Introduction: The ability to remain safe behind the wheels can become arduous with aging, yet important for sustaining local travel needs. This review aimed to explore safe mobility issues involving ...older adults and gain a broad understanding of older drivers' self-regulatory driving practices and motivators behind such behavioral changes, including strategies adopted to reduce or cease driving while maintaining safe mobility. Methods: A systematic literature search was performed on 11 online databases for quantitative studies describing self-regulation of driving amongst older adults aged 60 years and above from database inception until December 2018. Data were described narratively and, where possible, data were pooled using random-effects meta-analysis. Results: Of the 1556 studies identified, 54 studies met the inclusion criteria and 46 studies were included in the meta-analyses. All included studies examined car drivers only. Older adults who were single or female were found to be at higher odds of driving cessation. Physical fitness, mental health, social influence, and support systems received by older adults were important driving forces influencing mobility and adjustments made in their travel patterns. Conclusions: Driving self-regulation amongst older adults is a multifaceted decision, impacting mobility and mental health. Therefore, future interventions and support systems should not only create opportunities for retaining mobility for those who have ceased driving, but also promote better psychological and social well-being for regulators and for those who are transitioning from driving to non-driving status. Practical applications: (a) Engage and educate older adults about self-regulation, including strategies that can be adopted and non-car mobility options available. (b) Expand the research focus to explore potential interactions of factors facilitating or hindering the transition process to develop a more comprehensive framework of self-regulation. (c) Encourage ongoing research to formulate, monitor, and evaluate the effectiveness of policies and interventions implemented. (d) Expand the research horizon to explore and understand the perspectives of older adults from developing countries.
•Older adults who were single or female were more likely to cease driving.•Aging can affect the feelings and perceptions of older adults, which were important precursors to adopt and practice self-regulation.•Gradual driving reduction was favored over abrupt driving cessation to ensure healthy aging amongst older adults.•A research gap in developing countries exists, where mixed travel modes are common and largely involved in road crashes.
Anemia is the most prevalent nutritional deficiency during pregnancy. Except for a study conducted 10 years ago in Kelantan, Malaysia's available statistics are based on isolated small urban ...maternity hospital studies from the 1980s. There was therefore, a need for a large study at national level to estimate the magnitude of the problem in the country as well as to understand its epidemiology. This multi-center, cross-sectional study was conducted from February to March 2005, to assess the prevalence of anemia. Multistage stratified random sampling technique was used and 59 Ministry of Health (MOH) primary health care clinics were selected. Our final dataset consisted of 1,072 antenatal mothers from 56 clinics. The overall prevalence of anemia in this population was 35 % (SE 0.02) if the cut off level is 11 g/dL and 11 % (SE 0.03) if the cut-off level is 10 g/dL. The majority was of the mild type. The prevalence was higher in the teenage group, Indians followed by Malays and Chinese being the least, grandmultiparas, the third trimester and from urban residence. After multiple linear regression analysis, only gestational age remained significant. These findings are useful for our Maternal Health program planners and implementers to target and evaluate interventions. Work is in progress for outcomes and cost-effectiveness studies to best tackle this problem. In conclusion, the prevalence of anemia is 35% and mostly of the mild type and more prevalent in the Indian and Malays.
Oxidative stress and abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) influence atherosclerosis formation and development. Oxidative stress significantly influences the ...abnormal proliferation and migration of VSMCs, and nuclear factor erythroid 2-related factor 2 (Nrf2) is a major antioxidant factor. However, the precise function of Nrf2 in the regulation of abnormal proliferation and migration of VSMCs and atherosclerosis is unclear.
We investigated the proliferation and migration of VSMCs in atherosclerosis in male Apoe−/− and Apoe−/−Nrf2−/− mice fed a high-fat diet for 12 weeks. In cultured mouse VSMCs, we studied the effect of Nrf2 on ox-LDL-stimulated proliferation and migration by using siRNA treatment to silence Nrf2. We then performed dual luciferase reporter and immunoprecipitation assays to study the interaction between Nrf2 and the promoter sequence of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1).
Our results demonstrate that Nrf2 expression levels were increased in the aorta and VSMCs of mice in the atherosclerosis model group compared with the control group. We also provide evidence that Nrf2 deficiency attenuated atherosclerotic plaque burden, diminished proliferation, and migration of VSMCs but enhanced VSMC-specific marker gene expression in vitro and in vivo. This is related to Nrf2 binding to the promoter sequence of LOX-1. Furthermore, Nrf2 downregulation contributes to restrain both transcriptional and translational activities of LOX-1.
Together, our data indicate that Nrf2 insufficiency is linked to attenuation of atherosclerosis, and could diminish the pathological process by blunting LOX-1-mediated proliferation and migration of VSMCs.
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•Nrf2 drives atherosclerotic plaque formation.•Ox-LDL augments the expression of Nrf2 in mouse vascular smooth muscle cells (VSMCs).•Nrf2 induces proliferation and migration of VSMCs in Apoe−/− mice and in vitro.•Nrf2 deficiency diminishes LOX-1 activity and the oxidative stress level of VSMCs in vitro and in vivo.•Nrf2 binds LOX-1 promoter and increases its expression.
Fasting during Ramadan is obligatory for adult Muslims, except those who have a medical illness. Many Muslims with type 2 diabetes (T2DM) choose to fast, which may increase their risks of ...hypoglycaemia and dehydration.
To assess the effects of interventions for people with type 2 diabetes fasting during Ramadan.
We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, WHO ICTRP and ClinicalTrials.gov (29 June 2022) without language restrictions.
Randomised controlled trials (RCTs) conducted during Ramadan that evaluated all pharmacological or behavioural interventions in Muslims with T2DM.
Two authors screened and selected records, assessed risk of bias and extracted data independently. Discrepancies were resolved by a third author. For meta-analyses we used a random-effects model, with risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes with their associated 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach.
We included 17 RCTs with 5359 participants, with a four-week study duration and at least four weeks of follow-up. All studies had at least one high-risk domain in the risk of bias assessment. Four trials compared dipeptidyl-peptidase-4 (DPP-4) inhibitors with sulphonylurea. DPP-4 inhibitors may reduce hypoglycaemia compared to sulphonylureas (85/1237 versus 165/1258, RR 0.53, 95% CI 0.41 to 0.68; low-certainty evidence). Serious hypoglycaemia was similar between groups (no events were reported in two trials; 6/279 in the DPP-4 versus 4/278 in the sulphonylurea group was reported in one trial, RR 1.49, 95% CI 0.43 to 5.24; very low-certainty evidence). The evidence was very uncertain about the effects of DPP-4 inhibitors on adverse events other than hypoglycaemia (141/1207 versus 157/1219, RR 0.90, 95% CI 0.52 to 1.54) and HbA1c changes (MD -0.11%, 95% CI -0.57 to 0.36) (very low-certainty evidence for both outcomes). No deaths were reported (moderate-certainty evidence). Health-related quality of life (HRQoL) and treatment satisfaction were not evaluated. Two trials compared meglitinides with sulphonylurea. The evidence is very uncertain about the effect on hypoglycaemia (14/133 versus 21/140, RR 0.72, 95% CI 0.40 to 1.28) and HbA1c changes (MD 0.38%, 95% CI 0.35% to 0.41%) (very low-certainty evidence for both outcomes). Death, serious hypoglycaemic events, adverse events, treatment satisfaction and HRQoL were not evaluated. One trial compared sodium-glucose co-transporter-2 (SGLT-2) inhibitors with sulphonylurea. SGLT-2 may reduce hypoglycaemia compared to sulphonylurea (4/58 versus 13/52, RR 0.28, 95% CI 0.10 to 0.79; low-certainty evidence). The evidence was very uncertain for serious hypoglycaemia (one event reported in both groups, RR 0.90, 95% CI 0.06 to 13.97) and adverse events other than hypoglycaemia (20/58 versus 18/52, RR 1.00, 95% CI 0.60 to 1.67) (very low-certainty evidence for both outcomes). SGLT-2 inhibitors result in little or no difference in HbA1c (MD 0.27%, 95% CI -0.04 to 0.58; 1 trial, 110 participants; low-certainty evidence). Death, treatment satisfaction and HRQoL were not evaluated. Three trials compared glucagon-like peptide 1 (GLP-1) analogues with sulphonylurea. GLP-1 analogues may reduce hypoglycaemia compared to sulphonylurea (20/291 versus 48/305, RR 0.45, 95% CI 0.28 to 0.74; low-certainty evidence). The evidence was very uncertain for serious hypoglycaemia (0/91 versus 1/91, RR 0.33, 95% CI 0.01 to 7.99; very low-certainty evidence). The evidence suggests that GLP-1 analogues result in little to no difference in adverse events other than hypoglycaemia (78/244 versus 55/255, RR 1.50, 95% CI 0.86 to 2.61; very low-certainty evidence), treatment satisfaction (MD -0.18, 95% CI -3.18 to 2.82; very low-certainty evidence) or change in HbA1c (MD -0.04%, 95% CI -0.45% to 0.36%; 2 trials, 246 participants; low-certainty evidence). Death and HRQoL were not evaluated. Two trials compared insulin analogues with biphasic insulin. The evidence was very uncertain about the effects of insulin analogues on hypoglycaemia (47/256 versus 81/244, RR 0.43, 95% CI 0.13 to 1.40) and serious hypoglycaemia (4/131 versus 3/132, RR 1.34, 95% CI 0.31 to 5.89) (very low-certainty evidence for both outcomes). The evidence was very uncertain for the effect of insulin analogues on adverse effects other than hypoglycaemia (109/256 versus 114/244, RR 0.83, 95% CI 0.44 to 1.56; very low-certainty evidence), all-cause mortality (1/131 versus 0/132, RR 3.02, 95% CI 0.12 to 73.53; very low-certainty evidence) and HbA1c changes (MD 0.03%, 95% CI -0.17% to 0.23%; 1 trial, 245 participants; very low-certainty evidence). Treatment satisfaction and HRQoL were not evaluated. Two trials compared telemedicine with usual care. The evidence was very uncertain about the effect of telemedicine on hypoglycaemia compared with usual care (9/63 versus 23/58, RR 0.42, 95% CI 0.24 to 0.74; very low-certainty evidence), HRQoL (MD 0.06, 95% CI -0.03 to 0.15; very low-certainty evidence) and HbA1c change (MD -0.84%, 95% CI -1.51% to -0.17%; very low-certainty evidence). Death, serious hypoglycaemia, AEs other than hypoglycaemia and treatment satisfaction were not evaluated. Two trials compared Ramadan-focused patient education with usual care. The evidence was very uncertain about the effect of Ramadan-focused patient education on hypoglycaemia (49/213 versus 42/209, RR 1.17, 95% CI 0.82 to 1.66; very low-certainty evidence) and HbA1c change (MD -0.40%, 95% CI -0.73% to -0.06%; very low-certainty evidence). Death, serious hypoglycaemia, adverse events other than hypoglycaemia, treatment satisfaction and HRQoL were not evaluated. One trial compared drug dosage reduction with usual care. The evidence is very uncertain about the effect of drug dosage reduction on hypoglycaemia (19/452 versus 52/226, RR 0.18, 95% CI 0.11 to 0.30; very low-certainty evidence). No participants experienced adverse events other than hypoglycaemia during the study (very low-certainty evidence). Death, serious hypoglycaemia, treatment satisfaction, HbA1c change and HRQoL were not evaluated.
There is no clear evidence of the benefits or harms of interventions for individuals with T2DM who fast during Ramadan. All results should be interpreted with caution due to concerns about risk of bias, imprecision and inconsistency between studies, which give rise to low- to very low-certainty evidence. Major outcomes, such as mortality, health-related quality of life and severe hypoglycaemia, were rarely evaluated. Sufficiently powered studies that examine the effects of various interventions on these outcomes are needed.
Researchers and educators continue to explore the potential of Immersive Virtual Reality (IVR) technology for safety training in children, as unintentional injuries persist as the leading cause of ...global mortality among this cohort. In order to implement IVR as a safety training tool, it is important to understand its effectiveness compared to other methods. However, few studies have systematically summarised the use of IVR for unintentional injury prevention training with children. To address this gap, a systematic review was conducted using five databases, following the PRISMA guidelines. Sixteen studies published until March 2024 were identified that evaluated the effectiveness of IVR technology for unintentional injury prevention training with children aged 1–14 years. We evaluated: i) the types of unintentional injury skills taught, ii) research designs, data collection methods and measures used, iii) IVR interface and equipment utilised, and iv) the effectiveness of IVR technologies in comparison to conventional methods of training. The majority of the identified studies focused on road safety, with three on fire safety, and one on water safety. Varied instruments were used to measure outcomes including knowledge, behaviour, immersion, interest, enjoyment, and usability. IVR interventions employed head-mounted displays (N = 13) and Cave Automatic Virtual Environments (N = 3), with either interactive or passive experiences. Overall, the studies suggest a positive role for IVR in unintentional injury prevention training with children. However, only two studies made direct comparisons with other methods, underscoring the need for a cautious interpretation of the findings. Future studies should prioritise evaluating the transfer of learnings from the virtual environment to real-world settings, direct comparisons between IVR and conventional training methods, the relationship between different IVR learning approaches and cognitive and motor skill acquisition, and the correlation between immersion and learning outcomes.
•Immersive virtual reality (IVR) has growing potential for child safety training.•TThis systematic review analysed 16 studies on IVR for child injury prevention.•IVR facilitates experiential learning and limits exposure to real-life hazards.•Few studies directly compare the learning outcomes of IVR to conventional teaching.•Research is needed on applying learnings gained from IVR to the real world.
The impact of the COVID-19 pandemic on mental health is an emerging problem globally. This study aimed to examine the mediating effect of chronic illnesses in the relationship between psychological ...health and the acceptance of the COVID-19 vaccine, prior to the national vaccine rollout in Malaysia. An online cross-sectional study was conducted in Malaysia between December 10, 2020, and February 9, 2021. In addition to the descriptive analyses, a mediation analysis was performed to examine the mediating effect of chronic illnesses in the relationship between psychological distress and the willingness to accept the vaccine. A total of 1738 participants completed the survey. The psychological distress levels were found to be significantly different across demographic factors such as age, gender, and social economic status. This study demonstrated a partial mediating effect of chronic illnesses in the relationship between psychological distress and vaccine acceptance.
In the United States, between 1995 and 2013, night-time visual flight rules (VFR) Helicopter Emergency Medical Service (HEMS) fatal accidents mostly encountered adverse weather, and pilots with <6 yr ...of HEMS experience showed higher likelihood of a night operational accident. One adverse weather indicator is cloud-ceiling likelihood indicated by temperature dew point spread (TDPS). This study investigated the relationship between TDPS and HEMS pilot years of experience. It was hypothesized pilots with <6 yr HEMS experience were associated with fatal outcomes encountered at lower TDPS.
Between 1995 and 2013, 32 single pilot night VFR HEMS fatal accidents occurring in the United States, caused by controlled flight into terrain or loss of control, were analyzed. Using Federal Aviation Administration weather guidance, the 0-4°C TDPS was selected as an indicator of cloud ceiling. Each flight's TDPS was analyzed with pilots' HEMS domain task experience.
There were 27 flights which entered the 0-4°C TDPS range; 20 (74%) were significantly associated with adverse weather. A significant negative linear relationship was found between TDPS of each mission and years of pilot HEMS experience (r = -0.423, P = 0.028). Pilots with <6 yr of experience were significantly associated with fatal outcomes (P = 0.049).
Pilots' incremental years of HEMS experience were associated with a TDPS decrement. Fatal outcomes were over nine times higher for pilots with <6 yr of HEMS experience in night VFR operational accidents in those conditions. Interventions for <6-yr pilots are recommended during experience building to prevent likelihood of operational accidents.Aherne BB, Zhang C, Chen WS, Newman DG. Pilot decision making in weather-related night fatal helicopter emergency medical service accidents. Aerosp Med Hum Perform. 2018; 89(9):830-836.
The Manchester Driver Behaviour Questionnaire (DBQ) can be regarded as one of the well accepted self-report measures of aberrant driver behaviour in more than 20 years. The various factor structures ...of DBQ had extensively been examined in past studies related to driving behaviour. The objective of this study is to examine the equivalence of the Malay DBQ factor structures in samples of older car drivers and older motorcycle riders in Malaysia.
Five hundred respondents were recruited for this study. Respondents were current and former car drivers or motorcycle riders, aged 60 years and above, and resided in Malaysia. All car drivers and motorcycle riders responded to the Malay DBQ either using a paper-form or an online platform via Qualtrics.
All four factors in the Malay DBQ were found to be internally consistent for both car drivers sample and motorcycle riders sample. Older motorcycle riders perceived lapse items differently compared to older car drivers.
The four-factor structures of the Malay DBQ were very similar to the original DBQ, but not identical. This study suggested declining cognitive capabilities of older people were likely to be associated with the increasing likelihood of problems with attention.
•The four-factor structures of the Malay DBQ were very similar to the original British DBQ, but not identical.•The alpha reliability coefficients showed the aggressive violations, ordinary violations, errors and lapses in the Malay DBQ were internally consistent.•The aggressive violation items and ordinary violation items were clearly differentiated, similar to the original British DBQ, but not the lapse items.•Declining cognitive capabilities of older drivers and riders were associated with the increasing problems with attention.
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