METHODOLOGY: A cross-sectional study involving 520 HCWs across all categories was conducted in Kelantan State, Malaysia. A proforma and validated Malay version of the Job Content Questionnaires were administered to obtain the data. The participants were then classified into four categories of workers according to Karasek's job demands-control model classification which were active, passive, high strain, and low strain.
RESULTS: We found that a total of 145 (28.5%) HCWs in the study have job stress (high-strain job type). HCWs with a degree or higher qualification had the highest proportion of job stress (41.2%), while the diploma group has the lowest proportion of job stress among the four academic qualification groups (22.9%). Pearson chi-square shows a significant association between Karasek's job types and the level of social support from their supervisors (p < 0.05) but no association between job strain and the level of supervisor's social support (p > 0.05).
CONCLUSION: Job stress among HCWs is prevalent, and the professional group had the highest percentage of risk job stress as compared to other groups. There is a significant association between the supervisor's social support and Karasek's job strain categories.
METHODS: We conducted a systematic review of published CVD mortality studies that reported ASMR as an indicator for premature mortality measurement. All English articles published as of October 2022 were searched in four electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). We computed pooled estimates of ASMR using random-effects meta-analysis. We assessed heterogeneity from the selected studies using the I2 statistic. Subgroup analyses and meta regression analysis was performed based on sex, main CVD types, income country level, study time and age group. The analysis was performed using R software with the "meta" and "metafor" packages.
RESULTS: A total of 15 studies met the inclusion criteria. The estimated global ASMR for premature mortality from total CVD was 96.04 per 100,000 people (95% CI: 67.18, 137.31). Subgroup analysis by specific CVD types revealed a higher ASMR for ischemic heart disease (ASMR = 15.57, 95% CI: 11.27, 21.5) compared to stroke (ASMR = 12.36, 95% CI: 8.09, 18.91). Sex-specific differences were also observed, with higher ASMRs for males (37.50, 95% CI: 23.69, 59.37) than females (15.75, 95% CI: 9.61, 25.81). Middle-income countries had a significantly higher ASMR (90.58, 95% CI: 56.40, 145.48) compared to high-income countries (21.42, 95% CI: 15.63, 29.37). Stratifying by age group indicated that the age groups of 20-64 years and 30-74 years had a higher ASMR than the age group of 0-74 years. Our multivariable meta-regression model suggested significant differences in the adjusted ASMR estimates for all covariates except study time.
CONCLUSIONS: This meta-analysis synthesized a comprehensive estimate of the worldwide burden of premature CVD mortality. Our findings underscore the continued burden of premature CVD mortality, particularly in middle-income countries. Addressing this issue requires targeted interventions to mitigate the high risk of premature CVD mortality in these vulnerable populations.
PATIENTS AND METHODS: A community-based cross-sectional study was conducted at various sites in Karachi, Pakistan, from February 2022 to August 2022. Newly diagnosed cases of MetS with no physical disability, known illness, and not taking any regular medication were recruited. MetS was defined based on the definition of International Diabetes Federation. The major outcome was 10-year risk for CVD using the FRS and Globorisk Score.
RESULTS: Of 304 patients, 59.2% were classified as low risk according to FRS, while 20.4% were classified as moderate and high risk each. Using the Globorisk score, 44.6% of 224 patients were classified as low risk, 34.4% as moderate risk, and 21.0% as high risk. A moderate positive correlation was observed between the two CVD risk scores (r = 0.651, 95% CI 0.58-0.71). Both risk scores have reported age, gender, and current smokers as significant risk factors in predicting CVD in 10-years (P < 0.05).
CONCLUSION: The outcome of both CVD risk scores predicted moderate-to-high risk of CVD in 10-years in almost half of the newly diagnosed patients with MetS. In particular, the risk of development of CVD in 10-years in newly diagnosed MetS is higher with increasing age, in male gender, and current smokers.
METHODS: This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool.
RESULTS: In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients.
CONCLUSION: Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.
OBJECTIVE: To investigate the accuracy of anthropometric indices as a screening tool for predicting MetS among apparently healthy individuals in Karachi, Pakistan.
METHODS: A community-based cross-sectional survey was conducted in Karachi, Pakistan, from February 2022 to August 2022. A total of 1,065 apparently healthy individuals aged 25 years and above were included. MetS was diagnosed using International Diabetes Federation guidelines. Anthropometric indices were defined based on body mass index (BMI), neck circumference (NC), mid-upper arm circumference (MUAC), waist circumference (WC), waist to height ratio (WHtR), conicity index, reciprocal ponderal index (RPI), body shape index (BSI), and visceral adiposity index (VAI). The analysis involved the utilization of Pearson's correlation test and independent t-test to examine inferential statistics. The receiver operating characteristic (ROC) analysis was also applied to evaluate the predictive capacities of various anthropometric indices regarding metabolic risk factors. Moreover, the area under the curve (AUC) was computed, and the chosen anthropometric indices' optimal cutoff values were determined.
RESULTS: All anthropometric indices, except for RPI in males and BSI in females, were significantly higher in MetS than those without MetS. VAI [AUC 0.820 (95% CI 0.78-0.86)], WC [AUC 0.751 (95% CI 0.72-0.79)], WHtR [AUC 0.732 (95% CI 0.69-0.77)], and BMI [AUC 0.708 (95% CI 0.66-0.75)] had significantly higher AUC for predicting MetS in males, whereas VAI [AUC 0.693 (95% CI 0.64-0.75)], WHtR [AUC 0.649 (95% CI 0.59-0.70)], WC [AUC 0.646 (95% CI 0.59-0.61)], BMI [AUC 0.641 (95% CI 0.59-0.69)], and MUAC [AUC 0.626 (95% CI 0.57-0.68)] had significantly higher AUC for predicting MetS in females. The AUC of NC for males was 0.656 (95% CI 0.61-0.70), while that for females was 0.580 (95% CI 0.52-0.64). The optimal cutoff points for all anthropometric indices exhibited a high degree of sensitivity and specificity in predicting the onset of MetS.
CONCLUSION: BMI, WC, WHtR, and VAI were the most important anthropometric predictors for MetS in apparently healthy individuals of Pakistan, while BSI was found to be the weakest indicator.
OBJECTIVE: To identify the studies on premature cardiovascular disease (CVD) mortality and synthesise their findings on YLL based on the regional area, main CVD types, sex, and study time.
METHOD: We conducted a systematic review of published CVD mortality studies that reported YLL as an indicator for premature mortality measurement. A literature search for eligible studies was conducted in five electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The synthesis of YLL was grouped into years of potential life lost (YPLL) and standard expected years of life lost (SEYLL) using descriptive analysis. These subgroups were further divided into WHO (World Health Organization) regions, study time, CVD type, and sex to reduce the effect of heterogeneity between studies.
RESULTS: Forty studies met the inclusion criteria for this review. Of these, 17 studies reported premature CVD mortality using YPLL, and the remaining 23 studies calculated SEYLL. The selected studies represent all WHO regions except for the Eastern Mediterranean. The overall median YPLL and SEYLL rates per 100,000 population were 594.2 and 1357.0, respectively. The YPLL rate and SEYLL rate demonstrated low levels in high-income countries, including Switzerland, Belgium, Spain, Slovenia, the USA, and South Korea, and a high rate in middle-income countries (including Brazil, India, South Africa, and Serbia). Over the past three decades (1990-2022), there has been a slight increase in the YPLL rate and the SEYLL rate for overall CVD and ischemic heart disease but a slight decrease in the SEYLL rate for cerebrovascular disease. The SEYLL rate for overall CVD demonstrated a notable increase in the Western Pacific region, while the European region has experienced a decline and the American region has nearly reached a plateau. In regard to sex, the male showed a higher median YPLL rate and median SEYLL rate than the female, where the rate in males substantially increased after three decades.
CONCLUSION: Estimates from both the YPLL and SEYLL indicators indicate that premature CVD mortality continues to be a major burden for middle-income countries. The pattern of the YLL rate does not appear to have lessened over the past three decades, particularly for men. It is vitally necessary to develop and execute strategies and activities to lessen this mortality gap.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021288415.
METHODOLOGY: Primary data from 117 respondents who did not register for the COVID-19 vaccination were collected using self-administered questionnaires to capture predictors of vaccination intention amongst individuals in a Malaysian context. The partial least squares structural equation modeling (PLS-SEM) technique was used to analyze the data.
RESULTS: Subjective norms and attitude play key mediating roles between the HBM factors and vaccination intention amongst the unregistered respondents. In particular, subjective norms mediate the relationship between cues to action and vaccination intention, highlighting the significance of important others to influence unregistered individuals who are already exposed to information from mass media and interpersonal discussions regarding vaccines. Trust, perceived susceptibility, and perceived benefits indirectly influence vaccination intention through attitude, indicating that one's attitude is vital in promoting behavioral change.
CONCLUSION: This study showed that the behavioral factors could help understand the reasons for vaccine refusal or acceptance, and shape and improve health interventions, particularly among the vaccine-hesitant group in a developing country. Therefore, policymakers and key stakeholders can develop effective strategies or interventions to encourage vaccination amongst the unvaccinated for future health pandemics by targeting subjective norms and attitude.
METHODS: This community-based cross-sectional survey was conducted in Karachi, Pakistan, from January 2022 to August 2022. A total of 1065 healthy individuals aged 25-80 years of any gender were consecutively included. MetS was assessed using the National Cholesterol Education Program for Adult Treatment Panel (NCEP-ATP) III guidelines, International Diabetes Federation (IDF), and modified NCEP-ATP III.
RESULTS: The prevalence of MetS was highest with the modified NCEP-ATP III definition at 33.9% (95% CI: 31-36), followed by the IDF definition at 32.2% (95% CI: 29-35). In contrast, the prevalence was lower at 22.4% (95% CI: 19-25) when using the NCEP ATP III definition. The risk of MetS significantly increases with higher BMI, as defined by the IDF criteria (adjusted OR [ORadj] 1.13, 95% CI 1.09-2.43), NCEP-ATP III criteria (ORadj 1.15, 95% CI 1.11-1.19), and modified NCEP-ATP III criteria (ORadj 1.16, 95% CI 1.12-1.20). Current smokers had significantly higher odds of MetS according to the IDF (ORadj 2.72, 95% CI 1.84-4.03), NCEP-ATP III (ORadj 3.93, 95% CI 2.55-6.06), and modified NCEP-ATP III (ORadj 0.62, 95% CI 0.43-0.88). Areca nut use was associated with higher odds of MetS according to both IDF (ORadj 1.71, 95% CI 1.19-2.47) and modified NCEP-ATP III criteria (ORadj 1.58, 95% CI 1.10-2.72). Furthermore, low physical activity had significantly higher odds of MetS according to the NCEP-ATP III (ORadj 1.36, 95% CI 1.01-1.84) and modified NCEP-ATP III criteria (ORadj 1.56, 95% CI 1.08-2.26).
CONCLUSION: One-third of the healthy individuals were diagnosed with MetS based on IDF, NCEP-ATP III, and modified NCEP-ATP III criteria. A higher BMI, current smoking, areca nut use, and low physical activity were significant factors.
METHODS: A total of 240 cancer patients participated in this prospective cohort study, with follow-up visits from October 2019 until July 2021. Data were collected using several instruments: Brief COP E, the Source of Social Support Scale (SSSS), the Post-Traumatic Growth Inventory - Short Form (P T GI-SF), and a Malay version of the 34-Item Shortform Supportive Care Need Survey (SCNS-SF34).
RESULTS: The results indicated a significant change from T1 to T3 for all domains of the unmet needs (p-value < 0.001), except for the sexual domain. A lower SCNS-SF34 score resulted from more unfavorable social support. The P T GI-SF results indicated a trend toward meeting the unmet needs, and a higher SCNS-SF-34 score predicted a considerably higher P T GI-SF score.
CONCLUSIONS: Our study findings suggest that majority of the factors evaluated in terms of unmet needs among cancer patients have undergone considerable changes.
METHODOLOGY: Data were collected using self-administered questionnaires from 1,914 respondents aged 18 and above by a marketing consulting firm via its online panel. The partial least squares structural equation modeling (PLS-SEM) technique was used to analyze the data.
RESULTS: Out of the 1,914 respondents, 55.9% reported having a continuance intention to vaccinate against COVID-19, similar to other developing countries. The multivariate analysis revealed that perceived usefulness and satisfaction significantly influenced individuals' continuance intention to vaccinate against COVID-19. Additionally, attitude was found to play a key role in influencing behavioral change among individuals towards their perceptions of continuously getting vaccinated against COVID-19.
CONCLUSIONS: By integrating three theoretical frameworks (i.e., HBM, TRA and ECM), this study showed that behavioral characteristics could provide insights towards continuance vaccination intention. Hence, policymakers and key stakeholders can develop effective public health strategies or interventions to encourage vaccine booster uptake by targeting behavioral factors such as perceived usefulness, attitude, satisfaction, and subjective norms.