Healthcare utilisation and economic burden of migraines among bank employees in China: a probabilistic modelling study.

BACKGROUND: Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored. AIM: To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines. METHODS: A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed. RESULTS: Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2-$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6-$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1-$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers. CONCLUSIONS: The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations.

Has Zika been forgotten? A qualitative exploration of knowledge gaps, perceived risk and preventive practices in pregnant women in Malaysia.

BACKGROUND: Although Zika virus infection is rarely reported now, continuous prevention is needed to achieve sustained eradication. This study aimed to explore the knowledge gaps, risk perception and preventive measures against Zika virus infection (ZIKV) in pregnant women in Malaysia. METHODS: We conducted in-depth virtual interviews with pregnant women between February and April 2022. The interviews were recorded and transcribed, and data were analyzed by content analysis. RESULTS: The majority of the participants demonstrated a commendable level of awareness regarding the signs and symptoms associated with ZIKV infection. They also exhibited a clear understanding of preventive measures, particularly emphasizing the importance of avoiding mosquito bites to minimize the risk of ZIKV transmission. However, a noteworthy gap in knowledge surfaced as a subset of participants remained uninformed about the potential for sexual transmission of ZIKV, which could lead to congenital ZIKV in pregnant women. Even among women who were cognizant of ZIKV and its potential negative health outcomes, associated with the infection, many of them did not perceive themselves to be at risk, mainly because ZIKV infection is infrequently discussed or heard of, leading to a sense of infections' rarity. While the adoption of preventive measures such as mosquito bite prevention during pregnancy was a common practice, however, prevention of sexually transmitted infections (STIs) including mosquito-borne diseases such as Zika is low. A minority of women express concerns about the sensitivity surrounding discussions and prevention of STIs within the context of marriage. Most of the participants were supportive of the provision of awareness of ZIKV infection in women during pregnancy and the involvement of men, especially in initiatives aimed at preventing transmission through sexual contact. CONCLUSION: This study uncovered gaps in both knowledge and practices pertaining ZIKV infection among pregnant women in the aftermath of the ZIKV pandemic. The insights gleaned from our research are valuable for shaping future interventions geared towards preventing the resurgence or facilitating the sustainable eradication of ZIKV.

Cost-based COVID-19 vaccination and willingness to pay: A post-pandemic review.

The primary objective of this paper is to serve as a valuable resource for policymakers who are confronted with the evolving landscape of the coronavirus disease 2019 (COVID-19), considering both free and cost-based vaccination approaches. The potential consequences of shifting from free to cost-based vaccination are explored, encompassing its impact on global vaccine equity and prioritization, economic well-being, healthcare systems and delivery, public health policies, and vaccine distribution strategies. Examining past studies on willingness to pay for the initial COVID-19 vaccine dose and booster shots provides insights into how individuals value COVID-19 vaccinations and underscores the significance of addressing issues related to affordability. If COVID-19 vaccinations incur expenses, using effective communication strategies that emphasize the importance of vaccination and personal health benefits can increase willingness to pay. Making COVID-19 vaccines accessible through public health programs or health insurance can help alleviate financial barriers and increase vaccination rates.

Exploring the perspectives of pharmaceutical experts and healthcare practitioners on senolytic drugs for vascular aging-related disorder: a qualitative study.

Objective: The field of targeting cellular senescence with drug candidates to address age-related comorbidities has witnessed a notable surge of interest and research and development. This study aimed to gather valuable insights from pharmaceutical experts and healthcare practitioners regarding the potential and challenges of translating senolytic drugs for treatment of vascular aging-related disorders. Methods: This study employed a qualitative approach by conducting in-depth interviews with healthcare practitioners and pharmaceutical experts. Participants were selected through purposeful sampling. Thematic analysis was used to identify themes from the interview transcripts. Results: A total of six individuals were interviewed, with three being pharmaceutical experts and the remaining three healthcare practitioners. The significant global burden of cardiovascular diseases presents a potentially large market size that offer an opportunity for the development and marketability of novel senolytic drugs. The pharmaceutical sector demonstrates a positive inclination towards the commercialization of new senolytic drugs targeting vascular aging-related disorders. However potential important concerns have been raised, and these include increasing specificity toward senescent cells to prevent off-site targeting, thus ensuring the safety and efficacy of these drugs. In addition, novel senolytic therapy for vascular aging-related disorders may encounter competition from existing drugs that treat or manage risk factors of cardiovascular diseases. Healthcare practitioners are also in favor of recommending the novel senolytic drugs for vascular aging-related disorders but cautioned that its high cost may hinder its acceptance among patients. Besides sharing the same outcome-related concerns as with the pharmaceutical experts, healthcare practitioners anticipated a lack of awareness among the general public regarding the concept of targeting cellular senescence to delay vascular aging-related disorders, and this knowledge gap extends to healthcare practitioner themselves as well. Conclusion: Senolytic therapy for vascular aging-related disorders holds great promise, provided that crucial concerns surrounding its outcomes and commercial hurdles are effectively addressed.

Factors Influencing HPV Vaccine Intentions in Malaysian Men Who Have Sex with Men: A Cross-Sectional Study in Malaysia.

In the landscape of healthcare disparities and the marginalized status of men who have sex with men (MSM) in Malaysia, understanding the dynamics surrounding HPV vaccination is of paramount importance. The purpose of this study is to examine the knowledge and attitudes of MSM regarding HPV vaccination and to identify factors that may hinder or facilitate its uptake. The findings will contribute to the development of targeted interventions to promote HPV vaccination and reduce the burden of HPV-related health issues among Malaysian MSM. Between May 2019 and September 2022, an online cross-sectional survey was conducted to collect data through popular social media platforms targeting MSM in Malaysia. A multivariable logistic regression model was employed to investigate the associations between HPV vaccination intention and various influencing factors. Out of the total 411 respondents in the study, 266 (60.3%) indicated an intent to receive the HPV vaccination, falling under the categories of "certain to happen", "very likely", and "likely". The average knowledge score for participants was 6.82 (SD = 3.93, range 0-13) out of a total possible score of 13. In the multivariate logistic model, participants who identified themselves as bisexual (OR 6.93, 95% CI 2.35-20.41) and gay/homosexual (OR 4.36, 95% CI 1.66-11.42) showed a greater inclination to receive the HPV vaccine compared to heterosexual participants. High intent to be vaccinated for HPV infection was positively and significantly associated with a high level of knowledge (OR 1.79, 95% CI 1.09-2.95). In the multivariable model, there was no significant association between all variables of attitudes towards HPV infection and HPV vaccinations and the intention to receive HPV vaccination. Study participants reported a low level of susceptibility to HPV infection despite their perception that HPV infection is severe. Two-thirds of participants expected to encounter stigma in healthcare settings during future implementation of HPV vaccination programs. This study underscores the importance of improving HPV vaccine acceptance among Malaysian MSM due to the moderate acceptance level observed. In Malaysia, promoting HPV awareness, enhancing risk perception, and addressing stigma and sensitivity surrounding HPV vaccination may be beneficial in increasing the vaccination willingness among MSM.

A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia.

BACKGROUND: Loss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care. METHOD: In-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method. RESULTS: We identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence. CONCLUSION: Study findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia.

Determinants of gastric cancer screening attendance in Southeastern China: a cross-sectional study.

OBJECTIVES: This study aimed to identify the determinants of gastric cancer screening attendance among individuals aged 40 years in a region with high gastric cancer in China. DESIGN: An anonymous, cross-sectional survey was conducted between October 2021 and March 2022. SETTING: A self-administered online survey was conducted in Fujian Province in Southeastern China. PARTICIPANTS: People aged 40 years living in five selected cities in Fujian Province with no history of cancer. MAIN OUTCOME MEASURES: Gastric cancer screening attendance was measured with the question 'Have you ever been screened for gastric cancer in the past'. RESULTS: In total, 2547 complete responses were obtained. The mean age of respondents was 47.72±7.20 years, and 59.8% were men. A total of 42.6% of participants reported that they had undergone gastric cancer screening. The result of multivariable logistic regression analysis showed that participants with a first-degree relative affected with gastric cancer (OR=2.02, 95% CI: 1.58 to 2.59) and high perceived susceptibility of gastric cancer (OR=2.03, 95% CI: 1.58 to 2.59) were the strongest facilitators for screening attendance. Other factors positively associated with screening attendance were age 51-60 years (OR=1.69, 95% CI: 1.31 to 2.18), living in urban regions (OR=1.27, 95% CI: 1.05 to 1.55), friends/neighbours/colleagues with gastric cancer (OR=1.30, 95% CI: 1.07 to 1.58), history of chronic gastric disease (OR=1.90, 95% CI: 1.57 to 2.30), perceived high cost (OR=1.28, 95% CI: 1.01 to 1.61) and physician recommendation (OR=1.71, 95% CI: 1.36 to 2.16). On the other hand, factors negatively associated with screening attendance included perceived barriers, namely screening is only necessary when symptoms present (OR=0.71, 95% CI: 0.58 to 0.87) and perceived appointment for gastroscopy screening is difficult and time-consuming (OR=0.75, 95% CI: 0.60 to 0.94). No significant association was found between knowledge level and participation in screening. CONCLUSION: This study highlights important individual-level factors and barriers to gastric cancer screening. Strategies targeting under-screened populations and eliminating patient-perceived barriers to gastric cancer screening are essential.

Bibliometric analyses of turnover intention among nurses: implication for research and practice in China.

Objective: The aim of this study was to analyze the current status of research on nurses' turnover intention and to provide suggestions and references for promoting research on turnover intention and for promoting hospital talent development. Methods: We used the bibliometric method "turnover intention" or "intention to leave" and "nurse*" as subject terms, and 1543 articles from 2017 to 2021 were retrieved from the WoS database using VOSViewer and CiteSpace software. Article based on this descriptive statistical analysis was performed on the year of publication, region, institution, journal of publication, and cited articles. Results: A total of 1,500 articles met the inclusion criteria. There is an overall upward trend in the number of articles published in the field of nursing in terms of turnover intention from 2017 to 2021. The United States has the highest number of publications and the highest number of institutions, while China ranks second in terms of publications, but there are no Chinese research institutions in the top 10. The top three journals in terms of the number of articles published are the Journal of nursing management, the Journal of advanced nursing, and the Journal of clinical nursing; Oman's League had the highest number of citations for their article in 2021; the most frequently occurring keywords are burnout, stress, satisfaction, model, work environment, organizational commitment, perception, predictor, mental health, and mediating role. Conclusion: There is a great need for further research on how to develop sound measures to tackle nurse turnover intention. The following improvements should be made, such as to enhance research institutional settings for nurses' turnover intention in China and to increase attention to nurse burnout and possible mediating influences in future studies.

Employees of the banking sector in Guizhou Province in China: prevalence of migraine, symptoms, disability and occupational risk factors.

BACKGROUND: Although studies have identified a high prevalence of migraine among employees in the banking sector, the symptoms of migraine, related disability and occupational risk factors are not well understood. AIMS: To determine migraine prevalence, symptoms and disability among bank employees in Guizhou province in China and to examine occupational risk factors associated with migraine positivity and symptoms. METHODS: In a cross-sectional survey, two-stage probability sampling was used to select bank employees in Guizhou province, China. From May to October 2022, uniformly trained interviewers conducted face-to-face interviews using the HARDSHIP questionnaire. Logistic regression was used to examine factors associated with migraine positivity and symptoms. RESULTS: Of 1,985 contactable eligible subjects, 1,929 (male 45.4%, female 54.6%) completed the survey. The one-year prevalence of migraine was 27.2% (95% CI 25.2-29.2%). Of migraine-positive individuals, 11.2% had a monthly frequency ≥ 15 days, 11.8% had an attack duration > 72 h, and 14.9% had severe pain intensity. The median of days lost from work, housework and social activities due to migraine during a three-month period was 4, 3 and 2 days, respectively, with more than half (52.8%) patients reporting Grade III or IV disability. In multivariable analyses, positions in data analysis (OR = 1.8 [95% CI 1.2-2.8], p < 0.01) and information technology (OR = 3.8 [95% CI 1.7-8.3], p < 0.01) were occupational risk factors for migraine positivity. It was also found that professional positions were predictive of migraine attacks ≥ 15 days per month, administrative positions were predictive of duration > 72 h and severe pain intensity of migraine attacks, and working in remote branches was predictive of duration > 72 h. CONCLUSIONS: Migraine is prevalent among employees in the banking sector in Guizhou province in China, with a large proportion of sufferers carrying a high burden of symptoms and disability. The practical implication of this study is that the risk factors identified here could be translated to the focus of workplace monitoring and interventions to manage and prevent migraine.

Parent-child relationships and psychological distress: survey of parents from low-income families after the COVID-19 pandemic.

Introduction: This study aims to shed light on parent-child relationships and the psychological health of parents from low-income families after the easing of the COVID-19 pandemic restrictions. Methods: This cross-sectional study recruited 553 parents of children aged 13-24 years in low-income community settings. The Parent-Child Conflict scale of the Parental Environment Questionnaire (PEQ) was used to measure parent-child conflict. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale short form (DASS-21). Results: The study revealed a low level of parent-child conflict in the overall study population, with a median PEQ of 48.0 (interquartile range [IQR] 36 to 48). Concerning demographics, married parents reported a likelihood of having a higher level of parent-child conflict over 3 times higher than single parents (OR = 3.18 95%, CI 1.30-7.75). More parent-child conflicts were also found in parents aged 60-72 years old who were unemployed, retired, or housewives and from lower-income groups. In regard to lifestyle factors, a higher level of physical activity and having enough sleep were associated with lower levels of parent-child conflict. Only approximately 1% of the participants reported symptoms of depression, anxiety, or stress. Discussion: Low risk exists for parent-child conflict and psychological sequelae following the easing of the COVID-19 pandemic restrictions, which could be due to various support measures implemented by the government. Vulnerable parents identified as being at risk of parent-child conflict warrant attention in future advocacy efforts.

COVID-19 responses and coping in young Malaysians from low-income families.

Introduction: This study aimed to shed light on how young people from low-income families were responding to COVID-19. Methods: This cross-sectional study recruited young people aged between 18 and 24 years from the low-income-group communities. A convenience sampling approach was used. Google Surveys were used to gather data from the survey. The questionnaire consisted of an assessment of demographic characteristics, lifestyle factors, parent-youth conflict (Parental Environment Questionnaire, PEQ), resilient coping (Brief Resilient Coping Scale, BRCS), and psychological distress (Depression, Anxiety, and Stress Scale-short form, DASS-21). Results: A total of 561 complete responses were received. The results showed a low level of parent-child conflict in the overall study population, with a median PEQ of 48.0 [interquartile range (IQR) 36-48]. Higher parent-child conflicts were found in females than in males (OR = 1.75, 95% CI 1.19-2.57) and in youth from households with an income below MYR 2000 than those earning MYR 3,001-5,000 (OR = 4.39, 95% CI 2.40-8.03). A low prevalence of depression (12.5%), anxiety (15.2%), and stress (6.4%) was found. Parent-child conflict remains the strongest significant predictor for higher levels of depression (OR = 10.90, 95% CI 4.31-27.57), anxiety (OR = 11.92, 95% CI 5.05-28.14), and stress (OR = 4.79, 95% CI 1.41-16.33) symptoms. Poor resilient coping was the second strongest predictor for depression and anxiety symptoms. Regarding lifestyle factors, a lower level of physical exercise was associated with higher symptoms of depression. By demographics, females reported more severe symptoms of depression and anxiety than males. Young people from low-income households reported greater severity in symptoms of depression, anxiety, and stress than those from high-income households. Young people who are employed also reported greater severity of anxiety symptoms than those who are unemployed. Discussion: The COVID-19 pandemic continues to have an unpredictable impact on the lives of vulnerable youth in low-income families that warrants attention in future advocacy efforts.

Conduct of body donation and cadaveric dissection training during the COVID-19 pandemic: challenges, impacts and mitigation.

The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysis was used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychological impact on the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.

COVID-19 Anti-Vaccine Sentiments in Malaysia: Narratives of Comments from Facebook Post.

The anti-vaccination movement was an ongoing issue in Malaysia, a Muslim-majority country, even before the COVID-19 pandemic. It is unclear whether the introduction of new COVID-19 vaccines would similarly provoke anti-vaccine sentiments. This study analyzed COVID-19 anti-vaccine sentiments in the Malaysian community. Anti-vaccine comments from Facebook page posts were extracted. The qualitative software QSR-NVivo 10 was used to manage, code and analyze the data. The fast-track COVID-19 vaccine evoked the fear of unknown long-term effects, safety, effectiveness and the duration of protection. The halal status of the COVID-19 vaccines is important. Although it is permissible to use vaccines that are not certified halal under the state of darurah (emergency), there was doubt that the current state has reached the stage of darurah that warrants the use of vaccines. COVID-19 vaccine microchip conspiracy theories were raised. COVID-19 is viewed as only severe for vulnerable populations, and hence vaccination is not needed for the healthy. There were opinions that coronavirus treatments would be more beneficial than vaccination. The anti-COVID-19 vaccine sentiments uncovered in this study provide important insights for the formulation of public health messages to instill confidence in new COVID-19 vaccines. Despite the pandemic being nearly over and many people worldwide having received COVID-19 vaccines, the findings provide important insight into potential issues regarding the introduction of new vaccines in the event of future pandemics.

Validation studies on migraine diagnostic tools for use in nonclinical settings: a systematic review / Estudos de validação de ferramentas de diagnóstico de enxaqueca (migrânea) para uso em ambientes não clínicos: uma revisão sistemática

Abstract Background Migraine underdiagnosis and undertreatment are so widespread, that hence is essential to diagnose migraine sufferers in nonclinical settings. A systematic review of validation studies on migraine diagnostic tools applicable to nonclinical settings can help researchers and practitioners in tool selection decisions. Objective To systematically review and critically assess published validation studies on migraine diagnostic tools for use in nonclinical settings, as well as to describe their diagnostic performance. Methods A multidisciplinary workgroup followed transparent and systematic procedures to collaborate on this work. PubMed, Medline, and Web of Science were searched for studies up to January 17, 2022. The QUADAS-2 was employed to assess methodological quality, and the quality thresholds adopted by the Global Burden Disease study were used to tail signaling questions. Results From 7,214 articles identified, a total of 27 studies examining 19 tools were eligible for inclusion. There has been no high-quality evidence to support any tool for use of migraine diagnosis in nonclinical settings. The diagnostic accuracy of the ID-migraine, structured headache and HARDSHIP questionnaires have been supported by moderate-quality evidence, with sensitivity and specificity above 70%. Of them, the HARDSHIP questionnaire has been the most extensively validated. The remaining 16 tools have provided poor-quality evidence for migraine diagnosis in nonclinical populations. Conclusions Up till now, the HARDSHIP questionnaire is the optimal choice for diagnosing migraine in nonclinical settings, with satisfactory diagnostic accuracy supported by moderate methodological quality. This work reveals the crucial next step, which is further high-quality validation studies in diverse nonclinical population groups.

Resumo Antecedentes O sub-diagnóstico e o subtratamento da enxaqueca são tão difundidos que, portanto, é essencial para diagnosticar os portadores de enxaqueca em ambientes não-clínicos. Uma revisão sistemática dos estudos de validação das ferramentas de diagnóstico da enxaqueca aplicáveis a ambientes não-clínicos pode ajudar os pesquisadores e profissionais nas decisões de seleção de ferramentas. Objetivo Revisar sistematicamente e avaliar criticamente estudos de validação publicados sobre ferramentas de diagnóstico da enxaqueca para uso em ambientes não-clínicos, bem como descrever seu desempenho diagnóstico. Métodos Um grupo de trabalho multidisciplinar seguiu procedimentos transparentes e sistemáticos para colaborar neste trabalho. PubMed, Medline e Web of Science foram pesquisados por estudos até 17 de janeiro de 2022. O QUADAS-2 foi empregado para avaliar a qualidade metodológica, e os limites de qualidade adotados pelo estudo da Global Burden Disease foram usados para responder a questões de sinalização. Resultados De 7.214 artigos identificados, um total de 27 estudos examinando 19 ferramentas foram elegíveis para inclusão. Não houve evidência de alta qualidade para apoiar qualquer ferramenta para o uso de diagnóstico de enxaqueca em ambientes não clínicos. A precisão diagnóstica do ID-Migraine, questionário de dor de cabeça estruturada e questionário HARDSHIP foram apoiados por evidências de qualidade moderada, com sensibilidade e especificidade acima de 70%. Deles, o questionário HARDSHIP foi o mais amplamente validado. As 16 ferramentas restantes forneceram provas de má qualidade para o diagnóstico de enxaqueca em populações não-clínicas. Conclusões Até agora, o questionário HARDSHIP é a escolha ideal para o diagnóstico da enxaqueca em ambientes não-clínicos, com precisão diagnóstica satisfatória apoiada por uma qualidade metodológica moderada. Este trabalho revela o próximo passo crucial, que é a realização de mais estudos de validação de alta qualidade em diversos grupos populacionais não-clínicos.

Effectiveness of Dengue Awareness Calendar on Indigenous Population: Impact on Knowledge, Belief and Practice.

BACKGROUND: Dengue is prevalent among the indigenous community due to impoverished living conditions near the forest fringe areas and lack of health awareness. The study aims to determine the effect of a dengue awareness calendar on knowledge, belief, and practices (KBP) among the indigenous population. METHOD: A cross-sectional study was conducted in nine selected indigenous villages in Selangor, Malaysia. A dengue awareness calendar was distributed to the indigenous communities after pre-intervention. The KBP scores were compared between the pre-and post-intervention. RESULT: A total of 609 paired responses were obtained. Knowledge, perceived severity, cues to action, self-efficacy, and prevention practices were significantly improved after the intervention (p > 0.00). Participants with primary (Odds Ratio (OR) 2.627; 95% CI 1.338-5.160) and secondary level education (OR 2.263; 95% Cl 1.126-4.550) reported a high increment in practices score. High increments in dengue knowledge scores (OR 2.190; 95% CI 1.521-3.757, p < 0.00) were significantly more likely to report a high increment in practices score. Housewives (OR 0.535; 95% Cl 0.289-0.950), perceived severity (OR 0.349; 95% CI 0.184-0.662), and perceived susceptibility (OR 0.474; 95% CI 0.286-0.785) were significantly less likely to report an increment in prevention practices score. CONCLUSION: Findings inferred that the dengue awareness calendar significantly improved knowledge and practices. Our findings revealed the effectiveness of the dengue awareness calendar in dengue prevention among indigenous communities.

Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program.

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.

Psychological Consequences of the Delay in the Silent Mentor Programme During the COVID-19 Pandemic: Perspectives From Family Members of Silent Mentors.

The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.

Validation studies on migraine diagnostic tools for use in nonclinical settings: a systematic review.

BACKGROUND: Migraine underdiagnosis and undertreatment are so widespread, that hence is essential to diagnose migraine sufferers in nonclinical settings. A systematic review of validation studies on migraine diagnostic tools applicable to nonclinical settings can help researchers and practitioners in tool selection decisions. OBJECTIVE: To systematically review and critically assess published validation studies on migraine diagnostic tools for use in nonclinical settings, as well as to describe their diagnostic performance. METHODS: A multidisciplinary workgroup followed transparent and systematic procedures to collaborate on this work. PubMed, Medline, and Web of Science were searched for studies up to January 17, 2022. The QUADAS-2 was employed to assess methodological quality, and the quality thresholds adopted by the Global Burden Disease study were used to tail signaling questions. RESULTS: From 7,214 articles identified, a total of 27 studies examining 19 tools were eligible for inclusion. There has been no high-quality evidence to support any tool for use of migraine diagnosis in nonclinical settings. The diagnostic accuracy of the ID-migraine, structured headache and HARDSHIP questionnaires have been supported by moderate-quality evidence, with sensitivity and specificity above 70%. Of them, the HARDSHIP questionnaire has been the most extensively validated. The remaining 16 tools have provided poor-quality evidence for migraine diagnosis in nonclinical populations. CONCLUSIONS: Up till now, the HARDSHIP questionnaire is the optimal choice for diagnosing migraine in nonclinical settings, with satisfactory diagnostic accuracy supported by moderate methodological quality. This work reveals the crucial next step, which is further high-quality validation studies in diverse nonclinical population groups.

ANTECEDENTES: O sub-diagnóstico e o subtratamento da enxaqueca são tão difundidos que, portanto, é essencial para diagnosticar os portadores de enxaqueca em ambientes não-clínicos. Uma revisão sistemática dos estudos de validação das ferramentas de diagnóstico da enxaqueca aplicáveis a ambientes não-clínicos pode ajudar os pesquisadores e profissionais nas decisões de seleção de ferramentas. OBJETIVO: Revisar sistematicamente e avaliar criticamente estudos de validação publicados sobre ferramentas de diagnóstico da enxaqueca para uso em ambientes não-clínicos, bem como descrever seu desempenho diagnóstico. MéTODOS: Um grupo de trabalho multidisciplinar seguiu procedimentos transparentes e sistemáticos para colaborar neste trabalho. PubMed, Medline e Web of Science foram pesquisados por estudos até 17 de janeiro de 2022. O QUADAS-2 foi empregado para avaliar a qualidade metodológica, e os limites de qualidade adotados pelo estudo da Global Burden Disease foram usados para responder a questões de sinalização. RESULTADOS: De 7.214 artigos identificados, um total de 27 estudos examinando 19 ferramentas foram elegíveis para inclusão. Não houve evidência de alta qualidade para apoiar qualquer ferramenta para o uso de diagnóstico de enxaqueca em ambientes não clínicos. A precisão diagnóstica do ID-Migraine, questionário de dor de cabeça estruturada e questionário HARDSHIP foram apoiados por evidências de qualidade moderada, com sensibilidade e especificidade acima de 70%. Deles, o questionário HARDSHIP foi o mais amplamente validado. As 16 ferramentas restantes forneceram provas de má qualidade para o diagnóstico de enxaqueca em populações não-clínicas. CONCLUSõES: Até agora, o questionário HARDSHIP é a escolha ideal para o diagnóstico da enxaqueca em ambientes não-clínicos, com precisão diagnóstica satisfatória apoiada por uma qualidade metodológica moderada. Este trabalho revela o próximo passo crucial, que é a realização de mais estudos de validação de alta qualidade em diversos grupos populacionais não-clínicos.

Is the Blood Pressure-Enabled Smartwatch Ready to Drive Precision Medicine? Supporting Findings From a Validation Study.

Background: The popular wrist-worn wearables recording a variety of health metrics such as blood pressure (BP) in real time could play a potential role to advance precision medicine, but these devices are often insufficiently validated for their performance to enhance confidence in its use across diverse populations. The accuracy of BP-enabled smartwatch is assessed among the multi-ethnic Malaysians, and findings is discussed in comparison with conventional automated upper-arm BP device. Methods: Validation procedures followed the guidelines by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). Quota sampling was employed to obtain eligible patients with normal and abnormal BP as per guideline. The measurements of BP were taken at wrist using HUAWEI WATCH D (test BP); and the readings were assessed against reference BP by the mercury sphygmomanometer. Agreement statistics and linear regression analyses were performed. Results: BP measurements (234 data pairs) from 78 patients that fulfilled AAMI/ESH/ISO protocol were analyzed. The BP readings taken by the HUAWEI WATCH D were comparable to reference BP by sphygmomanometer based on 1) Criterion 1: systolic blood pressure (SBP) = -0.034 (SD 5.24) and diastolic blood pressure (DBP) = -0.65 (SD 4.66) mm Hg; and 2) Criterion 2: SBPs = -0.034 (SD 4.18) and DBPs = -0.65 (SD 3.94) mm Hg. Factors of sociodemographic characteristics, anthropometric measurements, cardiovascular comorbidities, and wrist hair density were not significantly associated with the mean BP differences. Conclusions: HUAWEI WATCH D fulfilled criteria 1 and 2 of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) guidelines. It can be recommended for clinical use across a wider population. The rich data from real-time BP measurements in concurrent with other health-related parameters recorded by the smartwatch wearable offer opportunities to drive precision medicine in tackling therapeutic inertia by personalizing BP control regimen.

Cancer-related costs, the resulting financial impact and coping strategies among cancer survivors living in a setting with a pluralistic health system: a qualitative study.

Background: Evidence on the financial experiences of cancer survivors living in settings with pluralistic health systems remains limited. We explored the out-of-pocket costs, the resulting financial impact and the coping strategies adopted by cancer survivors in Malaysia, a middle-income country with a government-led tax-funded public health sector, and a predominantly for-profit private health sector. Methods: Data were derived from 20 focus group discussions that were conducted in five public and private Malaysian hospitals, which included 102 adults with breast, cervical, colorectal or prostate cancers. The discussions were segregated by type of healthcare setting and gender. Thematic analysis was performed. Results: Five major themes related to cancer costs emerged: 1) cancer therapies and imaging services, 2) supportive care, 3) complementary therapies, 4) non-medical costs and 5) loss of household income. Narratives on out-of-pocket medical costs varied not only by type of healthcare setting, clinical factors and socioeconomic backgrounds, but also by private health insurance ownership. Non-health costs (e.g. transportation, food) and loss of income were nonetheless recurring themes. Coping mechanisms that were raised included changing of cancer treatment decisions, continuing work despite ill health and seeking financial assistance from third parties. Unmet needs in coping with financial distress were especially glaring among the women. Conclusion: The long-term costs of cancer (medications, cancer surveillance, supportive care, complementary medicine) should not be overlooked even in settings where there is access to highly subsidised cancer care. In such settings, patients may also have unmet needs related to non-health costs of cancer and loss of income.