Browse publications by year: 2017

  1. Citation: Consensus Guidelines on the Management of Epilepsy 2017. Epilepsy Council, Malaysia Society of Neuroscience.

    Older version: Citation: Consensus Guidelines on the Management of Epilepsy 2010. Epilepsy Council, Malaysia Society of Neuroscience.
    http://www.neuro.org.my/MSN_GUIDELINE/MSN_GUIDELINE_Consensus%20Guidelines%20on%20the%20Management%20of%20Epilepsy%202010.pdf
    Keywords: CPG
    MeSH terms: Anticonvulsants; Automobile Driving; Epilepsy*; Humans; Malaysia; Guidelines as Topic
  2. Obeng EM, Dullah EC, Razak NSA, Danquah MK, Budiman C, Ongkudon CM
    J Biol Methods, 2017;4(2):e71.
    PMID: 31453229 DOI: 10.14440/jbm.2017.172
    Endotoxin has been one of the topical chemical contaminants of major concern to researchers, especially in the field of bioprocessing. This major concern of researchers stems from the fact that the presence of Gram-negative bacterial endotoxin in intracellular products is unavoidable and requires complex downstream purification steps. For instance, endotoxin interacts with recombinant proteins, peptides, antibodies and aptamers and these interactions have formed the foundation for most biosensors for endotoxin detection. It has become imperative for researchers to engineer reliable means/techniques to detect, separate and remove endotoxin, without compromising the quality and quantity of the end-product. However, the underlying mechanism involved during endotoxin-biomolecule interaction is still a gray area. The use of quantitative molecular microscopy that provides high resolution of biomolecules is highly promising, hence, may lead to the development of improved endotoxin detection strategies in biomolecule preparation. Förster resonance energy transfer (FRET) spectroscopy is one of the emerging most powerful tools compatible with most super-resolution techniques for the analysis of molecular interactions. However, the scope of FRET has not been well-exploited in the analysis of endotoxin-biomolecule interaction. This article reviews endotoxin, its pathophysiological consequences and the interaction with biomolecules. Herein, we outline the common potential ways of using FRET to extend the current understanding of endotoxin-biomolecule interaction with the inference that a detailed understanding of the interaction is a prerequisite for the design of strategies for endotoxin identification and removal from protein milieus.
    MeSH terms: Antibodies; Endotoxins; Microscopy; Peptides; Recombinant Proteins; Spectrum Analysis; Biosensing Techniques; Fluorescence Resonance Energy Transfer
  3. Mat Nor ZM, Yusoff SBM, Abdul Rahim FA
    J Taibah Univ Med Sci, 2017 Aug;12(4):343-348.
    PMID: 31435261 DOI: 10.1016/j.jtumed.2017.01.003
    OBJECTIVE: Mentoring programmes are important elements of the personal and professional development of medical students. Mentors must focus on the real issues that students face during the mentoring process. This study explores the need for mentoring programmes for first-year medical students at the Universiti Sains, Malaysia (USM).

    METHODS: A qualitative case study was conducted with medical students who were in the early phases of their training. Purposive sampling was employed to select the study participants. Data collection was carried out using semi-structured interviews. The interviews were recorded and transcribed verbatim, and they were later analysed using NVivo 10 software and employing open coding, axial coding and selective coding techniques. Nine medical students participated in the study. To ensure trustworthiness of the data, member checks, an audit trail, the Cohen kappa index, and peer checking were utilized.

    RESULTS: Based on thematic analysis, four themes and seven categories were identified. Themes include soft skills, an academic overview, social skills and motivation from mentors. Categories include time management, study skills, communication skills, social adjustment, social activities, moral support and personal support.

    CONCLUSION: Results indicate that mentoring is essential to medical students in developing their identity and professional maturity. The effectiveness of the mentoring programme is supported by several factors that, as a whole, lead to the development of a professional graduate.

  4. Draman N, Mohamad N, Yusoff HM, Muhamad R
    J Taibah Univ Med Sci, 2017 Oct;12(5):412-417.
    PMID: 31435272 DOI: 10.1016/j.jtumed.2017.05.005
    Objectives: This study aimed to determine the association between decision making for breastfeeding practices and associated factors for exclusive breastfeeding practices among parents attending primary health care facilities.

    Methods: This cross-sectional study involved 196 parents who attended primary health care facilities in suburban Malaysia. A self-administered questionnaire was given to assess decision-making styles and factors associated with exclusive breastfeeding practices. Systematic random sampling was used for the non-exclusive breastfeeding group, and convenience sampling was used for the exclusive breastfeeding group. Multiple logistic regression analysis was conducted to determine the associated factors for exclusive breastfeeding practices.

    Results: We found an association between the mutual decision of parents on exclusive breastfeeding and exclusive breastfeeding practices. Previous exclusive breastfeeding experience, fathers' ages, mothers' occupations and mutual decisions had significant impact on exclusive breastfeeding practices.

    Conclusion: The important determinant for practising exclusive breastfeeding is parents' mutual decisions. Therefore, practitioners need to continuously educate and emphasize the fathers' role in the breastfeeding process.

    MeSH terms: Breast Feeding; Cross-Sectional Studies; Decision Making; Family Relations; Fathers; Female; Malaysia; Male; Mothers; Occupations; Primary Health Care; Surveys and Questionnaires; Logistic Models
  5. Sukeri S, Bakar RS, Othman A, Ibrahim MI
    J Taibah Univ Med Sci, 2017 Oct;12(5):424-429.
    PMID: 31435274 DOI: 10.1016/j.jtumed.2017.05.002
    Objectives: The present study aimed to determine the barriers that deter mothers of children with disabilities from attaining their unmet needs.

    Methods: In-depth interviews of 12 mothers of children with disabilities were conducted from November 2014 to January 2015 in Kelantan, Malaysia. The mothers were recruited by purposive sampling. Thematic analysis was used for identifying, analysing and reporting the data.

    Results: Barriers to the unmet needs among mothers of children with disabilities were found to stem from the mothers' expectation and further propagated by lack of support, the role of healthcare professionals in providing care, inappropriate policies and shortage of resources required for survival and maintaining care.

    Conclusions: Identification of the barriers to the attainment of unmet needs among mothers of disabled children is crucial for resolving the issue of unmet needs. Deeper understanding of these barriers may facilitate positive actions toward addressing the needs of these mothers and to alleviate the stress on mothers of disabled children. A concerted effort to coordinate services across all disciplines is required to dismantle these barriers by improving the provision of health care delivery and evaluation of welfare policies and services.
    MeSH terms: Child; Female; Health Resources; Humans; Long-Term Care; Malaysia; Mothers; Social Welfare; Disabled Children; Qualitative Research
  6. Sukeri S, Man NNN
    J Taibah Univ Med Sci, 2017 Dec;12(6):477-482.
    PMID: 31435282 DOI: 10.1016/j.jtumed.2017.05.009
    Objectives: This qualitative study aims to discover the factors that influenced the decisions of women who successfully escaped domestic violence by attaining a divorce.

    Methods: In-depth interviews were conducted with 17 women, ages 21-56 who were either divorced or currently in the process of getting divorced in Kelantan, Malaysia.

    Results: Several themes emerged, indicating the following five reasons for divorce: 1) reaching the point of ultimatum, 2) having adequate support pre- and post-divorce, 3) concern for children's welfare, 4) seeking financial independence, and 5) fear of harm.

    Conclusion: The identification of the driving factors for divorce may spark a change in our society's mindset to empower female divorcees and allow them to lead happy, abuse-free lives.

    MeSH terms: Child; Child Abuse; Child Welfare; Divorce; Fear; Female; Humans; Malaysia; Domestic Violence; Qualitative Research
  7. Ishak NH, Mohd Yusoff SS, Rahman RA, Kadir AA
    J Taibah Univ Med Sci, 2017 Dec;12(6):504-511.
    PMID: 31435286 DOI: 10.1016/j.jtumed.2017.03.008
    OBJECTIVES: Diabetes is a primarily self-manageable condition. Healthcare professionals usually offer education, treatment, and support, but patients themselves are responsible for the daily management of their condition. Increasing the effectiveness of self-management support may have a considerable impact on health care, especially for elderly people. The aim of this study was to describe diabetes self-care among elderly diabetics and to determine its associated factors.
    METHODS: This report describes a cross-sectional study involving 143 elderly diabetes patients in the outpatient department of the Hospital Universiti Sains Malaysia (HUSM). Self-care activities assessed in this study included dietary control, physical activity, self-monitoring of blood glucose, medication adherence, and situational related adherence behaviour, all of which were obtained using the validated Malay Elderly Diabetes Self-Care Questionnaire (MEDSCaQ).
    RESULTS: The mean (±SD) age of the subjects was 67.9 (±5.4) years old. A majority was Malay, with a mean HbA1c of 8.4 (±1.9). The mean diabetes self-care score was 26.5 (±8.0). Factors with a positive impact on diabetes self-care included being non-Malay (β = 5.275, p = 0.002), having family as care givers (β = 8.995, p = 0.004), having a higher level of family support (β = 0.159, p = 0.042), and possessing acceptable (β = 4.375, p = 0.001) or good knowledge of diabetes (β = 5.893, p = 0.004). The presence of neuropathy negatively impacted self-care, while diabetes nephropathy had a positive impact on self care (β = -4.053, p = 0.003).
    CONCLUSIONS: Elderly individuals with type 2 diabetes in HUSM have a moderate score of diabetes self-care practice based on the MEDSCaQ. Determinants for good diabetes self-care include race, social support, having care-takers during periods of illness, diabetes knowledge, and diabetic microvascular complications.
    Study site: outpatient department, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    MeSH terms: Aged; Ambulatory Care Facilities; Blood Glucose; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Nephropathies; Humans; Health Knowledge, Attitudes, Practice; Malaysia; Outpatients; Surveys and Questionnaires; Self Care; Social Support; Exercise; Caregivers; Medication Adherence
  8. Pau A, Omar H, Khan S, Jassim A, Seow LL, Toh CG
    Singapore Dent J, 2017 12;38:45-54.
    PMID: 29229074 DOI: 10.1016/j.sdj.2017.08.001
    BACKGROUND: To quantify participation in dental research activities in Malaysia, and investigate its association with socio-demographic and professional characteristics, and perceptions of research and development (R&D) culture.

    MATERIALS AND METHODS: Dental academics in Malaysian dental schools were invited to complete a questionnaire by email and post. The survey comprised questions on research activities in the past 12 months, socio-demographic and professional characteristics, and the R&D Culture Index. Principal components factor analysis was carried out to confirm the factor structure of the R&D Culture Index. Chi-square test was used to identify association of research activities with R&D culture, and socio-demographic and professional characteristics. Binary logistic regression was carried to identify predicators of research activities.

    RESULTS: Of 256 potential participants contacted, 128 (50%) useable responses were returned. Three R&D Culture factors accounting for 57.4% of variance were extracted. More positive perception of R&D Support was associated with Malaysians (0.025) and those employed in Government schools (0.017). R&D Skills and Aptitude were associated with older respondents (0.050), PhD qualification (0.014) and more years in academia (0.014). R&D Intention was associated with any of the socio-demographic characteristics. Thirty (23.4%) respondents reported a peer-review research publication in the past 12 months, which was associated with having a PhD (OR 12.79, CI 1.28-127.96), after adjustment in regression analyses.

    DISCUSSION: Postgraduate research training should be encouraged to promote participation in research activities. R&D culture did not appear to impact on research productivity. Other factors such as individual attitudinal interests should be studied.

    MeSH terms: Adult; Attitude of Health Personnel*; Clinical Competence; Cross-Sectional Studies; Efficiency; Female; Humans; Malaysia; Male; Perception; Surveys and Questionnaires; Research Support as Topic; Schools, Dental/organization & administration*; Organizational Culture*; Dental Research*; Intention
  9. Mulimani PS, Azmi MIB, Jamali NR, Basir NNBM, Soe HHK
    Singapore Dent J, 2017 12;38:71-77.
    PMID: 29229077 DOI: 10.1016/j.sdj.2017.09.002
    MeSH terms: Ethnic Groups*; Female; Humans; Malaysia; Male; Malocclusion/diagnosis; Malocclusion/ethnology*; Malocclusion/therapy; Orthodontics, Corrective; Young Adult
  10. Ahmad Zawawi A, Nasurdin AM
    Int J Nurs Sci, 2017 Jul 10;4(3):285-290.
    PMID: 31406754 DOI: 10.1016/j.ijnss.2017.03.009
    Purpose: This study sought to examine the relationship between team task features and team task performance. Team task performance revolved around the team's technical knowledge and the technical core activities of the organization. On the other hand, team task characteristics include task identity, task significance, and task interdependence.

    Methods: This study involved a total of 300 nursing teams (1436 individual nurses) from seven state hospitals in Peninsular Malaysia. Data were collected using two sets of questionnaires which were initially distributed to 320 teams. One set was given to the team members and another set was given to the team leaders. Of the 320 sets sent out, 300 sets were returned. Responses were then combined and aggregated to the team level to get the team's final score. Analyses of the hypotheses were done using Partial Least Squares (PLS) through assessment of the measurement and structural model.

    Results: Results from the path analysis revealed that of the three dimensions of team task attributes, only task significance was positively and significantly related to team task performance (β = 0.076, P > 0.05), while task identity (β = 0.076, P > 0.05) and task interdependence (β = -0.037, P > 0.05) were found unrelated to team task performance.

    Conclusions: This study demonstrated that task significance is important to predict team task performance. Task significance reflects meaningfulness and nobility of tasks, thus elevate the desire to perform better in each assigned task.

    MeSH terms: Hospitals, State; Leadership; Malaysia; Nursing, Team; Surveys and Questionnaires; Task Performance and Analysis; Least-Squares Analysis; Knowledge; Educational Personnel
  11. Cosset CCP, Edwards DP
    Ecol Appl, 2017 09;27(6):1932-1945.
    PMID: 28543995 DOI: 10.1002/eap.1578
    Selective logging is the most prevalent land-use change in the tropics. Despite the resulting degradation of forest structure, selectively logged forests still harbor a substantial amount of biodiversity leading to suggestions that their protection is the next best alternative to conserving primary, old-growth forests. Restoring carbon stocks under Reducing Emissions from Deforestation and Forest Degradation (REDD+) schemes is a potential method for obtaining funding to protect logged forests, via enrichment planting and liberation cutting of vines. This study investigates the impacts of restoring logged forests in Borneo on avian phylogenetic diversity, the total evolutionary history shared across all species within a community, and on functional diversity, with important implications for the protection of evolutionarily unique species and the provision of many ecosystem services. Overall and understorey avifaunal communities were studied using point count and mist netting surveys, respectively. Restoration caused a significant loss in phylogenetic diversity and MPD (mean pairwise distance) leaving an overall bird community of less total evolutionary history and more closely related species compared to unlogged forests, while the understorey bird community had MNTD (mean nearest taxon distance) that returned toward the lower levels found in a primary forest, indicating more closely related species pairs. The overall bird community experienced a significant loss of functional strategies and species with more specialized traits in restored forests compared to that of unlogged forests, which led to functional clustering in the community. Restoration also led to a reduction in functional richness and thus niches occupied in the understorey bird community compared to unlogged forests. While there are additional benefits of restoration for forest regeneration, carbon sequestration, future timber harvests, and potentially reduced threat of forest conversion, this must be weighed against the apparent loss of phylogenetic and functional diversity from unlogged forest levels, making the biodiversity-friendliness of carbon sequestration schemes questionable under future REDD+ agreements. To reduce perverse biodiversity outcomes, it is important to focus restoration only on the most degraded areas or at reduced intensity where breaks between regimes are incorporated.
    MeSH terms: Animals; Birds*; Borneo; Conservation of Natural Resources*; Malaysia; Forestry*; Biodiversity*
  12. Tewari D, Mocan A, Parvanov ED, Sah AN, Nabavi SM, Huminiecki L, et al.
    Front Pharmacol, 2017;8:690.
    PMID: 29026369 DOI: 10.3389/fphar.2017.00690
    [This corrects the article on p. 519 in vol. 8, PMID: 28848436.].
    MeSH terms: Humans
  13. Akimov SA, Volynsky PE, Galimzyanov TR, Kuzmin PI, Pavlov KV, Batishchev OV
    Sci Rep, 2017 09 22;7(1):12152.
    PMID: 28939906 DOI: 10.1038/s41598-017-12127-7
    Lipid membranes serve as effective barriers allowing cells to maintain internal composition differing from that of extracellular medium. Membrane permeation, both natural and artificial, can take place via appearance of transversal pores. The rearrangements of lipids leading to pore formation in the intact membrane are not yet understood in details. We applied continuum elasticity theory to obtain continuous trajectory of pore formation and closure, and analyzed molecular dynamics trajectories of pre-formed pore reseal. We hypothesized that a transversal pore is preceded by a hydrophobic defect: intermediate structure spanning through the membrane, the side walls of which are partially aligned by lipid tails. This prediction was confirmed by our molecular dynamics simulations. Conversion of the hydrophobic defect into the hydrophilic pore required surmounting some energy barrier. A metastable state was found for the hydrophilic pore at the radius of a few nanometers. The dependence of the energy on radius was approximately quadratic for hydrophobic defect and small hydrophilic pore, while for large radii it depended on the radius linearly. The pore energy related to its perimeter, line tension, thus depends of the pore radius. Calculated values of the line tension for large pores were in quantitative agreement with available experimental data.
    MeSH terms: Algorithms; Cell Membrane Permeability; Elasticity; Lipid Bilayers/chemistry*; Models, Biological; Phospholipids/chemistry; Thermodynamics; Porosity; Molecular Dynamics Simulation; Hydrophobic and Hydrophilic Interactions
  14. Wan Mohamad WM, Mohd Ashari NS, Wan AbHamid WZ
    Objective: We presented a case report, systemic lupus erythematosus (SLE) in a Malay boy. Interestingly, this case occurs in a boy, which is not so common because autoimmune disease usually occurs in female. Design: Case report. Methods: We highlighted a case of a boy with SLE who presented with clinical symptoms suggestive of SLE and fulfilled the criteria for SLE diagnosis. Results: The patient was successfully managed with antihypertensive, intravenous cyclophosphamide and oral prednisolone and respond well to the therapy. Conclusion: Systemic lupus erythematosus is a chronic autoimmune disease which rarely occurs in male. However we reported one such case which fulfilled the criteria for SLE. © 2017 Japan Health Sciences University & Japan International Cultural Exchange Foundation.
    MeSH terms: Azathioprine; Child; Coombs Test; Cyclophosphamide; Enalapril; Erythema; Fatigue; Fever; Leukocyte Count; Lupus Erythematosus, Systemic*; Lupus Nephritis; Malaysia; Malaysia/ethnology; Male; Partial Thromboplastin Time; Physical Examination; Prednisolone; Proteinuria; Urea; Urinalysis; International Normalized Ratio
  15. Bhaskar Raj N, Saha S, Saha S, Hashim HA, Mohd Zahir NEB, Huda F
    Background: This study was done to identify the problems associated with physical dysfunction in relation to proprioception in osteoarthrosis (OA) of knee. OA is a degenerative joint disorder, which commonly occurs in knee of middle aged and elderly patients, with a high prevalence rate amongst individuals with higher body-mass index. As the Community Orientated Program for Control of Rheumatic Diseases (COPCORD) reported that, 23% of Malaysians aging more than 55 yrs. and 39% of those aged more than 65 yrs. complained of sharp increase in knee pain.
    Materials and Methods: From a pool of six-hundred ninety-seven elderly individuals suffering from pain in knee, four-hundred forty-four individuals (two hundred fifty-three females and one-hundred ninety-one male patients) aging between fifty-six to sixty-five years were selected on the basis of Kellgren's (Grade - II) criteria of deficit in proprioception. Participants were subjected to assessment of body-composition analyses using the BOD-POD analyser. Extent of proprioception was evaluated by the Isokinetic device and problems associated with stiffness were evaluated by the 3D motion tracking system.
    Results: Following WOMAC assessment protocol, extent of difficulties associated with knee pain was evaluated. Regression analyses reports however revealed that, taller old individuals, if had higher BMI & higher extent of stiffness, were evident as having most difficulty in proprioception.
    Conclusion: Significance of perceived stiffness was evident, which in association with different metabolic indices emerged as significant predictor of deficient proprioception and related knee osteoarthrosis. © 2017 Japan Health Sciences University & Japan International Cultural Exchange Foundation.
    MeSH terms: Adult; Aged; Cross-Sectional Studies; Female; Malaysia; Male; Osteoarthritis, Knee*
  16. Golpich M, Amini E, Mohamed Z, Azman Ali R, Mohamed Ibrahim N, Ahmadiani A
    CNS Neurosci Ther, 2017 Jan;23(1):5-22.
    PMID: 27873462 DOI: 10.1111/cns.12655
    Neurodegenerative diseases are a heterogeneous group of disorders that are incurable and characterized by the progressive degeneration of the function and structure of the central nervous system (CNS) for reasons that are not yet understood. Neurodegeneration is the umbrella term for the progressive death of nerve cells and loss of brain tissue. Because of their high energy requirements, neurons are especially vulnerable to injury and death from dysfunctional mitochondria. Widespread damage to mitochondria causes cells to die because they can no longer produce enough energy. Several lines of pathological and physiological evidence reveal that impaired mitochondrial function and dynamics play crucial roles in aging and pathogenesis of neurodegenerative diseases. As mitochondria are the major intracellular organelles that regulate both cell survival and death, they are highly considered as a potential target for pharmacological-based therapies. The purpose of this review was to present the current status of our knowledge and understanding of the involvement of mitochondrial dysfunction in pathogenesis of neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS) and the importance of mitochondrial biogenesis as a potential novel therapeutic target for their treatment. Likewise, we highlight a concise overview of the key roles of mitochondrial electron transport chain (ETC.) complexes as well as mitochondrial biogenesis regulators regarding those diseases.
    MeSH terms: Animals; Organelle Biogenesis*; Histocompatibility Antigens/genetics; Histocompatibility Antigens/metabolism; Humans; Neurodegenerative Diseases/complications*; Neurodegenerative Diseases/metabolism*; Mitochondrial Diseases/etiology*
  17. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators
    Lancet, 2017 Sep 16;390(10100):1211-1259.
    PMID: 28919117 DOI: 10.1016/S0140-6736(17)32154-2
    BACKGROUND: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
    METHODS: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
    FINDINGS: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).
    INTERPRETATION: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
    FUNDING: Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
    Malaysian collaborators: School of Medicine, Xiamen University Malaysia Campus, Sepang, Malaysia (Y J Kim PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (R Sahathevan PhD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD)
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death/trends*; Child; Child, Preschool; Communicable Diseases/mortality; Female; Disabled Persons/statistics & numerical data*; Humans; Infant; Infant, Newborn; Male; Middle Aged; Global Health/statistics & numerical data; Wounds and Injuries/mortality; Incidence; Prevalence; Age Distribution; Sex Distribution; Young Adult; Global Burden of Disease/statistics & numerical data*
  18. GBD 2016 Causes of Death Collaborators
    Lancet, 2017 Sep 16;390(10100):1151-1210.
    PMID: 28919116 DOI: 10.1016/S0140-6736(17)32152-9
    BACKGROUND: Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.
    METHODS: We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.
    FINDINGS: The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.
    INTERPRETATION: The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.
    FUNDING: Bill & Melinda Gates Foundation.
    Malaysian collaborators: School of Medicine, Xiamen University Malaysia Campus, Sepang, Malaysia (Y J Kim PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (R Sahathevan PhD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD)
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death/trends*; Child; Child, Preschool; Communicable Diseases/mortality; Disasters/statistics & numerical data; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nutrition Disorders/mortality; Pregnancy; Pregnancy Complications/mortality; Socioeconomic Factors; Global Health/statistics & numerical data; Wounds and Injuries/mortality; Age Distribution; Young Adult; Global Burden of Disease/statistics & numerical data*
  19. Citation: The ninth report of the National Eye Database 2015. Goh PP, Salowi MA, Adnan TH, Sa'at N, editors. Kuala Lumpur: Clinical Research Centre; 2017
    MeSH terms: Eye Diseases; Humans; Malaysia; Registries
  20. Citation: Clinical Practice Guidelines: Management of Asthma in Adults. Putrajaya: Ministry of Health, Malaysia; 2017

    Quick Reference: http://www.acadmed.org.my/view_file.cfm?fileid=866
    Training Manual: http://www.acadmed.org.my/view_file.cfm?fileid=903

    Older version:
    Clinical Practice Guidelines for the Management of Adult Asthma. Kuala Lumpur: Ministry of Health, Malaysia; 2002
    Keywords: CPG
    MeSH terms: Adult; Asthma; Humans; Malaysia; Guidelines as Topic
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