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  1. Bartlett AW, Lumbiganon P, Jamal Mohamed TA, Lapphra K, Muktiarti D, Du QT, et al.
    J. Acquir. Immune Defic. Syndr., 2019 Dec 15;82(5):431-438.
    PMID: 31714422 DOI: 10.1097/QAI.0000000000002184
    BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.

    SETTING: Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.

    METHODS: Data from PHIVA (aged 10-19 years) who received combination antiretroviral therapy 2007-2016 were used to analyze LTFU through (1) an International epidemiology Databases to Evaluate AIDS (IeDEA) method that determined LTFU as >90 days late for an estimated next scheduled appointment without returning to care and (2) the absence of patient-level data for >365 days before the last data transfer from clinic sites. Descriptive analyses and competing-risk survival and regression analyses were used to evaluate LTFU epidemiology and associated factors when analyzed using each method.

    RESULTS: Of 3509 included PHIVA, 275 (7.8%) met IeDEA and 149 (4.3%) met 365-day absence LTFU criteria. Cumulative incidence of LTFU was 19.9% and 11.8% using IeDEA and 365-day absence criteria, respectively. Risk factors for LTFU across both criteria included the following: age at combination antiretroviral therapy initiation <5 years compared with age ≥5 years, rural clinic settings compared with urban clinic settings, and high viral loads compared with undetectable viral loads. Age 10-14 years compared with age 15-19 years was another risk factor identified using 365-day absence criteria but not IeDEA LTFU criteria.

    CONCLUSIONS: Between 12% and 20% of PHIVA were determined LTFU with treatment fatigue and rural treatment settings consistent risk factors. Better tracking of adolescents is required to provide a definitive understanding of LTFU and optimize evidence-based models of care.

    Matched MeSH terms: Ambulatory Care Facilities
  2. Kua KP, Saw PS, Lee SWH
    Int J Clin Pharm, 2019 Oct;41(5):1131-1132.
    PMID: 31444688 DOI: 10.1007/s11096-019-00891-7
    Understanding older adult and caregiver attitudes towards deprescribing will contribute to medication optimization in clinical practice. The objectives of this study were to explore quantitatively the attitudes and beliefs of older adults and caregivers towards deprescribing and identify participant characteristics that were associated with willingness to have a medication deprescribed. This study was conducted in a government-led primary care health clinic and three private community pharmacies in Malaysia with older adults and caregivers of older adults. The revised patients' attitudes towards deprescribing (rPATD) questionnaire was administered. The rPATD questionnaire had four factors in both older adults' and caregivers' versions of the questionnaire (with four to five questions retained in each factor) alongside two global questions that were not included in any of the scoring factors. Our revised statement of main findings now states that most of older adult (n = 340, 67.7%) and caregiver (n = 34, 65.4%) participants agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible to do so.
    Matched MeSH terms: Ambulatory Care Facilities
  3. Alias AM, Shahruniza AS, Sulaiman H
    Med. J. Malaysia, 2019 Oct;74(5):456-458.
    PMID: 31649232
    Fosfomycin (FMT) was first isolated in 1969 and has gained popularity in the past few decades, specifically in the treatment of uncomplicated urinary tract infection (UTI). A retrospective study was undertaken to study the pattern of FMT use in our outpatient clinics. Subjects were divided into guideline compliant (GC) and non-guideline compliant (NGC) groups, based on available guidelines. More than half of the subjects (51, 51%) fall in the NGC group. Diabetes was an independent risk factor for inappropriate FMT prescription. This represented an opportunity for antimicrobial stewardship in treating diabetic patients with uncomplicated UTI when this agent is chosen.
    Matched MeSH terms: Ambulatory Care Facilities
  4. Aman Z, Liew SM, Ramdzan SN, Philp I, Khoo EM
    Singapore Med J, 2019 Aug 16.
    PMID: 31423540 DOI: 10.11622/smedj.2019100
    INTRODUCTION: Many older people rely on caregivers for support. Caring for older people can pose significant burdens for caregivers yet may also have positive effects. This study aimed to assess the impact on the caregivers and to determine factors associated with caregivers who were burdened.
    METHODS: This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers who were aged ≥ 21 years and provided ≥ 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire, which included the Carers of Older People in Europe (COPE) index and the EASYCare Standard 2010 independence score. The COPE index was used to assess the impact of caregiving. A highly burdened caregiver was defined as one whose scores for all three COPE subscales were positive for burden. Care recipients' independence was assessed using the independence score of the EASYCare Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden.
    RESULTS: 73 (19.0%) caregivers were burdened, of whom two were highly burdened. Caregivers' median scores on the positive value, negative impact and quality of support scales were 13.0, 9.0 and 12.0, respectively. Care recipients' median independence score was 18.0. Ethnicity and education levels were found to be associated with caregiver burden.
    CONCLUSION: Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with a caregiver being burdened.
    Study site: Klinik kesihatan, Selangor, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  5. Nini Shuhaida MH, Siti Suhaila MY, Azidah KA, Norhayati NM, Nani D, Juliawati M
    J Taibah Univ Med Sci, 2019 Jun;14(3):268-276.
    PMID: 31435416 DOI: 10.1016/j.jtumed.2019.03.002
    Objective: This study aims to identify risks induced by depression, anxiety, stress, and socio-demographic factors associated with poor glycaemic control among type II diabetes mellitus patients in Kuala Terengganu, Malaysia.
    Methods: This cross-sectional study was performed in two Malaysian health clinics by using the Malay version of a self-administered questionnaire. This instrument contains a diabetes care profile, a 21-item version of the Depression Anxiety Stress Scales (DASS21), and a Malaysian Medication Adherence Score (MalMAS). Simple and multiple logistic regression analyses were performed.
    Results: A total of 338 type II diabetes mellitus patients responded (response rate 93.1%). The proportion of patients with poor glycaemic control was 76.0%. Multiple logistic regression analysis showed that 1) social support scores [Adj. OR (95% CI): 1.06 (1.03,1.10); p = 0.001]; 2) unemployment [Adj. OR (95% CI): 0.46 (0.22,0.95); p = 0.035]; 3) pensioner status [Adj. OR (95% CI): 0.28 (0.13,0.61); p = 0.001]; and 4) perception of diabetes as interfering with daily living activities [Adj. OR (95% CI): 3.18 (1.17,8.70); p = 0.024] were significant factors for poor glycaemic control.
    Conclusions: Unemployment, perception of diabetes' interference with daily living activities, and social support are significantly correlated with poor glycaemic control. Further studies assessing other important clinical and psychosocial factors that may influence glycaemic control are suggested. A younger age range of participants is recommended for better outcomes and interventional implementation of findings.
    Matched MeSH terms: Ambulatory Care Facilities
  6. Tong WT, Ng CJ, Lee YK, Lee PY
    J Eval Clin Pract, 2019 May 21.
    PMID: 31115132 DOI: 10.1111/jep.13161
    RATIONALE, AIMS, AND OBJECTIVES: Few studies focus on patients' views on factors influencing implementation of patient decision aids (PDAs). This study aims to explore patients' views on the factors influencing implementation of an "insulin choice" PDA in a primary care setting.
    METHODS: This study used a descriptive qualitative study design. Interviews were conducted using a semistructured interview guide developed based on the theoretical domains framework. Nine in-depth interviews and three focus group discussions were conducted with patients with type 2 diabetes who have been advised to start insulin or were currently using insulin and those who had been seeking diabetes treatment in the clinic for more than 1 year. Interviews were conducted after the participants were familiarized with the PDA. Data were analysed using a thematic approach.
    RESULTS: Five themes emerged from the data analysis: (a) trust in the physician (patients preferred physicians to other health care providers in delivering the insulin PDA to them as they trusted physicians more when it comes to making decisions such as starting insulin), (b) physician's attitude (patients were more likely to trust a physician who is friendly and sympathetic hence would be more willing to use the insulin PDA), (c) physician's communication style (patients were more willing to use the insulin PDA if the physicians would take time and guide them in the PDA use), (d) conducive environment (patients preferred to read the PDA at home), and (e) cost (patients would not be willing to pay to use the insulin PDA unless they needed it).
    CONCLUSIONS: Patients want physicians to play a major role in the implementation of the insulin PDA; physicians' communication style and commitment may influence implementation outcomes. Health care authorities need to create a conducive environment and provide patients with free access to PDA to promote effective implementation.
    Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  7. Yaacob LH, Abdul Mokti S, Muhammad J
    J Women Aging, 2019 Apr 09.
    PMID: 30967095 DOI: 10.1080/08952841.2019.1593799
    Urinary incontinence (UI) is common in women in postmenopausal age, but many women delay seeking treatment. The objective of this study is to determine health-seeking behavior of postmenopausal women with UI and its associated factors. This is a cross-sectional study involving 348 postmenopausal women from the outpatient clinic using personal data forms and a validated UI questionnaire. A total of 348 menopausal women were involved in the study. Only 13.17% of patients with UI sought treatment. Factors associated with seeking treatment were age of menopause and severity of UI. More health education needs to be done among these patients.
    Study site: Primary care clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  8. Muda CMC, Ismail TAT, Jalil RA, Hairon SM, Sulaiman Z, Johar N
    Women Birth, 2019 Apr;32(2):e243-e251.
    PMID: 30057368 DOI: 10.1016/j.wombi.2018.07.008
    BACKGROUND: The first week after childbirth is a crucial period for exclusive breastfeeding initiation.

    OBJECTIVE: This study aims to determine the association of postnatal breastfeeding education with knowledge, attitude, and exclusive breastfeeding practice at six months after childbirth among women who delivered at two district hospitals in the northeast part of Peninsular Malaysia.

    METHODS: This is a quasi-experimental study design. A newly developed and validated questionnaire was used to determine scoring for baseline and six months after childbirth. The intervention consisted of individualized postnatal breastfeeding education delivered by researchers using flipchart one week after childbirth and breastfeeding diary in addition to usual care. The comparison group received the usual postnatal care by health clinics. Repeated measure analysis of variance and multiple logistic regression analysis were used.

    RESULTS: A total of 116 participants were included in this study (59 in intervention group and 57 in comparison group). Six months after childbirth, the adjusted mean score of knowledge and attitude of the intervention group were significantly higher than that of the comparison group (p<0.001 and p=0.002, respectively). More participants in the intervention group (n=26, 44.1%) exclusively breastfed their infants compared with 15 (26.3%) in the comparison group (p=0.046). Postnatal breastfeeding education was significantly associated with exclusive breastfeeding practice six months after childbirth [adjusted odds ratio 2.31; 95% confidence interval: 1.02, 5.14; p=0.040].

    CONCLUSIONS: Postnatal breastfeeding education was significantly associated with an improvement in women's knowledge, attitude and exclusive breastfeeding practice six months after childbirth.
    Matched MeSH terms: Ambulatory Care Facilities
  9. Shahar MA, Omar AM, Loh HH
    Can J Diabetes, 2019 Mar;43(2):98-104.e7.
    PMID: 30145243 DOI: 10.1016/j.jcjd.2018.06.003
    OBJECTIVES: As is true for other chronic illnesses, perception of disease control is pivotal to patient empowerment in diabetes care. This study aimed to describe the perception of diabetes control by patients with poor glycated hemoglobin (A1C) levels so as to explore the relationship between perception and various sociodemographic and disease characteristics and to measure the patients' knowledge, attitudes and practices in diabetes care.
    METHODS: A cross-sectional study was made involving 276 patients with type 2 diabetes mellitus. After obtaining informed consent, their sociodemographics, medical histories and most recent available blood investigations were documented. Patients were asked about their perceptions of diabetes control-whether it was excellent, moderate or poor. A Malay-language knowledge, attitudes and practice questionnaire was administered to respondents. Analyses were descriptive and exploratory.
    RESULTS: The median age of the subjects and the durations of diabetes were 56 (interquartile range, 48-62) years and 8 (interquartile range, 4-13) years, respectively. The median A1C level was 9.5% (interquartile range, 8.3%-11.4%). Despite having poor A1C levels, 28.4% of patients perceived that their diabetes control was excellent; 58.9% perceived it as moderate, and only 12.7% accurately perceived it as poor. A significant number of those with higher education had wrong perceptions, indicating that other factors, such as effective communication, need to be considered. The absence of an association between perception and duration of diabetes suggests that information given over the years did not contribute to patients' understanding of disease control. Younger patients had better knowledge scores. Those with higher education levels had higher quartiles of knowledge and attitude but not practice scores.
    CONCLUSIONS: This study demonstrated discordance between perceived diabetes control and actual A1C levels, which may hinder effective diabetes care.
    Study site: a tertiary referral center and a primary care centre in Kuantan, Pahang, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  10. Ng YL, Teoh SH, Mohd Radzniwan AR, Syahnaz MH
    J Taibah Univ Med Sci, 2019 Feb;14(1):88-94.
    PMID: 31435395 DOI: 10.1016/j.jtumed.2018.12.002
    Objectives: Undiagnosed glycaemic disorders remain a major health concern as in such cases the opportunity for early interventions that can potentially prevent complications is missed. Erectile dysfunction (ED) has been suggested as a predictor for glycaemic disorders in men. However, data on men with ED having undiagnosed glycaemic disorders is limited, especially in the Malaysian context. This study aimed to identify prevalence and associated factors of undiagnosed glycaemic disorders in men with ED.
    Methods: We applied a cross-sectional purposive sampling technique on a group of 114 men with ED without underlying glycaemic disorders. They underwent a 2-h oral glucose tolerance test and the cases were then classified into two groups: normal and undiagnosed glycaemic disorders groups. The glycaemic disorders group consisted of patients with diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG). The patients were interviewed, and their medical records were reviewed for their sociodemographic and clinical profiles.
    Results: Prevalence of undiagnosed glycaemic disorders in men with ED was 41.2%. Higher age (adjusted OR = 1.10, 95% CI: 1.03, 1.17, p = 0.002) and BMI (adjusted OR = 1.16, 95% CI: 1.05, 1.29, p = 0.003) were found to be significantly associated with undiagnosed glycaemic disorders.
    Conclusion: This study found that men with ED had a high prevalence of undiagnosed glycaemic disorders. ED was associated with advancing age and higher BMI. Further research to validate the findings of this study is needed to increase the prevalence of DM screening among men with ED.
    Study site: Klinik Kesihatan Kajang, Selangor, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  11. Pannir Selvam SB, Khoo EM, Chow SY, Wong PF, Mohsin SS, Abdullah A, et al.
    Sex Transm Dis, 2019 Feb;46(2):143-145.
    PMID: 30278029 DOI: 10.1097/OLQ.0000000000000918
    Management of sexually transmitted diseases and human immunodeficiency virus is challenging due to the social stigma attached. We describe the development of a client-friendly sexually transmitted disease service in a primary care clinic in Malaysia with a special focus on key populations. Challenges and key lessons learnt from its development and implementation are discussed.
    Matched MeSH terms: Ambulatory Care Facilities
  12. Devaraj NK
    Ethiop J Health Sci, 2019 Jan;29(1):957-958.
    PMID: 30700964 DOI: 10.4314/ejhs.v29i1.18
    The diagnosis of rheumatologic problem can be difficult, especially if not all the diagnostic criteria or typical clinical features are seen. This includes conditions such as rheumatoid arthritis which needs early diagnosis to start disease modifying drugs (DMARDs) which can improve the prognosis and prevent further joint erosion and organ damage. This case report focused on a similar scenario in an elderly woman initially thought to have osteoarthritis but was diagnosed later with rheumatoid arthritis which brought much relief to her current predicament.
    Matched MeSH terms: Ambulatory Care Facilities
  13. Gillani SW, Ansari IA, Zaghloul HA, Sulaiman SAS, Rathore HA, Baig MR, et al.
    Curr Ther Res Clin Exp, 2019;90:53-60.
    PMID: 31193026 DOI: 10.1016/j.curtheres.2019.04.001
    Background: Diabetes Mellitus is a progressive, chronic and multifactorial endocrine disorder characterized by elevated serum glucose levels. It has a direct effect to social and health related quality of life.

    Objective: This study aimed to determine the health-related quality of life among patients with type II diabetes mellitus (T2DM) using insulin therapy.

    Methods: Cross-sectional observational study design was used to collect data from Malaysian patients with T2DM. Subjective and objective assessments were made either by using several questionnaires or each patient's specific medication profile registered to care sites. Study participants were recruited from both public hospitals and community health clinics located in Kuala Lumpur, Malaysia.

    Results: A total of 430 patients with T2DM were recruited in this study with a response rate of 94.7%. The oral antidiabetic medication (OAM) group consisted of 63.0% of the study population and the rest (37.0%) were Insulin users. The body mass index and glycosylated hemoglobin patterns were significantly different between groups (P < 0.011 and P < 0.001). Insulin users showed high percentages of healthy body mass index index (44.7%) compared with OAM users (35.8%) and controlled glycemic index (glycosylated hemoglobin ≤7.5%) was significantly (P = 0.001) better among the insulin-user group compared with the OAM group. The Euro Quality of Life-5 dimension domain analysis indicated significant differences with domains of usual work (P < 0.047), pain and discomfort (P < 0.041), and anxiety and depression (P < 0.001) among insulin users versus OAM users. We also observed a significant difference between the groups regarding diet, monitoring, and disease-specific knowledge. The mean (SD) adherence score showed that insulin users were significantly (P < 0.001) more adherent (6.09 [2.98]) than OAM were nonadherent (4.19 [4.68]).

    Conclusions: This study suggests the valuable effect of insulin therapy among patients with T2DM compared with OAMs on health-related quality of life, medication adherence, and health state. Insulin users reported they had better diabetes-related knowledge and treatment adherence characteristics than noninsulin users.
    Matched MeSH terms: Ambulatory Care Facilities
  14. Chew BH, Vos RC, Fernandez A, Shariff Ghazali S, Shamsuddin NH, Ismail M, et al.
    Ther Adv Endocrinol Metab, 2019;10:2042018819853761.
    PMID: 31210922 DOI: 10.1177/2042018819853761
    Background: Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control).
    Methods: VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect.
    Results: Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ.
    Conclusions: Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified.
    Trial registration: NCT02730078; NMRR-15-1144-24803.
    Matched MeSH terms: Ambulatory Care Facilities
  15. Kang PS, Mohazmi M, Ng YM, Liew SM
    Malays Fam Physician, 2019;14(1):18-25.
    PMID: 31289627
    Background: Postpartum depression (PPD) affects 10-15% of women worldwide, and screening is recommended by clinical guidelines. In Malaysia, nurses in maternal and child health (MCH) clinics provide postpartum care.

    Aim: To determine nurses' level of knowledge, beliefs and practices regarding PPD and factors associated with screening practices.

    Methods: A cross-sectional study using universal sampling was conducted on nurses from seven government MCH clinics in Malaysia. Data was collected from March until April 2016 through a self-reported questionnaire. Univariate and multivariate analyses were performed to identify factors associated with having ever performed PPD screening.

    Results: Of the 108 nurses, 55.6% scored above the median total knowledge score (17 out of 24 points). Despite a high proportion of nurses believing that they were responsible for PPD screening (72.2%), counselling depressed mothers (72.2%) and referring mothers for further treatment (87.0%), only 64.8% and 51.9% were confident in recognizing PPD and counselling depressed mothers, respectively. Only 25.9% had ever practiced PPD screening, which was associated with beliefs concerning screening taking too much time (adjusted odds ratio [AOR]=0.13, 95% confidence interval [CI]= 0.02-0.74, P=0.022) and that screening is their responsibility (AOR=14.12, 95%CI=1.65-120.75, P=0.016).

    Conclusion: More than half of the nurses scored above the median total knowledge score and had positive beliefs towards PPD screening. However, PPD screening practices were poor, and this outcome was associated with their beliefs regarding time and responsibility.
    Matched MeSH terms: Ambulatory Care Facilities
  16. Woon FC, Chin YS, Ismail IH, Batterham M, Abdul Latiff AH, Gan WY, et al.
    PLoS ONE, 2019;14(6):e0216439.
    PMID: 31233513 DOI: 10.1371/journal.pone.0216439
    BACKGROUND: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.

    METHODS: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30-50 nmol/L), and sufficient (≥ 50 nmol/L).

    RESULTS: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93-0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05-0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.

    CONCLUSION: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.
    Matched MeSH terms: Ambulatory Care Facilities
  17. Elnaem MH, Mohamed MHN, Huri HZ, Shah ASM
    Ther Clin Risk Manag, 2019;15:137-145.
    PMID: 30705590 DOI: 10.2147/TCRM.S182716
    Background: Cardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors.

    Methods: A multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality.

    Results: The overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects.

    Conclusion: There is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required.
    Matched MeSH terms: Ambulatory Care Facilities
  18. Rajiah K, Maharajan MK, Yin PY, Yee YW, Lin WW, Kean CH
    DOI: 10.3390/microorganisms7030087
    Zika virus has been declared as a public health emergency of international concern. The Center for Disease Control and Prevention has issued guidelines reminding healthcare workers about the importance of taking steps to prevent the spread of Zika virus, how to test and isolate patients suspected of carrying the Zika virus, and how to protect themselves from infection. Therefore, it is of utmost importance for healthcare professionals to be fully aware of Zika virus preparedness, and response measures should an outbreak occur in Malaysia in order to quickly and efficiently contain the outbreak, ensure the safety of individual or healthcare personnel safety, as well as to prevent further spreading of the disease. This research aims to show how prepared Malaysian healthcare professionals are against Zika virus and how well can they respond during an outbreak. In total, 504 healthcare professionals (128 general practitioners, 215 community pharmacists, 161 nurses) from private health clinics were the target population of the four states of Malaysia where Zika cases suspected. The sample size of each category was calculated by using a formula for estimating the population proportion. An additional 10% of the calculated sample size was added to compensate the non-response rate. The Center For Disease Control and Prevention and World Health Organisation provided a checklist to assess how prepared healthcare professionals are for an Zika outbreak. This checklist was modified to a questionnaire in order to assess health care professionals' preparedness and response to the Zika outbreak. Community pharmacists are still lacking in their preparedness and perceived response to the Zika outbreak compared to the general practitioners in the private sector. Hence community pharmacists should attend training given by the Ministry of Health Malaysia as a continuing education, which may help them to respond during a Zika outbreak.
    Matched MeSH terms: Ambulatory Care Facilities
  19. Nursazila Asikin MA, Siti Norhani S, Nur Arzuar AR, Azam OE
    Introduction: Edinburgh Postpartum Depression Scale (EPDS) is a tool used to assess the risk of postpartum depression (PPD). In this study we determined the reliability and validity of the Malay version of EPDS when administered at two different time points in the postpartum period.
    Materials and Methods: This cross-sectional study design was carried out between May and September 2017 at three government primary healthcare clinics located in Batang Padang district, a suburban area of Perak state in Peninsular Malaysia. We recruited a total of 89 women; 41 women were in the early postpartum period (1-30 days) and 48 women were in the late postpartum period (31-120 days). Cronbach's alpha coefficient, inter-item correlation, and corrected item-total correlation were used to assess the internal consistency. The concurrent validity was assessed using Spearman's correlation. The data were analyzed using SPSS version 20 and R 3.4.2.
    Results: The Cronbach's alpha for the first and second group was 0.78 and 0.62, respectively, which indicated satisfactory reliability. At both time periods, removing Item 2 from the scale resulted in a significant increase in Cronbach's alpha (to 0.847 and 0.709, respectively). As expected, the EPDS scores correlated moderately with the BDI-II scores (1-30 days: Spearman's rho = 0.65, p < 0.01; 31-120 days: Spearman's rho = 0.73, p < 0.01).
    Conclusion: The Malay version of the EPDS is a reliable screening instrument for detecting postpartum depression. It showed reasonability and feasibility and can be used in postpartum clinical settings or for assessing intervention effects in research studies. Furthermore, as our results indicated, removing Item 2 from the Malay version would increase the internal consistency of the EPDS. © 2019 Default.
    Study site: Klinik Kesihatan, Perak, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  20. Shaharir SS, Mohamed Said MS, Mohd R, Abdul Cader R, Mustafar R, Abdul Rahman R
    PLoS ONE, 2019;14(9):e0222343.
    PMID: 31539383 DOI: 10.1371/journal.pone.0222343
    Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
    Matched MeSH terms: Ambulatory Care Facilities
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