Displaying publications 141 - 160 of 164 in total

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  1. Tunbosun, Olawumi Edward, Rampal, Lekhraj, Hejar Abdul Rahman, Roslaini Abdul Majid
    MyJurnal
    Introduction: Worm infection is one of the major global public health problems especially among rural communities.
    Objectives: to determine the prevalence of intestinal worm infection and factors associated among Semai Aboriginal
    children aged between 6 to 13 years in Tapah, Malaysia. Methods: A cross-sectional study design was used in this
    study. The estimated sample size was 508. Data was collected using a validated pretested questionnaire. Faecal
    samples were also examined. Data was analysed using SPSS version 22. Results: The response rate was 80.9%.
    The overall mean age of the 411 respondents was 10.1 years(95% CI = 9.89, 10.22). Majority (71.5%) were poor.
    Prevalence of intestinal worm infections was 60.8% and 57.2% had multiple infections. The multiple logistic
    regression analysis showed that those with poor hygiene practices were 2.18 times the odds of worm infection
    when compared with children with good hygiene practices (95% CI = 1.4, 3.4). Similarly, poor attitudes towards
    prevention of worm infection increased the odds of having worm infection by 1.62 times among Orang Asli children.
    Children living without toilets had 2.45 times higher odds as compared with those who had proper toilets. Absence
    of river near by these areas where there is no safe water supply also increases the risk of worm infection among
    children by 1.84 times among Orang Asli children. Conclusions: the prevalence of worm infection is still very
    high among rural Aboriginal community. Current control measures should be reassessed to enable introduction of
    effective measures to reduce the worm infection among Orang Asli children.
    Matched MeSH terms: Sample Size
  2. Partap U, Young EH, Allotey P, Sandhu MS, Reidpath DD
    PMID: 30263138 DOI: 10.1017/gheg.2018.13
    Background: Integration of biomarker data with information on health and lifestyle provides a powerful tool to enhance the scientific value of health research. Existing health and demographic surveillance systems (HDSSs) present an opportunity to create novel biodata resources for this purpose, but data and biological sample collection often presents challenges. We outline some of the challenges in developing these resources and present the outcomes of a biomarker feasibility study embedded within the South East Asia Community Observatory (SEACO) HDSS.

    Methods: We assessed study-related records to determine the pace of data collection, response from potential participants, and feedback following data and sample collection. Overall and stratified measures of data and sample availability were summarised. Crude prevalence of key risk factors was examined.

    Results: Approximately half (49.5%) of invited individuals consented to participate in this study, for a final sample size of 203 (161 adults and 42 children). Women were more likely to consent to participate compared with men, whereas children, young adults and individuals of Malay ethnicity were less likely to consent compared with older individuals or those of any other ethnicity. At least one biological sample (blood from all participants - finger-prick and venous [for serum, plasma and whole blood samples], hair or urine for adults only) was successfully collected from all participants, with blood test data available from over 90% of individuals. Among adults, urine samples were most commonly collected (97.5%), followed by any blood samples (91.9%) and hair samples (83.2%). Cardiometabolic risk factor burden was high (prevalence of elevated HbA1c among adults: 23.8%; of elevated triglycerides among adults: 38.1%; of elevated total cholesterol among children: 19.5%).

    Conclusions: In this study, we show that it is feasible to create biodata resources using existing HDSS frameworks, and identify a potentially high burden of cardiometabolic risk factors that requires further evaluation in this population.

    Matched MeSH terms: Sample Size
  3. Wan Ahmad Hazim, Nur Hidayah Aeshah Ng, Salleha Khalid
    MyJurnal
    Minimally invasive surgery results in faster recovery. The objective of this study is to identify criteria for the feasibility of 24-hour discharge post laparoscopic ovarian cystectomy. This is a prospective cross-sectional study that was carried out at the Obstetrics and Gynaecology Department in Putrajaya Hospital between 1 January and 31 December, 2016. The inclusion criteria were: age between 15 and 45, no comorbidities, no family history of malignancy, BMI of less than 30, mass size less than 18 weeks, single uninoculated simple cyst and no ascites. The exclusion criteria were post-menopause women, known medical illness, family history of malignancy, mass size more than 18 weeks, multiloculated or bilateral ovarian cyst, presence of solid area within the cyst and ascites. The sample size was calculated to be 14. A total of 16 participants were identified. Results showed that using the Visual Analogue Score (VAS), the mean pain score post operatively in the first six hours, 24 hours, 48 hours, two weeks and three months were 3.67, 2.57, 0.5, 0 and 0, respectively. Two of the subjects experienced post-operative nausea and vomiting, one had urinary tract infection and one had minor bleeding from the surgical site. All the participants were discharged within 24 hours post-operatively. There was no readmission. In conclusion, 24-hour discharge post laparoscopic cystectomy is safe and feasible. Factors determining the success must be adhered to closely to ensure a good and satisfactory outcome. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
    Matched MeSH terms: Sample Size
  4. Zun AB, Ibrahim MI, Hamid AA
    Oman Med J, 2018 Sep;33(5):416-422.
    PMID: 30210721 DOI: 10.5001/omj.2018.76
    Objectives: Implemented in 2010, 1 Malaysia Clinic (1MC) is the latest innovation in public primary healthcare services in Malaysia to serve the urban population. This study aimed to assess the level of satisfaction and its associated factors using the SERVQUAL (SERV-service, QUAL-quality) instrument. We also sought to compare the difference of mean score between expectation and perception of SERVQUAL dimension among patients attending 1MC in Kota Bharu district, Malaysia.

    Methods: This cross-sectional study included all nine 1MCs in the Kota Bharu district, Malaysia, and used the validated SERVQUAL questionnaire from Ministry of Health, Malaysia. The primary data was collected in January 2017. The sample size was proportionate to the average daily patient attendance for each clinic, and a simple random sampling method was applied to reduced selection bias. Satisfaction level was determined by the mean gap score of expectation and perception of the SERVQUAL dimension.

    Results: A total of 386 patients were involved in this study (184 male and 202 female). Most were from the low socioeconomic group. Less than half of the patients were satisfied with the clinic services. The tangible dimension (service quality (SQ) gap: -0.25) was the most critical dimension among all five SQ dimensions assessed. The factors included low education level (adjusted odds ratio (adj. OR) 1.87; 95% confidence interval (CI): 1.06, 2.67; p = 0.024), monthly household income less than RM 3000 (adj. OR 2.97; 95% CI: 1.72, 5.51; p < 0.001), and frequency 3 3 visits (adj. OR 2.23; 95% CI: 1.44, 3.45; p < 0.001) had significant association with high level of satisfaction.

    Conclusion: 1MC has achieved its objective to increase the accessibility of health services among the low-income population in urban settings. However, most patients were not satisfied with certain parts of the services. Thus, proper evaluation of the service gap is required for improvement of the service.
    Matched MeSH terms: Sample Size
  5. Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S, Ahmad N, et al.
    PMID: 31114693 DOI: 10.1186/s40545-019-0169-y
    Objectives: Existing literature does not provide enough information on evaluation of factors associated with pre-dialysis controlled hypertension among euvolemic hemodialysis (HD) patients. We conducted a study to evaluate the rate and factors influencing pre-dialysis controlled hypertension among euvolemic HD patients.

    Design: A multicenter prospective follow-up study.

    Setting: Tertiary care teaching hospital and its associated private dialysis centers.

    Participants: This study included 145 euvolemic eligible hypertensive patients. Various sociodemographic, clinical factors and drugs were investigated and analyzed by using appropriate statistical methods to determine the factors influencing hypertension control among the study participants.

    Results: On baseline visit, the mean pre-dialysis systolic and diastolic BP (mmHg) of study participants was 161.2 ± 24. and 79.21 ± 11.8 retrospectively, and 30 (20.6%) patients were on pre-dialysis goal BP. At the end of the 6-months follow-up, the mean pre-dialysis systolic BP and diastolic BP (mmHg) of the patients was 154.6 ± 18.3 and 79.2 ± 11.8 respectively, and 42 (28.9%) were on pre-dialysis goal BP. In multivariate analysis, the use of calcium channel blockers (CCBs) was the only variable which had statistically significant association with pre-dialysis controlled hypertension at baseline (OR = 7.530, p-value = 0.001) and final (OR = 8.988, p-value size and longer follow up time is needed to confirm the findings of the current study.

    Matched MeSH terms: Sample Size
  6. Woon, L.S., Hazli Z., Gan, L.L.Y.
    MyJurnal
    Comorbid adult attention-deficit hyperactivity disorder (ADHD) and stimulant dependence is widely recognized, but efficacy of pharmacotherapy in this patient population is not well established. We aimed to review whether pharmacotherapy is efficacious in reducing ADHD symptoms and stimulant use in comorbid adult ADHD and stimulant use disorder. English articles until June 2017 were systematically searched in electronic databases (MEDLINE and PsycINFO), an online clinical trials register (ClinicalTrial.gov), and through hand-search of article references. Randomized, double-blind, placebo-controlled trials that studied efficacy of pharmacotherapy in adults with comorbid ADHD and stimulant dependence were included. Two reviewers assessed studies for inclusion and extracted data; disagreements were resolved by consensus. Study outcomes included were changes in ADHD symptom severity, substance abstinence, treatment retention rates and safety. From the 1394 records identified, five trials (n=358) were included. Four studies involved methylphenidate; in another study extended-release mixed amphetamine were used. The comorbid stimulant was cocaine in three studies, and amphetamines in the rest. All were short-term studies involving predominantly young male adults conducted in outpatient settings. There is early promising but mixed evidence for therapeutic efficacy in improving ADHD symptoms. Stimulant medications did not worsen stimulant dependence or adverse effects of stimulant medications. Side effects were mild and tolerable. High attrition rates and small sample size limited the generalizability of findings. Current limited evidence suggests that stimulant treatment for comorbid adult ADHD and stimulant dependence is feasible. Welldesigned trials with adequate power are needed for more robust evidence on ADHD and stimulant use outcomes.
    Matched MeSH terms: Sample Size
  7. Tee JYH, Gan WY, Lim PY
    BMJ Open, 2020 01 12;10(1):e032874.
    PMID: 31932391 DOI: 10.1136/bmjopen-2019-032874
    OBJECTIVE: To compare the performance of different anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and a body shape index to predict high blood pressure (BP) in adolescents using the 90th and 95th percentiles as two different thresholds.

    DESIGN: Cross-sectional study.

    SETTING: Probability proportionate to size was used to randomly select two schools in Selangor state, Malaysia.

    PARTICIPANTS: A total of 513 adolescents (58.9% women and 41.1% men) aged 12-16 years were recruited.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Weight, height, WC and BP of the adolescents were measured. The predictive power of anthropometric indices was analysed by sex using the receiver operating characteristic curve.

    RESULTS: BMI and WHtR were the indices with higher areas under the curve (AUCs), yet the optimal cut-offs to predict high BP using the 95th percentile were higher than the threshold for overweight/obesity. Most indices showed poor sensitivity under the suggested cut-offs. In contrast, the optimal BMI and WHtR cut-offs to predict high BP using the 90th percentile were lower (men: BMI-for-age=0.79, WHtR=0.46; women: BMI-for-age=0.92, WHtR=0.45). BMI showed the highest AUC in both sexes but had poor sensitivity among women. WHtR presented good sensitivity and specificity in both sexes.

    CONCLUSIONS: These findings suggested that WHtR might be a useful indicator for screening high blood pressure risk in the routine primary-level health services for adolescents. Future studies are warranted to involve a larger sample size to confirm these findings.

    Matched MeSH terms: Sample Size
  8. Zaki, R.A., Roffeei, S.N., Hazwan, A.E., Musa, N.
    JUMMEC, 2018;21(2):38-44.
    MyJurnal
    Objective: The study was designed to determine the risk perception of the public population in Kota Kinabalu towards childhood immunisation.
    Methodology: This was a cross-sectional study where self-administered questionnaires were distributed to the public in Kota Kinabalu. The respondents who consented were 18 years old and older. The illiterate persons and the foreigners were excluded. The calculated sample size was 400. Only 313 samples collected were suitable for analysis using SPSS v21.0.
    Results: Fever, pain swelling and allergic reaction were correctly identified as risks of immunisation. Autism, mental retardation and even death could also result from vaccination. Of the total respondents, 76.7% agreed with the practice of childhood vaccination, 70.0% thought that childhood vaccinations were safe and effective and 58.1% felt that its benefit outweighed the risk. Other than that, 32.0% refused childhood vaccination from fear of its risks, and this fear was the main reason for the refusal of childhood vaccination. Age, marital status, race and income were the factors which influenced parental willingness to vaccinate their children (p<0.05).
    Conclusions: Most participants understood the risks of childhood vaccination, but few agreed to the practice of childhood immunisation for herd immunity. Public health campaigns are needed, to increase the understanding and acceptance of childhood vaccination especially in the rural community.
    Keywords: Childhood Immunisation, Parental Risk, Perception, Public Acceptance
    Matched MeSH terms: Sample Size
  9. AL-Battawi, S., Hameed, S., Ng, E.S.C., Amini, F.
    JUMMEC, 2018;21(2):45-52.
    MyJurnal
    Graft-versus-host Disease (GVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic
    stem cell transplantation (alloHSCT). In spite of immune-suppressive prophylaxis, most survivors suffer from
    acute and chronic GVHD (aGVHD and cGVHD). The outcome of alloHSCT may be affected by the presence of
    single nucleotide polymorphism (SNP) in non-HLA genes including those involved in innate immune responses.
    This study aimed to evaluate the impact of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and caspase recruitment
    domain 15 (NOD2/CARD15) gene polymorphisms on the incidence and severity of aGVHD and cGVHD following
    alloHSCT. A structured literature review was carried out using various keywords and MESH terms such as
    stem cell transplantation, allogenic haematopoietic stem cell transplantation, GVHD, and non-HLA gene
    polymorphism, in PubMed, Google Scholar and Cochrane Database. A total of 8 studies that met inclusion
    criteria (English publications from 2006 to 2017) were included. Ten SNPs in CTLA-4 gene and three SNPs in
    NOD2/CARD15 gene were tested in patients with underlying haematological malignancies. Four studies tested
    the SNPs of CTLA-4 gene and two were found to have an association with CTLA-4 SNPs (rs3087243, rs231775)
    and increased incidence of aGVHD. The other four studies tested the SNPs of NOD2/CARD15 gene and one
    found an association between SNP13 and increased incidence of aGVHD. None of these eight studies found
    any effect on severity of GVHD. In conclusion, two SNPs in CTLA-4 and one SNP in NOD2/CARD15 increased
    the incidence of aGVHD but not its severity. The higher incidence of aGVHD in studies with larger sample size
    could support the impact of SNPs in the outcome of alloHSCT. However, due to the heterogeneity of studies in
    regard to the age of patients and donor, and conditioning regimen, it is difficult to draw a definite conclusion.
    Matched MeSH terms: Sample Size
  10. Punitan R, Sulaiman SA, Hasan HB, Shatriah I
    Cureus, 2019 Mar 27;11(3):e4332.
    PMID: 31186997 DOI: 10.7759/cureus.4332
    Introduction Pseudomonas aeruginosa is a common cause of microbial keratitis that can cause a significant loss of visual acuity. Antibiotics, including fluoroquinolones and aminoglycosides, are clinically effective against Pseudomonas-induced keratitis, but their effectiveness has been conspicuously reduced as resistant pathogens have become more potent. This study sought to evaluate the clinical and antibacterial effects of tualang honey as an alternative therapeutic agent against Pseudomonas-induced keratitis. Methods We conducted a randomized control trial in which 30 rabbits were injected intrastromally with 1,000 colony-forming units (CFU) of Pseudomonas aeruginosa in the right eye of each rabbit (n = 30). The rabbits were then randomized into three groups of 10 rabbits each. Group A was treated with topical gentamicin 0.3%, group B was treated with topical tualang honey 30%, and group C received both treatments. The specified treatments were administered every two hours from 24 to 48 hours post injection, and subsequently every four hours for six days. Clinical examinations were performed on days one, two, three, five, and seven, and the mean results of slit lamp examinations (SLEs) were documented. On day seven after pseudomonas induction, the rabbits were euthanized and their corneas were harvested to determine the median CFU per cornea. Results There were no statistically significant differences (p > 0.05) in mean SLE scores (p = 0.209) or median CFU values (p = 0.820) between the three groups. Conclusion Topical gentamicin, topical tualang honey, and the combination of the two all showed similar clinical and antimicrobial effects in treating Pseudomonas-induced keratitis in rabbits. These findings should be verified in further studies with larger sample sizes and the addition of a control group.
    Matched MeSH terms: Sample Size
  11. Salari N, Mohammadi M, Vaisi-Raygani A, Abdi A, Shohaimi S, Khaledipaveh B, et al.
    BMC Geriatr, 2020 02 03;20(1):39.
    PMID: 32013895 DOI: 10.1186/s12877-020-1444-0
    BACKGROUND: Depression is one of the most common psychiatric disorders in the older adult and one of the most common risk factors for suicide in the older adult. Studies show different and inconsistent prevalence rates in Iran. This study aims to determine the prevalence of severe depression in Iranian older adult through a meta-analysis approach.

    METHODS: The present meta-analysis was conducted between January 2000-August 2019. Articles related to the subject matter were obtained by searching Scopus, Sciencedirect, SID, magiran, Barakat Knowledge Network System, Medline (PubMed), and Google Scholar databases. The heterogeneity of the studies was evaluated using I2 index and the data were analyzed in Comprehensive Meta-Analysis software.

    RESULTS: In a study of 3948 individuals aged 50-90 years, the overall prevalence of severe depression in Iranian older adult was 8.2% (95% CI, 4.14-6.3%) based on meta-analysis. Also, in order to investigate the effects of potential factors (sample size and year of study) on the heterogeneity of severe depression in Iranian older adult, meta-regression was used. It was reported that the prevalence of severe depression in Iranian older adult decreased with increasing sample size and increasing years of the study, which is significantly different (P 

    Matched MeSH terms: Sample Size
  12. Damiani LP, Berwanger O, Paisani D, Laranjeira LN, Suzumura EA, Amato MBP, et al.
    Rev Bras Ter Intensiva, 2017 Apr-Jun;29(2):142-153.
    PMID: 28977255 DOI: 10.5935/0103-507X.20170024
    BACKGROUND: The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy).

    OBJECTIVE: To describe the data management process and statistical analysis plan.

    METHODS: The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes.

    CONCLUSION: According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results.

    TRIAL REGISTRATION: ClinicalTrials.gov number, NCT01374022.
    Matched MeSH terms: Sample Size
  13. Yap E, Law ZK, Aslan Abdullah NM, Abdul Wahid SF
    EXCLI J, 2017;16:1233-1248.
    PMID: 29285019 DOI: 10.17179/excli2017-805
    Patients with advanced aggressive B-cell non-Hodgkin lymphomas (NHL) are usually treated with rituximab in combination with chemotherapy. However, disease relapse rates are high. Radiotherapy (RT) has been shown to be efficacious in treating early-stage NHL but its role in advanced stage diseases is unclear. We performed a systematic review of randomized controlled trials (RCTs) comparing chemotherapy with RT to chemotherapy alone in patients with newly diagnosed advanced aggressive NHL. We searched online databases and pooled similar outcome estimates. For time-to-event outcomes, we estimated hazard ratios (HR) for overall survival (OS) and event-free survival (EFS) using the fixed-effect model. Two RCTs involving 254 patients met inclusion criteria. The trials were single-centre RCTs with follow-up period of five and ten years. Both trials were conducted in the pre-rituximab era. Patients treated with consolidation RT had better OS (HR for mortality 0.61; 95 % CI 0.38 to 0.97) and EFS (HR for mortality 0.67; 95 % CI 0.46 to 0.98) compared to those who received no RT. There was an apparent benefit of RT on local control (OR 0.09; 95 % CI 0.04 to 0.20); although this was estimated as a dichotomous rather than time-to-event outcome. Limited evidence shows benefits of consolidation RT in advanced aggressive NHL. However, we were not able to estimate the effect size with confidence due to small number of trials and sample size. We cannot recommend routine consolidation RT in advanced aggressive NHL. More RCTs with the inclusion of rituximab and PET-CT monitoring are needed.
    Matched MeSH terms: Sample Size
  14. Kesintha A, Rampal L, Sherina MS, Kalaiselvam T
    Med J Malaysia, 2018 02;73(1):31-40.
    PMID: 29531200 MyJurnal
    INTRODUCTION: Poor sleep quality among adolescents is becoming a major worldwide concern and is widely recognized as a significant public health issue.

    OBJECTIVES: To determine the prevalence and predictors of poor sleep quality among secondary school students in Gombak District, Selangor.

    METHODS: A cross-sectional study was conducted in Gombak District. The sample size was 1,092 based on two group comparison formula. Students were selected using sampling with probability to proportionate to size. Selfadministered pretested questionnaires were used to collect the data. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 22. Chi-square or Fisher's exact test was performed to determine the association between individual categorical variables and sleep quality. Variables with p-value <0.25 were selected to be subjected into multivariate logistic regression to determine the predictors.

    RESULTS: The response rate was 93.0%. The prevalence of poor sleep quality was 24.0% (95% CI = 21.5, 26.6). Based on the analysis of simple logistic regression seven variables that were significantly associated with poor sleep quality were age, gender, marital status of parents, depression, anxiety, stress and academic performance found fit in the model. Multivariate logistic analysis showed that the significant predictors of poor sleep quality were age, marital status of parents, depression, anxiety, stress and academic performance. Factors that were not statistically significant were gender, religion, ethnicity, parent's educational level and family income.

    CONCLUSIONS: Prevalence of poor sleep quality among adolescents is high. The predictors of poor sleep quality are age, marital status of parents, depression, anxiety, stress and academic performance.

    Matched MeSH terms: Sample Size
  15. Chan PY, Mohd Ripin Z, Abdul Halim S, Kamarudin MI, Ng KS, Eow GB, et al.
    Sci Rep, 2019 May 31;9(1):8117.
    PMID: 31148550 DOI: 10.1038/s41598-019-44142-1
    There is a lack of evidence that either conventional observational rating scale or biomechanical system is a better tremor assessment tool. This work focuses on comparing a biomechanical system and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale in terms of test-retest reliability. The Parkinson's disease tremors were quantified by biomechanical system in joint angular displacement and predicted rating, as well as assessed by three raters using observational ratings. Qualitative comparisons of the validity and function are made also. The observational rating captures the overall severity of body parts, whereas the biomechanical system provides motion- and joint-specific tremor severity. The tremor readings of the biomechanical system were previously validated against encoders' readings and doctors' ratings; the observational ratings were validated with previous ratings on assessing the disease and combined motor symptoms rather than on tremor specifically. Analyses show that the predicted rating is significantly more reliable than the average clinical ratings by three raters. The comparison work removes some of the inconsistent impressions of the tools and serves as guideline for selecting a tool that can improve tremor assessment. Nevertheless, further work is required to consider more variabilities that influence the overall judgement.
    Matched MeSH terms: Sample Size
  16. Stephenson NL, Das AJ, Condit R, Russo SE, Baker PJ, Beckman NG, et al.
    Nature, 2014 Mar 6;507(7490):90-3.
    PMID: 24429523 DOI: 10.1038/nature12914
    Forests are major components of the global carbon cycle, providing substantial feedback to atmospheric greenhouse gas concentrations. Our ability to understand and predict changes in the forest carbon cycle--particularly net primary productivity and carbon storage--increasingly relies on models that represent biological processes across several scales of biological organization, from tree leaves to forest stands. Yet, despite advances in our understanding of productivity at the scales of leaves and stands, no consensus exists about the nature of productivity at the scale of the individual tree, in part because we lack a broad empirical assessment of whether rates of absolute tree mass growth (and thus carbon accumulation) decrease, remain constant, or increase as trees increase in size and age. Here we present a global analysis of 403 tropical and temperate tree species, showing that for most species mass growth rate increases continuously with tree size. Thus, large, old trees do not act simply as senescent carbon reservoirs but actively fix large amounts of carbon compared to smaller trees; at the extreme, a single big tree can add the same amount of carbon to the forest within a year as is contained in an entire mid-sized tree. The apparent paradoxes of individual tree growth increasing with tree size despite declining leaf-level and stand-level productivity can be explained, respectively, by increases in a tree's total leaf area that outpace declines in productivity per unit of leaf area and, among other factors, age-related reductions in population density. Our results resolve conflicting assumptions about the nature of tree growth, inform efforts to undertand and model forest carbon dynamics, and have additional implications for theories of resource allocation and plant senescence.
    Matched MeSH terms: Sample Size
  17. El Hajj MS, Awaisu A, Kheir N, Mohamed MHN, Haddad RS, Saleh RA, et al.
    Trials, 2019 Jan 08;20(1):25.
    PMID: 30621772 DOI: 10.1186/s13063-018-3068-7
    BACKGROUND: Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar.

    METHODS/DESIGN: The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach.

    DISCUSSION: If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder.

    TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03518476 . Registered on 8 May 2018. Version 1/22 June 2018.

    Matched MeSH terms: Sample Size
  18. Lee YL, Lim YMF, Law KB, Sivasampu S
    Trials, 2020 Jun 16;21(1):530.
    PMID: 32546189 DOI: 10.1186/s13063-020-04349-4
    INTRODUCTION: There are few sources of published data on intra-cluster correlation coefficients (ICCs) amongst patients with type 2 diabetes (T2D) and/or hypertension in primary care, particularly in low- and middle-income countries. ICC values are necessary for determining the sample sizes of cluster randomized trials. Hence, we aim to report the ICC values for a range of measures from a cluster-based interventional study conducted in Malaysia.

    METHOD: Baseline data from a large study entitled Evaluation of Enhanced Primary Health Care interventions in public health clinics (EnPHC-EVA: Facility) were used in this analysis. Data from 40 public primary care clinics were collected through retrospective chart reviews and a patient exit survey. We calculated the ICCs for processes of care, clinical outcomes and patient experiences in patients with T2D and/or hypertension using the analysis of variance approach.

    RESULTS: Patient experience had the highest ICC values compared to processes of care and clinical outcomes. The ICC values ranged from 0.01 to 0.48 for processes of care. Generally, the ICC values for processes of care for patients with hypertension only are higher than those for T2D patients, with or without hypertension. However, both groups of patients have similar ICCs for antihypertensive medications use. In addition, similar ICC values were observed for clinical outcomes, ranging from 0.01 to 0.09. For patient experience, the ICCs were between 0.03 (proportion of patients who are willing to recommend the clinic to their friends and family) and 0.25 (for Patient Assessment of Chronic Illness Care item 9, Given a copy of my treatment plan).

    CONCLUSION: The reported ICCs and their respective 95% confidence intervals for T2D and hypertension will be useful for estimating sample sizes and improving efficiency of cluster trials conducted in the primary care setting, particularly for low- and middle-income countries.

    Matched MeSH terms: Sample Size
  19. Saleh Faidah H, Haseeb A, Yousuf Lamfon M, Mohammad Almatrafi M, Abdullah Almasoudi I, Cheema E, et al.
    BMC Pediatr, 2019 02 04;19(1):46.
    PMID: 30717737 DOI: 10.1186/s12887-019-1391-0
    BACKGROUND: Excessive and inappropriate antimicrobial use in the community is one risk factor that can result in the spread of antimicrobial resistance. Upper respiratory tract infections are most frequently reported among children and mainly of viral origin and do not require antibiotics. We have conducted Knowledge, Attitude and Perception (KAP) survey of parents to explore the parent's knowledge, attitude & perception of Saudi parents.

    METHODS: A knowledge attitude perception questioner was adopted from a previous study conducted in Greece by Panagakou et al. Raosoft online sample size calculator calculated the sample size by adding the total estimated Makkah population of 5,979,719 with a response rate of 30%, 5% margin of error and 99% confidence interval. Based on the described criteria five hundred & fifty-eight was the required sample size of the study. Incomplete questioners were excluded from the statistical analysis. SPSS version 21 was used to analyse data and to produce descriptive statistics.

    RESULTS: Most of the mothers (95%) responded among parents. 67% had no health insurance to cover medications costs. Most of them (74%) were related to medium income level. Seventy per cent of the parents believed physicians as a source of information for judicious antibiotics use. Interestingly, only 8% were agreed that most of the upper respiratory tract infections are caused by viral reasons. Majority of Saudi parents (53%) expect pediatricians to prescribe antimicrobials for their children for symptoms like a cough, nose discharge, sore throat and fever. Moreover, most the parents had the poor knowledge to differentiate commonly used OTC medications for URTI and antibiotics like Augmentin (Co-amoxiclav), Ceclor (cefaclor) and Erythrocin (Erythromycin). While comparing males and female's knowledge level, few males have identified Amoxil (Amoxicillin). Similarly, parents of age 20-30 years have good knowledge about the antibiotics.

    CONCLUSIONS: Majority of Saudi parents believe in pediatricians and use antibiotics on physician's advice. Most of them expect antibiotics from their physicians as a primary treatment for upper respiratory tract infections. There is need for more educational activities to parents by the pharmacists to prevent antibiotics overuse among children.

    Matched MeSH terms: Sample Size
  20. Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, et al.
    Int J Radiat Oncol Biol Phys, 2014 Nov 15;90(4):748-55.
    PMID: 25585779 DOI: 10.1016/j.ijrobp.2014.06.033
    We wanted to confirm the benefit of mometasone furoate (MF) in preventing acute radiation reactions, as shown in a previous study (Boström et al, Radiother Oncol 2001;59:257-265).
    Matched MeSH terms: Sample Size
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