Objectives: To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI). Design: This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome. Setting: Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia. Participants: 1648 community-dwelling older Malaysians. Results: The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep. Conclusion: The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

Background: Dengue is an emerging infectious disease that infects up to 390 million people yearly. The growing demand of dengue diagnostics especially in low-resource settings gave rise to many rapid diagnostic tests (RDT). This study evaluated the accuracy and utility of ViroTrack Dengue Acute - a new biosensors-based dengue NS1 RDT, SD Bioline Dengue Duo NS1/IgM/IgG combo - a commercially available RDT, and SD Dengue NS1 Ag enzyme-linked immunosorbent assay (ELISA), for the diagnosis of acute dengue infection. Methods: This prospective cross-sectional study consecutively recruited 494 patients with suspected dengue from a health clinic in Malaysia. Both RDTs were performed onsite. The evaluated ELISA and reference tests were performed in a virology laboratory. The reference tests comprised of a reverse transcription-polymerase chain reaction and three ELISAs for the detection of dengue NS1 antigen, IgM and IgG antibodies, respectively. The diagnostic performance of evaluated tests was computed using STATA version 12. Results: The sensitivity and specificity of ViroTrack were 62.3% (95%CI 55.6–68.7) and 95.0% (95%CI 91.7–97.3), versus 66.5% (95%CI 60.0–72.6) and 95.4% (95%CI 92.1–97.6) for SD NS1 ELISA, and 52.4% (95%CI 45.7–59.1) and 97.7% (95%CI 95.1–99.2) for NS1 component of SD Bioline, respectively. The combination of the latter with its IgM and IgG components were able to increase test sensitivity to 82.4% (95%CI 76.8–87.1) with corresponding decrease in specificity to 87.4% (95%CI 82.8–91.2). Although a positive test on any of the NS1 assays would increase the probability of dengue to above 90% in a patient, a negative result would only reduce this probability to 23.0–29.3%. In contrast, this probability of false negative diagnosis would be further reduced to 14.7% (95%CI 11.4–18.6) if SD Bioline NS1/IgM/IgG combo was negative. Conclusions: The performance of ViroTrack Dengue Acute was comparable to SD Dengue NS1 Ag ELISA. Addition of serology components to SD Bioline Dengue Duo significantly improved its sensitivity and reduced its false negative rate such that it missed the fewest dengue patients, making it a better point-of-care diagnostic tool. New RDT like ViroTrack Dengue Acute may be a potential alternative to existing RDT if its combination with serology components is proven better in future studies.

Diverse clinical manifestation makes early dengue diagnosis difficult. Detection of dengue non structural antigen-1 (NS1) can confirm dengue diagnosis early. This study aimed to compare the diagnostic accuracy of a new biosensors-based rapid diagnostic test (RDT) and an enzyme-linked immunosorbent assay (ELISA) for the detection of dengue NS1 antigen. 91 archived serum samples previously collected from hospitalised patients with suspected dengue were used. 50 cases and 41 controls were ascertained using reverse transcription-polymerase chain reaction, Pan-E Dengue Early ELISA, Immunoglobulin M ELISA, and haemagglutination inhibition. The samples were tested on ViroTrack Dengue Acute and SD Dengue NS1 Ag ELISA by two independent researchers blinded to the reference standard. Statistical analysis was performed using STATA version 12. The sensitivity and specificity of ViroTrack were 92.0% (95%CI 80.8-97.8) and 95.1% (95%CI 83.5-99.4), as compared to 82.0% (95%CI 68.6-91.4) (p=0.03) and 92.7% (95%CI 80.1-98.5) (p=0.32) for the ELISA, respectively. The positive and negative predictive values were 95.8% (95%CI 85.7-99.5) and 90.7% (95%CI 77.9-97.4) for ViroTrack, versus 93.2% (95%CI 81.3-98.6) (p-0.58) and 80.9% (95%CI 66.7-90.9) (p=0.18) for the ELISA, respectively. The diagnostic accuracy of ViroTrack was comparable to ELISA. It may be a more efficient tool for the diagnosis of acute dengue in low resource settings

OBJECTIVES: To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians. DESIGN: Two-year prospective cohort study. SETTING: Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur. PARTICIPANTS: Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later. MEASURES: EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions. RESULTS: The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain—age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio51.52, 95% confidence interval (CI)51.03–2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio51.14, 95% CI50.81– 1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data. CONCLUSION: Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health out comes. J Am Geriatr Soc 2018.

Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

Our study aims at describing mortality among reported elder abuse experiences in rural Malaysia. This is a population-based cohort study with a multistage cluster sampling method. Older adults in Kuala Pilah (n = 1,927) were interviewed from November 2013 to May 2014. Mortality was traced after 2 years using the National Registration Department database. Overall, 139 (7.2%) respondents died. Fifteen (9.6%) abuse victims died compared to 124 (7.0%) not abused. Mortality was highest with financial abuse (13%), followed by psychological abuse (10.8%). There was a dose-response relationship between mortality and clustering of abuse: 7%, 7.7%, and 14.0% for no abuse, one type, and two types or more, respectively. Among abuse victims, 40% of deaths had ill-defined causes, 33% were respiratory-related, and 27% had cardiovascular and metabolic origin. Results suggest a link between abuse and mortality. Death proportions varied according to abuse subtypes and gender. Keywords: Abuse outcome; Malaysia; descriptive study; effects of elder abuse; elder mistreatment; exploratory; family violence; mortality.

Background: As Malaysia is fast becoming an ageing nation, the health, safety and welfare of elders are major societal concerns. Elder abuse is a phenomenon recognised abroad but less so locally. This paper presents the baseline findings from the Malaysian Elder Mistreatment Project (MAESTRO) study, the first community-based study on elder abuse in Malaysia. Design: Cross-sectional study, analysing baseline findings of a cohort of older adults. Setting: Kuala Pilah district, Negeri Sembilan state, Malaysia. Objectives: To determine the prevalence of elder abuse among community dwelling older adults and its associated factors. Participants: A total of 2112 community dwelling older adults aged 60 years and above were recruited employing a multistage sampling using the national census. Primary and secondary outcome measures: Elder abuse, measured using a validated instrument derived from previous literature and the modified Conflict Tactic Scales, similar to the Irish national prevalence survey on elder abuse with modification to local context. Factors associated with abuse and profiles of respondents were also examined. Results: The prevalence of overall abuse was reported to be 4.5% in the past 12 months. Psychological abuse was most common, followed by financial, physical, neglect and sexual abuse. Two or more occurrences of abusive acts were common, while clustering of various types of abuse was experienced by one-third of abused elders. Being male (adjusted OR (aOR) 2.15, 95%CI 1.23 to 3.78), being at risk of social isolation (aOR 1.96, 95%CI 1.07 to 3.58), a prior history of abuse (aOR 3.28, 95%CI 1.40 to 7.68) and depressive symptomatology (aOR 7.83, 95%CI 2.88 to 21.27) were independently associated with overall abuse. Conclusion: Elder abuse occurred among one in every 20 elders. The findings on elder abuse indicate the need to enhance elder protection in Malaysia, with both screening of and interventions for elder abuse.