Displaying publications 1 - 20 of 565 in total

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  1. Tiong, Xun Ting, Nur Sara Shahira Abdullah, Mohamad Adam Bujang, Fatin Ellisya Sapri, Selvasingam Ratnasingam, Chong, Kok Joon, et al.
    MyJurnal
    Objective: A quick assessment tool for screening individuals with depression or anxiety is pertinent in mental-health set up. This study aims to validate the K10 and the K6 to screen patients with non-specific
    psychological distress in a Malaysian population.

    Methods: Translation of the questionnaire was done from English to Malay. Face validity was conducted on patients, and a pilot study was performed to assess the reliability of the K10 questionnaire. Fieldwork was conducted to determine the reliability and validity of the K10 questionnaire based on convenience sampling of healthy individuals and patients diagnosed with psychiatric illness. Malay version for K10 was administered to healthy participants (group without psychological distress) and patients on psychiatric clinic follow up (psychological distress). Data collection was done between August 2016 and September 2016.

    Result: A total of 94 subjects were recruited in the study, of which 32 formed the case group. The Cronbach’s alpha coefficients for K10
    were 0.837(control) and 0.885 (case), as for K6 were 0.716 (control) and 0.859 (case). The total score of the
    K10 and the K6 clearly differentiated between the control and case groups (p

    Study site: Sarawak General Hospital
    Matched MeSH terms: Cohort Studies
  2. Bhupinder S, Kumara TK, Syed AM
    Med. J. Malaysia, 2010 Jun;65(2):123-6.
    PMID: 23756796
    This article describes the completed suicide patterns which occurred in the Timur Laut district of Penang Island, Malaysia. In a prospective cohort study over the three years period (2007-2009) there were 138 cases of suicide deaths. The number of suicide deaths for the year 2007, 2008 and 2009 were 45, 41 and 52 deaths, respectively. Majority of the suicide deaths were by jumping from height (47.1%), followed by hanging (34.1%) and by drowning (10.9%). The male victims outnumbered females in a 3 : 1 ratio.
    Matched MeSH terms: Cohort Studies
  3. Ho, S.E., Wan Ahmad, L., Tan, Z.Y., Ho, Christopher Ck, Nursharifah, M.S., Choy, Y.C., et al.
    Medicine & Health, 2015;10(1):58-65.
    MyJurnal
    Patient’s belief towards pain management may affect pain management outcomes and quality of life. The main aim of the present study was to determine the impact of a pre-operative pain education package towards pain belief among patients undergoing orthopaedic surgery in a tertiary hospital. A one-group pre-test post-test design study was conducted on orthopaedic surgery patients. Thirty respondents were recruited and pre-operative pain education was administered individually before surgery. Pre-operative and post-operative pain belief, management scores and side effects were measured using the Barrier Questionnaire (BQ-13). The results reported significant differences between pre-test scores (Mean = 41.87, Standard Deviation = 11.467) and post-test scores (Mean=34.80, Standard Deviation=13.026) of pain belief (t = 2.84, p = 0.004). There were also significant differences between pre-test scores (Mean = 37.10, Standard Deviation = 10.610) and post-test scores (Mean=30.80, Standard Deviation = 11.424) of pain management (t = 3.856, p = 0.0005). Respondent’s gender (t = -2.403, p = 0.023) and ethnicity (F = 5.038, p=0.014) reported significant differences with p value < 0.05, respectively. However, there were no significant differences between educational level, ethnicity, prior surgical history with pain belief (p> 0.05). There was positive impact of the pain education package towards pain belief and painmanagement among respondents who underwent orthopaedics surgery in a tertiary hospital. Reinforcement of pain educational program is pivotal in order to achieve optimal post-operative pain management.
    Keywords: pain, education, orthopaedics, patient, surgery
    Matched MeSH terms: Cohort Studies
  4. Abdollahi F, Zarghami M, Sazlina SG, Zain AM, Mohammad AJ, Lye MS
    Arch Med Sci, 2016 Oct 1;12(5):1043-1051.
    PMID: 27695496
    INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time.
    MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis.
    RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04).
    CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.
    KEYWORDS: depression; incidence; post-partum
    Matched MeSH terms: Cohort Studies
  5. Abdul Aziz AF, Ali MF, Yusof MF, Che' Man Z, Sulong S, Aljunid SM
    Sci Rep, 2018 Dec 19;8(1):17965.
    PMID: 30568180 DOI: 10.1038/s41598-018-36154-0
    Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p 
    Matched MeSH terms: Cohort Studies
  6. Ariffin F, Ahmad Zubaidi AZ, Md Yasin M, Ishak R
    Malays Fam Physician, 2015;10(1):26-33.
    PMID: 26425292 MyJurnal
    This audit report assessed the structure, processes and outcome of the pulmonary tuberculosis (PTB) management in adults conducted at eight government health clinics within the high TB burden Gombak district. All newly diagnosed PTB patients from November 2012 to November 2013 were identified from the tuberculosis registry. Patients less than 18 years old, were transferred out or extrapulmonary tuberculosis was excluded from the study. The assessment criteria for PTB were defined according to the latest Malaysian TB clinical practice guidelines (TB CPG) 2012. A total of 117 patients were included in this report and data were extracted and analysed using SPSS version 20.0. The mean age of patients was 40.4 ± 14.4 SD. Majority was men (63.2%). Out of 117 patients, 82.1% were Malaysian citizens and 17.9% were foreigners. Malays were the majority (65%) followed by 7.7% Chinese, 10.3% Indian and 17.1% others. The most common clinical feature was cough (88.0%) followed by loss of weight (58.1%), loss of appetite (57.3%), fever (56.4%), night sweat (30.8%) and haemoptysis (32.5%). Acid-fast bacilli (AFB) smear was positive in 94% of cases. Chest X-ray and human immunodeficiency virus (HIV) screening results were available for 89.1 and 82.1% cases respectively. The results for the sputum culture were available in 27.4% of patients and 54.7% were documented as done but pending results. The clinics have a successful directly observed therapy (DOT) program with 94.0% patients documented under DOT. Out of 53 patients on maintenance phase, 47.2% were identified as cured. Cure rate for those completed treatment was 100%. The defaulter rate was 17.1%. This audit demonstrated the attempt made by the clinics to adhere to the recommended guidelines. However, improvements are to be made in the documentation of medical records, tracing of investigation results and reduction of the number of defaulters.
    Matched MeSH terms: Cohort Studies
  7. Kheng CP, Rahman NH
    Int J Emerg Med, 2012;5(1):31.
    PMID: 22828152 DOI: 10.1186/1865-1380-5-31
    BACKGROUND: The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED.
    METHODS: This was a prospective observational study in a tertiary ED. One hundred three adults in shock with hypotension presenting to the ED were recruited into the study. They were grouped according to different types of shock, hypovolemic, cardiogenic, septic and others. Vital signs and ETCO2 were measured on presentation and at 30-min intervals up to 120 min. Blood gases and serum lactate levels were obtained on arrival. All patients were managed according to standard protocols and treatment regimes. Patient survival up to hospital admission and at 30 days was recorded.
    RESULTS: Mean ETCO2 for all patients on arrival was 29.07 ± 9.96 mmHg. Average ETCO2 for patients in hypovolemic, cardiogenic and septic shock was 29.64 ± 11.49, 28.60 ± 9.87 and 27.81 ± 7.39 mmHg, respectively. ETCO2 on arrival was positively correlated with systolic and diastolic BP, MAP, bicarbonate, base excess and lactate when analyzed in all shock patients. Early ETCO2 measurements were found to be significantly lower in patients who did not survive to hospital admission (p = 0.005). All patients who had ETCO2 ≤ 12mmHg died in the ED. However, normal ETCO2 does not ensure patient survival.
    CONCLUSION: The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
    Study site: Emergency department, Hospital Universiti Sains Malaysia
    Matched MeSH terms: Cohort Studies
  8. Azmawati M, Krisnan R
    Asian Pac. J. Cancer Prev., 2012;13(12):6023-6.
    PMID: 23464397
    The incidence of hepatocellular carcinoma (HCC) in Malaysia for the year 2001 was 2.8 per 100,000 people. The mortality rate is increasing. A retrospective cohort study measuring the survival of HCC patients who received treatment in Selayang Hospital was conducted from 1 January 2003 to 31 December 2006. The main objectives of the study were to measure the survival of the patients and to understand the influencing factors, especially ethnicity. The subjects were newly diagnosed cases of HCC by CT scan and histopathological assessment who underwent futher investigations and treatments in Hospital Selayang (inception cohort). The survival time was measured from the date of diagnosis until the subjects died, or failed to follow-up at the end of the study period (31 December 2007). A total of 299 patients were selected with 95 patients dying, the majority among Chinese (39.1%). Subgroup analysis according to ethnicity proved significantly that Chinese patients who had smaller tumor, less number of nodules, low AFP level, Child Pugh Class A and received surgical treatment had a better median survival rate compared to other ethnic groups. Malay (cHR: 1.3, 95%CI; 0.89-1.85) and Indian (cHR: 1.3, 95%CI; 0.74-2.26) patients had a poor survival compared to Chinese patients, but not in the final model. Therefore ethnicity may play a role in survival of HCC patients, but not as a main hazard prognostic factor.
    Matched MeSH terms: Cohort Studies
  9. Aziz, N.A., Nashrah, H., Fadilah A.Z., Ali, M.F., Zawawi, S., Katijah, A.
    Medicine & Health, 2011;6(2):114-122.
    MyJurnal
    Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.
    Study site: Combined Stroke Rehabiltation clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Cohort Studies
  10. Nik Muhamad NA, Kwong LJ
    Medicine & Health, 2016;11(1):22-28.
    MyJurnal
    The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit.
    Matched MeSH terms: Cohort Studies
  11. Muhamad Saiful Bahri Yusoff
    MyJurnal
    Introduction: The LA-i was found to be valid, reliable, simple and easy to be administered and consumed minimal time. However, to author knowledge, none of articles reported its stability across multiple observations. Realising its potential, continued research is required to optimize its role, usefulness and applicability as a tool to help educators to understand their students’ learning approaches. Objective: To determine stability of the LA-i to measure characteristics of students’ learning approaches at different time and occasions in a sample of medical students.Method: A prospective cohort study was done on 177 first year medical students. It was administered to a cohort of medical students at four different intervals. The Cronbach’s alpha and intra-class correlation analysis were applied to measure internal consistency and agreement level across the
    intervals. The analysis was done using SPSS 18. Result: A total of 157 (88.7%) first year medical students responded completely to the inventory. The overall Cronbach’s alpha value of the LA-i at different intervals ranged between 0.79 and 0.92, The Cronbach’s alpha values for surface learning
    approach subscale ranged between 0.65 and 0.80. The Cronbach’s alpha value for strategic learning approach subscale ranged between 0.76 and 0.84. The Cronbach’s alpha value for deep learning approach subscale ranged between 0.83 and 0.95. ICC values for the three learning approach subscales ranged between 0.46 and 0.50. Conclusion: This study reflected that the LA-i had high level of internal stability to measure students’ learning approaches at different time and occasions. Continued research is required to optimize its role, usefulness and applicability at various educational settings.
    Matched MeSH terms: Cohort Studies
  12. Hasanain Faisal Ghaz, Al-abed Ali Ahmed Al-abed, TibaNezar Hasan, Zaleha Md. Is, Mohammed A. AbdalQader, Saif Abdul-Majeed
    MyJurnal
    The association between nutrition and cancer in general had been a controversial issue between scientists in the last
    three decades, because some argued that there is a relationship and some nutrients can help in preventing cancer
    occurrence, although this has not been a consistent finding by other studies. Studies were identified through a
    systematic review of literature available on PubMed in between 1st January 2010 to 31st December 2013. We
    included all studies that assessed nutrition or diet with occurrence or mortality of breast cancer. Out of 42 articles,
    we included 8 articles in our screening and discussion. Among these 8 studies, there were 2 case-controls, 3 cohort
    and 3 randomized control trials (RCT) studies. Although most studies reported that nutrition isassociated with
    decreased risk, some reported the contrary,whereas others reported no relation. It was demonstrated a conflict
    between the included papers in regards of the association between nutrition and breast cancer. These finding needs
    to be re-evaluated in future studies.
    Matched MeSH terms: Cohort Studies
  13. Bergin PS, Beghi E, Sadleir LG, Brockington A, Tripathi M, Richardson MP, et al.
    Epilepsia Open, 2017 Mar;2(1):20-31.
    PMID: 29750210 DOI: 10.1002/epi4.12033
    Objective: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials.

    Methods: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification.

    Results: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70.

    Significance: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to participate in these investigator-led clinical trials.

    Matched MeSH terms: Cohort Studies
  14. Rashid Ali MR, Parameswaran U, William T, Bird E, Wilkes CS, Lee WK, et al.
    J Trop Med, 2015;2015:261925.
    PMID: 25838829 DOI: 10.1155/2015/261925
    Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of susceptibility results.
    Methods. Prospective study of adult outpatients with smear-positive pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the reference laboratory for clinical purposes during the study.
    Results. 176 outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in 159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB). Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate second-line regimen for varying durations (4.5-9 months). Median delay to commencement of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM.
    Conclusions. Current community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB.
    Study site: Tuberculosis clinic, Klinik Kesihatan Luyang, Kota Kinabalu, Sabah, Malaysia
    Matched MeSH terms: Cohort Studies
  15. Chan CM, Wan Ahmad WA, Md Yusof M, Ho GF, Krupat E
    Eur J Cancer Care (Engl), 2015 Nov;24(6):938-44.
    PMID: 25810106 DOI: 10.1111/ecc.12312
    Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds (P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival.
    Study site: Oncology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Cohort Studies
  16. Tan MP, Kamaruzzaman SB, Zakaria MI, Chin AV, Poi PJ
    Geriatr Gerontol Int, 2015 Jan 22.
    PMID: 25613422 DOI: 10.1111/ggi.12446
    METHODS: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department.
    RESULTS: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P 
    Matched MeSH terms: Cohort Studies
  17. Brand JS, Onland-Moret NC, Eijkemans MJ, Tjønneland A, Roswall N, Overvad K, et al.
    Hum. Reprod., 2015 Jun;30(6):1491-8.
    PMID: 25779698 DOI: 10.1093/humrep/dev054
    STUDY QUESTION: Do women who have diabetes before menopause have their menopause at an earlier age compared with women without diabetes?

    SUMMARY ANSWER: Although there was no overall association between diabetes and age at menopause, our study suggests that early-onset diabetes may accelerate menopause.

    WHAT IS KNOWN ALREADY: Today, more women of childbearing age are being diagnosed with diabetes, but little is known about the impact of diabetes on reproductive health.

    STUDY DESIGN, SIZE, DURATION: We investigated the impact of diabetes on age at natural menopause (ANM) in 258 898 women from the European Prospective Investigation into Cancer and Nutrition (EPIC), enrolled between 1992 and 2000.

    PARTICIPANTS/MATERIALS, SETTING, METHODS: Determinant and outcome information was obtained through questionnaires. Time-dependent Cox regression analyses were used to estimate the associations of diabetes and age at diabetes diagnosis with ANM, stratified by center and adjusted for age, smoking, reproductive and diabetes risk factors and with age from birth to menopause or censoring as the underlying time scale.

    MAIN RESULTS AND THE ROLE OF CHANCE: Overall, no association between diabetes and ANM was found (hazard ratio (HR) = 0.94; 95% confidence interval (CI) 0.89-1.01). However, women with diabetes before the age of 20 years had an earlier menopause (10-20 years: HR = 1.43; 95% CI 1.02-2.01, <10 years: HR = 1.59; 95% CI 1.03-2.43) compared with non-diabetic women, whereas women with diabetes at age 50 years and older had a later menopause (HR = 0.81; 95% CI 0.70-0.95). None of the other age groups were associated with ANM.

    LIMITATIONS, REASONS FOR CAUTION: Strengths of the study include the large sample size and the broad set of potential confounders measured. However, results may have been underestimated due to survival bias. We cannot be sure about the sequence of the events in women with a late age at diabetes, as both events then occur in a short period. We could not distinguish between type 1 and type 2 diabetes.

    WIDER IMPLICATIONS OF THE FINDINGS: Based on the literature, an accelerating effect of early-onset diabetes on ANM might be plausible. A delaying effect of late-onset diabetes on ANM has not been reported before, and is not in agreement with recent studies suggesting the opposite association.

    STUDY FUNDING/COMPETING INTERESTS: The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMMF) (Germany); Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC) and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and Wellcome Trust (UK). None of the authors reported a conflict of interest.

    Matched MeSH terms: Cohort Studies
  18. Thanimalai S, Shafie AA, Ahmad HM, Sinnadurai J
    Value Health, 2014 Nov;17(7):A487.
    PMID: 27201439 DOI: 10.1016/j.jval.2014.08.1428
    Objectives: Systematic anticoagulation management clinic is now recommended to manage warfarinized atrial fibrillation (AF) patient. In Malaysia, the service is recently introduced as pharmacist managed Warfarin Medication Therapy Adherence Clinic (WMTAC). The objective of the present study was to assess the cost effectiveness of anticoagulation clinic in comparison with usual medical in Kuala Lumpur Hospital.
    Methods: A Markov model built using the provider perspective and 20 year time horizon was used to assess the cost effectiveness. The base case analysis assumed a cohort of patients with AF 57 years of age with comorbid illnesses. Data sources include a 6 month retrospective cohort analysis of the effectiveness of the clinics, the cost of drugs, cost of personnel and space of the clinics, cost of monitoring and cost of adverse events were obtained from the local source and publications. The transition probabilities of these clinics outcomes were obtained from a literature search. Future costs were discounted by 3% to convert to present values. All costs were in Ringgit Malaysia (RM) based on year 2012.
    Results: The results of a 20-year period model showed that UMC was dominated by the WMTAC in the same time period. The mean cost of the WMTAC was RM 5864 whereas the UMC cost was RM 6550. The sensitivity analysis showed that clinic treatment costs and effectiveness influenced the cost-effectiveness. If the cost of WMTAC was increased by 50% of the current cost, the WMTAC would not be a dominant intervention. WMTAC was also cost effective for a willingness to pay of RM32000.
    Conclusions: The anticoagulation management service appears to cost less and provide greater effectiveness than usual care. In conclusion, the Markov model suggests that from the provider perspective the anticoagulation clinic is a more cost effective option than the usual medical clinic in Kuala Lumpur Hospital.
    Study site: Medication Therapy Adherence Clinic, Hospital Kuala Lumpur, Malaysia
    Matched MeSH terms: Cohort Studies
  19. Yusof AS, Isa ZM, Shah SA
    Asian Pac. J. Cancer Prev., 2012;13(9):4713-7.
    PMID: 23167408
    OBJECTIVES: This systematic review of cohort studies aimed to identify any association between specific dietary patterns and risk of colorectal cancer (CRC). Dietary patterns involve complex interactions of food and nutrients summarizing the total diet or key aspects of the diet for a population under study.

    METHODS AND MATERIALS: This review involves 6 cohort studies of dietary patterns and their association with colorectal cancer. An exploratory or a posteriori approach and a hypothesis-oriented or a priori approach were employed to identify dietary patterns.

    RESULTS: The dietary pattern identified to be protective against CRC was healthy, prudent, fruits and vegetables, fat reduced/diet foods, vegetables/fish/poultry, fruit/wholegrain/dairy, healthy eating index 2005, alternate healthy eating index, Mediterranean score and recommended food score. An elevated risk of CRC was associated with Western diet, pork processed meat, potatoes, traditional meat eating, and refined grain pattern.

    CONCLUSION: The Western dietary pattern which mainly consists of red and processed meat and refined grains is associated with an elevated risk of development of CRC. Protective factors against CRC include a healthy or prudent diet, consisting of vegetables, fruits, fish and poultry.
    Matched MeSH terms: Cohort Studies
  20. Song M, Rolland B, Potter JD, Kang D
    J Epidemiol, 2012;22(4):287-90.
    PMID: 22672913
    In this era of chronic diseases, large studies are essential in investigating genes, environment, and gene-environment interactions as disease causes, particularly when associations are important but not strong. Moreover, to allow expansion and generalization of the results, studies should be conducted in populations outside Western countries. Here, we briefly describe the Asia Cohort Consortium (ACC), a collaborative cancer cohort research project that was first proposed in 2004 and now involves more than 1 million healthy individuals across Asia. There are approximately 50 active members from Bangladesh, China, India, Japan, Korea, Malaysia, Singapore, Taiwan, Thailand, the United States, and elsewhere. To date, the work of the ACC includes 3 articles published in 2011 on the roles of body mass index, tobacco smoking, and alcohol consumption in mortality, diabetes, and cancer of the small intestine. Many challenges remain, including data harmonization, resolution of ethical and legal issues, establishment of protocols for biologic samples and transfer agreements, and funding procurement.
    Matched MeSH terms: Cohort Studies
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