Chronic migraine (CM; ≥15 headache days per month, ≥3 months) is associated with a higher prevalence of comorbidities than episodic migraine (<15 headache days per month). However, it is unclear whether a similar pattern exists in Asian patients. To examine this, a retrospective matched cohort study was conducted using the Taiwan National Health Insurance Research Database. CM cases were defined as patients with at least one neurological outpatient visit with a primary or secondary ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code of 346.11, diagnosed by neurologists at medical centers during 2007–2008. The study group was compared with patients suffering from other migraine subtypes and non-migraineurs in the general population. Both comparison groups were matched with CM sufferers at a 4:1 ratio by age, gender, urbanization level of the residence, income, and hospital setting. Relative risk (RR) was calculated using conditional logistic regression. Compared with patients with other migraines (n = 2,226), CM sufferers (n = 681) had a higher risk of hyperlipidemia (RR = 1.32; P = 0.041), asthma (RR = 1.77; P = 0.007), depression (RR = 1.88; P < 0.0001), bipolar disorder (RR = 1.81; P = 0.022) and anxiety disorders (RR = 1.48; P = <0.0001). Compared with the non-migraineurs (n = 3,790), CM sufferers (n = 948) had significantly increased risks of cardiovascular disease, sinusitis, asthma, gastrointestinal ulcers, vertigo and psychiatric disorders by 1.6–3.9-fold. In conclusion, CM is associated with significant comorbidities in Asian patients. Differences in the comorbidity profiles of CM compared with other migraines have highlighted that patients with CM differ not just in terms of headache frequency but also in other important aspects.

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BackgroundThe prevalence of known hypertension has resulted from the progression of undiagnosed hypertension. This study is targeted to examine and compare the risk factors based on the estimated odds ratios of modifiable and non-modifiable risk factors on different outcome levels of hypertension.MethodsA nationwide representative secondary data from the Fourth National Health of Morbidity Survey (NHMS IV) which consists of 24,632 non-institutionalised Malaysian population conducted by the Ministry of Health in 2011 has been used. Odds ratio (OR) with 95% confidence interval has been estimated using multinomial logistic regression.ResultsObese and overweight respondents exhibit increased likelihood of having undiagnosed and known hypertension. Physically inactive, ex-smokers and unclassified drinkers are found having higher likelihood to have known hypertension. However, current drinkers are found to have higher likelihood of having undiagnosed hypertension. Elderly, retirees, home makers and lower educated respondents are shown higher odds to have undiagnosed hypertension. Likewise, the likelihood of having known hypertension has been found to increase among the elderly and other Bumiputra.ConclusionThrough this research, significant predictors which consist of obese and overweight respondents, current drinkers, older respondents (above 65 years old) and primary educated respondents are having higher likelihood to have undiagnosed hypertension.

Purpose -The purpose of this paper is to develop a conceptual model to examine the multidimensionality of total quality management (TQM) practices and its impact on role stressors. Design/methodology/approach -The background of TQM philosophy and theory of role stressors serve as starting-points to develop the conceptual model. From the extensive literature review, six practices of TQM and two components of role stressors were identified to construct the model. Findings -The model based on TQM with respect to role stressors provides a basis for assessing the level of role conflict and role ambiguity under which the use of different aspects of TQM should be retained or revised. This finding suggests that TQM is not a panacea that can be unthinkingly applied, but must be practised with a clear sense of the impact on role stressors. Practical implications -Given that role stressors are often detrimental to organizational functional efficiency, it is appropriate for management to invest time and effort to diagnose effects of implementation of TQM practices on role stressors. For this analysis, this model will prove valuable. Originality/value -This conceptual model provides an insightful foundation for the analysis of multidimensionality of TQM practices on role stressors. The model examines the independent influences of TQM practices on role stressors and treats role conflict and role ambiguity as dependent variables. This design stands in contrast to other researchers' study of conflict and ambiguity as independent variables.

PurposeThe purpose of this paper is to examine the total quality management (TQM) practices of both manufacturing and service firms in order to determine the relationship between the multidimensionality of TQM practices and role conflict of employees.Design/methodology/approachQuestionnaires are distributed to 433 employees of 98 different firms from manufacturing and service industries in Malaysia.FindingsThe results support significant negative correlation among all TQM practices (i.e. leadership, strategic planning, customer focus, human resource focus, process management and information analysis) and role conflict. By employing multiple regression analysis, leadership, process management and information analysis are found to have significant and negative relationship with role conflict. Human resource focus is reported to have a significant and positive relationship with role conflict.Practical implicationsThis model is ideal for practical usage by managers to evaluate the perceptions of role conflict of employees in TQM‐oriented firms. The findings suggest that firms should look into ways of developing the major roles of leadership and process management as well as improving efficient use of information analysis in order to reduce the detrimental role conflict of employees. This finding may also help administrators and individuals to attain a fine‐grained understanding of different dimensions of TQM in relation to role conflict.Originality/valueTQM practices appear to be related to role conflict, addressing an apparent noticeable gap in the literature of TQM and the psychological well‐being of employees. This paper also lays the foundation for formation of a theoretically based model which integrates the elements of TQM and role conflict.