Displaying publications 41 - 60 of 117 in total

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  1. Earnshaw VA, Jin H, Wickersham J, Kamarulzaman A, John J, Altice FL
    Trop Med Int Health, 2014 Jun;19(6):672-679.
    PMID: 24666546 DOI: 10.1111/tmi.12306
    OBJECTIVES: Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia.
    METHODS: An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university.
    RESULTS: The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs.
    CONCLUSIONS: It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care.
    KEYWORDS: HIV/AIDS; Malaisie; Malasia; Malaysia; VIH/SIDA; cuidados sanitarios profesionales; discriminación; discrimination; estigma; homosexuality; professional healthcare students; stigma; stigmatisation; substance abuse; étudiants en profession de soins de santé
  2. Sivarajan S, Mani SA, John J, Fayed MMS, Kook YA, Wey MC
    Korean J Orthod, 2021 Jan 25;51(1):55-74.
    PMID: 33446621 DOI: 10.4041/kjod.2021.51.1.55
    Objective: To systematically review studies on canine agenesis prevalence in different populations and continents, based on the jaw, sex, location, and associated dental anomalies.

    Methods: Electronic and hand searches of English literature in PubMed, Web of Science, Scopus, OpenGrey, and Science Direct were conducted, and the authors were contacted when necessary. Observational studies (population-based, hospital/clinic-based, and cross-sectional) were included. For study appraisal and synthesis, duplicate selection was performed independently by two reviewers. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology checklist, with main outcome of prevalence of canine agenesis.

    Results: The global population prevalence of canine agenesis was 0.30% (0.0-4.7%), highest in Asia (0.54%), followed by Africa (0.33%), and the least in Europe and South America (0.19% in both continents). Canine agenesis was more common in the maxilla (88.57%), followed by both maxilla and mandible (8.57%), and the least common was mandible-only presentation (2.86%). The condition was more common in females (female:male ratio = 1.23), except in Asia (female:male ratio = 0.88) and Africa (female:male ratio = 1). In Asia, unilateral agenesis was almost twice as prevalent as bilateral, but in Europe, the bilateral form was more common.

    Conclusions: The overall prevalence of canine agenesis is 0.30%, with the highest prevalence in Asia, followed by Africa, Europe, and South America. The condition is more common in the maxilla than the mandible, and in females than males (except in Asia and Africa), with unilateral agenesis being more common in Asia and the bilateral form showing a greater prevalence in Europe.

  3. Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al.
    AIDS Care, 2014;26(10):1223-8.
    PMID: 24625279 DOI: 10.1080/09540121.2014.894616
    Stigma perpetuated by health-care providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWIDs), and men who have sex with men (MSM) in multiple clinical contexts and remains unexamined among professional health-care students in Malaysia. This cross-sectional, anonymous, and Internet-based survey assessed the attitudes of medical and dental students toward HIV-infected, PWID, and MSM patients. Survey invitation was emailed to 3191 students at 8 professional schools; 1296 (40.6%) responded and scored their attitudes toward these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0 (most negative) to 100 (most positive). Compared to general patients (mean = 76.50), the mean scores for HIV-infected (mean = 54.04; p < 0.001), PWID (mean = 37.50; p < 0.001), and MSM (mean = 32.13; p < 0.001) patients were significantly lower and significantly different between each group comparison. Within group differences, most notably religion, ethnicity, and personally knowing someone from these populations were associated with significant differences in attitudes. No differences were noted between pre-clinical and clinical year of training. Health-care students represent the next generation of clinicians who will be responsible for future HIV prevention and treatment efforts. Our findings suggest alarmingly negative attitudes toward these patients, especially MSM, necessitating prompt and effective interventions designed to ameliorate the negative attitudes of health-care students toward vulnerable populations, specifically HIV-infected, PWID, and MSM patients in Malaysia.
    Site site: online surveys at seven universities: University of Malaya, National University of Malaysia, International Islamic University Malaysia, Universiti Malaysia Sarawak, Penang International Dental College, Universiti Teknologi MARA Malaysia, and Universiti Sains Malaysia.
  4. Paramasvaran S, Sani RA, Hassan L, Hanjeet K, Krishnasamy M, John J, et al.
    Trop Biomed, 2009 Apr;26(1):67-72.
    PMID: 19696729
    Rodents were collected from five wet markets (Chow Kit, Dato Keramat, Setapak, Jinjang and Kepong) in Kuala Lumpur, Federal Territory between March to April 2006. Ninety seven rats were trapped using wire traps measuring 29 x 22 x 50 cm baited with fruits, coconuts, dried fish or sweet potatoes. A total of 17 different species of parasites were identified from three species of rats out of which 11 (65%) were identified to be zoonotic. The helminths identified from the urban rats were nematodes- Capillaria hepatica, Gongylonema neoplasticum, Heterakis spumosa, Heterakis sp., Masterphorus muris, Nippostrongylus brasiliensis, Physolaptera sp., Pterogodermatis sp., Rictularia tani and Syphacia muris; cestodes- Hymenolepis nana, Hymenolepis diminuta, Hymenolepis sabnema, Hymenolepis sp., Raillietina sp. and Taenia taeniaeformis, and acanthocephalan- Moniliformis moniliformis. The following parasites are of potential medical importance: C. hepatica, G. neoplasticum, R. tani, S. muris, H. diminuta, H. nana, Raillietina sp. and T. taeniaeformis.
  5. Heo CC, Mohamad AR, Rosli H, Nurul Ashikin A, Chen CD, John J, et al.
    Trop Biomed, 2009 Apr;26(1):106-9.
    PMID: 19696735
    An observational study was conducted in an oil palm plantation in Tanjung Sepat, Selangor, Malaysia on August until September 2007 to note the decomposition process of pigs and their related faunal succession. We collected six species of ants (Formicidae) from 3 subfamilies: Formicinae (Oecophylla smaragdina and Anoplolepis gracilipes), Myrmicinae (Tetramorium sp. and Pheidologeton sp.) and Ponerinae (Odontoponera sp. and Diacamma sp.) that were associated with pig carcasses placed on the ground. Oecophylla smaragdina, Pheidologeton sp. and Tetramorium sp. were found on a partially burnt pig carcass whereas the other species were recovered from unburned pig carcass. These ants predated on fly eggs, larvae, pupae and adults. Ants could be found at all stages of decomposition starting from fresh until dry stage. Predatory ants can reduce fly population and thus may affect the rate of carcass decomposition but this was not seen in our study. Even though O. smaragdina was seen at all stages of decomposition of the burnt pig, this did not alter much the decomposition process by fly larvae.
  6. Paramasvaran S, Krishnasamy M, Lee HL, John J, Lokman H, Naseem BM, et al.
    Trop Biomed, 2005 Dec;22(2):191-4.
    PMID: 16883287 MyJurnal
    A survey for small mammal parasites carried out in a secondary forest of Ulu Gombak, Selangor, Peninsula Malaysia yielded the following animals: Rattus bowersi (7), Rattus tiomanicus jalorensis (2), Maxomys rajah (12), Maxoyms whiteheadi (3), Leopoldamys sabanus(13), Sundamys muelleri(10), Lariscus insignis (1), Sundasciurus tenuis (1) and Tupaia glis (2). The following nematodes: Capillaria hepatica, Hepatojarakus malayae, Trichostrongylus sp. and Streptopharagus sp., the following cestodes: Hymenolepis sp., Raillietina sp. and Taenia taeniaformis; and trematode, Zonorchis sp. from Tupaia glis were recovered. No parasites were observed during blood examination. No endoparasite was seen in Maxomys whiteheadi, Lariscus insignis and Sundasciurus tenuis. The following parasites, Capillaria hepatica, Hymenolepis sp., Raillietina sp. and Taenia taeniaformis are considered of medical importance.
  7. Faulks D, Dougall A, Ting G, Ari T, Nunn J, Friedman C, et al.
    Eur J Dent Educ, 2018 May;22(2):e278-e290.
    PMID: 28940883 DOI: 10.1111/eje.12292
    INTRODUCTION: Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery.

    MATERIALS AND METHODS: A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries.

    RESULTS: The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity.

    DISCUSSION: These results are positive, and the scales now need to be validated in the field.

    CONCLUSIONS: It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

  8. Al-Amery SM, Nambiar P, John J, Purmal K, Ngeow WC, Mohamed NH, et al.
    J Vet Dent, 2018 Jun;35(2):96-102.
    PMID: 29865987 DOI: 10.1177/0898756418776448
    This case report illustrates the teeth morphology of a chimpanzee and its anatomical variations. A well-preserved skull of a male Pan troglodytes troglodyte chimpanzee was scanned using a cone-beam computed tomography machine. Measurements included tooth and crown height, root length, root canal length and width (posterior teeth), and pulp cavity length (anterior teeth). Nonmetrical parameters included number of canals and foramina per root of every root. Interestingly, the mandibular central incisor was longer than the lateral incisor, and all the mandibular anterior teeth presented with a solitary flame-shaped or conical-calcified structure in their pulp cavity. The premolars are usually dual rooted except for the first maxillary premolar that displayed 3 roots. Other unusual discoveries were the presence of bilateral radicular dens invaginatus in the mandibular first premolars and the possibility of having 2 canals and 2 foramina in the roots of the posterior teeth. The presence of conical stone mineralizations at the pulp cavity and the presence of dens invaginatus were of particular interest.
  9. Abdul Rahman NA, Mohd Desa MN, Masri SN, Taib NM, Sulaiman N, Hazman H, et al.
    Pol J Microbiol, 2023 Jun 01;72(2):103-115.
    PMID: 37314355 DOI: 10.33073/pjm-2023-023
    Streptococcus pneumoniae (pneumococcus) belongs to the Gram-positive cocci. This bacterium typically colonizes the nasopharyngeal region of healthy individuals. It has a distinct polysaccharide capsule - a virulence factor allowing the bacteria to elude the immune defense mechanisms. Consequently, it might trigger aggressive conditions like septicemia and meningitis in immunocompromised or older individuals. Moreover, children below five years of age are at risk of morbidity and mortality. Studies have found 101 S. pneumoniae capsular serotypes, of which several correlate with clinical and carriage isolates with distinct disease aggressiveness. Introducing pneumococcal conjugate vaccines (PCV) targets the most common disease-associated serotypes. Nevertheless, vaccine selection pressure leads to replacing the formerly dominant vaccine serotypes (VTs) by non-vaccine types (NVTs). Therefore, serotyping must be conducted for epidemiological surveillance and vaccine assessment. Serotyping can be performed using numerous techniques, either by the conventional antisera-based (Quellung and latex agglutination) or molecular-based approaches (sequetyping, multiplex PCR, real-time PCR, and PCR-RFLP). A cost-effective and practical approach must be used to enhance serotyping accuracy to monitor the prevalence of VTs and NVTs. Therefore, dependable pneumococcal serotyping techniques are essential to precisely monitor virulent lineages, NVT emergence, and genetic associations of isolates. This review discusses the principles, associated benefits, and drawbacks of the respective available conventional and molecular approaches, and potentially the whole genome sequencing (WGS) to be directed for future exploration.
  10. May LW, John J, Seong LG, Abidin ZZ, Ibrahim N, Danaee M, et al.
    J Indian Prosthodont Soc, 2021 5 4;21(2):198-203.
    PMID: 33938871 DOI: 10.4103/jips.jips_41_21
    Aim: To investigate the effect of different cooling methods on denture base adaptation of rapid heat-cured acrylic resin using 3D superimposition technique.

    Setting and Design: In vitro - Comparative study.

    Materials and Methods: Denture base adaptation of two different rapid heat-cured polymethyl methacrylate acrylic resins using five different cooling methods were compared. Forty maxillary edentulous stone cast were prepared to produce the denture bases with standardized thickness. The specimens were divided into five groups (n = 8) according to type of materials and cooling methods. The master stone cast and all forty denture bases were scanned with 3Shape E1 laboratory scanner. The scanned images of each of the denture bases were superimposed over the scanned image of the master cast using Materialize 3-matic software. Three dimensional differences between the two surfaces were calculated and color surface maps were generated for visual qualitative assessment.

    Statistical Analysis Used: Generalized Linear Model Test, Bonferroni Post Hoc Analysis.

    Results: All bench-cooled specimens showed wide green-colored area in the overall palatal surface, while the rapid cooled specimens presented with increased red color areas especially at the palate and post dam area. Generalized Linear Model test followed by Bonferroni post hoc analysis showed significant difference in the root mean square values among the specimen groups.

    Conclusion: Samples that were bench cooled, demonstrated better overall accuracy compared to the rapid cooling groups. Regardless of need for shorter denture processing time, bench cooling of rapid heat-cured PMMA is essential for acceptable denture base adaptation.

  11. Nhu VH, Shirzadi A, Shahabi H, Singh SK, Al-Ansari N, Clague JJ, et al.
    PMID: 32316191 DOI: 10.3390/ijerph17082749
    Shallow landslides damage buildings and other infrastructure, disrupt agriculture practices, and can cause social upheaval and loss of life. As a result, many scientists study the phenomenon, and some of them have focused on producing landslide susceptibility maps that can be used by land-use managers to reduce injury and damage. This paper contributes to this effort by comparing the power and effectiveness of five machine learning, benchmark algorithms-Logistic Model Tree, Logistic Regression, Naïve Bayes Tree, Artificial Neural Network, and Support Vector Machine-in creating a reliable shallow landslide susceptibility map for Bijar City in Kurdistan province, Iran. Twenty conditioning factors were applied to 111 shallow landslides and tested using the One-R attribute evaluation (ORAE) technique for modeling and validation processes. The performance of the models was assessed by statistical-based indexes including sensitivity, specificity, accuracy, mean absolute error (MAE), root mean square error (RMSE), and area under the receiver operatic characteristic curve (AUC). Results indicate that all the five machine learning models performed well for shallow landslide susceptibility assessment, but the Logistic Model Tree model (AUC = 0.932) had the highest goodness-of-fit and prediction accuracy, followed by the Logistic Regression (AUC = 0.932), Naïve Bayes Tree (AUC = 0.864), ANN (AUC = 0.860), and Support Vector Machine (AUC = 0.834) models. Therefore, we recommend the use of the Logistic Model Tree model in shallow landslide mapping programs in semi-arid regions to help decision makers, planners, land-use managers, and government agencies mitigate the hazard and risk.
  12. Mwase-Vuma TW, Janssen X, Okely AD, Tremblay MS, Draper CE, Florindo AA, et al.
    J Sci Med Sport, 2022 Dec;25(12):1002-1007.
    PMID: 36270900 DOI: 10.1016/j.jsams.2022.10.003
    OBJECTIVES: To validate parent-reported child habitual total physical activity against accelerometry and three existing step-count thresholds for classifying 3 h/day of total physical activity in pre-schoolers from 13 culturally and geographically diverse countries.

    DESIGN: Cross-sectional validation study.

    METHODS: We used data involving 3- and 4-year-olds from 13 middle- and high-income countries who participated in the SUNRISE study. We used Spearman's rank-order correlation, Bland-Altman plots, and Kappa statistics to validate parent-reported child habitual total physical activity against activPAL™-measured total physical activity over 3 days. Additionally, we used Receiver Operating Characteristic Area Under the Curve analysis to validate existing step-count thresholds (Gabel, Vale, and De Craemer) using step-counts derived from activPAL™.

    RESULTS: Of the 352 pre-schoolers, 49.1 % were girls. There was a very weak but significant positive correlation and slight agreement between parent-reported total physical activity and accelerometer-measured total physical activity (r: 0.140; p = 0.009; Kappa: 0.030). Parents overestimated their child's total physical activity compared to accelerometry (mean bias: 69 min/day; standard deviation: 126; 95 % limits of agreement: -179, 316). Of the three step-count thresholds tested, the De Craemer threshold of 11,500 steps/day provided excellent classification of meeting the total physical activity guideline as measured by accelerometry (area under the ROC curve: 0.945; 95 % confidence interval: 0.928, 0.961; sensitivity: 100.0 %; specificity: 88.9 %).

    CONCLUSIONS: Parent reports may have limited validity for assessing pre-schoolers' level of total physical activity. Step-counting is a promising alternative - low-cost global surveillance initiatives could potentially use pedometers for assessing compliance with the physical activity guideline in early childhood.

  13. Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, et al.
    PMID: 9886108
    The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.
  14. Uma E, Nieminen P, Mani SA, John J, Haapanen E, Laitala ML, et al.
    Healthcare (Basel), 2021 Oct 20;9(11).
    PMID: 34828454 DOI: 10.3390/healthcare9111408
    Social media use among students has infiltrated into dental education and offers benefits but may also cause problems. The aim of this study was to explore and compare current social media usage among dental undergraduate students from two countries-Malaysia and Finland. A self-administered structured online questionnaire was used. WhatsApp, YouTube, Instagram, Facebook and Snapchat were the services that were most familiar to the respondents from both countries. There were differences between the students from the two countries among the most preferred platforms. The most frequently used applications were WhatsApp (91.1% of students in Malaysia and 96.1% in Finland used it very frequently) and Instagram (74.3% of students in Malaysia and 70.0% in Finland used it very frequently). Students in Malaysia spent significantly more hours per week using the platforms as study tools than students in Finland. Over 80% of the Finnish dental students reported that lack of knowledge was not an issue in social media usage, while 85% of Malaysian students felt that lack of knowledge prevented them from using social media platforms frequently. The findings offer evidence that dental students used social media extensively.
  15. Lolekha S, Cooksley G, Chan V, Isahak I, Ismael S, John J, et al.
    PMID: 11414406
    Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.
  16. Ngwe Tun MM, Mori D, Sabri SB, Kugan O, Shaharom SB, John J, et al.
    Am J Trop Med Hyg, 2021 Nov 22;106(2):601-606.
    PMID: 34814105 DOI: 10.4269/ajtmh.21-0802
    Several Zika virus (ZIKV) seroprevalence studies have been conducted in Africa, Asia, Oceania, the Americas, and the Caribbean. However, studies on ZIKV seroprevalence are limited in Malaysia though several studies have shown that the disease is endemic in the Malaysian state of Sabah. To evaluate the seroprevalence of ZIKV infection, 818 serum samples were collected from febrile patients and healthy blood donors from the Kudat and Kota Kinabalu districts in Sabah from 2017 to 2018. They were screened for ZIKV infection by IgM and IgG ELISA, and positive ZIKV IgM samples were subjected to a 90% neutralization test for confirmation. Twenty-four (6% [95% CI 4 to 8]) confirmed and two (0.5% [95% CI 0.13 to 1.8]) probable ZIKV infections were detected among 400 febrile illness patients. Of 418 healthy blood donor samples, six (1.4% [95% CI 0.65 to 3]) were determined as confirmed ZIKV infections and six (1.4% [95% CI 0.65 to 3]) indicated probable ZIKV infection. This is the first study on the seroprevalence of ZIKV infections among patients and healthy blood donors in Sabah. Compared with previous studies in Malaysia, this study shows that the incidence of ZIKV infection has increased. It also suggests that a sero-surveillance system is essential to determine the circulation of ZIKV in Sabah, Malaysia.
  17. Watts GF, Gidding S, Wierzbicki AS, Toth PP, Alonso R, Brown WV, et al.
    J Clin Lipidol, 2014 Mar-Apr;8(2):148-72.
    PMID: 24636175 DOI: 10.1016/j.jacl.2014.01.002
    Familial hypercholesterolemia (FH) is a dominantly inherited disorder present from birth that markedly elevates plasma low-density lipoprotein cholesterol and causes premature coronary heart disease. There are at least 20 million people with FH worldwide, but the majority remains undetected, and current treatment is often suboptimal. To address this major gap in coronary prevention we present, from an international perspective, consensus-based guidance on the care of FH. The guidance was generated from seminars and workshops held at an international symposium. The recommendations focus on the detection, diagnosis, assessment, and management of FH in adults and children and set guidelines for clinical purposes. They also refer to best practice for cascade screening and risk notifying and testing families for FH, including use of genetic testing. Guidance on treatment is based on risk stratification, management of noncholesterol risk factors, and the safe and effective use of low-density lipoprotein-lowering therapies. Recommendations are given on lipoprotein apheresis. The use of emerging therapies for FH is also foreshadowed. This international guidance acknowledges evidence gaps but aims to make the best use of contemporary practice and technology to achieve the best outcomes for the care of FH. It should accordingly be used to inform clinical judgment and be adjusted for country-specific and local healthcare needs and resources.
  18. Watts GF, Gidding S, Wierzbicki AS, Toth PP, Alonso R, Brown WV, et al.
    Eur J Prev Cardiol, 2015 Jul;22(7):849-54.
    PMID: 24776375 DOI: 10.1177/2047487314533218
    Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL) cholesterol and causes premature coronary heart disease. There are at least 20 million people with FH worldwide, but the majority remains undetected and current treatment is often suboptimal.To address this major gap in coronary prevention we present, from an international perspective, consensus-based guidance on the care of FH. The guidance was generated from seminars and workshops held at an international symposium. The recommendations focus on the detection, diagnosis, assessment and management of FH in adults and children, and set guidelines for clinical purposes. They also refer to best practice for cascade screening and risk notifying and testing families for FH, including use of genetic testing. Guidance on treatment is based on risk stratification, management of non-cholesterol risk factors and safe and effective use of LDL lowering therapies. Recommendations are given on lipoprotein apheresis. The use of emerging therapies for FH is also foreshadowed.This international guidance acknowledges evidence gaps, but aims to make the best use of contemporary practice and technology to achieve the best outcomes for the care of FH. It should accordingly be employed to inform clinical judgment and be adjusted for country-specific and local healthcare needs and resources.
  19. Leder K, Openshaw JJ, Allotey P, Ansariadi A, Barker SF, Burge K, et al.
    BMJ Open, 2021 01 08;11(1):e042850.
    PMID: 33419917 DOI: 10.1136/bmjopen-2020-042850
    INTRODUCTION: Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.

    METHODS AND ANALYSIS: RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.

    ETHICS: Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.

    TRIAL REGISTRATION NUMBER: ACTRN12618000633280; Pre-results.

  20. Kariippanon KE, Chong KH, Janssen X, Tomaz SA, Ribeiro EHC, Munambah N, et al.
    Med Sci Sports Exerc, 2022 Jul 01;54(7):1123-1130.
    PMID: 35142711 DOI: 10.1249/MSS.0000000000002886
    PURPOSE: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample.

    METHODS: This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density.

    RESULTS: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures.

    CONCLUSIONS: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

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