Systematic Review on the Cost-Effectiveness of Seasonal Influenza Vaccines in Older Adults.

OBJECTIVES: Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults. METHODS: This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity. RESULTS: A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ. CONCLUSIONS: The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.

Attachment: the mediating role of hope, religiosity, and life satisfaction in older adults.

BACKGROUND: Attachment and support from family and friends are core to the experiences of ageing for older adults. The purpose of this study is to examine the relationships between attachment styles and hope, religiosity, and life satisfaction and provide new knowledge that may assist future planning for a rapidly ageing global population. METHODS: In this cross-sectional study, 504 Iranian older adult participants from Qazvin province were recruited between December 2015 and April 2016. They completed a questionnaire that included the Revised Adult Attachment Scale, the Life Satisfaction Index-Z, and the Herth Hope Index. RESULTS: Participants in the study had a mean age of 66.20 years (SD: 5.76) and most of them were women (57.5%). A mediation model testing the direct relationships between attachment, hope, religiosity, and life satisfaction showed a positive relationship between close attachment and religiosity (ß = .226, p < .001) and a negative relationship between anxiety attachment and religiosity (ß = - .229, p < .001). Religiosity was positively related to hope (ß = .384, p < .01) and hope was related to life satisfaction (ß = .448, p < .001). Religiosity and hope mediated the relationship between close attachment (ß = .119, p < .001) and anxiety attachment (ß = - .056, p < .01) with life satisfaction. More specifically, while religiosity and hope fully mediated the relationship between close attachment and life satisfaction, they partially mediated the attachment anxiety-life satisfaction link. CONCLUSIONS: Findings of the study provide insight into only a narrow perspective of life satisfaction and attachment given the many and varied variables that influence these constructs. Future research is needed whereby other related variables are introduced into the model to be examined further.

Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment.

OBJECTIVE: This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia. METHOD: A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined. RESULTS: Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = -1.460, p < 0.001). SIGNIFICANCE OF RESULTS: The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.

Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia.

OBJECTIVES: The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia. METHOD: By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor. RESULTS: As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93). CONCLUSION: In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.

Immunogenicity of mRNA-1273 and BNT162b2 in Immunocompromised Patients: Systematic Review and Meta-analysis Using GRADE.

INTRODUCTION: Immunocompromised (IC) patients mount poor immune responses to vaccination. Higher-dose coronavirus disease 2019 (COVID-19) vaccines may offer increased immunogenicity. METHODS: A pairwise meta-analysis of 98 studies reporting comparisons of mRNA-1273 (50 or 100 mcg/dose) and BNT162b2 (30 mcg/dose) in IC adults was performed. Outcomes were seroconversion, total and neutralizing antibody titers, and cellular immune responses. RESULTS: mRNA-1273 was associated with a significantly higher seroconversion likelihood [relative risk, 1.11 (95% CI, 1.08, 1.14); P < 0.0001; I2 = 66.8%] and higher total antibody titers [relative increase, 50.45% (95% CI, 34.63%, 66.28%); P < 0.0001; I2 = 89.5%] versus BNT162b2. mRNA-1273 elicited higher but statistically nonsignificant relative increases in neutralizing antibody titers and cellular immune responses versus BNT162b2. CONCLUSION: Higher-dose mRNA-1273 had increased immunogenicity versus BNT162b2 in IC patients.

Developing and Evaluating Data Infrastructure and Implementation Tools to Support Cardiometabolic Disease Indicator Data Collection.

Background: Assessment of aerobic exercise (AE) and lipid profiles among individuals with spinal cord injury or disease (SCI/D) is critical for cardiometabolic disease (CMD) risk estimation. Objectives: To utilize an artificial intelligence (AI) tool for extracting indicator data and education tools to enable routine CMD indicator data collection in inpatient/outpatient settings, and to describe and evaluate the recall of AE levels and lipid profile assessment completion rates across care settings among adults with subacute and chronic SCI/D. Methods: A cross-sectional convenience sample of patients affiliated with University Health Network's SCI/D rehabilitation program and outpatients affiliated with SCI Ontario participated. The SCI-HIGH CMD intermediary outcome (IO) and final outcome (FO) indicator surveys were administered, using an AI tool to extract responses. Practice gaps were prospectively identified, and implementation tools were created to address gaps. Univariate and bivariate descriptive analyses were used. Results: The AI tool had <2% error rate for data extraction. Adults with SCI/D (n = 251; 124 IO, mean age 61; 127 FO, mean age 55; p = .004) completed the surveys. Fourteen percent of inpatients versus 48% of outpatients reported being taught AE. Fifteen percent of inpatients and 51% of outpatients recalled a lipid assessment (p < .01). Algorithms and education tools were developed to address identified knowledge gaps in patient AE and lipid assessments. Conclusion: Compelling CMD health service gaps warrant immediate attention to achieve AE and lipid assessment guideline adherence. AI indicator extraction paired with implementation tools may facilitate indicator deployment and modify CMD risk.

Postconcussion Syndrome: A Diagnosis of Past Diagnostic and Statistical Manual of Mental Disorders.

ABSTRACT: After concussion, a subset of patients have persistent symptoms that are functionally limiting and may be difficult to treat. These symptoms were previously captured in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) under the diagnosis of "Post-Concussion Syndrome." However, in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, postconcussion syndrome has been eliminated. The elimination of "Post-Concussion Syndrome" moves the Diagnostic and Statistical Manual of Mental Disorders further away from congruence with the International Classification of Diseases (ICD-10) with respect to the classification of postconcussion symptomology. Although this change likely had the positive effect of reducing misdiagnoses of symptoms due to other causes, the authors highlight the potential issues surrounding the elimination of postconcussion syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This opinion piece also emphasizes the multiple diagnostic and therapeutic challenges that may result for those involved in the treatment of, or research regarding, concussion patients with persistent symptoms. Future revisions that provide clear clinical diagnostic criteria may be beneficial.

Fibromyalgia and Nociceptive Flexion Reflex (NFR) Threshold: A Systematic Review, Meta-Analysis, and Identification of a Possible Source of Heterogeneity.

BACKGROUND: The nociceptive flexion reflex is a physiological, polysynaptic reflex and refers to the level that an appropriate withdrawal response activates when a painful stimulus is detected. The nociceptive flexion reflex threshold (NFRthr) is defined as the lowest noxious stimulation intensity required to trigger a reflex motor response. Despite wide utilization and reports of the NFRthr, there has been no consensus on a standard and/or best method in assessment of the NFRthr. OBJECTIVE: To systematically review the literature that compared the NFRthr between individuals with fibromyalgia (FM) and healthy controls; and to identify a source of heterogeneity in these trials. METHODS: Employing the Cochrane methodology, we systematically searched Ovid MEDLINE, Embase, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO for clinical case-controlled trials assessing the NFRthr in individuals with and without fibromyalgia from inception to July 2019. Selected articles were passed for data extraction and meta-analyses. We utilized the random-effects model for meta-analysis assuming the true effect size may vary between studies. The sample sizes as a possible source of heterogeneity in multiple meta-regressions were investigated. This systematic review and meta-analysis were registered in PROSPERO before data extraction. RESULTS: Nine studies met our criteria and were included in the meta-analysis. Methodologies and settings varied between studies, eg, stimulation intensity, duration, and the current increments. Only two articles comprehensively described and reported details about electromyogram amplification, latency, and sampling rate. Evidence from 423 patients with fibromyalgia and 326 healthy individuals suggested that there may not be a meaningful decreased NFRthr in patients (overall mean difference = -3.16; 95% CI:-6.82 to 0.50; Z = 1.69; P=0.09). Published effect sizes were not homogenous (I2 = 0.91, τ 2 = 25.04, χ 2 = 91.22, df = 8, P < 0.00001). The multiple meta-regression analyses indicated that total and female sample sizes might be the main sources of heterogeneity for the effect sizes SStotal = -0.0570, P = 0.040; SSfemale = -0.0569; P = 0.047. CONCLUSION: Evidence suggests that the nociceptive flexion reflex threshold may not be different between patients with fibromyalgia and healthy controls. A unified and rigorous methodology and sample size calculation (probably sex specific investigation) is required for the assessment of nociceptive flexion reflex threshold in patients with fibromyalgia.

Pressure Pain Threshold in Patients With Chronic Pain: A Systematic Review and Meta-Analysis.

INTRODUCTION: In chronic pain conditions, the pressure pain threshold has been used to investigate the presence of central sensitization. METHODS: A systematic review and meta-analysis were conducted to compare the threshold in chronic pain patients and healthy individuals. Ovid MEDLINE and Embase up to July 2019 were used to conduct the search. Search strategy included terms and sets of terms that describe the concepts "sensory testing" and "pain measurement." RESULTS: The included studies consisted of 24 were case-control studies and 12 cross-sectional studies. The pooled total sample size was 1280 cases of patients with different diagnoses of chronic pain and 1463 healthy controls. Among the included studies, 32 reported a significant decrease of the pressure pain threshold among patients compared with the controls and four reported no statistically significant difference. The pooled pressure pain threshold mean difference was -1.17 (95% confidence interval = -1.45 to -0.90). There was, however, evidence of significant heterogeneity across the studies (I2 = 87.42%, P < 0.001). CONCLUSIONS: Patients who experience chronic pain have a significantly lower pressure pain threshold compared with healthy controls. Future research is needed to elucidate factors attributed to the change in pressure pain threshold among patients with chronic pain, as well as the time that the central sensitization occurs.

Systematic reviews in spinal cord injury: A step-by-step guide for rehabilitation science learners and clinicians.

BACKGROUND: The COVID-19 pandemic has created opportunity for multiple rehabilitation science learners and clinicians to critically evaluate and synthesize published research in the field of spinal cord injury (SCI) rehabilitation. OBJECTIVE: To provide a step-by-step guide for rehabilitation science learners and clinicians outlining how to conduct rigorous systematic reviews in the field of SCI. RESULTS: Steps for conducting a systematic review (SR) include: (1) formation of the SR team consisting of interprofessional experts; (2) formulation of the research question(s) with patient/population/problem, Intervention, Comparison, and Outcome (PICO) specification; (3) determination of inclusion and exclusion criteria; (4) development of SR protocol and registration; (5) development of the search strategies (database specific); (6) screening of titles and abstracts (level 1 screening), and full-texts (level 2 screening); (7) quality assessment of the included studies; (8) data extraction; (9) summary of findings and discussion; and, (10) dissemination of results. CONCLUSIONS: The enclosed ten steps for conducting SRs in SCI rehabilitation research have the potential to significantly improve the quality of evidence synthesis and the associated inferences. The importance of assembling team with diverse expertise is emphasized to assure a quality product with the potential to influence practice and inform the content of clinical practice recommendations.

Nociceptive Flexion Reflex Threshold in Chronic Pain Patients: A Needed Update for the Current Evidence.

BACKGROUND: The nociceptive flexion reflex is a physiological, polysynaptic reflex triggered by a nociceptive stimulus activating a withdrawal response. In chronic musculoskeletal-related pain conditions, a decreased nociceptive flexion reflex threshold has been suggested as a possible recognition evidence for central sensitization that may cause alteration of central nervous system processing. OBJECTIVE: The aim of the study was to systematically review reported comparisons of the nociceptive flexion reflex threshold in chronic pain patients and healthy individuals. METHODS: Electronic databases covering studies published between January 1990 and December 2019 were systematically searched. After application of exclusion criteria, 20 studies including 28 trials were included in this review. For meta-analysis, we used a random-effects model and funnel plot for publication bias. This research was registered at PROSPERO (CRD42019140354). RESULTS: Compared with healthy controls, standardized mean differences in nociceptive flexion reflex threshold were significantly lower in the total sample of chronic pain patients. Subgroup analysis indicated a homogenous decreased nociceptive flexion reflex threshold in studies reporting fibromyalgia, chronic pain, and joint pain while heterogeneity existed in other included pain conditions. CONCLUSIONS: A lower nociceptive flexion reflex threshold in patients experiencing chronic pain conditions may imply hyperexcitability in central nervous system processing. As a preliminary study, the findings would act as a basis for developing a methodology assisting current clinical practices.

A randomized double blinded placebo controlled study to evaluate motor unit abnormalities after experimentally induced sensitization using capsaicin.

Central sensitization is a condition that represents a cascade of neurological adaptations, resulting in an amplification of nociceptive responses from noxious and non-noxious stimuli. However, whether this abnormality translates into motor output and more specifically, ventral horn abnormalities, needs to be further explored. Twenty healthy participants aged 20-70 were randomly allocated to topical capsaicin or a placebo topical cream which was applied onto their left upper back to induce a transient state of sensitization. Visual analogue scale (VAS) ratings of pain intensity and brush allodynia score (BAS) were used to determine the presence of pain and secondary allodynia. Surface electromyography (sEMG) and intramuscular electromyography (iEMG) were used to record motor unit activity from the upper trapezius and infraspinatus muscles before and twenty minutes after application of capsaicin/placebo. Motor unit recruitment and variability were analyzed in the sEMG and iEMG, respectively. An independent t-test and Kruskal-Wallis H test were performed on the data. The sEMG results demonstrated a shift in the motor unit recruitment pattern in the upper trapezius muscle, while the iEMG showed a change in motor unit variability after application of capsaicin. These results suggest that capsaicin-induced central sensitization may cause changes in ventral horn excitability outside of the targeted spinal cord segment, affecting efferent pathway outputs. This preclinical evidence may provide some explanation for the influence of central sensitization on changes in movement patterns that occur in patients who have pain encouraging of further clinical investigation.Clinical Trials registration number: NCT04361149; date of registration: 24-Apr-2020.

Randomized controlled trials in non-pharmacological rehabilitation research: a scoping review of the reporting of sample size calculation, randomization procedure, and statistical analyses.

INTRODUCTION: The randomized controlled trials (RCTs) are often considered as the gold standard for clinical trials and researchers argue that the quality of RCT reports should be of the highest standards due to their clinical significance. To review the quality of reporting of the sample size calculation methods, and randomization procedures, and assess whether the statistical analyses correlate as reported in the trials' Evidence acquisition and Evidence synthesis sections in non-pharmacological, physiological rehabilitation RCT interventions. EVIDENCE ACQUISITION: A systematic electronic search was conducted in Cochrane Central from 1 January 2019 to 16 December 2019. Titles and abstracts were analyzed for inclusion independently by two authors, and disagreements were resolved by a third reader. Studies were included if they met the following criteria: 1) assessed and reported a type of non-pharmacological rehabilitation RCT (e.g. physiotherapy); 2) randomized intervention to patients with a disease comparing to healthy or patients without intervention as the comparison group; 3) published in an indexed journal; and 4) original research, available full text, human study, published in 2019, and written in English. The following information was extracted from the included articles: journal impact factor (JIF), sample size calculation methods (SS), randomization procedure (RND), and statistical analyses (STAT) reported. Analyzing the full text, whether SS and RND were reported or not and whether the STAT correlated with the Methods and Results sections. The prevalence of each statistical method was derived from the Methods section of the report and compared if it was reported in the Results section. The continuous variable of JIF was tested for normality and used for independent t-test for equality of means between categories. In addition, using Downs and Black checklist the methodological quality of the articles was assessed and categorized to be poor, fair, good, and excellent based on the checklist's score. Finally, the association between the assessed quality (categorical variable) of the articles and the reporting variables (categorical variables) was analyzed utilizing the Pearson χ2. EVIDENCE SYNTHESIS: One hundred and nighty-four articles were retrieved from the systematic search out of which 99 (51%) were included for data extraction and further analyses. About one in five (20.2%) and two in five (37.4%) did not properly and adequately report the SS and RND while one in five (19.2%) there was at least one mismatch in STAT. The JIF was not significantly associated to the quality of reporting of SS (t=1.974, P=0.051), RND (t=0.309, P=0.758), and STAT (t=-0.275, P=0.784). This finding could indicate that the quality of the journal did not assure the quality of the reporting these methods. However, there was a significant association between the assessed quality of the article measured with the Down's and Black checklist and the reporting of SS (χ2=29.149, DF=2, P<0.0001), RND (χ2=55.079, df=2, P<0.0001) and STAT (χ2=25.778, df=2, P<0.0001). CONCLUSIONS: Recent reporting quality of non-pharmacological rehabilitation RCTs was investigated. We found that the quality of the article but not the quality of the journal in which it is published in may be associated to the quality of reporting in sample size methods, randomization processes, and statistical analyses reporting. The quality of study reporting may be enhanced utilizing a guideline that addresses the required information in sample size calculation, randomization of individuals, and proper statistical analyses used and reported.

The Role of Subsymptom Threshold Aerobic Exercise for Persistent Concussion Symptoms in Patients With Postconcussion Syndrome: A Systematic Review.

In recent years, there has been a shift away from rest until total symptom resolution after concussion, due to the potential adverse consequences of inactivity. Aerobic exercise has been increasingly investigated for the treatment of postconcussion syndrome, whereby symptoms persist beyond 4 wks. The aim of this review was to systematically review the literature on subsymptom threshold aerobic exercise as a treatment for postconcussion syndrome. We conducted systematic literature searches in databases: MEDLINE (Ovid), CINAHL, PubMed, and Embase. After thorough review, 12 articles met the eligibility criteria and were included in the systematic review. The quality of selected studies was low to moderate. Subsymptom threshold aerobic exercise was associated with improvement in symptoms in patients with postconcussion syndrome for all included studies. The most commonly used protocols incorporated 20 mins of exercise at 80% of the heart rate that provoked symptoms, 5-6 days per week, with no adverse events documented. However, there was considerable variation in exercise protocols, and many studies incorporated subsymptom threshold aerobic exercise as part of a broader rehabilitation plan. Evidence supports subsymptom threshold aerobic exercise as a promising treatment for postconcussion syndrome. Further studies are required to delineate the optimal intensity, duration, and frequency of exercise for postconcussion syndrome in a variety of populations.

A new fluorene-based Schiff-base as fluorescent chemosensor for selective detection of Cr3+ and Al3.

2-((9H-fluoren-2-ylimino) methyl)phenol (F3) was synthesized by condensation reaction of 9H-fluoren-2-amine and 2-hydroxybenzaldehyde in EtOH and characterized by its melting point, 1H-,13C NMR and molecular mass. F3 exhibits a high selectivity for detection of Cr3+ and Al3+ ions as a fluorescent chemosensor and showed a single emission band at 536nm upon excitation at 333nm according to fluorescence emission studies. The addition of Cr3+ and Al3+ make a significant increase in fluorescent intensity at 536nm in CH3CN, while other metal ions have almost no influence on the fluorescence. The fluorescence enhancement was attributed to the inhibited CN isomerization and the obstructed excited state intra-molecular proton transfer (ESIPT) of compound F3. Job's plot and DFT calculations data showed that the binding stoichiometries of F3 with Cr3+ and Al3+ are 2:1. The association constants (Ka) for Cr3+ and Al3+ were calculated and found to be 8.33×104M-1 and 5.44×104M-1, respectively. The detection limits were also calculated for Cr3+ and Al3+ and found to be 2.5×10-7mol/L and 3.1×10-7mol/L, respectively.

Efficient synthesis of 9,10-dihydropyrano[2,3-h]chromene-2,8-dione derivatives in ionic liquid and the study of their antioxidant activity.

Ionic liquid N,N,N',N'-tetramethylguanidinium trifluoroacetate (TMGT) has been applied as a green and reusable catalyst for the one-pot synthesis of 10-aryl substituted-9,10-dihydropyrano[2,3-h]chromene-2,8-diones via reaction of various aromatic aldehydes, 5,7-dihydroxycoumarin derivatives and Meldrum's acid. The reactions were rapid, clean and the products were prepared in good yield. The ionic liquid was stable during the reaction process and reused without significant loss of its activity. The synthesised compounds were evaluated for their antioxidant activity by a 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay.

Physical activity, body composition and lipids changes in adolescents: analysis from the MyHeART Study.

Insufficient physical activity and growing obesity levels among Malaysian adolescents are becoming a public health concern. Our study is to identify the trends of self-reported physical activity (PA) levels, blood lipid profiles, and body composition (BC) indices from a cohort of 820 adolescents. The self-reported PA was assessed using a validated Malay version of the PA Questionnaire for Older Children (PAQ-C). Fasting blood samples were collected to investigate their lipid profiles. Height, weight, waist and hip circumferences as well as body fat percentage were measured. The baseline and the first follow-up were conducted in 2012 and 2014, respectively. A downward trend in the PA level was seen in all categories with a significant reduction among all rural adolescents (P = 0.013) and more specifically, PA among girls residing in rural areas dropped significantly (P = 0.006). Either a significant reduction in high-density lipoprotein (HDL) or a significant increment in BC indices (i.e., body mass index [BMI], waist circumference [WC], hip circumference, and body fat percentage [BF %]) were seen in this group. Female adolescents experienced more body fat increment with the reduction of physical activity. If not intervened early, adolescents from rural areas may increase their risk of developing cardiovascular diseases earlier.

Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

Body composition indices and predicted cardiovascular disease risk profile among urban dwellers in Malaysia.

OBJECTIVES: This study aims to compare various body composition indices and their association with a predicted cardiovascular disease (CVD) risk profile in an urban population in Kuala Lumpur, Malaysia. METHODS: A cross-sectional survey was conducted in metropolitan Kuala Lumpur, Malaysia, in 2012. Households were selected using a simple random-sampling method, and adult members were invited for medical screening. The Framingham Risk Scoring algorithm was used to predict CVD risk, which was then analyzed in association with body composition measurements, including waist circumference, waist-hip ratio, waist-height ratio, body fat percentage, and body mass index. RESULTS: Altogether, 882 individuals were included in our analyses. Indices that included waist-related measurements had the strongest association with CVD risk in both genders. After adjusting for demographic and socioeconomic variables, waist-related measurements retained the strongest correlations with predicted CVD risk in males. However, body mass index, waist-height ratio, and waist circumference had the strongest correlation with CVD risk in females. CONCLUSIONS: The waist-related indicators of abdominal obesity are important components of CVD risk profiles. As waist-related parameters can quickly and easily be measured, they should be routinely obtained in primary care settings and population health screens in order to assess future CVD risk profiles and design appropriate interventions.