Methods: A comprehensive electronic search was conducted using PubMed, the Library of Congress, Google Scholar, SAGE, and ScienceDirect. The following search keywords were used: adoptive breastfeeding, induced lactation, non-puerperal lactation, extraordinary breastfeeding, and milk kinship. The search was restricted to articles written in English and published from 1956 to 2019. All study designs were included except for practice protocols.
Results: A total of 50 articles about induced lactation were retrieved. Of these, 17 articles identified the experiences of women who underwent induced lactation. The articles included original papers (n=7), reviews (n=5), and case reports (n=5). Four articles were specifically related to Malaysia, and the others were international. These 17 articles concerning the experiences of women who induced lactation will be reviewed based on four themes related to inducing lactation: (a) understanding women's perception of satisfaction, (b) emotional aspects, (c) enabling factors, and (d) challenges.
Conclusion: Identifying a total of only 17 articles on induced lactation published over the last 53 years suggests that the subject is understudied. This review provides emerging knowledge regarding the experiences of women who have induced lactation in terms of satisfaction, emotions, enabling factors and challenges related to inducing lactation.
Aim: To determine the feasibility of a collaborative program between private general practitioners (GPs) and the public primary health clinics in PTB screening and to assess the yield of smear-positive PTB from this program.
Methods: A prospective cohort study using convenient sampling was conducted involving GPs and public health clinics in the North-East District, Penang, from March 2018 to May 2019. In this study, GPs could direct all suspected PTB patients to perform a sputum acid fast bacilli (AFB) direct smear in any of the dedicated public primary health clinics. The satisfaction level of both the GPs and their patients were assessed using a self-administered client satisfaction questionnaire. IBM SPSS Statistical Software was used to analyze the data.
Results: Out of a total of 31 patients who underwent the sputum investigation for PTB, one (3.2%) was diagnosed to have smear-positive PTB. Most of the patients (>90%) and GPs (66.7%) agreed to continue with this program in the future. Furthermore, most of the patients (>90%) were satisfied with the program structure.
Conclusion: It is potentially feasible to involve GPs in combating TB. However, a more structured program addressing the identified issues is needed to make the collaborative program a success.
Method: This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM).
Results: A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p < 0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy).
Conclusion: Vocational training in family medicine appears to improve primary care physicians' knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.
Objective: This study aimed to develop a maternal blues scale through bonding attachments to predict postpartum blues.
Method: The research design consisted of three stages: 1) phenomenology design and focus group discussion; 2) development and construction of the maternal blues scale, and 3) a cross-sectional study to measure validation of the scales. Respondents were postpartum mothers in the first week after birth. The sample comprised 501 participants. Sampling was done by consecutive sampling at the Public Health Center (PUSKESMAS) in the South Jakarta area. Data analysis used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), correlation, and a diagnostic testing .
Results: Item analysis produced 32 items consisting of 24 items regarding the mother's role and duties as internal factors and eight factors involving social, cultural, and economic support as external factors. Both factors were valid and reliable in predicting postpartum blues with indicators (t loading factors ≥ 1.96, standardized loading factor (SLF) ≥.50, internal factors: construct reliability (CR) ≥ .70 and extraction variants (VE) ≥ .50 and external factors: CR ≥ .74 to .83 VE ≥ .50 to .63). The relationship with Kennerley's maternity blues as a gold standard was significant. Internal factors had a score of 53, with a sensitivity of 60.2%. The external factors score was 19, with a sensitivity of 77.3%.
Conclusion: The new scale for postpartum blues prediction developed displayed internal consistency and validity of each indicator (internal and external factors) that was good (CR ≥ .70; VE ≥ .50). This scale provides a feasible tool to predict postpartum blues.
Objective: This study was conducted to identify stigmatizing attitudes toward people living with HIV/AIDS (PLWHA) and their determinants among primary health care providers in Kinta District, Perak.
Methodology: A cross-sectional study was conducted in 36 primary care clinics in Kinta District, Perak. Using stratified random sampling, 365 primary health care providers were recruited into the study. A validated self-administered questionnaire was used to obtain sociodemographic data as well as information on the healthcare experiences of healthcare providers, their knowledge of HIV/AIDS, and attitudes toward PLWHA. Determinants were identified using multiple linear regression.
Results: More than half of the respondents (54.1%) had never provided care to HIV/AIDS patients. A minority (29.9%) had received training on HIV/AIDS. This study shows that doctors (Coef.= -9.50, 95% CI: -18.93, -0.07, p= 0.048), respondents with HIV-positive relatives, (Coef.= -5.61, 95% CI: -10.57, -0.65, p= 0.027), those who had provided care to HIV/AIDS patients (Coef.= -2.38, 95% CI: -4.31, -0.45, p= 0.016), and those with a higher knowledge score on HIV/AIDS (Coef.= -0.86, 95% CI: -1.59, -0.13, p= 0.021) were less likely to show stigmatizing attitudes toward PLWHA.
Conclusion: The issue of stigmatizing attitudes toward PLWHA among primary health care providers needs to be addressed. This study finds that knowledge, profession, experiences with caring for PLWHA, gender, and having HIV-positive relatives are significant predictors of stigmatizing attitudes toward PLWHA among primary health care providers in Kinta District, Perak. Interventional programs to improve knowledge and awareness, as well as decrease stigma toward PLWHA, should be implemented among all health care providers, especially those who have no opportunity to provide direct care.
Method: This investigation comprises a cross-sectional descriptive study of all patients visiting two primary care clinics aged 18 years and above. Patients presenting with joint pain answered a questionnaire assessing demographic data, disabilities (measured by the Stanford HAQ-DI), and treatment options.
Results: Of 1,074 patients surveyed, 202 (18.8%) had MSK complaints. The mean age of those with MSK pain was 56.1 years. Incidence increased with age, reaching 78.8% of those over 48 years of age. The knee was the most common site of MSK pain (52.2%), with 20.3% requiring referral for specialist assessment. The median HAQ score was 0.375 and 89.6% of those surveyed had mild disability.
Conclusion: MSK pain is a common problem among patients visiting primary care clinics. The most common site of MSK pain was the knee. On formal assessment, the majority of these patients exhibited mild disability. A significant proportion of patients still required specialist referral. This finding would suggest a need for further training on the management of MSK disease at the primary care level to avoid over-burdening the secondary care services.
Methods: A total of 20 menopausal women were recruited using purposive sampling through social media in the state of Pahang, Malaysia. In-depth semi-structured interviews were used to explore how they perceived their menopausal experience. The data were then analyzed using thematic analysis.
Results: Three themes that emerged from the findings included perceptions of menopause, biopsychosocial changes and help-seeking behavior. For many Muslim women, menopause was perceived as a time for them to engage in religious commitment more than they had before.
Conclusion: The study findings uncovered a knowledge gap and a lack of support for women impacted by menopause. Muslim women regarded their menopause phase as a time for them to engage in religious duty fully. These results indicate the need for a psychosocial intervention and educational program to ensure women a better transition throughout their menopausal phase.
Methods: This cross-sectional study included all gout patients who attended the rheumatology clinic from January 2013 to June 2018 and had received febuxostat as a second-line ULT. Analysis focused on the proportion of gout patients who achieved target serum urate (sUA) of <360 μmol/L, duration taken to achieve target sUA, and febuxostat dosage at achievement of target sUA. Safety assessments included comparison of serum creatinine, estimated glomerular filtration rate (eGFR), and serum alanine aminotransferase (ALT) at baseline, at achievement of target sUA, and at 12-monthly intervals.
Results: Majority (90.9%) of patients achieved target sUA. Median duration required to achieve target sUA was 5.5 months with IQR (interquartile range) of 8.5. Five (22.7%) patients achieved target sUA within one month of therapy with febuxostat 40 mg per day. Eleven (55%) patients achieved target sUA within six months and 16 (80%) by 12 months. Equal proportion of patients achieved target sUA with febuxostat 40 mg per day and 80 mg per day, respectively. There was no significant difference in the changes in serum creatinine level, eGFR and ALT from baseline and at achievement of target sUA, nor at 12-monthly intervals throughout the duration of febuxostat therapy. Apart from three patients who developed hypersensitivity reactions to febuxostat, no other adverse events were reported.
Conclusion: A significant proportion of gout patients with CKD managed to achieve target sUA with a lower dose of febuxostat at 40 mg per day and it is reasonable to maintain this dose for up to six months before considering dose escalation.
Study design: Qualitative.
Place and duration of study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants' perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data.
Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran's family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified.
Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.