Methods: This study involved semi-structure in-depth interview with fifteen healthcare professionals from a training hospital focused on: (i) the existing issues and challenges encountered while managing patients for their nutrition and care and (ii) issues related to the current practice among healthcare professionals. Details pertaining to the participants' verbal and non-verbal responses were recorded, transcribed ad verbatim and analysed using themes codes.
Results: Patients' attitude and behaviour, language barriers and prioritising time were found as the common problems with patients, while limited knowledge on the relationship between diabetes-periodontitis, limited availability of appropriate and cultural-based health educational tools, lack of inter-professional multidisciplinary collaboration in managing patients, and constrains in time as well as costly therapy were common issues in the current practice.
Conclusions: Cost-effective efforts must be focused on overcoming these issues besides emphasizing the needs on developing an integrated module to achieve better management outcomes.
METHODS: The module was developed as an iterative and review process by five experts in nutrition and dietetics, periodontics, and dental public health. It consisted of three phases: (i) needs assessment on module contents and characteristics, (ii) module development and (iii) module evaluation by experts. Twelve healthcare professionals aged between 30 and 53 years (average 13.5 years of working experience) validated the module contents and its comprehensibility using the Patient Education Materials Assessment Tool for printable materials (PEMAT-P) and audio-visual materials (PEMAT-A/V). Scores of 0 (disagree) or 1 (agree) were given for sets of understandability and actionability statements and presented as a total percentage.
RESULTS: Seventeen infographic-flip charts and 13 short-videos were developed in the Malay language and grouped into four topics: (i) Introduction to Diabetes and Periodontitis, (ii) Diabetes and Periodontitis Care, (iii) Lifestyle Modification, and (iv) Myths and Facts. Flip charts were rated between 76-100% for understandability and 80-100% for actionability, while videos rated between 90-100% for understandability and 100% for actionability, respectively.
CONCLUSION: Overall, the newly developed module ranked high median scores for understandability and actionability. This finding reflects positive acceptance of the integrated module among the various healthcare professionals involved in managing patients with diabetes and periodontitis.
METHODS: A non-probability purposive sampling was used for the recruitment process. The inclusion criteria of the participants were registered female undergraduates and aged between 18-30 years old. A semi-structured in-depth interview was used to collect topic-related information from the participants and signed consents were obtained prior to the interview. The interview questions were on respondents' understanding of exercise, motivation and barriers to exercise, and exercise preferences. The recruitment process was conducted until the data was saturated. All interviews were audio recorded and manually transcribed verbatim. NVivo 11 was used to conduct the inductive analysis of the data to develop themes for motivation and barriers to exercise. For exercise preferences, four predetermined themes were used.
FINDINGS: A total of 26 respondents participated in this study. Eight themes were found for motivation to exercise, with the most common themes being maintaining or improving appearance, health benefits and togetherness. For barriers of exercising, five themes were found, and the most common ones were disliking exercise and no motivation. For exercise preferences, most respondents preferred a structured exercise program with flexibility in terms of when and where the exercise could be conducted. Light or moderate intensity exercise for 10-30 minutes with a frequency of 1-2 times a week was desired the most among the respondents.
CONCLUSION: In conclusion, personal and environmental factors play important roles in motivating or hampering female undergraduates to exercise, and a structured program was the preferred mode of exercise of these respondents. A new exercise module was designed based on this needs assessment with a 70% acceptance rate among the participants. These findings can help the future development of more exercise modules tailored to female university students.
METHODS: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only national, or international physical activity and/or sedentary behaviour guidelines were included in the review. Included guidelines targeted children and adolescents aged between 5 and 18 years. A grey literature search was undertaken incorporating electronic databases, custom Google search engines, targeted websites and international expert consultation. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II).
RESULTS: The search resulted in 50 national or international guidelines being identified. Twenty-five countries had a national guideline and there were three international guidelines (European Union, Nordic countries (used by Iceland, Norway and Sweden), World Health Organization (WHO)). Nineteen countries and the European Union adopted the WHO guidelines. Guidelines varied in relation to date of release (2008 to 2019), targeted age group, and guideline wording regarding: type, amount, duration, intensity, frequency and total amount of physical activity. Twenty-two countries included sedentary behaviour within the guidelines and three included sleep. Total scores for all domains of the AGREE II assessment for each guideline indicated considerable variability in guideline quality ranging from 25.8 to 95.3%, with similar variability in the six individual domains. Rigorous guideline development is essential to ensure appropriate guidance for population level initiatives.
CONCLUSIONS: This review revealed considerable variability between national/international physical activity guideline quality, development and recommendations, highlighting the need for rigorous and transparent guideline development methodologies to ensure appropriate guidance for population-based approaches. Where countries do not have the resources to ensure this level of quality, the adoption or adolopment (framework to review and update guidelines) of the WHO guidelines or guidelines of similar quality is recommended.
TRIAL REGISTRATION: Review registration: PROSPERO 2017 CRD42017072558.
DESIGN: Cross-sectional survey conducted in 2019-2020.
SETTING: Multistage cluster sampling conducted in Central, Northern, Southern, and East Coast regions of Peninsular Malaysia.
PARTICIPANTS: 2989 children aged 0.5-12.9 years.
RESULTS: Prevalences of stunting, thinness, overweight, and obesity among children aged 0.5-12.9 years were 8.9%, 6.7%, 9.2%, and 8.8%, respectively. Among children below 5 years old, 11.4% were underweight, 13.8% had stunting, and 6.2% wasting. Data on nutritional biomarkers showed a small proportion of children aged 4-12 years had iron (2.9%) and vitamin A deficiencies (3.1%). Prevalence of anaemia was distinctly different between children below 4 years old (40.3%) and those aged 4 years and above (3.0%). One-fourth of children (25.1%) had vitamin D insufficiency, which was twice as prevalent in girls (35.2% vs. boys: 15.6%). The majority of children did not meet the recommended dietary intake for calcium (79.4%) and vitamin D (94.8%).
CONCLUSIONS: Data from SEANUTS II Malaysia confirmed that triple burden of malnutrition co-exists among children in Peninsular Malaysia, with higher prevalence of overnutrition than undernutrition. Anaemia is highly prevalent among children below 4 years old, while vitamin D insufficiency is more prevalent among girls. Low intakes of dietary calcium and vitamin D are also of concern. These findings provide policymakers with useful and evidence-based data to formulate strategies that address the nutritional issues of Malaysian children.