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  1. Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort
    Fransen HP, Beulens JW, May AM, Struijk EA, Boer JM, de Wit GA, et al.
    Prev Med, 2015 Aug;77:119-24.
    PMID: 26007298 DOI: 10.1016/j.ypmed.2015.05.014
    Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention.
    Matched MeSH terms: Young Adult
  2. Fulltext Human melioidosis reported by ProMED
    Nasner-Posso KM, Cruz-Calderón S, Montúfar-Andrade FE, Dance DA, Rodriguez-Morales AJ
    Int J Infect Dis, 2015 Jun;35:103-6.
    PMID: 25975651 DOI: 10.1016/j.ijid.2015.05.009
    OBJECTIVE: There are limited sources describing the global burden of emerging diseases. A review of human melioidosis reported by ProMED was performed and the reliability of the data retrieved assessed in comparison to published reports. The effectiveness of ProMED was evaluated as a source of epidemiological data by focusing on melioidosis.

    METHODS: Using the keyword 'melioidosis' in the ProMED search engine, all of the information from the reports and collected data was reviewed using a structured form, including the year, country, gender, occupation, number of infected individuals, and number of fatal cases.

    RESULTS: One hundred and twenty-four entries reported between January 1995 and October 2014 were identified. A total of 4630 cases were reported, with death reported in 505 cases, suggesting a misleadingly low overall case fatality rate (CFR) of 11%. Of 20 cases for which the gender was reported, 12 (60%) were male. Most of the cases were reported from Australia, Thailand, Singapore, Vietnam, and Malaysia, with sporadic reports from other countries.

    CONCLUSIONS: Internet-based reporting systems such as ProMED are useful to gather information and synthesize knowledge on emerging infections. Although certain areas need to be improved, ProMED provided good information about melioidosis.

    Matched MeSH terms: Young Adult
  3. Levels of Visual Stress in Proficient Readers: Effects of Spectral Filtering of Fluorescent Lighting on Reading Discomfort
    Loew SJ, Rodríguez C, Marsh NV, Jones GL, Núñez JC, Watson K
    Span J Psychol, 2015;18:E58.
    PMID: 26255657 DOI: 10.1017/sjp.2015.59
    Visual stress (VS) affects reading in 5-12% of the general population and 31-36% of children with reading disorders. Symptoms include print distortions and visual discomfort when reading, and are exacerbated by fluorescent lighting. Prior research has indicated that VS can also affect proficient readers. We therefore examined levels of visual discomfort in a group of expert readers (n = 24) under both standard and spectrally-filtered fluorescent lighting. Participants rated their awareness of six symptoms of VS under each lighting condition. Under the standard condition, 4(16.7%) of the group recorded moderate to high levels of VS. Differences in symptom levels and reading speed between conditions were analysed using the Wilcoxon Signed Rank Test. Under the filter condition, the group reported less discomfort regarding all six symptoms of VS surveyed. The differences were significant with respect to three of the symptoms (p = .029 - p < .001), with a medium effect size in all of them (r = .31 - r = .46) and total score (p = .007; r = .39). Variations in reading proficiency included significantly fewer self-corrections (p = .019) and total errors (p = .004). Here we present evidence that VS-type symptoms of reading discomfort are not confined to populations with reading difficulties and may also occur in proficient readers, and that simple adaptations to fluorescent lighting may alleviate such symptoms.
    Matched MeSH terms: Young Adult
  4. Fulltext Rapamycin and its analogues (rapalogs) for Tuberous Sclerosis Complex-associated tumors: a systematic review on non-randomized studies using meta-analysis
    Sasongko TH, Ismail NF, Nik Abdul Malik NM, Zabidi-Hussin ZA
    Orphanet J Rare Dis, 2015;10:95.
    PMID: 26259610 DOI: 10.1186/s13023-015-0317-7
    Rapamycin has gained significant attention for its potential activity in reducing the size of TSC-associated tumors, thus providing alternative to surgery. This study aimed at determining the efficacy of rapamycin and rapalogs for reducing the size of TSC-associated solid tumors in patients with Tuberous Sclerosis Complex (TSC).
    Matched MeSH terms: Young Adult
  5. Fulltext Effect of Internet-Based Cognitive Apprenticeship Model (i-CAM) on Statistics Learning among Postgraduate Students
    Saadati F, Ahmad Tarmizi R, Mohd Ayub AF, Abu Bakar K
    PLoS One, 2015;10(7):e0129938.
    PMID: 26132553 DOI: 10.1371/journal.pone.0129938
    Because students' ability to use statistics, which is mathematical in nature, is one of the concerns of educators, embedding within an e-learning system the pedagogical characteristics of learning is 'value added' because it facilitates the conventional method of learning mathematics. Many researchers emphasize the effectiveness of cognitive apprenticeship in learning and problem solving in the workplace. In a cognitive apprenticeship learning model, skills are learned within a community of practitioners through observation of modelling and then practice plus coaching. This study utilized an internet-based Cognitive Apprenticeship Model (i-CAM) in three phases and evaluated its effectiveness for improving statistics problem-solving performance among postgraduate students. The results showed that, when compared to the conventional mathematics learning model, the i-CAM could significantly promote students' problem-solving performance at the end of each phase. In addition, the combination of the differences in students' test scores were considered to be statistically significant after controlling for the pre-test scores. The findings conveyed in this paper confirmed the considerable value of i-CAM in the improvement of statistics learning for non-specialized postgraduate students.
    Matched MeSH terms: Young Adult
  6. Effectiveness of bone cleaning process using chemical and entomology approaches: time and cost
    Lai PS, Khoo LS, Mohd Hilmi S, Ahmad Hafizam H, Mohd Shah M, Nurliza A, et al.
    Malays J Pathol, 2015 Aug;37(2):123-35.
    PMID: 26277669 MyJurnal
    Skeletal examination is an important aspect of forensic pathology practice, requiring effective bone cleaning with minimal artefact. This study was conducted to compare between chemical and entomology methods of bone cleaning. Ten subjects between 20 and 40 years old who underwent uncomplicated medico-legal autopsies at the Institute of Forensic Medicine Malaysia were randomly chosen for this descriptive cross sectional study. The sternum bone was divided into 4 parts, each part subjected to a different cleaning method, being two chemical approaches i.e. laundry detergent and a combination of 6% hydrogen peroxide and powder sodium bicarbonate and two entomology approaches using 2nd instar maggots of Chrysomyia rufifacies and Ophyra spinigera. A scoring system for grading the outcome of cleaning was used. The effectiveness of the methods was evaluated based on average weight reduction per day and median number of days to achieve the average score of less than 1.5 within 12 days of the bone cleaning process. Using maggots was the most time-effective and costeffective method, achieving an average weight reduction of 1.4 gm per day, a median of 11.3 days to achieve the desired score and an average cost of MYR 4.10 per case to reach the desired score within 12 days. This conclusion was supported by blind validation by forensic specialists achieving a 77.8% preference for maggots. Emission scanning electron microscopy evaluation also revealed that maggots especially Chrysomyia rufifacies preserved the original condition of the bones better allowing improved elucidation of bone injuries in future real cases.
    Matched MeSH terms: Young Adult
  7. Brain activity elicited by reward and reward omission in individuals with psychopathic traits: An ERP study
    Salim MA, van der Veen FM, van Dongen JD, Franken IH
    Biol Psychol, 2015 Sep;110:50-8.
    PMID: 26188154 DOI: 10.1016/j.biopsycho.2015.07.001
    Psychopathy has been associated with behavioral adaptation deficits, which might be associated with problems in feedback and reward processing. In the present study, we examined the relation between psychopathic traits and reward processing in a passive gambling task. A total of 39 male participants who scored high (HP) and 39 male participants who scored low (LP) on the Triarchic Psychopathy Measure (TriPM), total score were tested. Feedback-related Event-Related Potentials (ERPs; i.e., P2, FRN, and P3) on predicted and unpredicted rewards and reward omissions were compared between both groups. It was found that in HP individuals, the P2 was enhanced for predicted rewards and reward omissions, but not for unpredicted stimuli. Moreover, HP individuals as compared to the LP individuals demonstrated a generally reduced P3 amplitude. The FRN amplitude, however, did not differ between the two groups. In addition, HP individuals showed enhanced reward sensitivity on the self-report level. Taken together, these findings suggest that HP individuals show enhanced sensitivity to early and reduced sensitivity to later markers of processing reinforcement learning signals, which points in the direction of compromised behavioral adaptation.
    Matched MeSH terms: Young Adult
  8. Fulltext Daily Consumption of a Fruit and Vegetable Smoothie Alters Facial Skin Color
    Tan KW, Graf BA, Mitra SR, Stephen ID
    PLoS One, 2015;10(7):e0133445.
    PMID: 26186449 DOI: 10.1371/journal.pone.0133445
    Consumption of dietary carotenoids or carotenoid supplements can alter the color (yellowness) of human skin through increased carotenoid deposition in the skin. As fruit and vegetables are the main dietary sources of carotenoids, skin yellowness may be a function of regular fruit and vegetable consumption. However, most previous studies have used tablets or capsules to supplement carotenoid intake, and less is known of the impact of increased fruit and vegetable consumption on skin color. Here, we examined skin color changes in an Asian population (Malaysian Chinese ethnicity) over a six week dietary intervention with a carotenoid-rich fruit smoothie. Eighty one university students (34 males, 47 females; mean age 20.48) were assigned randomly to consuming either a fruit smoothie (intervention group) or mineral water (control group) daily for six weeks. Participants' skin yellowness (CIELab b*), redness (a*) and luminance (L*) were measured at baseline, twice during the intervention period and at a two-week follow-up, using a handheld reflectance spectrophotometer. Results showed a large increment in skin yellowness (p<0.001) and slight increment in skin redness (p<0.001) after 4 weeks of intervention for participants in the intervention group. Skin yellowness and skin redness remained elevated at the two week follow up measurement. In conclusion, intervention with a carotenoid-rich fruit smoothie is associated with increased skin redness and yellowness in an Asian population. Changes in the reflectance spectrum of the skin suggest that this color change was caused by carotenoid deposition in the skin.
    Matched MeSH terms: Young Adult
  9. Fulltext Maternal filicide among women admitted to forensic psychiatric institutions in Malaysia: case series
    Razali S, Salleh RM, Yahya B, Ahmad SH
    East Asian Arch Psychiatry, 2015 Jun;25(2):79-87.
    PMID: 26118747
    Objectives: To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia.
    Methods: Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated.
    Results: A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted.
    Conclusion: Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.
    Key words: Depressive disorder; Domestic violence; Infanticide; Maternal behavior
    Matched MeSH terms: Young Adult
  10. An online open-source tool for automated quantification of liver and myocardial iron concentrations by T2* magnetic resonance imaging
    Git KA, Fioravante LA, Fernandes JL
    Br J Radiol, 2015 Sep;88(1053):20150269.
    PMID: 26118302 DOI: 10.1259/bjr.20150269
    To assess whether an online open-source tool would provide accurate calculations of T2(*) values for iron concentrations in the liver and heart compared with a standard reference software.
    Matched MeSH terms: Young Adult
  11. Relevance of Whitnall's tubercle and auditory meatus in diagnosing exclusions during skull-photo superimposition
    Jayaprakash PT, Hashim N, Yusop RA
    Forensic Sci Int, 2015 Aug;253:131.e1-10.
    PMID: 26103927 DOI: 10.1016/j.forsciint.2015.04.026
    Video vision mixer based skull-photo superimposition is a popular method for identifying skulls retrieved from unidentified human remains. A report on the reliability of the superimposition method suggested increased failure rates of 17.3 to 32% to exclude and 15 to 20% to include skulls while using related and unrelated face photographs. Such raise in failures prompted an analysis of the methods employed for the research. The protocols adopted for assessing the reliability are seen to vary from those suggested by the practitioners in the field. The former include overlaying the skull- and face-images on the basis of morphology by relying on anthropometric landmarks on the front plane of the face-images and evaluating the goodness of match depending on mix-mode images; the latter consist of orienting the skull considering landmarks on both the eye and ear planes of the face- and skull-images and evaluating the match utilizing images seen in wipe-mode in addition to those in mix-mode. Superimposition of a skull with face-images of five living individuals in two sets of experiments, one following the procedure described for the research on reliability and the other applying the methods suggested by the practitioners has shown that overlaying the images on the basis of morphology depending on the landmarks on the front plane alone and assessing the match in mix-mode fails to exclude the skull. However, orienting the skull relying on the relationship between the anatomical landmarks on the skull- and face-images such as Whitnall's tubercle and exocanthus in the front (eye) plane and the porion and tragus in the rear (ear) plane as well as assessing the match using wipe-mode images enables excluding that skull while superimposing with the same set of face-images.
    Matched MeSH terms: Young Adult
  12. Fulltext Fractional Diffusion Based Modelling and Prediction of Human Brain Response to External Stimuli
    Namazi H, Kulish VV
    Comput Math Methods Med, 2015;2015:148534.
    PMID: 26089955 DOI: 10.1155/2015/148534
    Human brain response is the result of the overall ability of the brain in analyzing different internal and external stimuli and thus making the proper decisions. During the last decades scientists have discovered more about this phenomenon and proposed some models based on computational, biological, or neuropsychological methods. Despite some advances in studies related to this area of the brain research, there were fewer efforts which have been done on the mathematical modeling of the human brain response to external stimuli. This research is devoted to the modeling and prediction of the human EEG signal, as an alert state of overall human brain activity monitoring, upon receiving external stimuli, based on fractional diffusion equations. The results of this modeling show very good agreement with the real human EEG signal and thus this model can be used for many types of applications such as prediction of seizure onset in patient with epilepsy.
    Matched MeSH terms: Young Adult
  13. Fulltext Practices of Dengue Fever Prevention and the Associated Factors among the Orang Asli in Peninsular Malaysia
    Chandren JR, Wong LP, AbuBakar S
    PLoS Negl Trop Dis, 2015;9(8):e0003954.
    PMID: 26267905 DOI: 10.1371/journal.pntd.0003954
    BACKGROUND: Dengue is prevalent among Malaysia's indigenous peoples, known as the Orang Asli, and it poses a serious health threat to them. The study aims to look at the socio-demographic factors, health beliefs, and knowledge about dengue and its association to dengue prevention practices among Orang Asli communities in Peninsular Malaysia.

    METHODS: A cross-sectional survey was conducted in 16 randomly selected Orang Asli villages from eight states in Peninsular Malaysia from April 2012 until February 2013.

    RESULTS: A total of 560 Orang Asli were interviewed and 505 completed the survey. Slightly above half of the participants (n = 280, 55.4%) had a total dengue prevention score of 51-100 (of a possible score of 0-100). Multivariate analysis findings showed dengue knowledge, perceived barriers to perform dengue prevention, fogging frequency, and perceived susceptibility to dengue fever as significant factors associated to dengue prevention practices. Participants with a lower dengue knowledge score (score 0-18) were less likely (OR = 0.63, 95%CI = 0.44-0.92 vs. score 19-36, P = 0.015) to practice dengue prevention. Participants with low perceived barriers to prevent dengue (score of 1-5) were more likely (OR = 2.06, 95%CI = 1.21-3.53, vs. score of 6-10, P = 0.008) to practice dengue prevention. Villages that were not fogged (OR = 0.49, 95%CI = 0.24-0.99, P = 0.045) or rarely fogged (OR = 0.40, 95%CI = 0.22-0.75, P = 0.004) had lower dengue prevention practices than villages that were fogged often. Participants with low perceived susceptibility of acquiring dengue (score of 1-5) were less likely (OR = 0.54, 95%CI = 0.33-0.89 vs. score of 6-10, P = 0.018) to practice dengue prevention measures.

    CONCLUSION: Findings imply that educational and health programmes should focus on enhancing dengue knowledge and perceived susceptibility of acquiring dengue and reducing perceived barriers to performing dengue prevention practices among the Orang Asli. More outreach on mosquito control campaigns should be carried out especially in villages where mosquito fogging is frequent.

    Matched MeSH terms: Young Adult
  14. Fulltext Assessment of knowledge regarding tuberculosis among non-medical university students in Bangladesh: a cross-sectional study
    Rana M, Sayem A, Karim R, Islam N, Islam R, Zaman TK, et al.
    BMC Public Health, 2015;15:716.
    PMID: 26215721 DOI: 10.1186/s12889-015-2071-0
    BACKGROUND: Tuberculosis (TB) is the second leading cause of human death and TB is one of the major public health problems in Bangladesh. The aim of the present study was to assess the Knowledge about TB among non-medical university students in Bangladesh.
    METHODS: A cross-sectional survey was performed on 839 non-medical university students. Data were collected from University of Rajshahi from March to August 2013 using a standard semi-structured questionnaire. Chi-square test was utilized to find the factors which are associated with students' knowledge about TB.
    RESULTS: Among 839 students, male and female were 68.2 % and 31.8 % respectively. Most of the students (94.4 %) were informed about the term TB, among them 50 % got information from electronic media. More than 50 % students believed that TB is a communicable disease, 42.8 % students agreed that bacteria is an agent for TB, most of the subjects (93 %) had the knowledge about the vaccination against TB and 97.6 % students believed that TB is curable. However, students had poor knowledge about latent TB (13.7 %) and DOTs program (28.5 %). χ (2)-test demonstrated that gender, residence, type of family and parents education were associated with students' knowledge of TB.
    CONCLUSION: In the present study demonstrated that the level of general knowledge about TB was insufficient among non-medical university students. Consequently, health education program is needed to improve the knowledge among university students regarding TB.
    Matched MeSH terms: Young Adult
  15. Multisensory distortions of the hand have differential effects on tactile perception
    Treshi-marie Perera A, Newport R, McKenzie KJ
    Exp Brain Res, 2015 Nov;233(11):3153-61.
    PMID: 26195170 DOI: 10.1007/s00221-015-4384-8
    Research has suggested that altering the perceived shape and size of the body image significantly affects perception of somatic events. The current study investigated how multisensory illusions applied to the body altered tactile perception using the somatic signal detection task. Thirty-one healthy volunteers were asked to report the presence or absence of near-threshold tactile stimuli delivered to the index finger under three multisensory illusion conditions: stretched finger, shrunken finger and detached finger, as well as a veridical baseline condition. Both stretching and shrinking the stimulated finger enhanced correct touch detections; however, the mechanisms underlying this increase were found to be different. In contrast, the detached appearance reduced false touch reports-possibly due to reduced tactile noise, as a result of attention being directed to the tip of the finger only. These findings suggest that distorted representations of the body could have different modulatory effects on attention to touch and provide a link between perceived body representation and somatosensory decision-making.
    Matched MeSH terms: Young Adult
  16. Fulltext Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series
    Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF
    BMC Anesthesiol, 2015;15:105.
    PMID: 26194896 DOI: 10.1186/s12871-015-0090-0
    The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.
    Matched MeSH terms: Young Adult
  17. Fulltext Healthcare professionals' and policy makers' views on implementing a clinical practice guideline of hypertension management: a qualitative study
    Lee PY, Liew SM, Abdullah A, Abdullah N, Ng CJ, Hanafi NS, et al.
    PLoS One, 2015;10(5):e0126191.
    PMID: 25942686 DOI: 10.1371/journal.pone.0126191
    INTRODUCTION: Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG) on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals.

    METHODS: This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses) at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data.

    RESULTS: Two main themes and three sub-themes emerged from this study. The main themes were (1) variation in the use of CPG and (2) barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations. Third, incorporate local CPG in professional training, link CPG adherence to key performance indicators and provide incentives for its use.

    CONCLUSIONS: Barriers to the use of CPG hypertension management span across all stakeholders. The development and implementation of CPG focused mainly on doctors with lack of involvement of other healthcare stakeholders. Guidelines should be made simple, current, reliable, accessible, inclusive of all stakeholders and with good policy support.

    Matched MeSH terms: Young Adult
  18. The effects of negative emotion on encoding-related neural activity predicting item and source recognition
    Yick YY, Buratto LG, Schaefer A
    Neuropsychologia, 2015 Jul;73:48-59.
    PMID: 25936685 DOI: 10.1016/j.neuropsychologia.2015.04.030
    We report here a study that obtained reliable effects of emotional modulation of a well-known index of memory encoding--the electrophysiological "Dm" effect--using a recognition memory paradigm followed by a source memory task. In this study, participants performed an old-new recognition test of emotionally negative and neutral pictures encoded 1 day before the test, and a source memory task involving the retrieval of the temporal context in which pictures had been encoded. Our results showed that Dm activity was enhanced for all emotional items on a late positivity starting at ~400 ms post-stimulus onset, although Dm activity for high arousal items was also enhanced at an earlier stage (200-400 ms). Our results also showed that emotion enhanced Dm activity for items that were both recognised with or without correct source information. Further, when only high arousal items were considered, larger Dm amplitudes were observed if source memory was accurate. Three main conclusions are drawn from these findings. First, negative emotion can enhance encoding processes predicting the subsequent recognition of central item information. Second, if emotion reaches high levels of arousal, the encoding of contextual details can also be enhanced over and above the effects of emotion on central item encoding. Third, the morphology of our ERPs is consistent with a hybrid model of the role of attention in emotion-enhanced memory (Pottage and Schaefer, 2012).
    Matched MeSH terms: Young Adult
  19. Should the threshold for expired-air carbon monoxide concentration as a means of verifying self-reported smoking abstinence be reduced in clinical treatment programmes? Evidence from a Malaysian smokers' clinic
    Wee LH, West R, Mariapun J, Chan CM, Bulgiba A, Peramalah D, et al.
    Addict Behav, 2015 Aug;47:74-9.
    PMID: 25889913 DOI: 10.1016/j.addbeh.2015.03.021
    BACKGROUND: It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success.
    METHODS: A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed.
    RESULTS: The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used.
    CONCLUSIONS: Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used.
    KEYWORDS: Carbon monoxide; Predictors for abstinence; Smoking cessation; Success rates
    Matched MeSH terms: Young Adult
  20. Fulltext A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine
    Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E
    BMC Med Educ, 2015;15:39.
    PMID: 25884717 DOI: 10.1186/s12909-015-0321-6
    BACKGROUND: Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.
    METHODS: A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.
    RESULTS: A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.
    CONCLUSIONS: BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.
    Matched MeSH terms: Young Adult
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