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  1. Fraga MV, Stoller JZ, Glau CL, De Luca D, Rempell RG, Wenger JL, et al.
    Pediatrics, 2019 Oct 15.
    PMID: 31615954 DOI: 10.1542/peds.2019-1401
    Point-of-care ultrasound is currently widely used across the landscape of pediatric care. Ultrasound machines are now smaller, are easier to use, and have much improved image quality. They have become common in emergency departments, ICUs, inpatient wards, and outpatient clinics. Recent growth of supportive evidence makes a strong case for using point-of-care ultrasound for pediatric interventions such as vascular access (in particular, central-line placement), lumbar puncture, fluid drainage (paracentesis, thoracentesis, pericardiocentesis), suprapubic aspiration, and soft tissue incision and drainage. Our review of this evidence reveals that point-of-care ultrasound has become a powerful tool for improving procedural success and patient safety. Pediatric patients and clinicians performing procedures stand to benefit greatly from point-of-care ultrasound, because seeing is believing.
    Matched MeSH terms: Ambulatory Care Facilities
  2. Wong YA, Mukari SZS, Harithasan D, Mazlan R
    PMID: 31174022 DOI: 10.1016/j.ijporl.2019.05.040
    OBJECTIVES: Maternal knowledge and attitude towards childhood hearing loss play an important role in determining the success of early diagnosis and intervention of hearing loss programs in children. This study aimed to 1) assess the knowledge and attitude of childhood hearing loss among mothers, 2) compare knowledge and attitude of childhood hearing loss in urban and rural mothers, 3) investigate the relationship between knowledge and attitude on childhood hearing loss, and 4) identify socio-demographic factors that influence mothers' knowledge and attitude on childhood hearing loss.

    METHOD: A cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ± 4.9 years, range: 20-48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss.

    RESULTS: Generally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p 
    Matched MeSH terms: Ambulatory Care Facilities
  3. Kua KP, Saw PS, Lee SWH
    Int J Clin Pharm, 2019 Aug 23.
    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
  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. Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, et al.
    BMC Pregnancy Childbirth, 2019 Jun 14;19(1):201.
    PMID: 31200677 DOI: 10.1186/s12884-019-2349-9
    BACKGROUND: Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia.

    METHODS: We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox's regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery.

    RESULTS: ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79-7.40) and west coast (RR = 3.82; 95% CI 1.86-7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39-4.38) and PTB (RR = 2.49; 95% CI 1.16-5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48-4.03) in west coast only.

    CONCLUSION: ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions.
    Matched MeSH terms: Ambulatory Care Facilities
  6. Md Bohari NF, Kruger E, John J, Tennant M
    Int Dent J, 2019 Jun;69(3):223-229.
    PMID: 30565655 DOI: 10.1111/idj.12454
    OBJECTIVE: The aim of this study was to analyse, in detail, the distribution of primary dental clinics in relation to the Malaysian population and relative population wealth, to test the hypothesis that an uneven distribution of dental services exists in Malaysia.

    METHOD: This 2016 study located every dental practice in Malaysia (private and public) and mapped these practices against population, using Geographic Information Systems (GIS) tools. Population clusters within 5, 10 and 20 km of a dental clinic were identified, and clinic-to-population ratios were ascertained. Population data were obtained from the Population and Housing Census of Malaysia 2010. Population relative wealth was obtained from the 2014 Report on Household Income and Basic Amenities Survey for Malaysia. The physical address for each dental practice in Malaysia was gathered from the Official Portal of Ministry of Health Malaysia. All data for analysis were extracted from the integrated database in Quantum GIS (QGIS) into Microsoft Excel.

    RESULT: The population of Malaysia (24.9 million) was distributed across 127 districts, with 119 (94%) having at least one dental clinic. Sixty-four districts had fewer than 10 dental clinics, and 11.3% of Malaysians did not reside in the catchment of 20 km from any dental clinic. The total dental clinic-to-population ratio was 1:9,000: for public dental clinics it was 1:38,000 and for private clinics it was 1:13,000.

    CONCLUSION: Dental services were distributed relative to high population density, were unevenly distributed across Malaysia and the majority of people with the highest inaccessibility to a dental service resided in Malaysian Borneo.

    Matched MeSH terms: Ambulatory Care Facilities
  7. Kua KP, Saw PS, Lee SWH
    Int J Clin Pharm, 2019 Jun;41(3):793-803.
    PMID: 31020599 DOI: 10.1007/s11096-019-00829-z
    Background Deprescribing describes a process of medication regimen optimization with the aim to reduce adverse events and improve quality of life. There is limited research on perceptions of older adults, defined as those 60 years of age and older, about their willingness to cease a medication in developing countries. Objective To ascertain patients' attitudes, beliefs, perceptions, and experiences regarding the number of medications they were taking and their opinions regarding deprescribing. Setting A primary care health clinic and three community pharmacies in Malaysia. Method A multicenter cross-sectional study was conducted by administering the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to older adults aged 60 years and over or caregivers attending a health clinic and three community pharmacies in Malaysia. Descriptive results were reported for participants' characteristics and questionnaire responses. Analysis of correlation between participant characteristics and their responses was performed using Spearman's correlation. Main outcome measure Patients' and caregivers' attitudes and beliefs towards reducing medications and characteristics of patients such as age, gender, education level, number of medication taken and number of medical center managing the patient. Results 650 participants were approached and the response rate was 85.2%. A total of 554 participants completed the questionnaire (502 older adults and 52 caregivers). Older adults in the study were taking a median of three medications and/or supplements compared to four in caregiver recipients. 88.1% of older adults were satisfied with their current medication regimen and 67.7% would like to try stopping or reducing the dose of their medicines when their doctor recommended. 82.7% of caregivers were satisfied with their care recipient's current medications and 65.4% were willing to stop taking or reduce the number of drugs taken by their care recipient's upon doctor's recommendation. Older adults (p = 0.003) and those with lower education level (p 
    Matched MeSH terms: Ambulatory Care Facilities
  8. 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
  9. 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
  10. 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
  11. 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
  12. Azniza MR, Draman N, Siti Suhaila MY, Muhamad R
    Med. J. Malaysia, 2019 Apr;74(2):103-108.
    PMID: 31079119
    OBJECTIVE: Elderly with diabetes has been found to have a higher chance of depression. Therefore, the aim of this study is to determine the prevalence of depression and its associated factors among elderly with Type 2 Diabetes Mellitus in Kedah.
    METHODS: A cross-sectional study was conducted at the Klinik Kesihatan Bandar, Sungai Petani, Kedah. The inclusion criteria were patients aged ≥60 years with Type 2 Diabetes Mellitus. Those with cognitive impairment, presence of organic brain syndrome, presence of severe mental disorder and patients who are either deaf or mute were excluded. The Malay version of Geriatric Depression Scale (M-GDS-14) was used to assess the depressive symptoms. The data was analysed using descriptive statistic and multiple logistic regression.
    RESULTS: A total of 511 patients participated in the study. The mean age of the respondents is 64.5 (Standard Deviation 7.0) years old. There were slightly more males (53.8%). Majority were Malay (63.0%), married (76.9%) and has a household income of less than RM1000 (67.5%). The prevalence of depression was 32.1%. The number of elderly people living with their children (Adjusted Odds Ratio, aOR0.20, 95%CI: 0.07, 0.55), elderly living with spouse, children, in law and grandchildren (aOR2.95, 95%CI: 1.18, 7.37), diabetic complication (aOR4.68, 95%CI: 2.63, 8.35) and HbA1c (aOR1.23, 95%CI: 1.09, 1.39) are significantly associated with depression.
    CONCLUSION: The level of depression was found to be high. Factors contributing to the significantly high level of depression are found to be associated with living arrangements, diabetic complication and HbA1c were significantly associated with depression.
    Study site: Klinik Kesihatan Bandar, Sungai Petani, Kedah, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  13. Mardiana O, Nor Afiah MZ, Norliza A A
    Med. J. Malaysia, 2019 Apr;74(2):151-159.
    PMID: 31079127
    INTRODUCTION: Short Interpregnancy interval (IPI) is defined as the interval between the live birth outcome and the next pregnancy conception of less than 24 months. It has been linked to adverse maternal and perinatal outcomes. The objective of this study was to determine the prevalence and the predictors of short IPI among antenatal mothers.

    METHODS: A cross-sectional study was conducted among 452 antenatal mothers attending health clinics in Klang in April 2018. Probability sampling was used and data was collected by using a validated self-administered questionnaire. The dependent variable of the study was short IPI and the independent variables were sociodemographic, obstetric history and planning of pregnancy. Analysis of data collected in the study was performed by using IBM Statistical Package for Social Science (SPSS) version 24.

    RESULTS: The prevalence of short IPI found in this study was 48%. Seven identified predictors of short IPI were: age less than 25 years old (Adjusted Odd Ratios; AOR 12.16, 95%CI: 4.72, 31.30), age of 26 to 30 years old (AOR 5.20, 95%CI: 2.62, 10.32), age of 31 to 35 years old (AOR 2.90, 95% CI: 1.50, 5.64), higher education (AOR 2.11, 95% CI: 1.34, 3.34), parity more than three (AOR 3.12, 95% CI: 1.42, 6.84), irregular menstruation (AOR 2.17, 95% CI: 1.40, 3.37) and unintended pregnancy (AOR 2.88, 95% CI: 1.88, 4.40).

    CONCLUSION: Innovative programmes, for example by making IPI information available through online resources, could effectively target young mothers as the younger generation prefers quick, easily-accessible and reliable information.
    Matched MeSH terms: Ambulatory Care Facilities
  14. Rozita Z, Lim MT, Lee HS
    Med. J. Malaysia, 2019 Apr;74(2):145-150.
    PMID: 31079126
    INTRODUCTION: The prevalence of overweight and obesity is increasing at an alarming rate. It is a major factor for many other metabolic disorders. This study aimed to determine the prevalence of increase body mass index (BMI) and obesity and their associated demographic characteristics among adults in an urban area.
    METHODS: A retrospective study was conducted where data was extracted from the Health Status Screening Form (BSSK) at health clinics in Johor Bahru. Using the World Health Organization (WHO), criteria for obesity, BMI≥30.0 kg/m2 was specified as obese and combination of both BMI ranges for overweight (25.0-30.0kg/m2) and obesity (≥30.0kg/m2) as elevated BMI.
    RESULTS: The overall prevalence of elevated BMI and obesity was 54.6% and 20.1% respectively. Men had a higher prevalence of elevated BMI (57.4%) with odds of 1.28 higher (95%CI: 1.04-1.58). High prevalence of elevated BMI and obesity were seen among the Indians (elevated BMI - 60.2%, obesity - 19.4%) followed by Malays (elevated BMI -57.8%, obesity - 23.1%) and Chinese showed the lowest (elevated BMI - 39.0%, obesity - 8.8%). The odds of elevated BMI and obesity were lower among younger adults as compared to older adults (≥30 years old).
    CONCLUSION: Using WHO criteria, about one in two adults had elevated BMI while one in five were obese. Elevated BMI and obesity disparities were evident in age and ethnicity, but sex differences were encountered in elevated BMI group.
    Study site: Klinik Kesihatan, Johor Bahru, Johor, Mlalaysia
    Matched MeSH terms: Ambulatory Care Facilities
  15. Tay CL, Myint PK, Mohazmi M, Soiza RL, Tan MP
    Med. J. Malaysia, 2019 Apr;74(2):121-127.
    PMID: 31079122
    INTRODUCTION: Hyponatraemia is the commonest electrolyte abnormality and has major clinical implications. However, few studies of hyponatraemia in the primary care setting has been published to date.
    OBJECTIVES: To determine the prevalence, potential causes and management of hyponatraemia and to identify factors associated with severity of hyponatraemia among older persons in a primary care setting.
    METHODS: Electronic records were searched to identify all cases aged ≥60 years with a serum sodium <135mmol/l, attending outpatient clinic in 2014. Patients' medical records with the available blood test results of glucose, potassium, urea and creatinine were reviewed.
    RESULTS: Of the 21,544 elderly, 5873 patients (27.3%) had electrolyte profile tests. 403 (6.9%) had hyponatraemia in at least one blood test. Medical records were available for 253, mean age 72.9±7.3 years, 178 (70.4%) had mild hyponatraemia, 75 (29.6%) had moderate to severe hyponatraemia. Potential causes were documented in 101 (40%). Patients with moderate to severe hyponatraemia were five times more likely to have a cause of hyponatraemia documented (p<0.01). Medications were the commonest documented cause of hyponatraemia (31.7%). Hydrochlorothiazide use was attributed in 25 (78.1%) of 32 with medication-associated hyponatraemia. Repeat renal profile (89%) was the commonest management of hypotonic hyponatraemia.
    CONCLUSION: Whilst hyponatraemia was common in the clinic setting, many cases were not acknowledged and had no clear management strategies. In view of mild hyponatraemia has deleterious consequences, future studies should determine whether appropriate management of mild hyponatraemia will lead to clinical improvement.
    Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  16. 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
  17. 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
  18. Muhammad J, Jamial MM, Ishak A
    Korean J Fam Med, 2019 Jan 14.
    PMID: 30636386 DOI: 10.4082/kjfm.18.0026
    Background: Home blood pressure monitoring is recommended to achieve controlled blood pressure. This study evaluated home blood pressure monitoring-improvement of office blood pressure control and treatment compliance among hypertensive patients.
    Methods: A randomized controlled trial was conducted from December 2014 to April 2015. The home blood pressure monitoring group used an automatic blood pressure device along with standard hypertension outpatient care. Patients were seen at baseline and after 2 months. Medication adherence was measured using a novel validated Medication Adherence Scale (MAS) questionnaire. Office blood pressure and MAS were recorded at both visits. The primary outcomes included evaluation of mean office blood pressure and MAS within groups and between groups at baseline and after 2 months.
    Results: Mean changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and MAS differed significantly within groups. The home blood pressure monitoring group showed greater mean changes (SBP 17.6 mm Hg, DBP 9.5 mm Hg, MAS 1.5 vs. SBP 14.3 mm Hg, DBP 6.4 mm Hg, MAS 1.3), while between group comparisons showed no significant differences across all variables. The adjusted mean difference for mean SBP was 4.74 (95% confidence interval [CI], -0.65 to 10.13 mm Hg; P=0.084), mean DBP was 1.41 (95% CI, -2.01 to 4.82 mm Hg; P=0.415), and mean MAS was 0.05 (95% CI, -0.29 to 0.40 mm Hg; P=0.768).
    Conclusion: Short-term home blood pressure monitoring significantly reduced office blood pressure and improved medication adherence, albeit similarly to standard care.
    Study site: Primary care clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  19. Lim MT, Lim YMF, Teh XR, Lee YL, Ismail SA, Sivasampu S
    PMID: 30608582 DOI: 10.1093/intqhc/mzy252
    Objective: To determine the extent of self-management support (SMS) provided to primary care patients with type 2 diabetes (T2D) and hypertension and its associated factors.
    Design: Cross-sectional survey conducted between April and May 2017.
    Setting: Forty public clinics in Malaysia.
    Participants: A total of 956 adult patients with T2D and/or hypertension were interviewed.
    Main Outcome Measures: Patient experience on SMS was evaluated using a structured questionnaire of the short version Patient Assessment of Chronic Illness Care instrument, PACIC-M11. Linear regression analysis adjusting for complex survey design was used to determine the association of patient and clinic factors with PACIC-M11 scores.
    Results: The overall PACIC-M11 mean was 2.3(SD,0.8) out of maximum of 5. The subscales' mean scores were lowest for patient activation (2.1(SD,1.1)) and highest for delivery system design/decision support (2.9(SD,0.9)). Overall PACIC-M11 score was associated with age, educational level and ethnicity. Higher overall PACIC-M11 ratings was observed with increasing difference between actual and expected consultation duration [β = 0.01; 95% CI (0.001, 0.03)]. Better scores were also observed among patients who would recommend the clinic to friends and family [β = 0.19; 95% CI (0.03, 0.36)], when health providers were able to explain things in ways that were easy to understand [β = 0.34; 95% CI (0.10, 0.59)] and knew about patients' living conditions [β = 0.31; 95% CI (0.15, 0.47)].
    Conclusions: Our findings indicated patients received low levels of SMS. PACIC-M11 ratings were associated with age, ethnicity, educational level, difference between actual and expected consultation length, willingness to recommend the clinic and provider communication skills.
    Study site: Klinik Kesihatan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  20. 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
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