Better health through better housing - Current impact and future prospects of randomized trials.

Safe and stable housing in integrated neighborhoods with access to basic amenities and social elements is indispensable for good health. Recent randomized controlled trials have demonstrated that improvements in the built environment have positive impacts on malaria, fall injuries, and gun violence outcomes. There are several challenges associated with performing studies that assess house improvement as an intervention for advancing human health and well-being, including ethical issues, lack of blinding, spillover effects, and differential behavior. Future research is warranted to evaluate the clinical benefits and cost-effectiveness of prototype houses or energy-efficient prefabricated modular homes by employing more holistic strategies, such as integration of data analytics, peer support, and whole health coaching, addition of social contextual perspectives on mobile technology-supported community-based interventions, and combination of digital technology-informed community-engaged citizen science and participatory action programs with multisector partnerships. Gleaning stronger evidence from clinical trials and model-based economic analyses that ascertain the effects of multiple intersecting factors on individuals and communities would illuminate effective policy making options in healthy housing and guide successful implementation of sustainable public health policies. Straightforward and cost-effective pathways should therefore be created based on highest-quality scientific data to lead the scaling up of novel housing interventions and capacity building for health-in-all-policies to support population health equity, thereby ensuring that everyone has access to housing and the chance to live a healthy and productive life.

Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study.

Background Deprescribing describes a process of medication regimen optimization with the aim to reduce adverse events and improve quality of life. There is limited research on perceptions of older adults, defined as those 60 years of age and older, about their willingness to cease a medication in developing countries. Objective To ascertain patients' attitudes, beliefs, perceptions, and experiences regarding the number of medications they were taking and their opinions regarding deprescribing. Setting A primary care health clinic and three community pharmacies in Malaysia. Method A multicenter cross-sectional study was conducted by administering the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to older adults aged 60 years and over or caregivers attending a health clinic and three community pharmacies in Malaysia. Descriptive results were reported for participants' characteristics and questionnaire responses. Analysis of correlation between participant characteristics and their responses was performed using Spearman's correlation. Main outcome measure Patients' and caregivers' attitudes and beliefs towards reducing medications and characteristics of patients such as age, gender, education level, number of medication taken and number of medical center managing the patient. Results 650 participants were approached and the response rate was 85.2%. A total of 554 participants completed the questionnaire (502 older adults and 52 caregivers). Older adults in the study were taking a median of three medications and/or supplements compared to four in caregiver recipients. 88.1% of older adults were satisfied with their current medication regimen and 67.7% would like to try stopping or reducing the dose of their medicines when their doctor recommended. 82.7% of caregivers were satisfied with their care recipient's current medications and 65.4% were willing to stop taking or reduce the number of drugs taken by their care recipient's upon doctor's recommendation. Older adults (p = 0.003) and those with lower education level (p < 0.001) were more willing to have their medications deprescribed. Other demographic characteristics such as gender, number of medication taken or number of doctors managing patient were not found to be correlated with willingness to stop a medication. Conclusion Older adults taking multiple medications for various medical conditions were largely accepting of a trial of cessation of medication.