Displaying publications 1 - 20 of 38 in total

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  1. Liam CK, Pang YK, Chua KT
    Asian Pac J Allergy Immunol, 2014 Jun;32(2):145-52.
    PMID: 25003728 DOI: 10.12932/AP0359.32.2.2013
    OBJECTIVE: To evaluate Malaysian patients' satisfaction levels and asthma control with Symbicort SMART® in the primary care setting.
    METHOD: This is a cross-sectional, multicentre study involving adult patients with persistent asthma who were prescribed only Symbicort SMART in the preceding one month prior to recruitment. Patients' satisfaction with Symbicort SMART and asthma control were evaluated using the self-administered Satisfaction with Asthma Treatment Questionnaire (SATQ) and the Asthma Control Test (ACT).
    RESULTS: Asthma was controlled (ACT score >20) in 189 (83%) of 228 patients. The mean overall SATQ score for patients with controlled asthma was 5.65 indicating a high satisfaction level, which was positively correlated with high ACT scores. There were differences in asthma control based on ethnicity, number of unscheduled visits and treatment compliance.
    CONCLUSIONS: Symbicort SMART resulted in a high satisfaction level and asthma control among Malaysian patients treated in the primary care setting and it is an effective and appealing treatment for asthmatic patients.
    Study site: General practice clinics, Malaysia
    Matched MeSH terms: Primary Health Care/methods*
  2. Ching SM, Pang YK, Price D, Cheong AT, Lee PY, Irmi I, et al.
    Respirology, 2014 Jul;19(5):689-93.
    PMID: 24708063 DOI: 10.1111/resp.12291
    BACKGROUND AND OBJECTIVE: Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting.
    METHODS: This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtain demographic data and relevant information. Handheld spirometry was performed according to a standard protocol using the COPd-6 device (Model 4000, Vitalograph, Ennis, Ireland) in addition to standard spirometry. Airflow limitation was defined as ratio of forced expiratory volume in 1 s (FEV1 )/forced expiratory volume in 6 s <0.75 (COPd-6) or FEV1 /forced vital capacity <0.7. Multiple logistic regression analyses were used to determine predictors of airflow limitation.
    RESULTS: A total of 416 patients were recruited with mean age of 53 years old. The prevalence of airflow limitation was 10.6% (n = 44) with COPd-6 versus 6% as gauged using standard spirometry. Risk factors for airflow limitation were age >65 years (odds ratio (OR) 3.732 95% confidence interval (CI): 1.100-1.280), a history of 'bad health' (OR 2.524, 95% CI: 1.037-6.142) and low to normal body mass index (OR 2.914, 95% CI: 1.191-7.190).
    CONCLUSIONS: In a primary care setting, handheld spirometry (COPd-6) found a prevalence of airflow limitation of ∼10% in smokers. Patients were older, not overweight and had an ill-defined history of health problems.
    KEYWORDS: Malaysia; chronic obstructive pulmonary disease; prevalence; primary care; smoke
    Study site: Public primary healthcare clinic (Klinik Kesihatan), Sepang District, Selangor, Malaysia
    Matched MeSH terms: Primary Health Care/methods*
  3. Chan GC
    Singapore Med J, 2005 Mar;46(3):127-31.
    PMID: 15735877
    A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines.
    Matched MeSH terms: Primary Health Care/methods
  4. Selvaraj FJ, Mohamed M, Omar K, Nanthan S, Kusiar Z, Subramaniam SY, et al.
    BMC Fam Pract, 2012;13:97.
    PMID: 23046818 DOI: 10.1186/1471-2296-13-97
    BACKGROUND: To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).
    METHODS: This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.
    RESULTS: Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).
    CONCLUSION: Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.
    TRIAL REGISTRATION:
    National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.
    Matched MeSH terms: Primary Health Care/methods*
  5. Aziz NA, Norzila MZ, Hamid MZ, Noorlaili MT
    Med J Malaysia, 2006 Dec;61(5):534-9.
    PMID: 17623952 MyJurnal
    The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.
    Study site: Klink HUKM Taman Jaya, Cheras, Kuala Lumpur, Malaysia (primary care clinic for Hospital University Kebangsaan Malaysia)
    Matched MeSH terms: Primary Health Care/methods*
  6. Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W
    Ann Glob Health, 2016 4 25;81(6):851-62.
    PMID: 27108152 DOI: 10.1016/j.aogh.2015.12.016
    BACKGROUND: Diabetes is a major public health concern in Malaysia, and the prevalence of type 2 diabetes (T2D) has escalated to 20.8% in adults above the age of 30, affecting 2.8 million individuals. The burden of managing diabetes falls on primary and tertiary health care providers operating in various settings.

    OBJECTIVES: This review focuses on the current status of diabetes in Malaysia, including epidemiology, complications, lifestyle, and pharmacologic treatments, as well as the use of technologies in its management and the adoption of the World Health Organization chronic care model in primary care clinics.

    METHODS: A narrative review based on local available health care data, publications, and observations from clinic experience.

    FINDINGS: The prevalence of diabetes varies among the major ethnic groups in Malaysia, with Asian Indians having the highest prevalence of T2D, followed by Malays and Chinese. The increase prevalence of overweight and obesity has accompanied the rise in T2D. Multidisciplinary care is available in tertiary and primary care settings with integration of pharmacotherapy, diet, and lifestyle changes. Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D. The latest medication options are available with increasing use of intensive insulin regimens, insulin pumps, and continuous glucose monitoring systems for managing glycemic control. A stepwise approach is proposed to expand the chronic care model into an Innovative Care for Chronic Conditions framework to facilitate implementation and realize better outcomes in primary care settings.

    CONCLUSIONS: A comprehensive strategy and approach has been established by the Malaysian government to improve prevention, treatment, and control of diabetes as an urgent response to this growing chronic disease.

    Matched MeSH terms: Primary Health Care/methods*
  7. Swarna Nantha Y
    Fam Pract, 2015 Oct;32(5):514-9.
    PMID: 26251026 DOI: 10.1093/fampra/cmv066
    BACKGROUND: The quality of anticoagulation management in atrial fibrillation patients is reflected by the concept of time spent in therapeutic range (TTR). In a primary care setting, the implementation of a dose nomogram could help increase the mean TTR among these patients.
    OBJECTIVE: This study compares the influence of a dose algorithm with an integrated recall on TTR prior to standard care and after the implementation of the protocol.
    PATIENTS AND METHODS: In a purposive sample of patients with AF, an uncontrolled 'before' and 'after' study design was utilized to measure the effects of the protocol on TTR. Demographic data, TTR levels, frequency of international normalized ratio (INR) within therapeutic range, clinician adherence to dose nomogram and warfarin dose changes were captured from consultations at the anticoagulation clinic.
    RESULTS: A total of 152 patients with AF were entered into the final analysis. The increment in mean TTR in the 'after' intervention phase (2.9%) was not statistically significant (57.5-60.4%, P=0.252). The increase in the frequency of INR values within therapeutic range in the 'after' intervention phase was significant (50.0-56.0%, P<0.05) but with a very low effect size (r=0.04).
    CONCLUSIONS: The implementation of a dose nomogram has the potential of reducing unnecessary dose changes for minor fluctuations in INR levels. The findings in this study needs to be confirmed in a future study involving other indications for anticoagulation, various regional primary care clinics and a larger population size.
    KEYWORDS: Atrial fibrillation; TTR; dose nomogram; predictors; primary care; warfarin.
    Study site: Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Primary Health Care/methods*
  8. Mohd Sidik S, Arroll B, Goodyear-Smith F
    J Prim Health Care, 2012 Mar;4(1):5-11, A1.
    PMID: 22377544
    Introduction: Anxiety is a common mental health disorder in primary care, with a higher prevalence among women compared to men.
    Aim: This is the first study to validate the Generalised Anxiety Disorder-7 questionnaire (GAD-7) as a case-finding instrument for anxiety in a primary care setting in Malaysia. The objective was to determine the diagnostic accuracy of the Malay version of the GAD-7 in detecting anxiety among women.
    Methods: This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive women participants attending the clinic during data collection were given self-administered questionnaires including the GAD-7 (Malay version). Participants then were selected using systematic weighted random sampling for Composite International Diagnostic Interviews (CIDI). The GAD-7 was validated against the CIDI reference standard.
    Results: The response rate was 87.5% for the questionnaire completion (895/1023), and 96.8% for diagnostic interviews (151/156). The prevalence of anxiety was 7.8%. The GAD-7 had a sensitivity of 76% (95% CI 61%–87%), a specificity of 94% (88%–97%), positive LR 13.7 (6.2–30.5) and negative LR 0.25 (0.14–0.45).
    Discussion: The Malay version of the GAD-7 was found to be valid and reliable in case-finding for anxiety in this study. Due to its brevity, it is a suitable case-finding instrument for detecting anxiety in primary care settings in Malaysia.
    Keywords: Validation; anxiety; primary care; women; Malaysia
    Questionnaire: Generalised Anxiety Disorder questionnaire; GAD-7; Composite International Diagnostic Interviews; CIDI; Patient Health Questionnaire; PHQ-9; General Health Questionnaire; GHQ-12
    Matched MeSH terms: Primary Health Care/methods*
  9. Jeyachelvi K, Juwita S, Norwati D
    Asian Pac J Cancer Prev, 2016;17(8):3983-8.
    PMID: 27644649
    BACKGROUND: Cervical cancer though preventable is still the leading cause of cancer death among women secondary to breast cancer. Persistent infection with HPV has been causally linked to the disease. A school based HPV vaccination program was introduced in late 2010 in Malaysia and nurse support is essential for its success.
    OBJECTIVES: To determine nurses knowledge and attitudes about HPV infection and its vaccines, and factors associated with their knowledge.
    MATERIALS AND METHODS: This cross-sectional study was conducted among nurses working at primary health clinics in Kelantan from mid-June till the end of July 2014. Its involved 330 nurses selected through multistage random sampling. A validated self-administered questionnaire consisting of 11 items for the knowledge domain and eight items for the attitude domain was used.
    RESULTS: The response rate of the study was 93.7%. The mean knowledge and mean attitude (SD) scores were 5.37 (1.76) and 29.8 (3.51) respectively. Only 24% knew that HPV is the most common sexually transmitted infection and 67% correctly answered that Gardasil vaccine can protect against four types of HPV. Nearly 60% of participants wrongly answered that HPV vaccines cannot be offered to sexually active women. Likewise, 70.9% participants were not aware that HPV vaccine may be appropriate for females aged 9 through 26 years. Though 90% of participants believed that the vaccine is safe, nearly half of them were unsure about efficacy. From multiple linear regression analysis, among the factors tested only participant's level of education showed a statistically significant association with the HPV knowledge score (<0.001).
    CONCLUSIONS: This study indicates nurses have favorable attitudes towards HPV vaccination; however they have significant knowledge deficit and major misunderstanding in critical knowledge items. Among the factors tested, nursing qualification is the only factor that is significantly associated with the nurses knowledge score.
    Matched MeSH terms: Primary Health Care/methods
  10. Jackson AA, Lai PSM, Alias AM, Atiya N, Ramdzan SN, Abdul Malik TF, et al.
    J Infect Dev Ctries, 2019 03 31;13(3):219-226.
    PMID: 32040451 DOI: 10.3855/jidc.11089
    INTRODUCTION: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting.

    METHODOLOGY: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist.

    RESULTS: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available.

    CONCLUSION: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

    Matched MeSH terms: Primary Health Care/methods*
  11. Fung FY, Koh YLE, Malhotra R, Ostbye T, Lee PY, Shariff Ghazali S, et al.
    BMC Geriatr, 2019 04 29;19(1):122.
    PMID: 31035928 DOI: 10.1186/s12877-019-1137-8
    BACKGROUND: Sarcopenia is the age-related loss of muscle mass and function, which increases fall risks in older persons. Hyperglycemia relating to Type-2 Diabetes Mellitus (T2DM) is postulated to aggravate sarcopenia. This study aimed to determine the prevalence of sarcopenia among ambulatory community-dwelling older patients, aged 60-89 years, with T2DM in a primary care setting and to identify factors which mitigate sarcopenia.

    METHODS: A total of 387 patients were recruited from a public primary care clinic in Singapore. Data on their socio-demography, clinical and functional status, levels of physical activity (International Physical Activity Questionnaire) and frailty status was collected. The Asian Working Group for Sarcopenia (AWGS) criteria were used to define sarcopenia based on muscle mass, grip strength and gait speed.

    RESULTS: The study population comprised men (53%), Chinese (69%), mean age = 68.3 ± SD5.66 years, lived in public housing (90%), had hypertension (88%) and dyslipidemia (96%). Their mean muscle mass was 6.3 ± SD1.2 kg/m2; mean gait speed was 1.0 ± SD0.2 m/s and mean grip strength was 25.5 ± SD8.1 kg. Overall, 30% had pre-sarcopenia, 24% with sarcopenia and 4% with severe sarcopenia. Age (OR = 1.14; 95%CI = 1.09-1.20;p 

    Matched MeSH terms: Primary Health Care/methods*
  12. Lim HM, Chia YC, Ching SM, Chinna K
    BMJ Open, 2019 Apr 20;9(4):e025322.
    PMID: 31005918 DOI: 10.1136/bmjopen-2018-025322
    OBJECTIVE: To determine the reproducibility of visit-to-visit blood pressure variability (BPV) in clinical practice. We also determined the minimum number of blood pressure (BP) measurements needed to estimate long-term visit-to-visit BPV for predicting 10-year cardiovascular (CV) risk.

    DESIGN: Retrospective study SETTING: A primary care clinic in a university hospital in Malaysia.

    PARTICIPANTS: Random sampling of 1403 patients aged 30 years and above without any CV event at baseline.

    OUTCOMES MEASURES: The effect of the number of BP measurement for calculation of long-term visit-to-visit BPV in predicting 10-year CV risk. CV events were defined as fatal and non-fatal coronary heart disease, fatal and non-fatal stroke, heart failure and peripheral vascular disease.

    RESULTS: The mean 10-year SD of systolic blood pressure (SBP) for this cohort was 13.8±3.5 mm Hg. The intraclass correlation coefficient (ICC) for the SD of SBP based on the first eight and second eight measurements was 0.38 (p<0.001). In a primary care setting, visit-to-visit BPV (SD of SBP calculated from 20 BP measurements) was significantly associated with CV events (adjusted OR 1.07, 95% CI 1.02 to 1.13, p=0.009). Using SD of SBP from 20 measurement as reference, SD of SBP from 6 measurements (median time 1.75 years) has high reliability (ICC 0.74, p<0.001), with a mean difference of 0.6 mm Hg. Hence, a minimum of six BP measurements is needed for reliably estimating intraindividual BPV for CV outcome prediction.

    CONCLUSION: Long-term visit-to-visit BPV is reproducible in clinical practice. We suggest a minimum of six BP measurements for calculation of intraindividual visit-to-visit BPV. The number and duration of BP readings to derive BPV should be taken into consideration in predicting long-term CV risk.

    Matched MeSH terms: Primary Health Care/methods
  13. Chia YC, Ching SM
    BMC Nephrol, 2012 Dec 24;13:173.
    PMID: 23259489 DOI: 10.1186/1471-2369-13-173
    BACKGROUND: Little is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.

    METHODS: This is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.

    RESULTS: The incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).

    CONCLUSIONS: The progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

    Matched MeSH terms: Primary Health Care/methods
  14. Ambigapathy R, Chia YC, Ng CJ
    BMJ Open, 2016 Jan 04;6(1):e010063.
    PMID: 26729393 DOI: 10.1136/bmjopen-2015-010063
    OBJECTIVE: Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients' role preference in decision-making and the associated factors.
    DESIGN: A cross-sectional study.
    SETTING: Study was conducted at an urban primary care clinic in Malaysia in 2012.
    PARTICIPANTS: Patients aged >21 years were chosen using systematic random sampling.
    METHODS: Consenting patients answered a self-administered questionnaire, which included demographic data and their preferred and actual role before and after consultation. Doctors were asked to determine patients' role preference. The Control Preference Scale was used to assess patients' role preference.
    PRIMARY OUTCOME: Prevalence of patients' preferred role in decision-making.
    SECONDARY OUTCOMES: (1) Actual role played by the patient in decision-making. (2) Sociodemographic factors associated with patients' preferred role in decision-making. (3) Doctors' perception of patients' involvement in decision-making.
    RESULTS: The response rate was 95.1% (470/494). Shared decision-making was preferred by 51.9% of patients, followed by passive (26.3%) and active (21.8%) roles in decision-making. Higher household income was significantly associated with autonomous role preference (p=0.018). Doctors' perception did not concur with patients' preferred role. Among patients whom doctors perceived to prefer a passive role, 73.5% preferred an autonomous role (p=0.900, κ=0.006).
    CONCLUSIONS: The majority of patients attending the primary care clinic preferred and played an autonomous role in decision-making. Doctors underestimated patients' preference to play an autonomous role.
    Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Primary Health Care/methods*
  15. Ramli AS, Lakshmanan S, Haniff J, Selvarajah S, Tong SF, Bujang MA, et al.
    BMC Fam Pract, 2014;15:151.
    PMID: 25218689 DOI: 10.1186/1471-2296-15-151
    Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol.
    Matched MeSH terms: Primary Health Care/methods*
  16. Swarna Nantha Y
    J Prim Care Community Health, 2014 Oct;5(4):263-70.
    PMID: 24879656 DOI: 10.1177/2150131914536988
    Objectives: The average consumption of sugar in the Malaysian population has reached an alarming rate, exceeding the benchmark recommended by experts. This article argues the need of a paradigm shift in the management of sugar consumption in the country through evidence derived from addiction research.
    Methods: “Food addiction” could lead to high levels of sugar consumption. This probable link could accelerate the development of diabetes and obesity in the community. A total of 94 reports and studies that describe the importance of addiction theory–based interventions were found through a search on PubMed, Google Scholar, and Academic Search Complete.
    Results: Research in the field of addiction medicine has revealed the addictive potential of high levels of sugar intake. Preexisting health promotion strategies could benefit from the integration of the concept of sugar addiction. A targeted intervention could yield more positive results in health outcomes within the country.
    Conclusion: Current literature seems to support food environment changes, targeted health policies, and special consultation skills as cost-effective remedies to curb the rise of sugar-related health morbidities.
    Keywords. sugar addiction, food environment, health promotion, non communicable diseases, dietary habits, health policies
    Matched MeSH terms: Primary Health Care/methods*
  17. Mohd Sidik S, Arroll B, Goodyear-Smith F
    Med J Malaysia, 2012 Jun;67(3):309-15.
    PMID: 23082424 MyJurnal
    OBJECTIVE: This study was conducted to determine the validity of the 9-item Patient Health Questionnaire (PHQ-9) (Malay version) as a case-finding instrument for depression among women in a primary care clinic.
    METHODS: A cross sectional study was conducted in a primary care clinic in Malaysia. Consecutive adult women patients who attended the clinic during data collection were given self-administered questionnaires, which included the PHQ-9 (Malay version). Systematic weighted random sampling was used to select participants for Composite International Diagnostic Interviews (CIDI). The PHQ-9 was validated against the CIDI reference standard.
    RESULTS: The response rate was 87.5% for the questionnaire completion (895/1023), and 96.8% for the CIDI interviews (151/156). The prevalence of depression was 12.1% (based on PHQ-9 scores of 10 and above). The PHQ-9 had a sensitivity of 87% (95% confidence interval 71% to 95%), a specificity of 82% (74% to 88%), positive LR 4.8 (3.2 to 7.2) and negative LR 0.16 (0.06 to 0.40).
    CONCLUSIONS: The Malay version of the PHQ-9 was found to be a valid and reliable case-finding instrument for depression in this study. Together with its brevity, it is a suitable case-finding instrument to be used in Malaysian primary care clinics.
    Questionnaire: Patient Health Questionnaire; PHQ-9; General Health Questionnaire; GHQ-12; Composite International Diagnostic Interview; CIDI; Generalized Anxiety Disorder scale; GAD-7
    Matched MeSH terms: Primary Health Care/methods*
  18. Mohd-Sidik S, Arroll B, Goodyear-Smith F, Zain AM
    Int J Psychiatry Med, 2011;41(2):143-54.
    PMID: 21675346 DOI: 10.2190/PM.41.2.d
    OBJECTIVE: To determine the diagnostic accuracy of the two questions with help question (TQWHQ) in the Malay language. The two questions are case-finding questions on depression, and a question on whether help is needed was added to increase the specificity of the two questions.
    METHOD: This cross sectional validation study was conducted in a government funded primary care clinic in Malaysia. The participants included 146 consecutive women patients receiving no psychotropic drugs and who were Malay speakers. The main outcome measures were sensitivity, specificity, and likelihood ratios of the two questions and help question.
    RESULTS: The two questions showed a sensitivity of 99% (95% confidence interval 88% to 99.9%) and a specificity of 70% (62% to 78%), respectively. The likelihood ratio for a positive test was 3.3 (2.5 to 4.5) and the likelihood ratio for a negative test was 0.01 (0.00 to 0.57). The addition of the help question to the two questions increased the specificity to 95% (89% to 98%).
    CONCLUSION: The two qeustions on depression detected most cases of depression in this study. The questions have the advantage of brevity. The addition of the help question increased the specificity of the two questions. Based on these findings, the TQWHQ can be strongly recommended for detection of depression in government primary care clnics in Malaysia. Translation did not apear to affect the validity of the TQWHQ.
    Matched MeSH terms: Primary Health Care/methods*
  19. Mafauzy M
    Med J Malaysia, 2005 Jun;60(2):212-7.
    PMID: 16114163 MyJurnal
    This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia. A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed. The majority of patients (96.5%) had type 2 diabetes mellitus and 81.4% had BMI > or =23 kg/m2. Only 12.0% of the patients had their HbA1c measured in the preceding 12 months. As for glycaemic control only 20% of the patients had HbA1c <7% and 11% had FPG < 6.7 mmol/L. As for lipid levels, only 12.3% of the patients had total cholesterol < 4.8 mmol/L; 30.9% had HDL-cholesterol > 1.2 mmol/L and 49.8% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia. only 12.4% of the patients were on lipid lowering therapy. As for blood pressure, 55.9% of the patients had systolic pressure > or =140 mmHg and 40.9% had diastolic pressure > or =90 mmHg. However, only 32.4% of the patients were on antihypertensive medication. Only 37.4% of the patients admitted to adhering to diabetic diet regularly and 32.0% exercised regularly. As for glucose monitoring only 6.9% of the patients did home blood glucose monitoring and 6.2% did home urine glucose. There was also a high complication rate with the commonest being neuropathy (30.1%) followed by background retinopthy (23.5%), albuminuria (22.9%) and microalbuminuria (20.4%). In conclusion, the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications. There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.
    Matched MeSH terms: Primary Health Care/methods*
  20. Chew BH, Vos R, Mohd-Sidik S, Rutten GE
    PLoS One, 2016;11(3):e0152095.
    PMID: 27002728 DOI: 10.1371/journal.pone.0152095
    Type 2 diabetes mellitus (T2DM) brings about an increasing psychosocial problem in adult patients. Prevalence data on and associated factors of diabetes related distress (DRD) and depression have been lacking in Asia. This study aimed to examine the prevalence of DRD and depression, and their associated factors in Asian adult T2DM patients. This study was conducted in three public health clinics measuring DRD (Diabetes Distress Scale, DDS), and depression (Patient Health Questionnaire, PHQ). Patients who were at least 30 years of age, had T2DM for more than one year, with regular follow-up and recent laboratory results (< 3 months) were consecutively recruited. Associations between DRD, depression and the combination DRD-depression with demographic and clinical characteristics were analysed using generalized linear models. From 752 invited people, 700 participated (mean age 56.9 years, 52.8% female, 52.9% Malay, 79.1% married). Prevalence of DRD and depression were 49.2% and 41.7%, respectively. Distress and depression were correlated, spearman's r = 0.50. Patients with higher DRD were younger (OR 0.995, 95% CI 0.996 to 0.991), Chinese (OR 1.2, 95% CI 1.04 to 1.29), attending Dengkil health clinic (OR 1.1, 95% CI 1.00 to 1.22) and had higher scores on the PHQ (OR 1.1, 95% CI 1.04 to 1.06). Depression was less likely in the unmarried compared to divorced/separately living and those attending Dengkil health clinic, but more likely in patients with microvascular complications (OR 1.4, 95% CI 1.06 to 1.73) and higher DDS (OR 1.03, 95% CI 1.02 to 1.03). For the combination of DRD and depression, unemployment (OR 4.7, 95% CI 1.02 to 21.20) had positive association, whereas those under medical care at the Salak health clinics (OR 0.28, 95% CI 0.12 to 0.63), and those with a blood pressure > 130/80 mmHg (OR 0.53, 95% CI 0.32 to 0.89) were less likely to experience both DRD and depression. DRD and depression were common and correlated in Asian adults with T2DM at primary care level. Socio-demographic more than clinical characteristics were related to DRD and depression.
    Matched MeSH terms: Primary Health Care/methods
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