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Determinants of multimorbidity in low- and middle-income countries: A systematic review of longitudinal studies and discovery of evidence gaps

Tan MMC, Barbosa MG, Pinho PJMR, Assefa E, Keinert AÁM, Hanlon C, et al.

Obes Rev, 2024 Feb;25(2):e13661.
PMID: 38105610 DOI: 10.1111/obr.13661

Multimorbidity-the coexistence of at least two chronic health conditions within the same individual-is an important global health challenge. In high-income countries (HICs), multimorbidity is dominated by non-communicable diseases (NCDs); whereas, the situation may be different in low- and middle-income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population-based or community-dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre-defined search terms and selection criteria, complemented by hand-searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle-Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full-text articles included for review, 8 longitudinal population-based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3-16 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio-economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally.

Matched MeSH terms: Longitudinal Studies
Riparian reserves within oil palm plantations conserve logged forest leaf litter ant communities and maintain associated scavenging rates

Gray CL, Lewis OT, Chung AY, Fayle TM

The Journal of applied ecology, 2015 Feb;52(1):31-40.
PMID: 25678717

The expansion of oil palm plantations at the expense of tropical forests is causing declines in many species and altering ecosystem functions. Maintaining forest-dependent species and processes in these landscapes may therefore limit the negative impacts of this economically important industry. Protecting riparian vegetation may be one such opportunity; forest buffer strips are commonly protected for hydrological reasons, but can also conserve functionally important taxa and the processes they support.We surveyed leaf litter ant communities within oil palm-dominated landscapes in Sabah, Malaysia, using protein baits. As the scavenging activity of ants influences important ecological characteristics such as nutrient cycling and soil structure, we quantified species-specific rates of bait removal to examine how this process may change across land uses and establish which changes in community structure underlie observed shifts in activity.Riparian reserves had similar ant species richness, community composition and scavenging rates to nearby continuous logged forest. Reserve width and vegetation structure did not affect ant species richness significantly. However, the number of foraging individuals decreased with increasing reserve width, and scavenging rate increased with vegetation complexity.Oil palm ant communities were characterized by significantly lower species richness than logged forest and riparian reserves and also by altered community composition and reduced scavenging rates.Reduced scavenging activity in oil palm was not explained by a reduction in ant species richness, nor by replacement of forest ant species by those with lower per species scavenging rates. There was also no significant effect of land use on the scavenging activity of the forest species that persisted in oil palm. Rather, changes in scavenging activity were best explained by a reduction in the mean rate of bait removal per individual ant across all species in the community.Synthesis and applications. Our results suggest that riparian reserves are comparable to areas of logged forest in terms of ant community composition and ant-mediated scavenging. Hence, in addition to protecting large continuous areas of primary and logged forest, maintaining riparian reserves is a successful strategy for conserving leaf litter ants and their scavenging activities in tropical agricultural landscapes.

Matched MeSH terms: Longitudinal Studies
Fulltext Use of pilot plant scale continuous fryer to simulate industrial production of potato chips: thermal properties of palm olein blends under continuous frying conditions

Tarmizi AH, Ismail R

Food Sci Nutr, 2014 Jan;2(1):28-38.
PMID: 24804062 DOI: 10.1002/fsn3.76

Binary blends of palm olein (PO) with sunflower oil (SFO), canola oil (CNO), and cottonseed oil (CSO) were formulated to assess their stability under continuous frying conditions. The results were then compared with those obtained in PO. The oil blends studied were: (1) 60:40 for PO + SFO; (2) 70:30 for PO + CNO; and (3) 50:50 for PO + CSO. The PO and its blends were used to fry potato chips at 180°C for a total of 56 h of operation. The evolution of analytical parameters such as tocols, induction period, color, p-anisidine value, free fatty acid, smoke point, polar compounds, and polymer compounds were evaluated over the frying time. Blending PO with unsaturated oils was generally proved to keep most qualitative parameters comparable to those demonstrated in PO. Indeed, none of the oils surpassed the legislative limits for used frying. Overall, it was noted that oil containing PO and SFO showed higher resistance toward oxidative and hydrolytic behaviors as compared to the other oil blends.

Matched MeSH terms: Longitudinal Studies
Fulltext Genetic and environmental effects on age at menarche, and its relationship with reproductive health in twins

Jahanfar S, Lye MS, Krishnarajah IS

Indian J Hum Genet, 2013 Apr;19(2):245-50.
PMID: 24019629 DOI: 10.4103/0971-6866.116127

INTRODUCTION: Menarche or first menstrual period is a landmark in reproductive life span and it is the most prominent change of puberty. The timing of menarche can be under the influence of genes as well as individual environmental factors interacting with genetic factors.
OBJECTIVE: Our study objectives were (a) to investigate the heritability of age of menarche in twins, (b) to obtain the association between age of menarche and childhood factors, and reproductive events/behavior, (c) to examine whether or not having a male co-twin affects early/late menarche.
METHODOLOGY: A group of female-female identical (n = 108, 54 pairs), non-identical twins (n = 68, 34 pairs) and 17 females from opposite-sex twin sets were identified from twin registries of Malaysia and Iran. Genetic analysis was performed via two methods of Falconers' formula and maximum likelihood.
RESULTS: Heritability was found to be 66% using Falconers' formula and 15% using univariate twin analysis. Model analysis revealed that shared environmental factors have a major contribution in determining the age of menarche (82%) followed by non-shared environment (18%).
DISCUSSION: Result of this study is consistent with that of the literature. Timing of menarche could be under the influence of shared and non-shared environmental effects. Hirsutism was found to have a higher frequency among subjects with late menarche. There was no significant difference in age of menarche between females of opposite-sex twins and females of same-sex twins.
CONCLUSION: It is concluded that twin models provide a powerful means of examining the total genetic contribution to age of menarche. Longitudinal studies of twins may clarify the type of environmental effects that determine the age of menarche.

Matched MeSH terms: Longitudinal Studies
Fulltext Data of continuous harvest of stem cells via partial detachment from thermoresponsive nanobrush surfaces

Yeh CC, Muduli S, Peng IC, Lu YT, Ling QD, Alarfaj AA, et al.

Data Brief, 2016 Mar;6:603-8.
PMID: 26909373 DOI: 10.1016/j.dib.2015.12.056

This data article contains two figures and one table supporting the research article entitled: "Continuous harvest of stem cells via partial detachment from thermoresponsive nanobrush surface" [1]. The table shows coating conditions of three copolymers, poly(styrene-co-acrylic acid) grafted with oligovitronectin, poly(styrene-co-N-isopropylacrylamide) and poly(styrene-co-polyethylene glycol methacrylate) to prepare thermoresponsive surface. XPS spectra show the nitrogen peak of the polystyrene surface coated with poly(styrene-co-acrylic acid) grafted with oligovitronectin. The surface coating density analyzed from sorption of poly(styrene-co-acrylic acid) grafted with oligovitronectin by UV-vis spectroscopy is also presented.

Matched MeSH terms: Longitudinal Studies
Pollination biology in a lowland dipterocarp forest inSarawak, Malaysia. I. Characteristics of the plant-pollinator communityin a lowland dipterocarp forest

Momose K, Yumoto T, Nagamitsu T, Kato M, Nagamasu H, Sakai S, et al.

Am J Bot, 1998 Oct;85(10):1477-501.
PMID: 21684899

Flowerings and flower visitors were observed continuously in alowland dipterocarp forest in Sarawak, Malaysia, for 53 mo in1992-1996. Flower visitors of 270 plant species were observed orcollected, and pollinators were assessed by observing body contact tostigmas and anthers. We recognized 12 categories of pollination systems.Among them, plants pollinated by social bees included the largest numberof species (32%) and were followed by beetle-pollinated species(20%). Pollination systems were significantly related with somefloral characters (flowering time of day, reward, and floral shape), butnot with floral color. Based on the relationships between pollinatorsand floral characters, we described pollination syndromes found in alowland dipterocarp forest. The dominance of social bees and beetlesamong pollinators is discussed in relation to the general floweringobserved in dipterocarp forests of West Malesia. In spite of high plantspecies diversity and consequent low population densities of lowlanddipterocarp forests, long-distance-specific pollinators were uncommoncompared with theNeotropics.

Matched MeSH terms: Longitudinal Studies
A longitudinal study of serum iron indices and haemoglobin concentration following copper-IUD insertion

Goh TH, Hariharan M, Tan CH

Contraception, 1980 Oct;22(4):389-95.
PMID: 7449387

The increase in menstrual blood loss associated with copper-bearing IUDs may cause or aggravate pre-existing anaemia. In order to evaluate this risk, 84 Malaysian women wearing copper-IUDs were studied longitudinally by means of serial measurements of blood haemoglobin concentration (Hb), serum iron (S/Fe) and transferrin saturation (T/S). The initial Hb was under 12 gm% in 33.7% of patients. The mean Hb showed no significant change up to 12 months while S/Fe fell significantly at the end of this time; the T/S was significantly reduced as early as 6 months post-insertion. There is a significant risk of anaemia following copper-IUD insertion, particularly with long-term usage. Progestogen-releasing IUDs may offer the most feasible solution to this problem in our local context since oral medication with iron or drugs to reduce menstrual blood loss is not practicable.

Matched MeSH terms: Longitudinal Studies
Fulltext Internalized stigma among urban tuberculosis patients in Selangor: the prediction

Qudsiah Suliman, Salmiah Md. Said, Lim Poh Ying, Nor Afiah Mohd. Zukefli, Tan Kit-Aun, Alif Ramli, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):60-60.
MyJurnal

Introduction: Evidently, stigma has potentially prompted the negative outcome in Tuberculosis (TB) control through delayed diagnosis and poor adherence to treatment. Amidst accelerating treatment interruption in Selangor, little attention is paid to the quantitative assessment of stigma, thus warrant further characterisation of TB stigma in ur-ban districts, Selangor. This study aimed to determine the predictors of internalised stigma among newly diagnosed PTB smear positive in urban districts, Selangor. Methods: A multi-centric longitudinal study recruited 345 newly diagnosed PTB smear positive patients who started TB treatment from November 2018 until June 2019. Baseline assessments utilised pre-tested self-administered questionnaire and standardised data collection form. Using IBM SPSS version 25.0, multiple linear regression was computed to determine the predictors. Results: The response rate was 84.7% with most of respondents were married and attained educational level up to secondary school. Other than low mean score of social support [mean (SD)=33.39(5.86)], the prominent findings were lacking knowledge of anti-TB side effect and wrongly perceived damaging effect of anti-TB drug to internal organ. The mean internalised stigma score was 24.88 (SD=4.70), which predicted by age, educational level (no formal education), employment status (retiree), alternative medicine practice, baseline symptoms score, perceived barrier, and social support, with entire group of variables significantly predicted TB stigma (F [9, 331] =21.476, p

Matched MeSH terms: Longitudinal Studies
Fulltext Hemicrania Continua With Scintillating Scotoma: A Rare Presentation

Hussein A, Han Shu T, Chong MF, Cheah CF

Cureus, 2020 Sep 27;12(9):e10680.
PMID: 33133846 DOI: 10.7759/cureus.10680

Headache can be a primary or secondary disorder. The characteristics of headache and its associated features, especially the presence of red flag signs, are important in distinguishing secondary from primary causes. Hemicrania continua is a type of primary headache disorder characterized by a continuous unilateral headache with episodes of exacerbations and association with cranial autonomic symptoms, which include several ocular symptoms. The absolute response to indomethacin remains the hallmark of this disease. We would like to report a rare case of hemicrania continua with scintillating scotoma during exacerbations apart from the typical autonomic features of conjunctival injection, ptosis, eyelid edema, and lacrimation.

Matched MeSH terms: Longitudinal Studies
Fulltext Fighting from the COVID-19 Frontline: A Junior Doctor's Perspective on Fear, Duty and Calling

Rasappan K, Oh J

Malays Orthop J, 2020 Nov;14(3):1-3.
PMID: 33403055 DOI: 10.5704/MOJ.2011.001

As the COVID-19 pandemic ravages the whole world, the frontline clinicians are tirelessly fighting to contain and manage the disastrous effects of the virus from their communities. Stress, despair, fear, physical and psychological burn out, decreased work out put and lowered morale are some side effects this endless battle has had on the frontline healthcare worker. Although there have been many accounts of surgeons working in the frontline, there have only been few reflections on this ongoing battle from the junior clinician's point of view. In this article, we feature the perspectives of young residents from the orthopaedic unit at the epicenter of the COVID-19 fight in Singapore. We highlight the thoughts, fears, emotions, morale, motivating factors and reflections of junior clinicians while they work at frontlines. Fear in a dangerous new environment and amidst uncertainty is natural. However, a doctor's call of duty goes far above fear.

Matched MeSH terms: Longitudinal Studies
Species composition and distribution data of benthic foraminifera from the straits of malacca during the early holocene

Minhat FI, Husain ML, Sulaiman A

Data Brief, 2019 Aug;25:104214.
PMID: 31372481 DOI: 10.1016/j.dib.2019.104214

The data presented herein were collected from the Straits of Malacca, along the west coast of Peninsular Malaysia. A 3.9 m core sample was retrieved from the Straits of Malacca in 2001. This core was continuously sub-sampled at 5-cm intervals between selected core depths of 220 cm and 380 cm. The 32 sub-samples obtained were analysed to understand the species composition of benthic Foraminifera in them and the changes in lithology during the Holocene. The data available in this article include the raw counts of different species of Foraminifera and the weight percentages of sediment of different grain sizes and organic matter at different depth. In addition, the estimated ages of the sediment samples are also provided. The chronostratigraphic framework of the core was based on radiocarbon-14 Accelerator Mass Spectrometry (AMS) dates estimated from three selected sediment intervals. The results of carbon dating were calibrated to calendar years (cal BC/AD) and calibrated radiocarbon years (cal BP). Calibration was done using the INTCAL program with a Delta R value of -19 ± 70.

Matched MeSH terms: Longitudinal Studies
CaMV 35S promoter directs β-glucuronidase expression in the laticiferous system of transgenic Hevea brasiliensis (rubber tree)

Arokiaraj P, Yeet Yeang H, Fong Cheong K, Hamzah S, Jones H, Coomber S, et al.

Plant Cell Rep, 1998 May;17(8):621-625.
PMID: 30736515 DOI: 10.1007/s002990050454

Hevea brasiliensis anther calli were genetically transformed using Agrobacterium GV2260 (p35SGUSINT) that harboured the β-glucuronidase (gus) and neomycin phosphotransferase (nptII) genes. β-Glucuronidase protein (GUS) was expressed in the leaves of kanamycin-resistant plants that were regnerated, and the presence of the gene was confirmed by Southern analysis. GUS was also observed to be expressed in the latex and more importantly in the serum fraction. Transverse sections of the leaf petiole from a transformed plant revealed GUS expression to be especially enhanced in the phloem and laticifers. GUS expression was subsequently detected in every one of 194 plants representing three successive vegetative cycles propagated from the original transformant. Transgenic Hevea could thus facilitate the continual production of foreign proteins expressed in the latex.

Matched MeSH terms: Longitudinal Studies
Fulltext Treatment of intracerebral haemorrhage with tranexamic acid - A review of current evidence and ongoing trials

Law ZK, Meretoja A, Engelter ST, Christensen H, Muresan EM, Glad SB, et al.

Eur Stroke J, 2017 Mar;2(1):13-22.
PMID: 31008298 DOI: 10.1177/2396987316676610

Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH.
Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms 'intracerebral haemorrhage', 'tranexamic acid' and 'antifibrinolytic'. Authors of ongoing clinical trials were contacted for further details.
Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid.
Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established.
Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

Matched MeSH terms: Longitudinal Studies
Fulltext The current role of the artificial urinary sphincter in male and female urinary incontinence

Islah M, Cho SY, Son H

World J Mens Health, 2013 Apr;31(1):21-30.
PMID: 23658862 DOI: 10.5534/wjmh.2013.31.1.21

The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59~97% in males vs. 60~92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence.

Matched MeSH terms: Longitudinal Studies
Fulltext Smart Logbook as alternative solution for continouos industrial training supervision problem: a purview study on student’s perception

Sulaiman Mahzan, Siti Fairuz Nurr Sadikan, Mohd Ab Malek Md Shah, Mohd Harun Shahudin, Zaini Saat, Shamsol Shafie

Jurnal Inovasi Malaysia, 2020;4(1):113-132.
MyJurnal

Supervision and monitoring of practical students are among the pertinent components in the management of industrial training among students in institutions of higher learning (IPT) in Malaysia. The easiest way to monitor is by reporting such students’ daily activities in their logbooks. Due to the dispersal of offshore industries, it directly impacts to students, institution and industry such as management costs, wastes supervision time for travel and stresses other factors in managing industry supervision such as ongoing supervision, verification of customization of industry entities regarding needs and reduction of allocation by IPT. Thus, a new mechanism needs to be implemented by considering the advantages and benefits that can be developed throughout the use of information technology (IT). In conjunction with this circumstance, a Smart LogBook prototype has been developed to address the problems encountered in the supervision process of the industry training students as stated. A study of students’ perceptions of the Smart Logbook prototype was also tailored to assess student perception compared to using supervisory methods using the old logbook. The Rapid Application Development (RAD) methodology was used in software development while a set of questionnaires was distributed to 65 respondents to obtain their assessment feedback data. The findings show that students have a positive assessment of their perception of the use of this prototype.

Matched MeSH terms: Longitudinal Studies
Effects Of Biotic Interactions, Abiotic Environments And Harvesting On The Spread Of Hantavirus Infection

Fauzi Mohamed Yusof, Mohd Hafiz Mohd, Yazariah Mohd Yatim, Ahmad Izani Md. Ismail

MATEMATIKA, 2020;36(1):1-14.
MyJurnal

In this paper, the combined influences of biotic interactions, environmental components and harvesting strategy on the spread of Hantavirus are investigated. By employing a multi-species model consisting of (susceptible and infected) rodents and alien species, we show that interspecific competition from alien species has an effect in reducing the spread of infection, and this species could be employed as a potential biocontrol agent. Our analysis using numerical continuation and simulation also reveals the conditions under which Hantavirus infection occurs and disappears as the environmental conditions and the intensity of harvesting change. Without harvesting, infection emerges when environments are conducive. Inclusion of moderate harvesting in favourable environments can lead to disappearance of infection among rodent species. However, as the intensity of harvesting increases, this situation can cause extinction of all rodents species and consequently, jeopardise biodiversity. Overall, our results demonstrate how the interplay of different factors can combine to determine the spread of infectious diseases.

Matched MeSH terms: Longitudinal Studies
Fulltext Implementing lean principles in administrative procedures: registration process for new student intake in Universiti Sains Islam Malaysia (USIM)

Hammad Farhi Mohd Saudi, Jamal Abdul Nassir Shaari

Malaysian Journal of Applied Sciences, 2019;4(1):60-72.
MyJurnal

The purpose of this case study is to look at how “Lean Techniques and Principles” can be successfully introduce and implement in the higher education institution or university context. In the last two decades, Lean techniques and principle has been applied to improve production system in manufacturing processes. Lean was introduced in the 1950s by Womack and Jones known as the Toyota Production System (TPS) by the legendary car manufacturer Toyota, the world’s most profitable automaker and have spent decades perfecting lean practices in the production. The method used was to produce more productivity while using fewer resources and identifying activities which creates value for customers, activities which do not create value but are required and actions which do not create value and can be eliminated. This case study demonstrates how “Lean Principles” can be adopted to the administration services particularly in the registration process for new student intake in USIM. The objective of this case study includes : to identify the needs of improving the registration process by eliminating the waste (Muda) such as time wastage, human resource wastage, to introduce the apparatus required to reduce and eliminate waste, to redesign the process using the lean techniques and principles to eliminate waste and to continually improve the process with the goal to achieve perfection for customer satisfaction and university’s reputation. How Lean Principles can transform the work process in the registration procedure, process efficiency, the reasons for implementing Lean in the process, minimize the lead time, minimize the financial cost and the role of management. This paper contains a comprehensive discussion and findings of the development of Lean principles and management through one of the models, namely; Value Stream Mapping (VSM) process which can enhance the operational process in the university environment to improve the process, particularly in the new student registration process.

Matched MeSH terms: Longitudinal Studies
Robotic Mounted Rail Arm System for implementing effective workplace safety for migrant workers

Wei H, Rahman MA, Hu X, Zhang L, Guo L, Tao H, et al.

Work, 2021;68(3):845-852.
PMID: 33612527 DOI: 10.3233/WOR-203418

BACKGROUND: The selection of orders is the method of gathering the parts needed to assemble the final products from storage sites. Kitting is the name of a ready-to-use package or a parts kit, flexible robotic systems will significantly help the industry to improve the performance of this activity. In reality, despite some other limitations on the complexity of components and component characteristics, the technological advances in recent years in robotics and artificial intelligence allows the treatment of a wide range of items.
OBJECTIVE: In this article, we study the robotic kitting system with a Robotic Mounted Rail Arm System (RMRAS), which travels narrowly to choose the elements.
RESULTS: The objective is to evaluate the efficiency of a robotic kitting system in cycle times through modeling of the elementary kitting operations that the robot performs (pick and room, move, change tools, etc.). The experimental results show that the proposed method enhances the performance and efficiency ratio when compared to other existing methods.
CONCLUSION: This study with the manufacturer can help him assess the robotic area performance in a given design (layout and picking a policy, etc.) as part of an ongoing project on automation of kitting operations.

Matched MeSH terms: Longitudinal Studies
Fulltext Neuro-enteric dysfunction in children with severe neurological impairment

Fahisham Taib, Nik Zainal Abidin Nik Ismail

Malaysian Journal of Paediatrics and Child Health, 2019;25(1):1-5.
MyJurnal

Visceral hyperalgesia, intestinal dysfunction and unexplained irritability in neurological impaired children is a medical enigma for many healthcare professionals. The neuro-medical management can be challenging and difficult, due to poor understanding of the underlying aetiology and pathophysiology of the condition. Neuro-enteric axis has been proposed as emerging physiologic mechanism in the pathogenesis of many gastrointestinal diseases. The bidirectional connection between enteric and central nervous system may represent a direct relationship between neurological system and gut physiology. Insult to the brain indirectly contribute to the ongoing gut and brain axis sequalae. Microbiota has been an important modulator in the brain-gut axis. Irritability episodes in severe neurological impairment children has been commonly associated with pain originated from gastrointestinal pathology. Management of such condition requires a holistic approach to tackle multidimensional factors that has contributed to the ‘totality’ of the symptoms.

Matched MeSH terms: Longitudinal Studies
Fulltext The impact of casemix reimbursement on hospital revenue in Indonesia

Aljunid, Syed Mohamed, Amrizal Muhammad Nur, Irwan Saputra

Jurnal Sains Kesihatan Malaysia, 2020;18(2):1-8.
MyJurnal

The objective of this study is to examine the impact of the casemix reimbursement on the hospital revenue at three selected hospitals (Type B, C and D) reimbursed using 602 groups from 14,749 cases. The results of the study showed that the hospitals received 32.4% higher income when reimbursed with Indonesia Case Bases Groups (INA-CBG) as compared to fee-for-service. Type D hospitals is the biggest gainer with 81.0% increased in income followed by Type B hospital that obtained 34.7% higher revenue. In conclusion, the use of INA-CBG as a prospective payment method has benefitted the hospitals by the increase in the revenues. It is hope that additional resources gained in this programme will allow the hospitals to provide optimum care to the population. It is recommended that the JKA management will use the INA-CBG casemix data to monitor the performance of the hospitals to ensure that quality and efficiency of the services provided to the population is continuously maintained.

Matched MeSH terms: Longitudinal Studies

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