both suggest that DNA damage reported by farmers may influence individual, occupational, and residential factors and are reported as significant predictor factors, whereas this effect is mainly caused by individual factors among the control group. The findings of the present study suggest that either farmer or control group bear certain extent of genotoxic burden contributed by different risk factors.

Matched MeSH terms: Risk Factors
Fulltext Metabolic syndrome components and prevalence of cardiovascular disease among type 2 diabetic patients in Malaysia

Tan MC, Wong TW, Ng OC, Joseph A, Hejar AR

Southeast Asian J. Trop. Med. Public Health, 2014 Jan;45(1):226-35.
PMID: 24964674

Metabolic syndrome (MetS) is common among patients with type 2 diabetes mellitus (T2DM) and increases the risk of cardiovascular disease (CVD) and all-cause mortality. The objective of this study was to investigate the association between the components of MetS and the prevalence of CVD among patients with T2DM. We studied 313 patients aged > or = 30 years diagnosed with T2DM at two tertiary care hospitals. Patients were recruited by systematic random sampling. Clinical data was obtained using an interviewer-administered structured questionnaire and from a review of their medical records. MetS was diagnosed using NCEP ATP III, WHO, IDF and the new Harmonized definitions. Specific MetS components such as BMI, waist circumference, waist-to-hip ratio, hypertension, HDL-C and triglyceride levels were evaluated to determine if they had an association with CVD. Thirty-six point one percent of the subjects had CVD. The mean age of the subjects was 55.7 +/- 9.2 years and the mean duration of having diabetes was 10.1 +/- 8.1 years. The overall prevalences of MetS (> or = 3 of 5 components) (95% CI) were 96.1% (94.0-98.3), 95.8% (93.6-98.1), 84.8% (80.8-88.9) and 97.7% (96.1-99.4) using NCEP ATP III, WHO, IDF and Harmonized definitions, respectively. Patients with MetS had a higher prevalence of CVD using NCEP ATP III (98.2% vs 93.5%), WHO (98.2% vs 93.0%), IDF (87.6% vs 82.0%) and Harmonized criteria (98.2% vs 96.0%). The greater the number of MetS components, the greater the chance of having CVD using three definitions for diagnosing MetS: WHO, IDF and Harmonized (p < 0.05). MetS and the combination of the individual components of MetS were significantly associated with CVD among type 2 diabetic patients in Malaysia. Aggressive treatment of MetS components is required to reduce cardiovascular risk in T2DM.

Matched MeSH terms: Risk Factors
Perception of breast health amongst Malaysian female adolescents

Che CC, Coomarasamy JD, Suppayah B

Asian Pac J Cancer Prev, 2014;15(17):7175-80.
PMID: 25227810

BACKGROUND: Breast cancer is the most common cancer among women in Malaysia, about one in 19 women being at risk. This study aimed to investigate knowledge and practice of breast self-examination (BSE), as well as knowledge of risk factors for breast cancer amongst female adolescents in Malaysia. Subsequently, relationships between demographic characteristics and knowledge level of BSE, risk factors for breast cancer and BSE practice were assessed.
MATERIALS AND METHODS: A descriptive, cross sectional survey was conducted using a sample of 500 Malaysian adolescents from the age of 15 to 19 years. A self-administered questionnaire was used to gather socio- demographic characteristics, knowledge of BSE, knowledge of risk factors for breast cancer and BSE practices.
RESULTS: The findings of this study indicated that female adolescents in Malaysia demonstrated an inadequate knowledge level of BSE and risk factors for breast cancer. Only 27.8% of female adolescents performed BSE regularly. BSE practice, knowledge of BSE and knowledge of risk factors for breast cancer showed significant positive relationships.
CONCLUSIONS: The study highlighted the importance of planning and implementing breast health education programs for female students in secondary schools in Malaysia. It will also provide the health care providers an avenue to stress on the importance of imparting breast health education to adolescents.

Matched MeSH terms: Risk Factors
Fulltext Molecular mechanisms of diabetic retinopathy, general preventive strategies, and novel therapeutic targets

Safi SZ, Qvist R, Kumar S, Batumalaie K, Ismail IS

Biomed Res Int, 2014;2014:801269.
PMID: 25105142 DOI: 10.1155/2014/801269

The growing number of people with diabetes worldwide suggests that diabetic retinopathy (DR) and diabetic macular edema (DME) will continue to be sight threatening factors. The pathogenesis of diabetic retinopathy is a widespread cause of visual impairment in the world and a range of hyperglycemia-linked pathways have been implicated in the initiation and progression of this condition. Despite understanding the polyol pathway flux, activation of protein kinase C (KPC) isoforms, increased hexosamine pathway flux, and increased advanced glycation end-product (AGE) formation, pathogenic mechanisms underlying diabetes induced vision loss are not fully understood. The purpose of this paper is to review molecular mechanisms that regulate cell survival and apoptosis of retinal cells and discuss new and exciting therapeutic targets with comparison to the old and inefficient preventive strategies. This review highlights the recent advancements in understanding hyperglycemia-induced biochemical and molecular alterations, systemic metabolic factors, and aberrant activation of signaling cascades that ultimately lead to activation of a number of transcription factors causing functional and structural damage to retinal cells. It also reviews the established interventions and emerging molecular targets to avert diabetic retinopathy and its associated risk factors.

Matched MeSH terms: Risk Factors
Parental smoking status, stress, anxiety, and depression are associated with susceptibility to smoking among non-smoking school adolescents in Malaysia

Lim KH, Chong Z, Khoo YY, Kaur J

Asia Pac J Public Health, 2014 Sep;26(5 Suppl):81S-90S.
PMID: 25038194 DOI: 10.1177/1010539514542426

Susceptibility to smoking is a reliable predictor of smoking initiation. This article describes its prevalence and associated factors among Malaysian school adolescents. Data were obtained from the Global School-Based Student Health Survey (GSHS) 2012, a nationwide representative sample of school adolescents. The overall prevalence of susceptibility to smoking was 6.0% and significantly higher among males (9.5%) compared with females (3.6%). Multivariable analyses revealed that males (adjusted odds ratio [aOR] 3.34, 95% confidence interval [CI] 2.70-4.18) and school adolescents of indigenous Sabahan or Sarawakian descents (aOR 1.62, 95%CI 1.21-2.18) were significantly more likely to be susceptible to smoking. Susceptible school adolescents had a slightly higher likelihood to have symptoms of stress (aOR 1.31, 95% CI 1.02-1.70), anxiety (aOR 1.19, 95% CI 1.01-1.40), depression (aOR 1.56, 95% CI 1.25-1.96), including those whose one or both parents/guardians were smokers (aOR 1.48, 95% CI 1.21-1.82; aOR 2.33, 95% CI 1.22-4.44, respectively). The findings from this study point out the need for proactive measures to reduce smoking initiation among Malaysian adolescents with particular attention toward factors associated with susceptibility to smoking.
Study name: Global School-Based Student Health Survey (GSHS)

Matched MeSH terms: Risk Factors
Prevalence and factors associated with physical fighting among Malaysian adolescents

Mat Hussin SF, Abd Aziz NS, Hasim H, Sahril N

Asia Pac J Public Health, 2014 Sep;26(5 Suppl):108S-15S.
PMID: 25038192 DOI: 10.1177/1010539514542423

Physical fighting among adolescents is one manifestation of interpersonal violence that is an important issue globally, but attention to this problem in Malaysia has been limited. We analyzed data available from the Malaysia Global School-Based Health Survey conducted in 2012. Of the 25 507 respondents, 27.4% reported having been in a physical fight in the past 12 months. Being bullied (adjusted odds ratio [aOR] = 3.01; 95% confidence interval [CI] = 2.67-3.39) was significantly and highly associated with involvement in physical fighting. Smoking (aOR = 2.56; 95% CI = 2.20-2.97), males (aOR = 1.77; 95% CI = 1.62-1.93), using drugs (aOR = 1.73; 95% CI = 1.09-2.15), and drinking alcohol (aOR = 1.42; 95% CI = 1.24-1.63) were other factors associated with physical fighting. Parental supervision showed no significant association with physical fighting. These findings indicate that more attention needs to be given to bullying at school by school authorities and parents.
Study name: Global School-Based Student Health Survey (GSHS)

Matched MeSH terms: Risk Factors
Impact of maternal marital status on birth outcomes among young Malaysian women: a prospective cohort study

Mohd Zain N, Low WY, Othman S

Asia Pac J Public Health, 2015 Apr;27(3):335-47.
PMID: 25005933 DOI: 10.1177/1010539514537678

This study evaluated the impact of maternal marital status on birth outcomes among young Malaysian women and investigated other risk factors influencing the birth outcomes. Pregnant women with and without marital ties at the point of pregnancy diagnosis were invited to participate in this study. Participants were interviewed using a structured questionnaire at pregnancy diagnosis and shortly after childbirth. From a total of 229 unmarried and 213 married women who participated, marital status was significantly associated with preterm birth (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.61) and low birth weight (OR, 3.61; 95% CI, 1.98-6.57). Other factors significantly associated with birth outcomes was prenatal care (OR, 4.92; 95% CI, 1.43-16.95), "use of drugs" (OR, 10.39; 95% CI, 1.14-94.76), age (OR, 1.12; 95% CI, 1.07-1.16), and number of prenatal visits (OR, 1.03; 95% CI, 1.00-1.07). Promoting access to prenatal care and social support programs for unmarried mothers may be important to reduce adverse pregnancy outcomes.

Matched MeSH terms: Risk Factors
Fulltext An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT)

Tan PJ, Khoo EM, Chinna K, Hill KD, Poi PJ, Tan MP

BMC Geriatr, 2014;14:78.
PMID: 24951180 DOI: 10.1186/1471-2318-14-78

Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults.
Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.
Discussion: Previous studies evaluating multifactorial interventions in falls have reported variable outcomes.
Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that
individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community.
Trial registration: ISRCTN11674947
Study: Malaysian Falls Assessment and Intervention Trial; MyFAIT

Matched MeSH terms: Risk Factors
Infanticide and illegal infant abandonment in Malaysia

Razali S, Kirkman M, Ahmad SH, Fisher J

Child Abuse Negl, 2014 Oct;38(10):1715-24.
PMID: 25048164 DOI: 10.1016/j.chiabu.2014.06.008

Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. The aim of this study was to describe the prevalence and characteristics of infanticide and illegal infant abandonment in Malaysia and to estimate annual rates for the most recent decade. Summaries of data about infanticide and illegal infant abandonment were gathered from police records; the annual number of live births was ascertained from the national registry. The estimated inferred infanticide rates for Malaysia were compared with the infanticide rates among countries of very high, high, medium, and low rankings on the Human Development, Gender Inequality, and Gini indices. From 1999 to 2011, 1,069 cases of illegal infant abandonment were recorded and 1,147 people were arrested as suspected perpetrators. The estimated inferred infanticide rate fluctuated between 4.82 and 9.11 per 100,000 live births, a moderate rate relative to the infanticide rates of other countries. There are substantial missing data, with details undocumented for about 78-87% of cases and suspected perpetrators. Of the documented cases, it appeared that more boys than girls were victims and that suspected perpetrators were predominantly Malays who were women, usually mothers of the victim; the possibility of arrest bias must be acknowledged. Economic and social inequality, particularly gender inequality, might contribute to the phenomena of infanticide and abandonment. Strategies to reduce rates of infanticide and illegal infant abandonment in Malaysia will require strengthening of the surveillance system and attention to the gender-based inequalities that underpin human development.

Matched MeSH terms: Risk Factors
Fulltext Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review

Mat S, Tan MP, Kamaruzzaman SB, Ng CT

Age Ageing, 2015 Jan;44(1):16-24.
PMID: 25149678 DOI: 10.1093/ageing/afu112

INTRODUCTION: osteoarthritis (OA) of knee has been reported as a risk factor for falls and reduced balance in the elderly. This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA.
METHODS: a computerised search was performed to identify relevant studies up to November 2013. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the PeDro score.
RESULTS: a total of 15 randomised controlled trials involving 1482 patients were identified. The mean PeDro score was 7. The pooled standardised mean difference in balance outcome for strength training = 0.3346 (95% CI: 0.3207-0.60, P = 0.01 < 0.00001, P for heterogeneity = 0.85, I(2) = 0%). Tai Chi = 0.7597 (95% CI: 0.5130-1.2043, P<=0.0014, P for heterogeneity = 0.26, I(2) = 0%) and aerobic exercises = 0.6880 (95% CI: 0.5704-1.302, P < 0.00001, P for heterogeneity = 0.71, I(2) = 0%). While pooled results for falls risk outcomes in, strength training, Tai chi and aerobics also showed a significant reduction in reduced risk of falls significantly with pooled result 0.55 (95% CI: 0.41-0.68, P < 0.00001, P for heterogeneity = 0.39, I(2) = 6%).
CONCLUSION: strength training, Tai Chi and aerobics exercises improved balance and falls risk in older individuals with knee OA, while water-based exercises and light treatment did not significantly improve balance outcomes. Strength training, Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA. However, a large randomised controlled study using actual falls outcomes is recommended to determine the appropriate dosage and to measure the potential benefits in falls reduction.
KEYWORDS: Tai Chi; elderly; exercises; falls; older people; osteoarthritis

Matched MeSH terms: Risk Factors
Dialysis-treated end-stage kidney disease in Libya: epidemiology and risk factors

Goleg FA, Kong NC, Sahathevan R

Int Urol Nephrol, 2014 Aug;46(8):1581-7.
PMID: 24671275 DOI: 10.1007/s11255-014-0694-1

PURPOSE: End-stage kidney disease (ESKD) is now a worldwide pandemic. In concert with this, ESKD in Libya has also increased exponentially in recent decades. This review aims to define the magnitude of and risks for this ESKD epidemic among Libyans as there is a dearth of published data on this subject.
METHODS: A systematic review was conducted by searching PubMed, EMBASE and Google scholar databases to identify all relevant papers published in English from 2003 to 2012, using the following keywords: end stage, terminal, chronic, renal, kidney, risk factors, Arab, North Africa and Libya.
RESULTS: In 2003, the reported incidence of ESKD and prevalence of dialysis-treated ESKD in Libya were the same at 200 per million population (pmp). In 2007, the prevalence of dialysis-treated ESKD was 350 pmp, but the true incidence of ESKD was not available. The most recent published WHO data in 2012 showed the incidence of dialysis-treated ESKD had risen to 282 pmp and the prevalence of dialysis-treated ESKD had reached 624 pmp. The leading causes of ESKD were diabetic kidney disease (26.5 %), chronic glomerulonephritis (21.1 %), hypertensive nephropathy (14.6 %) and congenital/hereditary disease (12.3 %). The total number of dialysis centers was 40 with 61 nephrologists. Nephrologist/internist to patient ratio was 1:40, and nurse to patient ratio was 1:3.7. Only 135 living-related kidney transplants had been performed between 2004 and 2007. There were no published data on most macroeconomic and renal service factors.
CONCLUSIONS: ESKD is a major public health problem in Libya with diabetic kidney disease and chronic glomerulonephritis being the leading causes. The most frequent co-morbidities were hypertension, obesity and the metabolic syndrome. In addition to provision of RRT, preventive strategies are also urgently needed for a holistic integrated renal care system.

Matched MeSH terms: Risk Factors
Fulltext Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review

Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M

Int J Tuberc Lung Dis, 2014 Mar;18(3):255-66.
PMID: 24670558 DOI: 10.5588/ijtld.13.0585

OBJECTIVE: To systematically review Indian literature on delays in tuberculosis (TB) diagnosis and treatment.
METHODS: We searched multiple sources for studies on delays in patients with pulmonary TB and those with chest symptoms. Studies were included if numeric data on any delay were reported. Patient delay was defined as the interval between onset of symptoms and the patient's first contact with a health care provider. Diagnostic delay was defined as the interval between the first consultation with a health care provider and diagnosis. Treatment delay was defined as the interval between diagnosis and initiation of anti-tuberculosis treatment. Total delay was defined as time interval from the onset of symptoms until treatment initiation.
RESULTS: Among 541 potential citations identified, 23 studies met the inclusion criteria. Included studies used a variety of definitions for onset of symptoms and delays. Median estimates of patient, diagnostic and treatment delay were respectively 18.4 (IQR 14.3-27.0), 31.0 (IQR 24.5-35.4) and 2.5 days (IQR 1.9-3.6) for patients with TB and those with chest symptoms combined. The median total delay was 55.3 days (IQR 46.5-61.5). About 48% of all patients first consulted private providers; an average of 2.7 health care providers were consulted before diagnosis. Number and type of provider first consulted were the most important risk factors for delay.
CONCLUSIONS: These findings underscore the need to develop novel strategies for reducing patient and diagnostic delays and engaging first-contact health care providers.

Matched MeSH terms: Risk Factors
A sweet promise among Malaysians

Loo KW, Griffiths LR, Gan SH

J Diabetes, 2014 Sep;6(5):447.
PMID: 24645716 DOI: 10.1111/1753-0407.12151
Matched MeSH terms: Risk Factors
Silica exposure is associated with an increased risk of developing ACPA-positive rheumatoid arthritis in an Asian population: evidence from the Malaysian MyEIRA case-control study

Yahya A, Bengtsson C, Larsson P, Too CL, Mustafa AN, Abdullah NA, et al.

Mod Rheumatol, 2014 Mar;24(2):271-4.
PMID: 24593203 DOI: 10.3109/14397595.2013.854076

OBJECTIVES: Silica exposure has been associated with an increased risk of developing rheumatoid arthritis (RA), especially among smokers. In this study, we aimed at examining the association between silica exposure (and its interaction with smoking) and the risk of RA in the Malaysian population.
METHODS: In total, 149 cases and 213 matched controls, all men, were included between August 2005 and December 2009. A case was defined as a person with early diagnosed RA using the 1987 American College of Rheumatology criteria for RA. Controls were randomly selected matched on sex, age and residential area. Silica exposure was defined as exposure to stone dust, rock drilling or stone crushing, and smoking status was categorized as ever/never cigarette smoking.
RESULTS: An increased risk of anti-citrullinated protein antibody (ACPA)-positive RA (OR = 2.4, 95 % CI 1.0-5.6) was observed among those exposed to silica. Ever-smokers exposed to silica had a particularly high risk of developing ACPA-positive RA (OR = 7.5, 95 % CI 2.3-24.2), compared with never-smokers not exposed to silica. No association was found regarding ACPA-negative RA.
CONCLUSION: Our data demonstrate that exposure to both silica and cigarette smoke comprise risks for developing RA in the Malaysian genetic context. The findings expand a link between environmental lung exposures and ACPA-positive RA to Asian populations.

Matched MeSH terms: Risk Factors

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