Higher rates of obesity and obesity-related chronic disease are prevalent in communities where there is limited access to affordable, healthy food. The B’More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment including food wholesalers and corner stores to improve the surrounding community’s access to healthy food. The objective of this article is to describe the development and implementation of BHCK’s corner store and wholesaler interventions through formal process evaluation. Researchers evaluated each level of the intervention to assess reach, dose delivered, and fidelity. Corner store and wholesaler reach, dose delivered, and fidelity were measured by number of interactions, promotional materials distributed, and maintenance of study materials, respectively. Overall, the corner store implementation showed moderate reach, dose delivered, and high fidelity. The wholesaler intervention was implemented with high reach, dose, and fidelity. The program held 355 corner store interactive sessions and had 9,347 community member interactions, 21% of which were with children between the ages of 10 and 14 years. There was a 15% increase in corner store promoted food stocking during Wave 1 and a 17% increase during Wave 2. These findings demonstrate a successfully implemented food retailer intervention in a low-income urban setting.
Background and Objective: Distinguishing attributes of stroke subtypes is crucial to establish appropriate planning for patient care and preventive measures. This study aims to compare the associations among demographic characteristics, risk factors, clinical manifestations, and outcomes of different stroke subtypes in a Malaysian stroke-ready hospital. Methods: The study utilized data that were collected from the local hospital-based stroke database, which is part of the Perai Regional Integrated Stroke Intervention System. The database is representative of the population in mainland Penang. All confirmed local ischaemic stroke (IS) and haemorrhagic stroke (HS) cases aged 18 years and above admitted to Hospital Seberang Jaya from 1st January 2010 to 31st December 2019 were included. Descriptive and inferential statistics were employed. Results: There was a total of 1,805 patients with 1,572 (87.1%) IS patients and 233 (12.9%) HS patients. The mean (SD) age for IS patients was 62.75 (12.08) and 60.51 (13.65) for HS patients. Generally, there were more male than female patients: 957 (60.9%) male IS patients and 137 (58.8%) male HS patients. A significantly higher proportion of IS patients were aged ≥60 years old (59.9%, p=0.021), of Indian origin (15.5%, p=0.034), had diabetes (51.2%, p<0.001), hyperlipidaemia (17.8%, p<0.001), ischaemic heart disease (10.9%, p=0.011) and were smokers (54.2%, p=0.028) as compared to HS patients. The proportion of IS patients who exhibited hemiparesis (76.0%, p=0.012) and speech disturbances (54.8%, p=0.015) was higher than HS patients. Most IS patients ranged from no disability to moderate disability (65.3%, p<0.001) with a length of stay in the hospital of ≤ 7 days (77.6%, p<0.001). Conclusion: Significant differences were observed on risk factors between IS and HS. IS was linked mainly with hemiparesis and speech disturbances, whereas HS patients mainly exhibited headaches, nausea and vomiting, altered sensorium, and seizures, in addition to more severe stroke and poor outcomes.
There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92-1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77-1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88-1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85-0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98-1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827.
Southeast Asia is rapidly becoming the region hit hardest by coronavirus disease (COVID-19), as evidenced by the surging daily number of new confirmed cases and deaths. The COVID-19 crisis continues to worsen with the entry of the more transmissible variants of concern, primarily the Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was first identified in India. Pregnant women are among the vulnerable population groups at risk of suffering from severe COVID-19 and may experience poor pregnancy and neonatal outcomes due to the infection. Vaccination seems to be the most effective strategy to curb the pandemic and secondarily by social distancing, wearing face masks and practising hand hygiene. There has been limited yet reassuring evidence in support of vaccinating pregnant women against COVID-19. We sought to review the latest evidence regarding the safety, immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women as well as the recommendations and guidance provided by the public health authorities in the countries in Southeast Asia.
In the midst of the COVID-19 pandemic, several unexpected positive outcomes have surfaced. The WHO public health measures have positively transformed people’s behaviour and lifestyles. The pandemic has prompted more focus on self-care and health awareness. Hand hygiene practice has been greatly emphasised. The acceptance rate for the use of personal protective equipment, such as face masks, has been remarkable. People with co-morbid conditions are paying more attention to their primary illnesses by improving diets and exercise methods. People are more willing to accept and act on public health messages. The pandemic lockdowns have not only successfully mitigated the transmission of coronavirus, but they have also indirectly reduced the hospital admission rates for endemic community respiratory infections and trauma-related emergencies like motor vehicle accidents. Fetomaternal health and wellness have significantly improved during the pandemic. The abrupt emergence of COVID-19 has also led to a massive societal shift on tobacco smoking cessation. Smokers are compelled to reflect on the harmful effects of cigarette smoking in relation to COVID-19. Issues of mental, relational and sexual health are put in the spotlight during the pandemic. People are investing more time in themselves, family and relationships. The world has seen an unprecedented global race in healthcare innovation and technology development in tackling the same global issue. Artificial intelligence, including robots and drones, have been rapidly developed and employed for healthcare as well as food and delivery services in order to minimise human physical contact. This article discusses several unforeseen positive impacts on healthcare that emerged from the COVID-19 public health measures that have been implemented. The positive impacts of the COVID-19 pandemic should be highlighted in order to provide hope to our community.
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