METHODS: This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors.
RESULTS: The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT.
CONCLUSION: Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.
METHODS: This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40-64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated.
RESULTS: The prevalence of WHO/ISH "high CVD risk" (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to "high risk". Of those at "moderate risk" (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication).
CONCLUSIONS: Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs.At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.
METHODS: A cross-sectional study was conducted in ten different dental hospitals of Pakistan. The one-way ANOVA test was used to analyze patient's demographic distribution with PSR-OHS and oral functions. The complex sample general linear model was used to determine association between clinical OH and PSR-OHS. Analyses of each age group were conducted separately.
RESULTS: A total of 1,804 outdoor patients participated in the study, out of which 660 were young adults, 685 adults and 459 were older adults. Overall self-perception of all age groups about their oral health was 'good' (mean = 3.71). Female gender and education status were a significant factor in young adults and adults. Family income affected PSR-OHS of only the adult age group. Frequent visit to dental clinic and preventive reason of dental attendance were associated with good PSR-OHS. DMFT score, prosthesis score and periodontal score also affected the PSR-OHS of individuals. Association between PSR-OHS and clinical examination was confirmed by complex general linear model.
CONCLUSION: There are differences in the perceived oral health status of young adults, adults and older adults. The variables, age, education, family income, DMFT score, prosthesis score and periodontal score directly influence the self-perception of individuals.
DESIGN: DP were derived from the MANS FFQ using principal component analysis. The cross-sectional association of the derived DP with prevalence of overweight was analysed.
SETTING: Malaysia.
PARTICIPANTS: Nationally representative sample of Malaysian adults from MANS (2003, n 6928; 2014, n 3000).
RESULTS: Three major DP were identified for both years. These were 'Traditional' (fish, eggs, local cakes), 'Western' (fast foods, meat, carbonated beverages) and 'Mixed' (ready-to-eat cereals, bread, vegetables). A fourth DP was generated in 2003, 'Flatbread & Beverages' (flatbread, creamer, malted beverages), and 2014, 'Noodles & Meat' (noodles, meat, eggs). These DP accounted for 25·6 and 26·6 % of DP variations in 2003 and 2014, respectively. For both years, Traditional DP was significantly associated with rural households, lower income, men and Malay ethnicity, while Western DP was associated with younger age and higher income. Mixed DP was positively associated with women and higher income. None of the DP showed positive association with overweight risk, except for reduced adjusted odds of overweight with adherence to Traditional DP in 2003.
CONCLUSIONS: Overweight could not be attributed to adherence to a single dietary pattern among Malaysian adults. This may be due to the constantly morphing dietary landscape in Malaysia, especially in urban areas, given the ease of availability and relative affordability of multi-ethnic and international foods. Timely surveys are recommended to monitor implications of these changes.
METHODS: A multistage sampling was performed across rural primary schools in Kuala Krai, Kelantan, Malaysia. Data were collected using self-administered questionnaires and the children aged 10-11 years (n=312) were subjected to cognitive tests including digit span, letter-number sequencing, coding, and symbol search. Cognitive performance was tested using subscales derived from the Wechsler Intelligence Scale for Children.
RESULTS: The prevalence of SHS exposure at home was 55.8%, where 11.9% of children lived with one smoker, while 43.9% of children lived with ≥2 smokers. There was a significant difference in the mean score of the combined cognitive tests between SHS-exposed and non-exposed children after adjustment for sex, parental educational level, family income and academic performance [Pillai's Trace=0.084, F statistic (df)=6.803 (4302), p<0.001].
CONCLUSIONS: More than half of the primary school children in rural Kuala Krai were exposed to SHS from at least one smoker at home. There was a significant association between SHS exposure at home and cognitive performance.
METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.
FINDINGS: During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.
INTERPRETATION: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.
FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments).
METHODS: In this multinational, prospective cohort study, we studied 157 436 adults aged 35-70 years who were enrolled in the PURE study in countries with ambient PM2·5 estimates, for whom follow-up data were available. Cox proportional hazard frailty models were used to estimate the associations between long-term mean community outdoor PM2·5 concentrations and cardiovascular disease events (fatal and non-fatal), cardiovascular disease mortality, and other non-accidental mortality.
FINDINGS: Between Jan 1, 2003, and July 14, 2018, 157 436 adults from 747 communities in 21 high-income, middle-income, and low-income countries were enrolled and followed up, of whom 140 020 participants resided in LMICs. During a median follow-up period of 9·3 years (IQR 7·8-10·8; corresponding to 1·4 million person-years), we documented 9996 non-accidental deaths, of which 3219 were attributed to cardiovascular disease. 9152 (5·8%) of 157 436 participants had cardiovascular disease events (fatal and non-fatal incident cardiovascular disease), including 4083 myocardial infarctions and 4139 strokes. Mean 3-year PM2·5 at cohort baseline was 47·5 μg/m3 (range 6-140). In models adjusted for individual, household, and geographical factors, a 10 μg/m3 increase in PM2·5 was associated with increased risk for cardiovascular disease events (hazard ratio 1·05 [95% CI 1·03-1·07]), myocardial infarction (1·03 [1·00-1·05]), stroke (1·07 [1·04-1·10]), and cardiovascular disease mortality (1·03 [1·00-1·05]). Results were similar for LMICs and communities with high PM2·5 concentrations (>35 μg/m3). The population attributable fraction for PM2·5 in the PURE cohort was 13·9% (95% CI 8·8-18·6) for cardiovascular disease events, 8·4% (0·0-15·4) for myocardial infarction, 19·6% (13·0-25·8) for stroke, and 8·3% (0·0-15·2) for cardiovascular disease mortality. We identified no consistent associations between PM2·5 and risk for non-cardiovascular disease deaths.
INTERPRETATION: Long-term outdoor PM2·5 concentrations were associated with increased risks of cardiovascular disease in adults aged 35-70 years. Air pollution is an important global risk factor for cardiovascular disease and a need exists to reduce air pollution concentrations, especially in LMICs, where air pollution levels are highest.
FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).