Morbidity Survey Research Articles

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

Background: The goal of this study was to understand the state of morbidity and mortality conferences held throughout our health system. Assessment of current approaches is necessary for a journey toward organizational high reliability and an opportunity to reduce unnecessary variation in patient and process outcomes. Study Design: Forty-two anonymous surveys were distributed through the Health System’s Vice-chairs of Quality to those in the best position to answer questions. Answers from all departments and—where semi-autonomous—divisions were solicited. Categories, among others, included written guidelines, who presented, what events were chosen for presentation, and what was done with the data. Results: Forty-one surveys were returned. Seventeen departments or divisions have written guidelines as to which events should be reported. Twenty-two of the departmental or divisional conferences present selected cases, only 13 present all mortalities. Decisions on how events are classified are made most often by the director of Quality with 13 responses. There was no consensus on how best to enhance the clinical learning environment for residents and fellows. Conclusion: Opportunities identified by our survey to reduce practice variation include best practices for written guidelines and standardized classification formats for morbidity and mortality events. A mortality committee charged with event review and classification should be considered. Lastly, more effort should be made to enhance the clinical learning environment of trainees in event review and presentation.

Effect of prehabilitation-related DIETary protein intake on Quality of Recovery after elective cardiac surgery (DIETQoR) study: protocol of a randomised controlled trial

IntroductionProtein malnutrition is associated with higher risks of postoperative complications, mortality, prolonged postoperative stays in hospital, slower physical and mental recovery after surgery and lower subsequent health-related quality of life....

Changes in loneliness prevalence in Denmark in the 21st century: Age-period-cohort analysis.

The aim of this study was to investigate changes in the prevalence of loneliness in Denmark from 2000 to 2021 by conducting age-period-cohort analysis. Our study was based on a sample (N=83,437; age: ⩾16 years) of the Danish Health and Morbidity Surveys conducted in Denmark in 2000, 2005, 2010, 2013, 2017 and 2021. We used logistic regression models by gender to estimate the age-period-cohort effects, with loneliness as the dependent variable and age, survey year and birth cohort as independent variables, mutually adjusted. The prevalence of adult loneliness increased by each survey year over the entire period (from 13.2% in 2000 to 27.4% in 2021 among men and from 18.8% to 33.7% among women). Overall, a U-shaped curve, for the prevalence of loneliness among different age groups, was observed, which was most pronounced among women. The greatest increase in the prevalence of loneliness from 2000 to 2021 was observed among the youngest age group (16-24 years), with 28.4 and 30.7 percentage points for men and women. No significant cohort effect was observed. The observed increase in loneliness prevalence from 2000 to 2021 was driven by period and age effects rather than cohort effects. It should be noted that data from 2021 were collected during a national lockdown due to an outbreak of COVID-19, which could explain part of the large increase in loneliness from 2017 to 2021.

A practical illustration of spatial smoothing methods for disconnected regions with INLA: spatial survey on overweight and obesity in Malaysia

BackgroundNational prevalence could mask subnational heterogeneity in disease occurrence, and disease mapping is an important tool to illustrate the spatial pattern of disease. However, there is limited information on techniques for the specification of conditional autoregressive models in disease mapping involving disconnected regions. This study explores available techniques for producing district-level prevalence estimates for disconnected regions, using as an example childhood overweight in Malaysia, which consists of the Peninsular and Borneo regions separated by the South China Sea. We used data from Malaysia National Health and Morbidity Survey conducted in 2015. We adopted Bayesian hierarchical modelling using the integrated nested Laplace approximation (INLA) program in R-software to model the spatial distribution of overweight among 6301 children aged 5–17 years across 144 districts located in two disconnected regions. We illustrate different types of spatial models for prevalence mapping across disconnected regions, taking into account the survey design and adjusting for district-level demographic and socioeconomic covariates.ResultsThe spatial model with split random effects and a common intercept has the lowest Deviance and Watanabe Information Criteria. There was evidence of a spatial pattern in the prevalence of childhood overweight across districts. An increasing trend in smoothed prevalence of overweight was observed when moving from the east to the west of the Peninsular and Borneo regions. The proportion of Bumiputera ethnicity in the district had a significant negative association with childhood overweight: the higher the proportion of Bumiputera ethnicity in the district, the lower the prevalence of childhood overweight.ConclusionThis study illustrates different available techniques for mapping prevalence across districts in disconnected regions using survey data. These techniques can be utilized to produce reliable subnational estimates for any areas that comprise of disconnected regions. Through the example, we learned that the best-fit model was the one that considered the separate variations of the individual regions. We discovered that the occurrence of childhood overweight in Malaysia followed a spatial pattern with an east–west gradient trend, and we identified districts with high prevalence of overweight. This information could help policy makers in making informed decisions for targeted public health interventions in high-risk areas.

THE DEFENCE MECHANISMS USED BY HYSTERIA MALAY STUDENTS IN KELANTAN TO PROTECT THEMSELVES FROM UNCOMFORTABLE BEHAVIOURS

Malaysians frequently use the term hysteria to describe an illness caused by a subtle disturbance or ghost behaviour. The Malay community considers hysteria to be 'phantom ghost' or 'disturbed’. Such beliefs arose because the Malay community believed that the hysteria that occurred in girls and women was a symptom of ghosts, jinn, and satanic disturbances or anything related to disturbances of subtle and unseen things. The burden of mental illness in Malaysia is high, and it is increasing. Malaysian mental health-related burden comprises up to 37% of total disability. The National Health and Morbidity Survey (NHMS) 2015 revealed a prevalence of 29.2% of Malaysians above 16 years to have mental health problems, with three in ten Malaysians struggling with some form of mental health issues. From the perspective of looking after the future generations of Malaysians, the picture of adolescent mental health is also worrying. The objective of this study was to describe how the Malay students used defence mechanism to protect themselves from unpleasant behaviours. A qualitative approach, psychological tests and triangulation method were used for this study, in which 10 specific hysteria students was selected for in-depth interview. The psychological test were DASS-21 Test and Drawing Test. Snow ball sampling was used to select young girls in high schools who experienced mass hysteria. The results show that the hysteria respondents suffered from trauma, emotional problems, verbal abuse, sexual harassment, and a lacking of their parents’ attention. There are two types of problems: internal and external. The internal problem is their personality. The findings of the study may guide students in Kelantan to get proper treatment from medical professional. If mass hysteria in the Kelantan context is better understood, teachers can be empowered through health education to enable them to identify mass hysteria outbreaks in schools early, manage victims and observers more effectively and refer victims to health workers for treatment.

Associations between common mental disorders and menopause: cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey.

We investigated whether women who participated in a household survey in England were more likely to screen positive for possible generalised anxiety disorder and depression during and after menopause. We used logistic regression in secondary cross-sectional analyses of 1413 participants from the 2014 Adult Psychiatric Morbidity Survey data, adjusting for potential confounders (including age, deprivation score and chronic disease).We found that participants who were post-menopausal were more likely to screen positive for possible depression compared with participants who were pre-menopausal (3.9% v. 1.7%; adjusted odds ratio 3.91, 95% CI 1.23-12.46), but there was no association with perimenopause. We found no evidence of an association between menopausal stage and possible generalised anxiety disorder or symptom score. Clinicians should be aware of the association between menopause and depression, to best support women. Future research could focus on to what extent associations are driven by somatic features, and how this might be modified.

HELLENIC CARDIORENAL MORBIDITY SNAPSHOT (HECMOS). HIGH PREVALENCE OF DIFFICULT-TO-CONTROL HYPERTENSION IN CARDIOLOGY INPATIENTS WITH COMORBIDITIES

Objective: Uncontrolled hypertension (HTN) remains a major public health problem, especially among older people with multiple comorbidities. We aimed to show the prevalence of uncontrolled HTN among the HECMOS participants. Design and method: HECMOS was a nationwide crossection survey of cardiorenal morbidity among 923 cardiology inpatients on the 3rd of March 2022 via an electronic case report form. Uncontrolled HTN was defined under the current ESH/ESC HTN guidelines, while patients with an estimated glomerular filtration rate below 60 ml/min/1.73m2 were considered as cases of chronic kidney disease (CKD). Results: HTN prevalence was linearly related to patients’ age, whereas difficult-to-control HTN showed a similar trend, found to be higher among patients older than 80. There was a statistically significant difference (p = 0,001) in HTN prevalence between patients aged over 60 years (60 - 69:71,1%, 70 - 79:74,1%, >OR = 80:79,0%) and younger participants (<40:3,1%, 40 - 49:33,3%, 50 - 59: 48,5%). HTN history was similarly reported among cases of Heart Failure (HF), Diabetes Mellitus (DM), Atrial Fibrillation (AF), and CKD, the four more prevalent morbid conditions in our sample. Nevertheless, HTN prevalence was higher in CKD and DM patients than in others without CKD or DM (76.6% vs. 63.6%, 77.6% vs. 61.4%, respectively, p = 0.001). Conclusions: In this nationwide opportunistic survey, HTN and difficult-to-control HTN was highly prevalent among cardiology inpatients of older age, CKD, and DM.

Use Of Guava As A Prevention Of Acute Diarrhea In Toddlers

The 2018 Balitbangkes Basic Health Research (Riskesdas) data shows the prevalence of diarrhea in toddlers is 12.3%. Riskesdas also stated that the most common cause of infant death was diarrhea (31.4%). According to the 2010 diarrhea morbidity survey, the largest proportion of sufferers was in the 6-11 month age group, which was 21.65% (Ministry of Health, 2011). This study aims to get an overview of the use of guava leaves as an effort to prevent acute diarrhea in toddlers.The method used in this study is quantitative, which is to find out an accurate description of the use of guava as an effort to prevent acute diarrhea in toddlers.From the results of the study it was found that most children who experienced diarrhea consumed guava as an alternative treatment by 60%.Giving decoction of guava leaves effective in reducing the frequency of diarrhea when consumed regularly, besides that it can used by the community as traditional medicine that has easy profit, easy way its use, and many residents who plant.It is suggested to mothers of toddlers to use an alternative to giving guava leaves as a treatment or prevention of acute diarrhea in toddlers.

Bariatric surgeries: Outcome throughout an annum at a specialist center in Malaysia.

Malaysia has the highest number of obese and overweight individuals in South-east Asia. The 2019 National Health & Morbidity survey found 50.1% of Malaysians to be overweight or obese with 30.4% being overweight and 19.7% being obese. This has led to the high rise of the bariatric surgeries demand and needs within the nation. To assess the level of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index) for the patients before and after bariatric surgeries (sleeve/gastric bypass) for a one year follow up period. The study was conducted among 1000 patients who underwent a single weight reduction surgery (sleeve/gastric bypass) by a single surgeon at the Cengild Medical Centre between January 2019 to January 2020. They were followed up for a one-year period through recording the parameters of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index). Study was conducted using universal sampling including all subjects visited the centre and a written consent was obtained from each participant. Descriptive statistics with mean was used and paired t-test was used for comparison and test the difference. The STOP-BANG acronym stands for: Snoring history, Tired during the day, Observed stop breathing while sleep, High blood pressure, BMI more than 35 kg/m2, Age more than 50 years, Neck circumference more than 40 cm and male Gender. The mean age of patients was 38 years old. Mean FBS for the patients one month before the operation was 10.42 mmol/L and 5.84 three months post procedure. The systolic blood pressure one month before the operation and 3 months after was 139.81 mmHg and 123.79 mmHg, while diastolic blood pressure was 86.84 mmHg and 81.07 mmHg respectively. BMI was reduced from 39.69 to 27.99 after one year from the weight reduction operation. All the above parameters showed a significant reduction between one-month pre operation as compared to 3 months and 12 months post operation and that improved the health parameters of the patients significantly. The weight reduction operations showed a significant reduction in the FBS, blood pressure, OSA scores and BMI at 3, 12 months after the operation These patients had better overall health after the significant reduction in these parameters.

Intimate partner violence perpetration and mental health service use in England: analysis of nationally representative survey data.

Intimate partner violence perpetration (IPVP) is associated with psychiatric disorders, but an association with mental health service use has not been fully established and is relevant for policy. Mental health service contact by perpetrators of intimate partner violence presents an opportunity for reducing harmful behaviours. To examine the association between IPVP and mental health service use. Analysis of national probability sample data from the 2014 Adult Psychiatric Morbidity Survey, testing for associations between lifetime IPVP and mental health service use. We assessed the impact of missing data with multiple imputation and examined misreporting using probabilistic bias analysis. The prevalence of reported lifetime IPVP was similar for men (8.0%) and women (8.6%). Before adjustments, IPVP was associated with mental health service use (odds ratio (OR) for any mental health service use in the past year for men: 2.8 (95% CI: 1.8-4.2), for women: 2.8 (95% CI: 2.1-3.8)). Adjustments for intimate partner violence victimisation and other life adversities had an attenuative influence. Associations remained on restricting comparisons with those without criminal justice involvement (OR for any mental health service use in the past year for men: 2.9 (95% CI: 1.7-4.8), for women: 2.3 (95% CI: 1.7-3.2)). The strong association of IPVP with mental health service use is partly attributable to the concurrent presence of intimate partner violence victimisation and other life adversities. Efforts to improve the identification and assessment of IPVP in mental health services could benefit population health.

Social determinants of stunting in Malay children aged

ObjectiveThis study aims to assess social determinants of stunting among children aged <5 y within the Malay ethnicity in Malaysia. MethodsThis study used data from the National Health and Morbidity Survey 2016: Maternal and Child Health. It includes a sample of 10 686 children, ages 0 to 59 mo, of Malay ethnicity. Height-for-age z score was determined based on the World Health Organization Anthro software. A binary logistic regression model was used to examine the association between the selected social determinants and the occurrence of stunting. ResultsAbout 22.5% of children aged <5 y of Malay ethnicity were stunted. For those ages 0 to 23 mo, stunting is more prevalent in boys, in rural areas, and in those who have screen exposure, whereas a reduction of stunting was observed for those children whose mothers work in the private sector and in those who consume formula milk and meat. As for those ages 24 to 59 mo, there was a higher prevalence of stunting for those with self-employed mothers and reduced prevalence in children with hygienic waste disposal practices as well as those who play with toys. ConclusionsThe prevalence of stunting among children of Malay ethnicity aged <5 in Malaysia necessitates immediate intervention. It is pertinent to facilitate early identification of those children at risk of stunting for additional care to promote healthy growth.

Age, Period, and Cohort Analysis of Smoking Intensity Among Current Smokers in Malaysia, 1996-2015.

Tobacco use is one of the major preventable risk factors for premature death and disability worldwide. Understanding the trend of tobacco use over time is important for informed policy making. The present study aimed to examine the changes in mean daily cigarette consumption among random samples of the Malaysian current smoker population over 20 years using an age-period-cohort (APC) approach. We conducted APC analysis using a multilevel hierarchical age-period-cohort model and data from four nationally representative, repeated cross-sectional surveys (National Health and Morbidity Survey) conducted in 1996, 2006, 2011, and 2015 among individuals aged 18 to 80 years. Analyses were also stratified by gender and ethnicity. Overall, mean daily cigarette consumption (smoking intensity) among current smokers increased with age until 60, after which a drop was observed. There were increases in daily cigarette consumption across birth cohorts. Age and cohort trends did not vary by gender but by ethnicity. The decreasing cigarette consumption after age 60 among the current smoker population was consistent with those observed among the Chinese and Indians, a trend that was not observed in Malays and other aborigines. In contrast, the increasing cohort trend was consistent with those observed among the Malays and other bumiputras. The present study highlighted important ethnic-specific trends for mean daily cigarette consumption among the current smoker population in Malaysia. These findings are essential in guiding the formulation of interventional strategies or implementation of national tobacco control policies and help achieve the Ministry of Health Malaysia's 2025 and 2045 targets for smoking prevalence. This is the first APC study on smoking intensity among current smokers in a multiracial, middle-income nation. Very few studies had performed gender- and ethnic-stratified APC analyses. The ethnic-stratified APC analyses provide useful insights into the overall age and cohort trends observed among the current smoker population in Malaysia. Therefore, the present study could add evidence to the existing literature on the APC trends of smoking intensity. The APC trends are also important in guiding the government to develop, implement, and evaluate antismoking strategies.

Poor Self-Rated Health and Associated Factors among Older Persons in Malaysia: A Population-Based Study.

This study aims to determine the prevalence of poor self-rated health (SRH) in Malaysia and its association with sociodemographic characteristics, lifestyle behavior, chronic diseases, depression, and functional limitations in activities of daily living (ADLs) among older persons. Cross-sectional. Setting, participants, and outcome measures: We used data from the National Health and Morbidity Survey 2018, a nationwide community-based study. This study was conducted using a two-stage stratified cluster sampling design. Older persons were defined as persons aged 60 years and above. SRH was assessed using the question "How do you rate your general health?" and the answers were "very good", "good", "moderate", "not good", and "very bad". SRH was then grouped into two categories; "Good" (very good and good) and "Poor" (moderate, not good, and very bad). Descriptive and logistic regression analyses were conducted using SPSS version 25.0. The prevalence of poor SRH among older persons was 32.6%. Poor SRH was significantly related to physical inactivity, depression, and limitations in activities of daily living (ADLs). Multiple logistic regression revealed that poor SRH was positively associated with those who had depression (aOR 2.92, 95% CI:2.01,4.24), limitations in ADLs (aOR 1.82, 95% CI: 1.31, 2.54), low individual income (aOR 1.66, 95% CI:1.22, 2.26), physical inactivity (aOR 1.40, 95% CI:1.08, 1.82), and hypertension (aOR 1.23, 95% CI:1.02, 1.49). Older persons with depression, limitations in ADLs, low income, physical inactivity, and hypertension were significantly associated with poor SRH. These findings provide information to aid health personnel and policymakers in the development and implementation of health promotion and disease prevention programs, as well as adequate evidence in planning different levels of care for the older population.

Effect of supplementary private health insurance on inpatient utilisation: Evidence from Malaysia

Supplementary private health insurance (PHI) provides better access to healthcare, improves health outcomes, potentially lowers the costs for health systems and supports the social security system. Improperly regulated PHI, however, may aggravate inequity of access towards preferential care and encourage moral hazard among PHI purchasers, altering the health-seeking behaviour, which is often observed through the pattern of health care utilisation. We investigated the effect of PHI ownership on private inpatient care utilisation, its frequency of admission and length of stay by conducting secondary data analysis of the Malaysian National Health Morbidity Survey (NHMS) 2015 data, a nationally representative community health survey. Malaysian adults 18 years of age and above who utilised inpatient healthcare facilities were included. In this cross-sectional study, we addressed the endogeneity effect of health insurance by employing instrumental variable estimation and a two-stage residual inclusion analysis. We found a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not (β = 4.39, p < 0.001). There was no significant difference in the frequency of admission and length of stay. The increase in private inpatient utilisation among PHI owners may reflect the demand for timely care and hospitality provided by the private sector, potentially exacerbating the moral hazard behaviour among PHI owners. Further exploration of this issue could impact future healthcare systems financing designs and PHI regulation.

Handling Missing Values in Surveys With Complex Study Design: A Simulation Study

Abstract The inverse probability weighting (IPW) method is commonly used to deal with missing-at-random outcome (response) data collected by surveys with complex sampling designs. However, IPW methods generally assume that fully observed predictor variables are available for all sampled units, and it is unclear how to appropriately implement these methods when one or more independent variables are subject to missing values. Multiple imputation (MI) methods are well suited for a variety of missingness patterns but are not as easily adapted to complex sampling designs. In this case study, we consider the National Survey of Morbidity and Risk Factors (EMENO), a multistage probability sample survey. To understand the strengths and limitations of using either missing data treatment method for the EMENO, we present an extensive simulation study modeled on the EMENO health survey, with the target analysis being the estimation of population prevalence of hypertension as well as the association between hypertension and income. Both variables are subject to missingness. We test a variety of IPW and MI methods in simulation and on empirical data from the survey, assessing robustness by varying missingness mechanisms, proportions of missingness, and strengths of fitted response propensity models.

The clustering of physical health conditions and associations with co-occurring mental health problems and problematic alcohol use: a cross-sectional study

BackgroundThere is strong evidence for the co-occurrence of mental health conditions and alcohol problems, yet physical health outcomes among this group are not well characterised. This study aimed to identify clusters of physical health conditions and their associations with mental health and problematic alcohol use in England’s general population.MethodsCross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey (N = 7546) was conducted. The survey used standardised measures of problematic alcohol use and mental health conditions, including the Alcohol Use Disorders Identification Test (AUDIT) and the Clinical Interview Schedule-Revised. Participants self-reported any lifetime physical health conditions. Latent class analysis considered 12 common physical illnesses to identify clusters of multimorbidity. Multinomial logistic regression (adjusting for age, gender, ethnicity, education, and occupational grade) was used to explore associations between mental health, hazardous drinking (AUDIT 8 +), and co-occurring physical illnesses.ResultsFive clusters were identified with statistically distinct and clinically meaningful disease patterns: ‘Physically Healthy’ (76.62%), ‘Emerging Multimorbidity’ (3.12%), ‘Hypertension & Arthritis’ (14.28%), ‘Digestive & Bowel Problems’’ (3.17%), and ‘Complex Multimorbidity’ (2.8%). Having a mental health problem was associated with increased odds of ‘Digestive & Bowel Problems’ (adjusted multinomial odds ratio (AMOR) = 1.58; 95% CI [1.15–2.17]) and ‘Complex Multimorbidity’ (AMOR = 2.02; 95% CI [1.49–2.74]). Individuals with co-occurring mental health conditions and problematic alcohol use also had higher odds of ‘Digestive & Bowel Problems’ (AMOR = 2.64; 95% CI [1.68–4.15]) and ‘Complex Multimorbidity’ (AMOR = 2.62; 95% CI [1.61–4.23]).ConclusionsIndividuals with a mental health condition concurrent with problematic alcohol use experience a greater burden of physical illnesses, highlighting the need for timely treatment which is likely to include better integration of alcohol and mental health services.

Morbidity survey of the history of snakebites in different communities in the alto Juruá, western Brazilian Amazon

The Alto Juruá region has a rich diversity of venomous snakes, and snakebites represent an important cause of morbidity. The present study was carried out in five communities in the Alto Juruá region, and aimed to evaluate the history of snakebites in terms of which snakes were involved and what was the victims’ conduct in relation to first aid and prevention. Between 2017 and 2019, semi-structured interviews were applied to 260 residents, 56 (21.53%) of whom had a history of snakebites. The profile of the victims is 73.2% male, a resident of rural areas who develops activities mainly in agriculture and extractivism and who has a low level of education. Just over half of the snakebites occurred during the rainy season (52.8%) and the majority during the day (77%). Bothrops bites were the most frequently reported (90.3%) and B. atrox was the most mentioned snake (jararaca and surucucu) for being responsible for snakebites (80.8%). Approximately 87.5% of the bites occurred to the lower limbs, and 48.2% of the victims were barefoot at the time of the bite. Inadequate first-aid procedures were reported, such as using tourniquets and consuming the drink known as “Específico Pessoa”, not drinking water, and treatment with traditional therapy (phytotherapics, zootherapeutics and faith healers), as well as not seeking hospital care. Thus, the need to facilitate access to hospital units in these communities and health education (prevention and first aid) are essential in order to minimize this situation.

Systematic reviews and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: mortality, morbidity, and organ failure

BackgroundMortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these measures are highly variable, and validity is often unclear. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid measures of mortality, morbidity, and organ failure for use in perioperative clinical trials. MethodsThree domains of endpoints (mortality, morbidity, and organ failure) were explored through systematic literature review and a three-stage Delphi consensus process using methods consistently applied across the StEP initiative. Reliability, feasibility, and patient-centredness were assessed in round 3 of the consensus process. ResultsA high level of consensus was achieved for two mortality time points, 30-day and 1-yr mortality, and these two measures are recommended. No organ failure endpoints achieved threshold criteria for consensus recommendation. The Clavien–Dindo classification of complications achieved threshold criteria for consensus in round 2 of the Delphi process but did not achieve the threshold criteria in round 3 where it scored equivalently to the Post Operative Morbidity Survey. Clavien–Dindo therefore received conditional endorsement as the most widely used measure. No composite measures of organ failure achieved an acceptable level of consensus. ConclusionsBoth 30-day and 1-yr mortality measures are recommended. No measure is recommended for organ failure. One measure (Clavien–Dindo) is conditionally endorsed for postoperative morbidity, but our findings suggest that no single endpoint offers a reliable and valid measure to describe perioperative morbidity that is not dependent on the quality of deli-vered care. Further refinement of current measures, or development of novel measures, of postoperative morbidity might improve consensus in this area.

The Association between Perceived Annoyances in the Indoor Home Environment and Respiratory Infections: A Danish Cohort Study with up to 19 Years of Follow-Up.

The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.

Patterns of polysubstance use among adults in Malaysia-A latent class analysis.

Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia. To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia. This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis. Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2). Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.