Plain Packaging and Pictorial Warning in Asia Countries: Where are We?

@#Worldwide, around 8 million people die yearly due to tobacco usage. Cigarette smoking is the most popular form of tobacco usage. Smoking has linked to many detrimental health effects among adults and adolescents. Recognising the burden of smoking, World Health Organization have implemented various tobacco control strategies under the Framework Convention of Tobacco Control and mPOWER. This includes implementation of plain packaging and pictorial warning. In Asia, only Thailand, Singapore, Turkey, Saudi Arabia, and Israel have implemented plain cigarette pack. However, some countries have made progress to implement plain cigarette pack. Although some countries have not implemented plain pack, implementation of larger pictorial warning serve as a pathway for implementation of plain packaging. Countries with pictorial warning on cigarette pack should ensure it covers at least 50% of pack. Timor Leste has the largest pictorial warning on cigarette pack in the world. In conclusion, only 5 countries in Asia have implemented plain pack and some countries in this region are yet to implement size of pictorial warning according to requirement of World Health Organization. All countries should target to implement standardized pack to denormalise tobacco usage.

Smartphone Apps as a Technological Innovation for Weight Reduction: A Systematic Review & Meta-analysis

@#Introduction The new technological innovation can have a vast potential for interventions to help weight loss and combat obesity. The current meta-analysis aimed to compare the effectiveness of smartphone applications (apps) with other methods for promoting weight loss. Methods PubMed, Ovid and Science Direct were searched from 2014 all-inclusive up to May 2019 for relevant studies that assessed any smartphone/mobile phone app intervention with anthropometric measurement. Statistical analysis performed to examine mean difference (95% CI) of body weight, body mass index and waist circumference. Six articles were included for meta-analysis. Findings According to the results, compared with conventional or other interventions, smartphone app interventions showed statistically non-significant decreases in body weight, body mass index and waist circumference. Intervention through smartphone apps alone does not produce substantial evidence of weight loss, even though they might be useful for specific groups. Originality/value There remain prospects to explore regarding the use of smartphone apps in combination with other approaches to aid and promote weight loss, as smartphone use has been proven to influence health-related behavioural modification.

History of severe hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A comparative case control study / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH.@*Methodology@#We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD.@*Results@#A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029).@*Conclusion@#In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies / 예방의학회지

OBJECTIVES@#Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer.@*METHODS@#A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review.@*RESULTS@#Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19).@*CONCLUSIONS@#Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies / 예방의학회지

OBJECTIVES: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer. METHODS: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review. RESULTS: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19). CONCLUSIONS: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.

Tuberculosis Contact Tracing In Low- And Middle- Income Countries: A Systematic Review

Introduction Tuberculosis (TB) a major global health challenge especially in low- and middle-income countries reflects improper, delayed or missed diagnosis. Contact screening should be utilized both as an efficient and effective targeted approach to intensify TB case finding.Methods Through a comprehensive systematic literature review of online database, this paper aims at providing an insight into the current practice of TB contact screening and to provide evidence based practice for formulation of appropriate policies in low- and middle-income countries. There are 24 articles included in this review from studies published from 2005 to 2014.Results Findings in literature varies substantially. Generally, contact screening is better intensified with clear operational guidelines, adequate training, include close contact outside household as appropriate and follow up at least for 1 year. Prioritizing high risk close contacts is helpful in resource limited setting. Tuberculin skin test is still of value as screening tool and intensified case finding must be accompanied with effective management protocol. Prophylaxis treatment is recommended especially for children especially less than 5 years old, unvaccinated, malnourished, living with person having HIV and close contact with MDR-TB.Conclusion Policy recommendations in improving TB management must incorporate complementary strategies to enhance case finding, effective management protocol for follow up or prophylaxis treatment, training for public health capacity and concerted dedication from various stakeholders.

Acceptance Factors of Pneumococcal Vaccination among Adult Population: A Systematic Review

@#Pneumococcal disease causes considerable morbidity and mortality, including among adults. Adult pneumococcal vaccines help to prevent these burdens, yet, they are underutilized. Our objective is to systematically collect and summarize the available evidence on the potential factors that lead to pneumococcal vaccination acceptance among of adult community.

Mesenchymal Stromal Cells from the Maternal Segment of Human Umbilical Cord is Ideal for Bone Regeneration in Allogenic Setting

Umbilical cord (UC) is a discarded product from the operating theatre and a ready source of mesenchymal stromal cells (MSCs). MSCs from UC express both embryonic and adult mesenchymal stem cell markers and are known to be hypoimmunogenic and non-tumorigenic and thus suitable for allogeneic cell transplantation. Our study aimed to determine the degree of immunotolerance and bone-forming capacity of osteodifferentiated human Wharton's jelly-derived mesenchymal stromal cells (hWJ-MSCs) from different segments of UC in an allogenic setting. UCs were obtained from healthy donors delivering a full-term infant by elective Caesarean section. hWJ-MSCs were isolated from 3 cm length segment from the maternal and foetal ends of UCs. Three-dimensional fibrin constructs were formed and implanted intramuscularly into immunocompetent mice. The mice were implanted with 1) fibrin construct with maternal hWJ-MSCs, 2) fibrin construct with foetal hWJ-MSCs, or 3) fibrin without cells; the control group received sham surgery. After 1 month, the lymphoid organs were analysed to determine the degree of immune rejection and bone constructs were analysed to determine the amount of bone formed. A pronounced immune reaction was noted in the fibrin group. The maternal segment constructs demonstrated greater osteogenesis than the foetal segment constructs. Both maternal and foetal segment constructs caused minimal immune reaction and thus appear to be safe for allogeneic bone transplant. The suppression of inflammation may be a result of increased anti-inflammatory cytokine production mediated by the hWJ-MSC. In summary, this study demonstrates the feasibility of using bone constructs derived from hWJ-MSCs in an allogenic setting.

Faktor-Faktor yang Mempengaruhi Persepsi Ibu terhadap Kanak-Kanak dengan Kecacatan Klef

A study was conducted to determine the level of mothers' perception on children with cleft deformity and its associated factors This was a cross sectional study involving 110 mothers with children attending the Plastic And Reconstructive Surgery Clinic. Data was gathered from a face to face interview based on a questionnaire that assesses the level of perception and its associated factors. The level of perception was evaluated from a scoring method and divided into four domains namely psychosocial, care management, treatment and education. The level of perception was high in all four domains ranged from 62% for treatment and 80% for education. Factors that were significantly associated with the level of perception were ethnicity, religion, type of cleft deformity and level of information. Information regarding cleft deformity must be tailored toward mothers’ personal characteristics and type of cleft deformity to improve mothers' perception on this problem.

Bullying and truancy: Predictors to sexual practices among school-going adolescents in Malaysia – a crosssectional study

Introduction: Adolescents’ involvement in sexual practices are becoming a major public health concern in Malaysia. This study aims to determine the prevalence of sexual practices among Malaysian school-going adolescents and its predictive factors. Methods: A cross-sectional study was carried out from April 2012 till September 2012 among 16-year-old school adolescents from two different schools. They were selected through simple random sampling and these adolescents answered a self-administered questionnaire consisting of three sections i.e. socio-demography, risk-taking behaviours and family-adolescents relationship. Data were analysed using Pearson Chi-Square test while Simple Logistic Regression and Multiple Logistic Regression were applied to determine the predictive factors. Results: The prevalence of sexual practices among the adolescents was 30.1% in which they were either involved in pornography (26.8%), pre-sexual activities (8.5%) or premarital sex (2.9%). Six predictive factors associated with sexual practices among this age group were identified which were male (adjusted Odds Ratio (aOR) 2.7, 95% Confidence Interval (95%CI) 1.4 to 2.5), truancy (aOR 2.3, 95%CI 1.3 to 4.2), bully (aOR 3.5, 95%CI 1.7 to 7.3), hanging out (aOR 2.8, 95% 1.4 to 5.6), staying out late (aOR 3.2, 95%CI 1.5 to 6.8) and conflict with family (aOR 4.1, 95%CI 1.9 to 8.9). Discussion: Asian background differs from the western countries and findings of this study may suggest suitable intervention programmes that can prevent high-risk sexual practices among Asian school-going adolescents.

Impulse control behaviours in a Malaysian Parkinson’s disease population

Background: Impulse control behaviours are repetitive and excessive activities that may be subsyndromal and not fulfil the criteria for impulse control disorder. These activities have potential to negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence of impulse control behaviours and its associated features in Parkinson’s disease in our population. Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV. Eighty patients were enrolled and screened for impulse control behaviours using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse control behaviours among our cohort was 11.3%; the features significantly associated with it were higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage (p= 0.01). The commonest impulse control behaviour in our cohort was compulsive medication use (7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%). Conclusions: There is an association between impulse control behaviour and higher levodopa dosage in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of pathological gambling as compared to studies performed in the West.

High prevalence of diabetes in stroke patients and its association with lacunar infarction

Background & Objectives: The burden of stroke is increasing, in part due to increasing prevalence of diabetes mellitus. Given the high prevalence of diabetes in the Malaysian population (22.6%), we aimed to determine the prevalence of diabetes in our stroke population. We also aimed to study the stroke subtype associated with diabetes. We hypothesized that lacunar infarction would be more prevalent in diabetics. Methods: We retrospectively reviewed data of consecutive patients with acute ischaemic stroke admitted from October 2004 to December 2010 from our stroke registry. Demographic data, risk factors profile and stroke subtypes were reviewed and analyzed. Results: Eight hundred and fifty eight patients were identified from the registry. As high as 59.3% (n=509) of our patients were diabetics, of which 49.2% (n=422) had pre-existing diabetes and 10.1% (n=87) were newly diagnosed. Lacunar infarction was the commonest stroke subtype, comprising 60.6% (n=519) of all strokes. Diabetes was significantly associated with lacunar infarction (OR 1.5, CI 95% 1.16-2.01, p=0.003), particularly in those aged ≤ 55 years (OR 2.29, 95% CI 1.12-4.67) and HbA1C ≥ 6.5% (χ²=8.77, p=0.003). Conclusions: The prevalence of diabetes in our stroke patients is amongst the highest reported. Diabetes mellitus, particularly those with poor glycaemic control is strongly associated with lacunar infarction.

Effect of Internet-based Intervention on Obesity among Adolescents in Kuala Lumpur: A School-based Cluster Randomised Trial

Background: Co-morbidities in adulthood is a significant problem and is associated with obesity during adolescent. Methods: This 3-months randomised controlled trial was aimed at determining the effectiveness of having internet-based intervention (obeseGO!) toward obesity among adolescents in Kuala Lumpur. Forty seven students were assigned randomly to the obeseGO! (intervention) group for internet-based intervention i.e., information on healthy lifestyle and diet were provided via the internet. Fifty students were assigned to the control group, where pamphlets containing health education were provided to these students. The measurement of body mass index (BMI), waist circumference, and the body fat percentage was taken at baseline and after 12 weeks of intervention. Results: The multivariate analysis of variance (MANOVA) analysis found that obeseGO! had a small effect in reducing BMI, waist circumference and body fat percentage. Conclusion: The internet-based obesity intervention program may be an effective medium for promoting healthy diet and physical activity among the obese adolescents.

Sleep Duration Pattern among Workers in a Tertiary Institution

Sleep has played a very important role in maintaining our health with good living quality therefore the aim of this study is to determine the pattern of sleep duration, especially short sleep and its associated factors among workers in a tertiary institution. A cross-sectional study was conducted from January until May 2012 among 128 randomly selected Universiti Kebangsaan Malaysia Medical Centre (UKMMC) staffs. Data was collected using a guided standardized data sheet which consist of three sections; (1):sociodemographic &socioeconomic, (2): lifestyle and, (3): anthropometric measurement and sleep diary. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 20.0. Majority of the staffs had normal sleep duration (67.2%) followed by short sleep duration (26.6%) and long sleep duration (6.3%). Simple logistic regression analysis indicated that late night snacking was significantly related to short sleep (cOR=3.47, 95% CI: 1.12, 12.23, p=0.048). Adequate sleep is important to maintain one’s health. Steps can be taken to limit late night snacking in order to improve the sleep pattern in this study population.​

impact on family among Down syndrome children with early intervention

Child with Down's syndrome is an individual who is suitable and eligible to receive early intervention services. This study aimed to measure the family outcome among parents of Down syndrome children, on the impact of receiving early intervention and identify the factors influencing it. A cross sectional was conducted from April 2009 until January 2010 with a total of 125 parents of children with Down syndrome. There are five domains of family outcomes that has been studied which are understanding the strengths, abilities and special needs of children, knowing the rights and talk on children behalf, assisting the child to grow and learn, having a support system and be involved in the community. Children with Down syndrome aged four to 15 years was chosen as the respondents when they were accompanying their children in seven rehabilitation centers or during house visits. Family outcomes among parents of Down syndrome children who receive early intervention is better, 67.3 percent, compared to parents of Down syndrome children who receive late intervention, 41.4 percent. There are significant relationship between the acceptance level of intervention, parents education level, family income and the family outcomes. Parents of children who receive early intervention were more positive in understanding the strengths, abilities and special needs of their children compared to other family outcomes. Families whom children received early intervention had indirectly proved the importance and benefit of early intervention, not only for children with special needs, but for their family as well