Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries.

Importance: Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective: To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants: This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures: Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures: Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results: Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance: In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.

Adaptation, Translation and Validation of the Condom Use SelfEfficacy Scale (CUSES) Malay Version Among STD/HIV Patients in Primary Care

@#Introduction: Consistent condom use can reduce the rate of transmission of STD/HIV. Condom self-efficacy is an important determinant of consistent condom use. The Condom Use Self-Efficacy Scale (CUSES) assesses the individual's confidence and expectations to obtain, use, dispose and negotiate use of condom with their sexual partners. This study aimed to adapt, translate and determine the validity and reliability of CUSES Malay version among STD/ HIV patients in a primary care clinic. Methods: This was a cross sectional validation study conducted among STD/ HIV patients in a primary care clinic. The CUSES Malay version underwent content validation (calculation of I-CVI), forward and backward translation, face validation and field testing for psychometric analysis. Psychometric analysis used included Principal Axis Factoring with direct oblimin rotation, internal consistency reliability (Cronbach's α) and test-retest reliability analyses (Intraclass Correlation (ICC)). Results: A total of 168 participants were enrolled into this study (99% response rate). In content validation, all items were retained as the I-CVI were >1.00. Feedback from face validation resulted in simpler phrases of some items. One item (B2) was removed due to poor factor loading of <0.3. This resulted in 27 items framed within four factors. These factors were identified as Mechanics, Perceived Barriers, Assertiveness and Intoxicants. Reliability analysis achieved an overall Cronbach's α of 0.878 and ICC >0.4. Conclusion: The CUSES-M is a valid, reliable and stable tool to measure condom use self-efficacy among STD/HIV patients in primary care.

Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry.

BACKGROUND: Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women. METHODS: This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control. RESULTS: Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides. CONCLUSION: Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted.

Effective implementation of a structured psychoeducation programme among caregivers of patients with schizophrenia in the community.

BACKGROUND: Psychoeducation has shown promising benefits in managing patients with schizophrenia. In Malaysia, the use of psychoeducation is rather limited and its impact indeterminate. AIMS: To assess the effectiveness of a structured psychoeducation programme for the community in improving caregiver knowledge, decreasing caregivers' burden, reducing patients' readmission and defaulter follow up rates. METHOD: In a controlled interventional study, 109 caregivers were included, 54 and 55 in the intervention and control groups respectively. Caregivers were assessed at baseline, 3 and 6 months post-intervention for knowledge and burden. Patients were monitored for relapse and defaulting follow up in the clinic. RESULTS: Caregivers in the intervention group showed significant improvement in knowledge, reduction in burden in assistance in daily living (severity) and a reduced defaulter rate was seen in the patients' follow up. CONCLUSION: The findings shows that structured psychoeducation programme among caregivers has the potential to improve outcome of care for patients with schizophrenia.