DESIGN: We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.
SETTING: Muar, Malaysia.
PARTICIPANTS: 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.
MEASUREMENTS: Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.
FINDINGS: Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.
CONCLUSIONS: Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.
METHODS: We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation.
RESULTS: 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005).
CONCLUSIONS: The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.
METHOD: A cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ± 4.9 years, range: 20-48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss.
RESULTS: Generally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p
DESIGN: Cross-sectional, randomised, single-blinded study.
STUDY SAMPLE: An Oticon-Dynamo HA manual was translated and revised based on best practice guidelines. Ninety participants aged 55 years and above participated in this study. They were randomly assigned into the control group (received translated manual) and the experimental group (received the revised translated manual). The Hearing Aid Management (HAM) test, which was developed in a previous study, was conducted to evaluate participant's ability to perform HA management tasks using the translated and the revised version of Malay HA manual.
RESULTS: The revised Malay HA manual had a lower reading grade level relative to the initial translated Malay HA manual. The ability to perform HA management tasks was better in the experimental group (mean = 12.2, SD = 1.15) versus the control group (mean = 8.7, SD = 2.11).
CONCLUSION: Further revision of existing HA manuals based on best practice guidelines is recommended to help individuals better manage their HAs.
METHODS: In this case-control observational study, 32 adults with post-TBI olfactory dysfunction (cases) were matched with 32 TBI patients with intact olfactory function (controls). All subjects self-rated their olfactory function using the Visual Analogue Scale (VAS). Cases also underwent objective olfactory function assessment with the Sniffin' Sticks test, which generated a Threshold, Discrimination, and Identification (TDI) score. QoL was assessed with the Questionnaire for Olfactory Disorders (QOD). Factors evaluated included age, gender, smoking, TBI severity and duration, lesion localisation, and Disability Rating Scale (DRS) score.
RESULTS: Cases had a higher mean QOD score than controls at 26.31 ± 14.37 and 9.44 ± 8.30, respectively (F = 16.426, p
DESIGN: In Phase I, 400 vowel-consonant-vowel (VCV) nonsense word samples containing 20 Mandarin consonants in /a/, /i/, or /u/ contexts were recorded from two speakers of different genders. Acoustic analyses, sound quality ratings, and item validations were used to guide selection of items to form two gender-specific test lists. In Phase II, performance-intensity functions and test-retest reliability for the lists were established.
STUDY SAMPLE: Native Mandarin-speaking adults with normal hearing participated in Phase I (n = 10) and Phase II (n = 69).
RESULTS: Eighty-four of the 400 VCV words were selected to form two gender-specific test lists. A two-way repeated measure ANOVA revealed a significant interaction effect between speaker-gender and presentation level [F (4.88, 283.20) = 22.79, p
Method: Fifteen hearing mothers of children with severe-to-profound sensorineural hearing loss were interviewed. Interviews were transcribed verbatim, and a grounded theory approach was used to inductively analyze parental stress in mothers of D/HH children. Theory generation was achieved through triangulation of data sources and systematic organization of data into codes. The coding process identified salient themes that were constantly cross-checked and compared across data to further develop categories, properties, and tentative hypotheses.
Results: In general, two main themes emerged from the interviews: the contextual stressors and stress-reducing resources. The contextual stressors were labeled as distress over audiology-related needs, pressure to acquire new knowledge and skills, apprehension about the child's future, and demoralizing negative social attitudes. The stress-reducing resources that moderated parenting stress were identified to be the child's progress, mother's characteristics, professional support, and social support. The interaction between the identified stressors and adjustment process uncovered a central theme termed maternal coherence.
Conclusion: The substantive theory suggests that mothers of D/HH children can effectively manage parenting stress and increase well-being by capitalizing on relevant stress-reducing resources to achieve maternal coherence.
Materials and Methods: A model of ATR-FTIR-PLSR was developed using ATR-FTIR spectra of mixed aflatoxin standards in 100% acetonitrile (112 samples) and 75% methanol (112 samples), validated by testing its prediction on 125 feed/food samples spiked with variable concentrations of aflatoxins, and applied to screen 660 samples of commercial chicken feeds and food grains from Nigerian and Malaysian markets for total aflatoxins, for which the dietary exposure risks to aflatoxins (DERA) and associated hepatocellular carcinoma (HCC) risks were evaluated for both countries.
Results: The ATR-FTIR-PLSR model demonstrated excellent prediction power [R 2 = 99.59%, p = 0.001, root mean square error of calibration (RMSEC) = 1.69, RMSE p = 1.98, bias = -0.26], sensitivity (limit of quantitation and limit of the method < 5.0 ng/gm), precision (coefficient of variation = 0.97-1.72), and accuracy (% recovery of 88%-106%) in all the spiked samples. The model's prediction was statistically reliable (R 2 = 99.8%, p < 0.05) when compared with a high-performance liquid chromatography method. Levels of aflatoxins in the commercial samples signify high DERA (0.92-138.2 ng of aflatoxins/kg BW/day) and HCC risk (1.07%-159.91% of HCC/100,000 people/year) in the exposed populations.
Conclusions: Results feature the conceivable implementation of the proposed ATR-FTIR-PLSR model for rapid, accurate determination and monitoring of aflatoxins in commercial chicken feeds and food grains; and the need to strengthen aflatoxin control/prevention strategies in the study populations.