m-Health views and perception among Malaysian: findings from a survey among individuals living in Selangor.

BACKGROUND: Information and communication technology can be a useful tool to improve population health especially in low-middle income countries. However, the full potential of m-health may be limited by the users' health and technology literacy. This study aims to explore the m-health and technology literacy among Malaysians, and factors that may promote the use of m-health. METHODS: A cross-sectional study was performed among residents residing around Klang and Petaling district in Selangor, Malaysia from November 2015 to January 2017. Multivariable logistic regression models were used to assess the predictors of mobile device and health apps usage and examine the association between apps use and intention to change behavior with sociodemographic predictors. RESULTS: A total of 4,504 respondents participated in our survey. Most respondents reported that they owned a mobile or smartphone, which was commonly used to make calls and deliver text messages. However, only one-fifth (20.4%) of respondents were familiar with the term m-health or had used a health related application, with millennial (individuals aged ≤39 years) generally more aware of the term m-health and were more likely to use m-health as a tool for health management. The most commonly used application were for promoting adherence as well as self-efficacy (e.g., lifestyle advice). Other factors associated with higher levels of m-health use were individuals with higher level of education and individuals taking multiple medications. CONCLUSIONS: While most Malaysian were not familiar with m-health, they reported to have a positive attitude towards m-health. Malaysians were willing to use m-health to manage their health conditions but expressed that they required further education and training. As m-health is still at its infancy in Malaysia, there is potential to further develop m-health as an innovative solution to manage the population health.

Correction: Deep language space neural network for classifying mild cognitive impairment and Alzheimer-type dementia.

[This corrects the article DOI: 10.1371/journal.pone.0205636.].

Effect of newer anti-epileptic drugs (AEDs) on the cognitive status in pentylenetetrazol induced seizures in a zebrafish model.

Epilepsy is marked by seizures that are a manifestation of excessive brain activity and is symptomatically treatable by anti-epileptic drugs (AEDs). Unfortunately, the older AEDs have many side effects, with cognitive impairment being a major side effect that affects the daily lives of people with epilepsy. Thus, this study aimed to determine if newer AEDs (Zonisamide, Levetiracetam, Perampanel, Lamotrigine and Valproic Acid) also cause cognitive impairment, using a zebrafish model. Acute seizures were induced in zebrafish using pentylenetetrazol (PTZ) and cognitive function was assessed using the T-maze test of learning and memory. Neurotransmitter and gene expression levels related to epilepsy as well as learning and memory were also studied to provide a better understanding of the underlying processes. Ultimately, impaired cognitive function was seen in AED treated zebrafish, regardless of whether seizures were induced. A highly significant decrease in γ-Aminobutyric Acid (GABA) and glutamate levels was also discovered, although acetylcholine levels were more variable. The gene expression levels of Brain-Derived Neurotrophic Factor (BDNF), Neuropeptide Y (NPY) and Cyclic Adenosine Monophosphate (CAMP) Responsive Element Binding Protein 1 (CREB-1) were not found to be significantly different in AED treated zebrafish. Based on the experimental results, a decrease in brain glutamate levels due to AED treatment appears to be at least one of the major factors behind the observed cognitive impairment in the treated zebrafish.

Deep language space neural network for classifying mild cognitive impairment and Alzheimer-type dementia.

It has been quite a challenge to diagnose Mild Cognitive Impairment due to Alzheimer's disease (MCI) and Alzheimer-type dementia (AD-type dementia) using the currently available clinical diagnostic criteria and neuropsychological examinations. As such we propose an automated diagnostic technique using a variant of deep neural networks language models (DNNLM) on the verbal utterances of affected individuals. Motivated by the success of DNNLM on natural language tasks, we propose a combination of deep neural network and deep language models (D2NNLM) for classifying the disease. Results on the DementiaBank language transcript clinical dataset show that D2NNLM sufficiently learned several linguistic biomarkers in the form of higher order n-grams to distinguish the affected group from the healthy group with reasonable accuracy on very sparse clinical datasets.

Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study.

We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p < 0.01). Overall, telemonitoring was a useful adjunct to reduce the risk of hypoglycaemia during Ramadan with no deterioration in glycaemic control.

Type 2 diabetes patient's perspective on Ramadan fasting: a qualitative study.

OBJECTIVE: We evaluated the beliefs, experience and diabetes management strategies of type 2 diabetes mellitus (T2DM) Muslim patients that chose to fast during Ramadan. RESEARCH DESIGN AND METHODS: A semistructured focus group interview was conducted with 53 participants with T2DM. Participants were purposefully sampled and asked to share their perspective on Ramadan fasting. All interviews were audio recorded, transcribed verbatim and analyzed thematically. RESULTS: Participants reported optimism towards fasting during Ramadan, as they believed that fasting was beneficial to their overall well-being, and a time for family bonding. Most participants made limited attempts to discuss with their doctors on the decision to fast and self-adjusted their medication based on experience and symptoms during this period. They also reported difficulty in managing their diet, due to fear of hypoglycemia and the collective social aspect of fasting. CONCLUSION: Muslims are optimistic about their well-being when fasting during Ramadan. Many choose to fulfill their religious obligation despite being discouraged by their doctors. Collaboration with religious authorities should be explored to ensure patients receive adequate education before fasting during Ramadan. TRIAL REGISTRATION NUMBER: NCT02189135; Results.

The epidemiology of childhood brain injury in the state of Selangor and Federal Territory of Kuala Lumpur, Malaysia.

BACKGROUND: There are limited studies describing the epidemiology of childhood brain injury, especially in developing countries. This study analyses data from the Malaysian National Trauma Database (NTrD) registry to estimate the incidence of childhood brain injury among various demographic groups within the state of Selangor and Federal Territory of Kuala Lumpur. METHODS: This study analysed all traumatic brain injury cases for children ages 0-19 included in the 2010 NTrD report. RESULTS: A total of 5,836 paediatric patients were admitted to emergency departments (ED) of reporting hospitals for trauma. Of these, 742 patients (12.7 %) suffered from brain injuries. Among those with brain injuries, the mortality rate was 11.9 and 71.2 % were aged between 15 and 19. Traffic accidents were the most common mode of injury (95.4 %). Out of the total for traffic accidents, 80.2 % of brain injuries were incurred in motorcycle accidents. Severity of injury was higher among males and patients who were transferred or referred to the reporting centres from other clinics. Glasgow Coma Scale (GCS) total score and type of admission were found to be statistically significant, χ (2) (5, N = 178) = 66.53, p < 0.001, in predicting patient outcomes. According to this analysis, the overall rate of childhood brain injury for this one year period was 32 per 100,000 children while the incidence of significant (moderate to severe) brain injury was approximately 8 per 100,000 children. CONCLUSIONS: This study provides an overview of traumatic brain injury rates among children within the most populous region of Malaysia. Most brain injuries occurred among older male children, with traffic, specifically motorcycle-related, accidents being the main mode of injury. These findings point to risk factors that could be targeted for future injury prevention programs.

Strategies to Make Ramadan Fasting Safer in Type 2 Diabetics: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials and Observational Studies.

Ramadan is the holy month for Muslims whereby they fast from predawn to after sunset and is observed by all healthy Muslim adults as well as a large population of type 2 diabetic Muslims.To determine the comparative effectiveness of various strategies that have been used for type 2 diabetic Muslim who fast during Ramadan.A systematic review and network meta-analysis of randomized controlled studies (RCT) as well as observational studies for patients with type 2 diabetes who fasted during Ramadan was conducted. Eight databases were searched from January 1980 through October 2015 for relevant studies. Two reviewers independently screened and assessed study for eligibility, assessed the risk of bias, and extracted relevant data. A network meta-analysis for each outcome was fitted separately, combining direct and indirect evidence for each comparison.Twenty-nine studies, 16 RCTs and 13 observational studies each met the inclusion criteria. The most common strategy used was drug changes during the Ramadan period, which found that the use of DPP-4 (Dipeptidyl peptidase inhibitor -4) inhibitors were associated with a reduction in incidence of experiencing hypoglycemia during Ramadan in both RCTs (pooled relative risk: 0.56; 95% confidence interval: 0.44-0.72) as well as in observational studies (pooled relative risk: 0.27; 0.09-0.75). Ramadan-focused education was shown to be beneficial in reducing hypoglycemia in observational studies but not RCTs (0.25 versus 1.00). Network meta-analyses suggest that incretin mimetics can reduce the risk of hypoglycemia by nearly 1.5 times.The newer antidiabetic agents appear to lower the risk of hypoglycemia and improved glycemic control when compared with sulfonylureas. Ramadan-focused education shows to be a promising strategy but more rigorous examination from RCTs are required.

Drug abuse, relapse, and prevention education in malaysia: perspective of university students through a mixed methods approach.

In recent years, there have been increasing accounts of illegal substance abuse among university students and professional groups in Malaysia. This study looks at university students' perceptions about this phenomenon. Students from Malaysian universities were asked for their impressions about drug availability and abuse, as well as factors contributing to drug abuse and relapse. The questionnaire also inquired into their knowledge and views regarding government versus private rehabilitation centers, as well as their exposure to, and views about, school-based drug-prevention education. Participants were 460 university students from five Malaysian states: Penang, Selangor, Kuala Lumpur, Sabah, and Sarawak. Results showed gender differences in perceptions of relapse prevention strategies, as well as factors leading to drug abuse and relapse. Students also believed that drug education would be more effective if initiated between the ages of 11 and 12 years, which is slightly older than the common age of first exposure, and provided suggestions for improving existing programs. Implications of student perceptions for the improvement of current interventions and educational programs are discussed.

Cross-cultural adaptation of the Malay version of the parent-proxy Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) in Malaysia.

PURPOSE: We aimed to cross-culturally adapt the parent-proxy Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) into Malay and to determine its validity and reliability among parents of children with epilepsy in Malaysia. METHODS: The English version of the parent-proxy CHEQOL-25 was translated according to international guidelines to Malay. Content validity was verified by an expert panel and piloted in five parents of children with epilepsy (CWE). The Malay parent-proxy CHEQOL-25 was then administered to 40 parents of CWE, aged 8-18years from two tertiary hospitals, at baseline and 2weeks later. Parents were also required to complete the Malay PedsQL™ 4.0 so that convergent validity could be assessed. Hypothesis testing was assessed by correlating the individual subscales in the parent-proxy CHEQOL-25 with epilepsy severity, the number of anticonvulsants, and the number of close friends. RESULTS: Participants from the pilot study did not encounter any problems in answering the final translated Malay parent-proxy CHEQOL-25. Hence, no further modifications were made. Cronbach's α for each subscale of the Malay parent-proxy CHEQOL-25 ranged from 0.67 to 0.83. The intraclass correlation coefficient for all items at test-retest ranged from 0.70 to 0.94. Both the CHEQOL-25 and the PedsQL™ 4.0 showed good correlation in the social and emotional subscales (r=0.598, p=0.002 and r=0.342, p=0.031, respectively). The severity of epilepsy, higher number of antiepileptic drug(s), poorer cognitive ability of the child, lower number of close friends, and lesser amount of time spent with friends were significantly associated with poorer health-related quality of life. CONCLUSIONS: The Malay parent-proxy CHEQOL-25 was found to be a valid and reliable instrument to assess parents' perceived HRQOL of their CWE in Malaysia.

Investigating diet and physical activity in Malaysia: education and family history of diabetes relate to lower levels of physical activity.

The National Health and Morbidity Survey (NHMS, 2011), estimates that the number of Malaysian adults suffering from type 2 diabetes has increased from 8.3 to 31.2% since 1996. This study is a preliminary investigation of possible factors contributing to this epidemic. Knowledge of diabetes, health locus of control, diet and exercise habits, as well as family history, education level and other demographic factors to better understand the correlates of risky and healthy behaviors. This was done as part of a larger initiative to improve prevention efforts. Questionnaires were completed by 770 individuals from three Malaysian states: Selangor, Penang, and Terengganu. Findings showed that people with better health knowledge and those who have a family history of type 2 diabetes were more likely to have healthy diets. Also, health knowledge related to lower alcohol consumption. Participants with diabetic family members, however, also reported higher levels of stress. Counterintuitively, higher educational levels, higher internal locus of control, better health knowledge, as well as a family history of diabetes all correlated with lower levels of physical activity. Thus, it is suggested that, while increasing health knowledge will be important in addressing the type 2 diabetes epidemic in Malaysia, especially in relation to diet, other cultural factors, specifically norms related to exercise and physical activity, also need to be addressed if the spread of type 2 diabetes is to be addressed over the long term.

Lack of association between synapsin II (SYN2) gene polymorphism and susceptibility epilepsy: a case-control study and meta-analysis.

OBJECTIVE: The SYN2 rs3773364 A>G polymorphism has been proposed to be involved in susceptibility to epilepsy, but research results have been inconclusive. The aim of this study was to investigate the association between the SYN2 rs3773364 A>G polymorphism and susceptibility against epilepsy in a case-control study and a meta-analysis. METHODS: The SYN2 rs3773364 A>G polymorphism was successfully genotyped in 1182 samples (618 epilepsy patients) of Chinese, Indian, and Malay ethnicities. Meta-analysis of the related studies, including this case-control study, was performed under alternative genetic models. RESULTS: Data from the case-control study indicated no allelic and genotypic association of this locus with susceptibility to epilepsy in the tri-ethnic Malaysian population. Similar finding was obtained by stratified analysis by epilepsy syndrome for idiopathic epilepsy. These results were verified by meta-analysis of the related pooled data. CONCLUSIONS: Our study indicated that SYN2 rs3773364 A>G polymorphism is not a risk factor for susceptibility to epilepsy.

Association between ABCB1 polymorphism and response to sodium valproate treatment in Malaysian epilepsy patients.

Over-expression of P-glycoprotein, encoded by the ABCB1 gene, is proposed to be involved in resistance to antiepileptic drugs in about 30% of patients with epilepsy. Here, we investigated the possible association between ABCB1 polymorphisms and sodium valproate (VPA) treatment in Malaysian epilepsy patients. Genotypes were assessed in 249 drug-resistant and 256 drug-responsive Malaysian patients for C1236T, G2677T/A, and C 5T polymorphisms in the ABCB1 gene. No genotypes, alleles, or haplotypes were associated with the response to VPA in either the overall group or Chinese, Indian, and Malay subgroups. Our data suggest that C1236T, G2677T/A, and C3435T polymorphisms in the ABCB1 gene do not contribute to the response to VPA in patients with epilepsy.