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Aims: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. Materials and Methods: Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low‐middle‐income countries (China and Malaysia) and two high‐income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three‐stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. Results: Thirty‐one PWLE participated in four focus groups. Thirty‐four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. Conclusions: We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health‐related research. [ABSTRACT FROM AUTHOR]

Malaysia is a multi-ethnic country with Malay, Chinese and Indian being the dominant ethnic groups. This paper investigates the three ethnic cultures in Malaysia by examining the individual-level values of managers and professionals. Based on 528 responses to a Schwartz Value Survey ( SVS) questionnaire, the paper identifies partial convergence of the value systems of Malay, Chinese and Indian people. It was found that the three ethnic groups do not differ significantly in the individualistic value dimensions of Self-enhancement and Openness-to-change. However, Malays are found to be more conservative and less self-transcendent than Chinese or Indians, while Chinese and Indians attribute the same importance to these two sets of values. [ABSTRACT FROM AUTHOR]

Objective. Obesity prevalence is unequally distributed across gender and ethnic group in Malaysia. In this paper, we examine the role of socioeconomic inequality in explaining these disparities. Design. The body mass index (BMI) distributions of Malays and Chinese, the two largest ethnic groups in Malaysia, are estimated through the use of quantile regression. The differences in the BMI distributions are then decomposed into two parts: attributable to differences in socioeconomic endowments and attributable to differences in responses to endowments. Results. For both males and females, the BMI distribution of Malays is shifted toward the right of the distribution of Chinese, i.e., Malays exhibit higher obesity rates. In the lower 75% of the distribution, differences in socioeconomic endowments explain none of this difference. At the 90th percentile, differences in socioeconomic endowments account for no more than 30% of the difference in BMI between ethnic groups. Conclusions. Our results demonstrate that the higher levels of income and education that accrue with economic development will likely not eliminate obesity inequality. This leads us to conclude that reduction of obesity inequality, as well the overall level of obesity, requires increased efforts to alter the lifestyle behaviors of Malaysians. [ABSTRACT FROM AUTHOR]

Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients' life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients' disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, "Gender" (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), "Presence of metastases" (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), "Metastasis site: Liver" (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), "Lymphovascular permeation" (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and "CEA-level" (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient's comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC. [ABSTRACT FROM AUTHOR]

Background: High prevalence of smartphone addiction among medical students may contribute to adverse physical and mental health outcomes. Aim: To estimate the prevalence of smartphone addiction, and explore the influencing factors and related mental health symptoms of smartphone addiction among Asian medical students. Design: Systematic review and meta-analysis. Methods: PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and EMBASE were searched for relevant literature from the inception to September 10, 2021. Using Stata software 11.0, the meta-analysis of prevalence and the influencing factors of smartphone addiction were determined with 95% confidence intervals. Results: Nineteen articles, published between 2014 and 2019, were included, producing medical student studies from seven different Asian countries. The included studies were conducted in India (n = 11) and Malaysia (n = 3), with China, Saudi Arabia, Turkey, Nepal, and Iran each contributing one study. Among a total of 5,497 medical students, the participants included 3,214 females, of whom 2,181 were medical students with smartphone addiction. The prevalence of smartphone addiction among Asian medical students was 41.93% (95% CI [36.24%, 47.72%]). The influencing factors of smartphone addiction among medical students included gender, duration of smartphone use, smartphone function, and marital status. Ten studies (52.63%) explored related mental health symptoms of smartphone addiction among Asian medical students. Smartphone addiction was positively correlated with poor sleep quality (r = .17-.31), stress (r = .30-.40), anxiety, depression, neuroticism, and general health among Asian medical students. Conclusion: Smartphone addiction is highly prevalent among Asian medical students. Smartphone addiction may adversely affect mental health, resulting in sleep disturbance, stress, anxiety, depression, and neuroticism. It is necessary to take appropriate precautionary actions and interventions to prevent smartphone overuse among medical students. [ABSTRACT FROM AUTHOR]

The Asia-Pacific region has the highest number of active smokers in the world. Efforts to reduce tobacco use should implement evidence-based measures. The Association of Pacific Rim Universities is a non-profit network of more than 50 universities representing 18 economies. In 2017, it held a virtual global health case competition relating to the use of universities as platforms for tobacco control. This study is a content analysis of tobacco control proposals submitted by 24 teams from 10 economies. Content analysis of the 10-min videos examined (1) general tone and scope of videos; (2) contextual analysis; (3) intervention approaches; (4) theoretical framework; (5) primary versus secondary prevention; (6) individual versus structural approaches. Proposals were not comprehensive; most included some but not all elements recommended by the WHO FCTC. Smoking was often referred to as a 'habit' (instead of an addiction), which likely explains the predominance of individual-level behavior change interventions (smoking cessation) over structural interventions (tobacco ad or sales bans). The most common intervention was the enforcement of current bans on smoking (proposed in 78% of videos), perceived as a major barrier to tobacco control. While most proposals emphasized individual components (e.g. health education and peer support), some also proposed to create more supportive smoke-free environments through billboards, posters and cues to action, such as 'no smoking' reminders and signs with cessation hotline numbers. University faculty, students and campus-wide organizations are well positioned to lead tobacco control efforts. More work is needed to support the establishment of smoke-free campus environments. [ABSTRACT FROM AUTHOR]

Preparing healthcare students for community care has been emphasised due to the global ageing population. An instrument to measure students' community care competency is lacking. This study aimed to develop and evaluate the psychometric properties of a new scale known as Community Care Competency Scale (CCCS) for measuring nursing students' community care competency. CCCS consists of 21 items derived from literature review and community care standards. Content validity was established through a panel of seven experts in the areas of knowledge with a content validity index of 0.96. A cross‐sectional study was undertaken in a university in Singapore by using an anonymous self‐administered questionnaire to nursing students, and obtained a response rate of 87% (n = 283). Psychometric properties were explored using convergent and known‐group validity testing, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and Cronbach's alpha test. The results showed good convergent and known‐group validity. EFA and CFA showed a coherent construct of the 21 items of CCCS in a one‐factor model. The Cronbach's alpha of 0.94 indicated excellent internal consistency. The CCCS is a valid, reliable and easy‐to‐administer instrument that measures community care competency. This instrument will contribute to the empirical body of knowledge on evaluating the effectiveness of community care educational programmes for nursing students to prepare future healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China. Methods Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank. Results Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12). Conclusions Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest. [ABSTRACT FROM AUTHOR]

Background Confinement (restrictions placed on diet and practices during the month right after delivery) represents a key feature of Asian populations. Few studies, however, have focused specifically on ethnic differences in confinement practices. This study assesses the confinement practices of three ethnic groups in a multi-ethnic Asian population. Methods Participants were part of a prospective birth cohort study that recruited 1,247 pregnant women (57.2% Chinese, 25.5% Malay, and 17.3% Indian) during their first trimester. The 1,220 participants were followed up 3 weeks postpartum at home when questionnaires were administered to ascertain the frequency of adherence to the following confinement practices: showering; confinement-specific meals; going out with or without the baby; choice of caregiver assistance; and the use of massage therapy. Results Most participants reported that they followed confinement practices during the first 3 weeks postpartum (Chinese: 96.4%, Malay: 92.4%, Indian: 85.6%). Chinese and Indian mothers tended to eat more special confinement diets than Malay mothers ( p < 0.001), and Chinese mothers showered less and were more likely to depend on confinement nannies during this period than mothers from the two other ethnic groups ( p < 0.001 for all). Malay mothers tended to make greater use of massage therapy ( p < 0.001), whilst Indian mothers tended to have their mothers or mothers-in-law as assistant caregivers ( p < 0.001). Conclusion Most Singapore mothers follow confinement practices, but the three Asian ethnic groups differed in specific confinement practices. Future studies should examine whether ethnic differences persist in later childrearing practices. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of a high-calcium vitamin D-fortified milk with added FOS-inulin versus regular milk on serum parathyroid hormone, and bone turnover markers in premenopausal (Pre-M) and postmenopausal (PM) women over 12 weeks. Methods: Premenopausal women ( n = 136, mean age 41 (±5) years) and postmenopausal women [ n = 121, mean age 59 (±4) years] were recruited, and each age group randomised into two groups to take two glasses per day of control = regular milk (500 mg calcium per day) or intervention (Int) = fortified milk (1000 mg calcium for pre-M women and 1200 mg calcium for PM women, 96 mg magnesium, 2.4 mg zinc, 15 µg vitamin D, 4 g FOS-inulin per day). At baseline, week 4 and week 12 serum minerals and bone biochemical markers were measured and bone density was measured at baseline. Results: Mean 25-hydroxyvitamin D [25(OH) vitamin D] levels among groups were between 49 and 65 nmol/L at baseline, and over the 12 weeks of supplementation, the fortified milk improved vitamin D status in both Int groups. CTx-1 and PINP reduced significantly in both Pre-M and PM groups over the 12 weeks, with the changes in CTx-1 being significantly different ( P < 0.035) between PM control and PM Int groups at week 12. Parathyroid hormone levels were significantly reduced in all groups over time, except for control PM group where levels increased at 12 weeks. Conclusion: The overall pattern of responses indicates that while both regular milk and fortified milk reduce bone resorption in young and older women, fortified milk is measurably more effective. [ABSTRACT FROM AUTHOR]

Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 911-917 (2012) Abstract Aims To study whether HbA1c, and its relationship with fasting plasma glucose, was significantly different among Chinese, Malays and Indians in Singapore. Methods A sample of 3895 individuals without known diabetes underwent detailed interview and health examination, including anthropometric and biochemical evaluation, between 2004 and 2007. Pearson's correlation, analysis of variance and multiple linear regression analyses were used to examine the influence of ethnicity on HbA1c. Results As fasting plasma glucose increased, HbA1c increased more in Malays and Indians compared with Chinese after adjustment for age, gender, waist circumference, serum cholesterol, serum triglyceride and homeostasis model assessment of insulin resistance ( P-interaction < 0.001). This translates to an HbA1c difference of 1.1 mmol/mol (0.1%, Indians vs. Chinese), and 0.9 mmol/mol (0.08%, Malays vs. Chinese) at fasting plasma glucose 5.6 mmol/l (the American Diabetes Association criterion for impaired fasting glycaemia); and 2.1 mmol/mol (0.19%, Indians vs. Chinese) and 2.6 mmol/mol (0.24%, Malays vs. Chinese) at fasting plasma glucose 7.0 mmol/l, the diagnostic criterion for diabetes mellitus. Conclusions Using HbA1c in place of fasting plasma glucose will reclassify different proportions of the population in different ethnic groups. This may have implications in interpretation of HbA1c results across ethnic groups and the use of HbA1c for diagnosing diabetes mellitus. [ABSTRACT FROM AUTHOR]