Longitudinal Association between Sarcopenia and Cognitive Impairment among Older Adults in Rural Malaysia.

Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using bioelectrical impedance analysis. Generalized estimating equation (GEE) was used to determine the longitudinal association between sarcopenia and cognitive impairment, presented as relative risk (RR) and its 95% confidence interval. The prevalence of sarcopenia was 5.0% (95% CI 4.00-5.90), and severe sarcopenia was 3.60% (95% CI 2.84-4.31). Upon adjusting for covariates, older adults with sarcopenia have an 80 per cent increased risk of cognitive impairment compared to those without (RR 1.80; 95% CI 1.18-2.75). Similarly, severe sarcopenia was found to significantly increase the risk of cognitive impairment by 101 per cent in the adjusted model (RR 2.01; 95% CI 1.24-3.27). Our study showed that sarcopenia, severe sarcopenia, low physical activity, depressive symptoms, hearing impairment and chronic pain were associated with a higher risk of cognitive impairment among community-dwelling older adults. Therefore, early intervention to prevent sarcopenia, depressive symptoms, hearing impairment, chronic pain, and higher physical activity among older adults is recommended.

Impact of a Workplace Health Promotion Program on Employees' Blood Pressure in a Public University.

INTRODUCTION: Workplace health promotion is important in the prevention of non-communicable diseases among employees. Previous workplace health programs have shown benefits such as lowered disease prevalence, reduced medical costs and improved productivity. This study aims to evaluate the impact of a 6-year workplace health promotion program on employees' blood pressure in a public university. METHODS: In this prospective cohort study, we included 1,365 employees enrolled in the university's workplace health promotion program, a program conducted since 2008 and using data from the 2008-2013 follow-up period. Participants were permanent employees aged 35 years and above, with at least one follow up measurements and no change in antihypertensive medication during the study period. Baseline socio-demographic information was collected using a questionnaire while anthropometry measurements and resting blood pressure were collected during annual health screening. Changes in blood pressure over time were analyzed using a linear mixed model. RESULTS: The systolic blood pressure in the hypertension subgroup decreased 2.36 mmHg per year (p<0.0001). There was also significant improvement in systolic blood pressure among the participants who were at risk of hypertension (-0.75 mmHg, p<0.001). The diastolic blood pressure among the hypertensive and at risk subgroups improved 1.76 mmHg/year (p<0.001) and 0.56 mmHg/year (p<0.001), respectively. However, there was no change in both systolic and diastolic blood pressure among participants in the healthy subgroup over the 6-year period. CONCLUSION: This study shows that continuing participation in workplace health promotion program has the potential to improve blood pressure levels among employees.

Use of the united theory of acceptance and use of technology model to study information communication technology- adoption in five Saudi Arabian private hospitals

We conducted a multi-institutional case study to identify the issues associated with the adoption of information and communication technology (ICT) in five private care hospitals in the Kingdom of Saudi Arabia. We conducted interviews with 37 respondents primarily comprising IT professionals. We found that there were three determinants of behavioural intentions in this case study: organisation objectives, facilitating conditions and social influence where there are no effects of performance expectancy or effort expectancy. In all five cases, none of the moderators (age, gender, experience and voluntariness) in the original united theory of acceptance and use of technology model were considered critically important by IT professionals. In the present paper, all qualitative elements such as themes, patterns and overarching in the data were analysed to reach a conclusion. In addition, the various perspectives of using ICT are discussed.

Genetic associations of the INSIG2 rs7566605 polymorphism with obesity-related metabolic traits in Malaysian Malays.

A genome-wide association study showed that the tagging single nucleotide polymorphism (SNP) rs7566605 in the insulin-induced gene 2 (INSIG2) was associated with obesity. Attempts to replicate this result in different populations have produced inconsistent findings. We aimed to study the association between the rs7566605 SNP with obesity and other metabolic parameters in Malaysian Malays. Anthropometric and obesity-related metabolic parameters and DNA samples were collected. We genotyped the rs7566605 polymorphism in 672 subjects using real-time polymerase chain reaction. No significant associations were found between the rs7566605 tagging SNP of INSIG2 with obesity or other metabolic parameters in the Malaysian Malay population. The INSIG2 rs7566605 SNP may not play a role in the development of obesity-related metabolic traits in Malaysian Malays.

Socioeconomic consequences of the 2004 tsunami: policy implications for natural disaster management.

OBJECTIVE: The objective of the study is to assess the socioeconomic status of the households affected by the tsunami of 2004 & to determine the factors associated with the recovery of household economic status. METHODS: The study was conducted in tsunami-affected areas in Malaysia in 2010-2011. A total of 193 households were included in the survey. Multivariate logistic regression was performed to determine the factors related to the recovery of households' economic status. FINDINGS: Among 193 households, 37% were in a better condition, 40% were unchanged and 22% had not recovered. It took 2.2 years to get back to pre-disaster economic status. Factors leading to successful household economic recovery were "household resided in Sungai Petani", "belong to highest income quartile" and "age of household head". In contrast, "extended family type" and "unemployed household head" reduced the odds of recovery. Households which lost their fishing boats during the tsunami had less chance to recover their previous status. CONCLUSION: The findings of our study would be useful for policy consideration and planning of post disaster management in order to enhance the recovery of household economic status in the short period.

Method comparison studies in medicine

Most of important variables measured in medicine are in numerical forms or continuous in nature. New instruments and tests are constantly being developed for the purpose of measuring various variables, with the aim of providing cheaper, non-invasive, more convenient and safe methods. When a new method of measurement or instrument is invented, the quality of the instrument has to be assessed. Agreement and reliability are both important parameters in determining the quality of an instrument. This article will discuss some issues related to methods comparison study in medicine for the benefit of medical professional and researcher. METHOD: This is a narrative review and this article review the most common statistical methods used to assess agreement and reliability of medical instruments that measure the same continuous outcome. The two methods discussed in detail were the Bland-Altman Limits of Agreement, and Intra-class Correlation Coefficient (ICC). This article also discussed some issues related to method comparison studies including the application of inappropriate statistical methods, multiple statistical methods, and the strengths and weaknesses of each method. The importance of appropriate statistical method in the analysis of agreement and reliability in medicine is also highlighted in this article. CONCLUSION: There is no single perfect method to assess agreement and reliability; however researchers should be aware of the inappropriate methods that they should avoid when analysing data in method comparison studies. Inappropriate analysis will lead to invalid conclusions and thus validated instrument might not be accurate or reliable. Consequently this will affect the quality of care given to a patient.

Genetic association of SNPs in the FTO gene and predisposition to obesity in Malaysian Malays

The common variants in the fat mass- and obesity-associated (FTO) gene have been previously found to be associated with obesity in various adult populations. The objective of the present study was to investigate whether the single nucleotide polymorphisms (SNPs) and linkage disequilibrium (LD) blocks in various regions of the FTO gene are associated with predisposition to obesity in Malaysian Malays. Thirty-one FTO SNPs were genotyped in 587 (158 obese and 429 non-obese) Malaysian Malay subjects. Obesity traits and lipid profiles were measured and single-marker association testing, LD testing, and haplotype association analysis were performed. LD analysis of the FTO SNPs revealed the presence of 57 regions with complete LD (D’ = 1.0). In addition, we detected the association of rs17817288 with low-density lipoprotein cholesterol. The FTO gene may therefore be involved in lipid metabolism in Malaysian Malays. Two haplotype blocks were present in this region of the FTO gene, but no particular haplotype was found to be significantly associated with an increased risk of obesity in Malaysian Malays.

Genetic association of SNPs in the FTO gene and predisposition to obesity in Malaysian Malays.

The common variants in the fat mass- and obesity-associated (FTO) gene have been previously found to be associated with obesity in various adult populations. The objective of the present study was to investigate whether the single nucleotide polymorphisms (SNPs) and linkage disequilibrium (LD) blocks in various regions of the FTO gene are associated with predisposition to obesity in Malaysian Malays. Thirty-one FTO SNPs were genotyped in 587 (158 obese and 429 non-obese) Malaysian Malay subjects. Obesity traits and lipid profiles were measured and single-marker association testing, LD testing, and haplotype association analysis were performed. LD analysis of the FTO SNPs revealed the presence of 57 regions with complete LD (D' = 1.0). In addition, we detected the association of rs17817288 with low-density lipoprotein cholesterol. The FTO gene may therefore be involved in lipid metabolism in Malaysian Malays. Two haplotype blocks were present in this region of the FTO gene, but no particular haplotype was found to be significantly associated with an increased risk of obesity in Malaysian Malays.

Job strain among Malaysian office workers of a multinational company.

BACKGROUND: Information on job strain exposure among Malaysian workers in multinational companies is limited. AIMS: To investigate the prevalence and factors associated with high job strain among office workers of a multinational company in Malaysia. METHODS: A cross-sectional study was conducted in November 2007 among 470 eligible workers. Respondents self-administered the Job Content Questionnaire downloaded from the company's intranet. A median-split procedure was applied to create four groups according to the Job Demand-Control Model: active, passive, high and low job strain. Logistic regression models were used to investigate the associations between socio-demographic, occupational and psychosocial factors and high job strain. RESULTS: A total of 356 questionnaires were received (response rate 76%). Twenty-one per cent of respondents were in the high job strain group, 35% were in the passive group, whereas 26% and 17% of workers were in the low strain and active groups, respectively. After controlling for confounders, three factors were found to be associated with high job strain: male workers (adjusted OR 1.94, 95% CI 1.04-3.64), working >48 h per week (adjusted OR 2.51, 95% CI 1.44-4.39) and job insecurity (adjusted OR 1.14, 95% CI 1.02-1.27). One protective factor for high job strain was the scale 'created skill', which is part of skill discretion (adjusted OR 0.70, 95% CI 0.57-0.86). CONCLUSIONS: About one in five workers in this study experience high job strain. Work improvement measures include reducing long working hours and job insecurity and giving workers the opportunity to learn, use creativity and develop abilities.

The prevalence of enamel opacities in permanent teeth of 11-12 year-old school children in Kuala Lumpur, Malaysia.

OBJECTIVE: To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community. DESIGN: A cross-sectional descriptive survey of enamel opacities in 11-12 year-old schoolchildren. CLINICAL SETTING: A questionnaire survey and a clinical examination of erupted teeth using the Modified DDE Index was conducted on schoolchildren in randomly selected schools. PARTICIPANTS: 957 schoolchildren from government schools in Kuala Lumpur comprising the three major ethnic groups of Malay, Chinese and Indian children. MAIN OUTCOME MEASURES: The severity of enamel opacities was assessed by the extent of buccal surface involvement. Normative treatment need was based on severity of opacities. RESULTS: Enamel opacities were found in 90.7% of subjects and 47.2% of teeth. Malays have the highest prevalence with Chinese the least. Although ethnic differences is statistically significant (p < 0.01), the differences in prevalence between ethnicity is small. The most common type of defect was "diffuse opacities" (88.6% of subjects). Most subjects (70%) showed bilateral distribution of diffuse opacities indicating a systemic disturbance. Posterior teeth were twice more commonly affected (p < 0.05). The majority of opacities in anterior teeth (66.7%) were minor, involving less than 1/3 of the labial surface. Only 0.6% of the whole sample required some form of aesthetic intervention. CONCLUSION: Despite the high prevalence of enamel opacities, the degree of severity is very mild with only minimal aesthetic and public health concern.

Tooth mortality in smokers and nonsmokers in a selected population in Sana'a, Yemen.

BACKGROUND AND OBJECTIVE: Tobacco smoking has been shown to be a major risk factor for tooth loss. The present study was designed to examine tooth mortality and the patterns of tooth loss in smokers and nonsmokers over a wide age range in a selected population from Sana'a, Yemen. MATERIAL AND METHODS: A total of 2506 persons between the ages of 15 and 64 years were examined, and every permanent tooth was assessed. Missing teeth included both extracted and missing teeth. Individuals currently smoking one or more boxes of cigarettes (20 cigarettes) a day for 5 years were considered as smokers, whereas individuals with no smoking history were considered as nonsmokers. RESULTS: Smokers had a higher mean tooth loss than nonsmokers. The difference was statistically significant at p < 0.001. Mean tooth loss was significantly higher in smokers across all age groups, except for those in the 45-54 years age group. Smokers had a significantly higher mean upper tooth loss than nonsmokers. Tooth loss decreased from the incisors to the canines and then increased, with peak loss in the first molars. CONCLUSION: Tooth loss among smokers is significantly higher than among nonsmokers. The central incisors, lateral incisors and first molars were the most commonly missing teeth in smokers, compared with nonsmokers.

Using neural networks and just nine patient-reportable factors of screen for AMI.

The study investigated the effect of different input selections on the performance of artificial neural networks in screening for acute myocardial infarction (AMI) in Malaysian patients complaining of chest pain. We used hospital data to create neural networks with four input selections and used these to diagnose AMI. A 10-fold cross-validation and committee approach was used. All the neural networks using various input selections outperformed a multiple logistic regression model, although the difference was not statistically significant. The neural networks achieved an area under the ROC curve of 0.792 using nine inputs, whereas multiple logistic regression achieved 0.739 using 64 inputs. Sensitivity levels of over 90 per cent were achieved using low output threshold levels. Specificity levels of over 90 per cent were achieved using threshold levels of 0.4-0.5. Thus neural networks can perform as well as multiple logistic regression models even when using far fewer inputs.

How well can signs and symptoms predict AMI in the Malaysian population?

The aim of the study was to use data from an electronic medical record system (EMR) to look for factors that would help us diagnose acute myocardial infarction (AMI) with the ultimate aim of using these factors in a decision support system for chest pain. We extracted 887 records from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. We cleaned the data, extracted 69 possible variables and performed univariate and multivariate analysis. From the univariate analysis we find that 22 variables are significantly associated with a diagnosis of AMI. However, multiple logistic regression reveals that only 9 of these 22 variables are significantly related to a diagnosis of AMI. Race (Indian), male sex, sudden onset of persistent crushing pain, associated sweating and a history of diabetes mellitus are significant predictors of AMI. Pain that is relieved by other means and history of heart disease on treatment are important predictors of a diagnosis other than AMI. The degree of accuracy is high at 80.5%. There are 13 factors that are significant in the univariate analysis but are not among the nine significant factors in the multivariate analysis. These are location of pain, associated palpitations, nausea and vomiting; pain relieved by rest, pain aggravated by posture, cough, inspiration and exertion; age more than 40, being a smoker and abnormal chest wall and face examination. We believe that these findings can have important applications in the design of an intelligent decision support system for use in medical care as the predictive capability can be further refined with the use of intelligent computational techniques.

Are examination findings important in screening for angina in the Malaysian patient?

BACKGROUND: The objective of this study is to look at how well patient history and examination findings can be used in screening for angina. METHODS: A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. The data was cleaned; 69 possible variables were extracted, and univariate and multivariate analyses were performed. RESULTS: From the univariate analysis, it was found that 19 variables are significantly associated with a diagnosis of angina. However, multiple logistic regression reveals that only 11 of these 19 variables are significantly related to a diagnosis of angina. Chest pain aggravated by exertion, history of diabetes mellitus, and history of heart disease (regardless of whether on treatment or not) are significant predictors of angina. Sudden onset chest pain, pain that is persistent, pain relieved by other means, pain aggravated by inspiration, and findings of rhonchi are important predictors of a diagnosis other than angina. The degree of overall accuracy is high at 71.3%. There are eight factors which are significant in the univariate analysis but are not significant in the multivariate analysis. These are marital status, pain relieved by glyceryl trinitrate (GTN), pain relieved by rest, associated nausea, pain aggravated by posture, pain aggravated by cough, history of hypertension, and history of smoking. CONCLUSIONS: These findings suggest that examination findings do not play a significant role in screening for angina.

Information technology in health care--what the future holds.

In 1998, Malaysia opened its first hospital based on the "paperless and filmless" concept. Two are now in operation, with more to follow. Telemedicine is now being used in some hospitals and is slated to be the technology to watch. Future use of technology in health care will centre on the use of centralised patient databases and more effective use of artificial intelligence. Stumbling blocks include the enormous capital costs involved and difficulty in getting sufficient bandwidth to support applications on a national scale. Problems with the use of information technology in developing countries still remain; mainly inadequate skilled resources to operate and maintain the technology, lack of home-grown technology, insufficient experience in the use of information technology in health care and the attitudes of some health staff. The challenge for those involved in this field will not be in building new "paperless and filmless" institutions but in transforming current "paper and film-based" institutions to "paperless and filmless" ones and changing the mindset of health staff. Universities and medical schools must be prepared to respond to this new wave by incorporating elements of medical/health informatics in their curriculum and assisting governments in the planning and implementation of these projects. The experience of the UMMC is highlighted as an example of the difficulty of transforming a paper-based hospital to a "paperless and filmless" hospital.

IT usage, perceptions and literacy of medical students.

A cross-sectional study of medical students using a self-administered questionnaire was carried out in the Faculty of Medicine, University of Malaya, Malaysia from December 2000 to January 2001 to determine IT usage, perceptions and literacy of medical students. 366 of 653 (56.0%) students reported owning some type of personal computer. Students mainly used the computer to get onto the Internet, do word-processing and make presentations. Junior (Year One and Two) students and those who had used computers before entering university were more likely to use the Internet. Those who own computers were more likely to feel comfortable with software (OR 1.61, 95% CI: 1.09, 2.38). Students who use the Internet were more likely to perceive that IT facilitated their studies (OR 4.61, 95% CI: 2.35, 9.05). The highest self-reported IT skill was e-mailing followed by surfing the World Wide Web and word-processing. Male students and junior students had significantly higher self-reported IT literacy scores compared to female students and senior students. Significant predictors for an IT identifier score after adjusting for other variables were self-reported rating of computer knowledge, number of siblings, parents' income and gender.

Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy.

OBJECTIVES: The aim of this study was to determine whether the number connection test (NCT) times of a group of cirrhotic patients without clinically overt hepatic encephalopathy and a group of healthy patients without liver disease who were undergoing endoscopy were prolonged after sedation with short acting i.v. benzodiazepines. METHODS: All patients were administered the NCT in a standard fashion for 30 min before sedation for an upper GI endoscopy and then 2 h after sedation postprocedure. Two NCTs were carried out before and 2 h after sedation, and the mean of the tests pre- and postsedation calculated. Based on the upper limit of the 95% CI of the presedation NCT of patients without liver disease as the cut-off level for hepatic encephalopathy, the proportion of cirrhotic patients with subclinical encephalopathy before and after sedation were also determined. RESULTS: A total of 61 consecutive cirrhotic patients who underwent therapeutic upper GI endoscopy completed the study. The mean presedation NCT time was 43.5 s (95% CI = 39.0-48.1 s) and the mean postsedation NCT time 60.0 s (95% CI = 50.7-69.3 s). The difference between the mean pre- and postsedation NCT times was 16.4 s (95% CI = 9.8-23.1 s; p < 0.001). A total of 38 consecutive patients without clinical or biochemical evidence of liver disease who presented for upper GI endoscopy completed the NCT as described for the group of cirrhotic patients. The mean (+/- SD) baseline NCT time was 34.7+/-7.9 s (95% CI = 32.1-37.2 s), whereas the mean postsedation NCT time was 33.7+/-8.5 s (95% CI = 30.9-36.5 s). This difference was not statistically significant (p = 0.177). Using the upper limit of the 95% CI of the mean (37.4 s) of the presedation time in the patients without liver disease as the cut-off between normal and encephalopathy, the number of cirrhotic patients with abnormal presedation NCT times was 33 patients (54.1%), and this number rose to 46 patients (75.4%) after sedation with midazolam. This increase in proportion of cirrhotic patients with prolonged NCT time was statistically significant (p < 0.001).