Search

PURPOSEBreast cancer deaths disproportionately affect women living in low- and middle-income countries (LMICs). Patient navigation has emerged as a cost-effective and impactful approach to enable women with symptoms or suspicious mammogram findings to access timely diagnosis and patients with breast cancer to access timely and appropriate multimodality treatment. However, few studies have systematically evaluated the impact of patient navigation on timeliness of diagnosis and treatment in LMICs.METHODSWe established a nurse- and community-navigator-led navigation program in breast clinics of four public hospitals located in Peninsular and East Malaysia and evaluated the impact of navigation on timeliness of diagnosis and treatment.RESULTSPatients with breast cancer treated at public hospitals reported facing barriers to accessing care, including having a poor recognition of breast cancer symptoms and low awareness of screening methods, and facing financial and logistics challenges. Compared with patients diagnosed in the previous year, patients receiving navigation experienced timely ultrasound (84.0% v 65.0%; P < .001), biopsy (84.0% v 78.0%; P = .012), communication of news (63.0% v 40.0%; P < .001), surgery (46% v 36%; P = .008), and neoadjuvant therapy (59% v 42%, P = .030). Treatment adherence improved significantly (98.0% v 87.0%, P < .001), and this was consistent across the network of four breast clinics.CONCLUSIONPatient navigation improves access to timely diagnosis and treatment for women presenting at secondary and tertiary hospitals in Malaysia.

INTRODUCTION:There is growing evidence to suggest the importance of self-regulatory practices amongst older adults to sustain mobility. However, the decision to self-regulate driving is a complex interplay between an individual's preference and the influence of their social networks including spouse. To our best knowledge, the influence of an older adult's spouse on their decisions during driving transition has not been explored. MATERIALS AND METHODS:This qualitative descriptive study was conducted amongst married older adults aged 60 years and above. All interview responses were transcribed verbatim and examined using thematic approach and interpretative description method. RESULTS:A total of 11 married couples were interviewed. Three major themes emerged: [1] Our roles in driving; [2] Challenges to continue driving; and, [3] Our driving strategies to ensure continued driving. Older couples adopted driving strategies and regulated their driving patterns to ensure they continued to drive safely. Male partners often took the active driving role as the principal drivers, while the females adopted a more passive role, including being the passenger to accompany the principal drivers or becoming the co-driver to help in navigation. Other coping strategies include sharing the driving duties as well as using public transportation or mixed mode transportation. DISCUSSION:Our findings suggest spouse play a significant role in their partners' decision to self-regulate driving. This underscores a need to recognise the importance of interdependency amongst couples and its impact on their driving decisions and outcomes.

Background: Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts. Methods: We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations. Results: Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on premenopausal and postmenopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. While alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%, =24 kg/m2 among postmenopausal women) were predominant in Asians. Conclusions: Our study shows that while the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary. [ABSTRACT FROM AUTHOR]

Objectives: To examine the difference in injury patterns between elderly (aged 60-74 years) and very elderly (aged 75 years and above) groups from road traffic accidents. Methods: A total of 362 geriatric patients (aged 60 years and above) with major trauma following road traffic accidents in Malaysia extracted from the National Trauma Database (NTrD) from 2007 to 2011 were included in this study. Results: Median age of the geriatric patients was found to be 67 years, with majority male patients (85%), of Malay ethnicity (48%) and sustained blunt injury (99.7%). Most of them had low injury severity, hemodynamically stable and more than half sustained injuries to head and neck region (54.7%). Very elderly group had significantly higher mortality rate than elderly group (P <0.001) with the increase in odds of mortality persisted even after adjustment for physiological status and injury severity (Odds Ratio, OR: 2.75, 95% Confidence Interval, CI: 1.51-5.05, P=0.001). Conclusions: Injury patterns from road traffic accidents and its associated fatalities involving older people had emerged to be public safety concerns in Malaysia. Findings suggested extra attention was recommended especially in the care of very elderly patients. [ABSTRACT FROM AUTHOR]