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Fulltext Prognostic factors and epidemiology of adult open globe injuries from Western Sydney: a twelve-year review

Ho H, Foo J, Li YC, Bobba S, Go C, Chandra J, et al.

BMC Ophthalmol, 2021 Apr 10;21(1):173.
PMID: 33838650 DOI: 10.1186/s12886-021-01929-z

BACKGROUND: To identify prognostic factors determining final visual outcome following open globe injuries.
METHODS: Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities.
RESULTS: A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p

Matched MeSH terms: Humans
Fulltext Computational fluid dynamics modelling of human upper airway: A review

Faizal WM, Ghazali NNN, Khor CY, Badruddin IA, Zainon MZ, Yazid AA, et al.

Comput Methods Programs Biomed, 2020 Nov;196:105627.
PMID: 32629222 DOI: 10.1016/j.cmpb.2020.105627

BACKGROUND AND OBJECTIVE: Human upper airway (HUA) has been widely investigated by many researchers covering various aspects, such as the effects of geometrical parameters on the pressure, velocity and airflow characteristics. Clinically significant obstruction can develop anywhere throughout the upper airway, leading to asphyxia and death; this is where recognition and treatment are essential and lifesaving. The availability of advanced computer, either hardware or software, and rapid development in numerical method have encouraged researchers to simulate the airflow characteristics and properties of HUA by using various patient conditions at different ranges of geometry and operating conditions. Computational fluid dynamics (CFD) has emerged as an efficient alternative tool to understand the airflow of HUA and in preparing patients to undergo surgery. The main objective of this article is to review the literature that deals with the CFD approach and modeling in analyzing HUA.
METHODS: This review article discusses the experimental and computational methods in the study of HUA. The discussion includes computational fluid dynamics approach and steps involved in the modeling used to investigate the flow characteristics of HUA. From inception to May 2020, databases of PubMed, Embase, Scopus, the Cochrane Library, BioMed Central, and Web of Science have been utilized to conduct a thorough investigation of the literature. There had been no language restrictions in publication and study design of the database searches. A total of 117 articles relevant to the topic under investigation were thoroughly and critically reviewed to give a clear information about the subject. The article summarizes the review in the form of method of studying the HUA, CFD approach in HUA, and the application of CFD for predicting HUA obstacle, including the type of CFD commercial software are used in this research area.
RESULTS: This review found that the human upper airway was well studied through the application of computational fluid dynamics, which had considerably enhanced the understanding of flow in HUA. In addition, it assisted in making strategic and reasonable decision regarding the adoption of treatment methods in clinical settings. The literature suggests that most studies were related to HUA simulation that considerably focused on the aspects of fluid dynamics. However, there is a literature gap in obtaining information on the effects of fluid-structure interaction (FSI). The application of FSI in HUA is still limited in the literature; as such, this could be a potential area for future researchers. Furthermore, majority of researchers present the findings of their work through the mechanism of airflow, such as that of velocity, pressure, and shear stress. This includes the use of Navier-Stokes equation via CFD to help visualize the actual mechanism of the airflow. The above-mentioned technique expresses the turbulent kinetic energy (TKE) in its result to demonstrate the real mechanism of the airflow. Apart from that, key result such as wall shear stress (WSS) can be revealed via turbulent kinetic energy (TKE) and turbulent energy dissipation (TED), where it can be suggestive of wall injury and collapsibility tissue to the HUA.

Matched MeSH terms: Humans
A case paradoxical hidradenitis suppurativa with janus kinase inhibitor, literature review and pooled analysis of biological agent-induced HS

Shaharir SS, Jamil A, Chua SH, Arumugam M, Rosli N

Dermatol Ther, 2020 11;33(6):e14021.
PMID: 32677247 DOI: 10.1111/dth.14021

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease. Biological therapy has revolutionized it's the treatment. Paradoxical HS occur with various biological and targeted agents. We report a patient with juvenile rheumatoid arthritis who developed HS after 6 months of tofacitinib therapy. A comprehensive literature review identified 43 cases of paradoxical HS among patients on biological and targeted agents. Pooled analysis of the cases showed Crohn's disease 18(41.8%) and RA 9(20.9%) as commonest indications for biological therapy. Adalimumab 20(46.5%) followed by infliximab 9(20.9%) were the commonest offending agents. Duration of biological treatment prior to HS manifestation was 12(1-120) months. Smoking 21(48.8%) and overweight or obese 20(46.5%) were most frequent HS risk factors. Fourteen (32.6%) patients had a second paradoxical event, 11(25.6%) developed psoriasis and 4(9.3%) Crohn's disease. Presence of ≥1 risk factor for HS, continuation of the implicated biological agent and occurrence of more than one paradoxical event were factors associated with poor paradoxical HS outcome.

Matched MeSH terms: Humans
Marrow Fat Content and Composition in β-Thalassemia: A Study using 1 H-MRS

Ismail UN, Azlan CA, Khairullah S, Azman RR, Omar NF, Md Shah MN, et al.

J Magn Reson Imaging, 2021 01;53(1):190-198.
PMID: 33237616 DOI: 10.1002/jmri.27294

BACKGROUND: β-thalassemia is a genetic disease that causes abnormal production of red blood cells (ineffective erythropoiesis, IE). IE is a condition known to change bone marrow composition.
PURPOSE: To evaluate the effect of IE on the marrow fat content and fat unsaturation levels in the proximal femur using 1 H-MRS.
STUDY TYPE: Prospective.
SUBJECTS: Twenty-three subjects were included in this study, seven control and 16 β-thalassemia subjects.
FIELD STRENGTH/SEQUENCE: 3.0T; stimulated echo acquisition Mode (STEAM); magnetic resonance spectroscopy (MRS) sequence.
ASSESSMENT: Multiecho MRS scans were performed in four regions of the proximal left femur of each subject, that is, diaphysis, femoral neck, femoral head, and greater trochanter. The examined regions were grouped into red (diaphysis and femoral neck) and yellow marrow regions (femoral head and greater trochanter).
STATISTICAL TESTS: The Jonckheere-Terpstra test was used to evaluate the impact of increasing disease severity on bone marrow fat fraction (BMFF), marrow conversion index, and fat unsaturation index (UI). Pairwise comparison analysis was performed when a significant trend (P

Matched MeSH terms: Humans
Fulltext Pathophysiological Perspective of Osteoarthritis

Yunus MHM, Nordin A, Kamal H

Medicina (Kaunas), 2020 Nov 16;56(11).
PMID: 33207632 DOI: 10.3390/medicina56110614

Osteoarthritis (OA) is the most well-known degenerative disease among the geriatric and is a main cause of significant disability in daily living. It has a multifactorial etiology and is characterized by pathological changes in the knee joint structure including cartilage erosion, synovial inflammation, and subchondral sclerosis with osteophyte formation. To date, no efficient treatment is capable of altering the pathological progression of OA, and current therapy is broadly divided into pharmacological and nonpharmacological measures prior to surgical intervention. In this review, the significant risk factors and mediators, such as cytokines, proteolytic enzymes, and nitric oxide, that trigger the loss of the normal homeostasis and structural changes in the articular cartilage during the progression of OA are described. As the understanding of the mechanisms underlying OA improves, treatments are being developed that target specific mediators thought to promote the cartilage destruction that results from imbalanced catabolic and anabolic activity in the joint.

Matched MeSH terms: Humans
Fulltext Eculizumab in Asian patients with anti-aquaporin-IgG-positive neuromyelitis optica spectrum disorder: A subgroup analysis from the randomized phase 3 PREVENT trial and its open-label extension

Kim HJ, Nakashima I, Viswanathan S, Wang KC, Shang S, Miller L, et al.

Mult Scler Relat Disord, 2021 May;50:102849.
PMID: 33676197 DOI: 10.1016/j.msard.2021.102849

Background Eculizumab, a terminal complement inhibitor, significantly reduced the risk of relapse compared with placebo in patients with anti-aquaporin-4 immunoglobulin G-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) in the PREVENT trial. We report efficacy and safety analyses in Asian patients in PREVENT and its open-label extension (OLE). Methods PREVENT was a double-blind, randomized, phase 3 trial. Patients with AQP4+ NMOSD were randomly assigned (2:1) to receive intravenous eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo. Patients who completed PREVENT could receive eculizumab in an OLE. Analyses were performed in a prespecified subgroup of Asian patients. Results Of 143 patients enrolled, 52 (36.4%) were included in the Asian subgroup (eculizumab, n = 37; placebo, n = 15); 45 Asian patients received eculizumab in the OLE. Most Asian patients (86.5%) received concomitant immunosuppressive therapy. During PREVENT, one adjudicated relapse occurred in patients receiving eculizumab and six occurred in patients receiving placebo in the Asian subgroup (hazard ratio, 0.05; 95% confidence interval: 0.01-0.35; p = 0.0002). An estimated 95.2% of Asian patients remained relapse-free after 144 weeks of eculizumab treatment. Upper respiratory tract infections, headache, and nasopharyngitis were the most common adverse events with eculizumab in the Asian subgroup. Conclusion Eculizumab reduces the risk of relapse in Asian patients with AQP4+ NMOSD, with a benefit-risk profile similar to the overall PREVENT population. The benefits of eculizumab were maintained during long-term therapy. Clinical trial registration ClinicalTrials.gov identifiers: NCT01892345 (PREVENT); NCT02003144 (open-label extension).

Matched MeSH terms: Humans
Fulltext Immunodeficiency and Thymoma: A Case Report on Good Syndrome, a Diagnosis Frequently Missed and Forgotten

Tang ASO, Loh WH, Wong QY, Yeo ST, Ng WL, Teoh PI, et al.

Am J Case Rep, 2021 Mar 13;22:e928659.
PMID: 33712551 DOI: 10.12659/AJCR.928659

BACKGROUND Good syndrome (thymoma with immunodeficiency) is a frequently missed and forgotten entity. It is a rare cause of combined B and T cell immunodeficiency in adults. To date, fewer than 200 patients with Good syndrome have been reported in the literature. CASE REPORT We report a case of type AB Masaoka-Koga stage I thymoma which predated the evidence of immune dysregulation by 5 years, manifesting as bilateral cytomegalovirus retinitis, multiple bouts of pneumonia, and bronchiectasis in a HIV-seronegative 55-year-old man. Intravitreal ganciclovir was administered in addition to intravenous systemic ganciclovir, which resulted in severe neutropenic sepsis. A thorough immunodeficiency workup confirmed the presence of hypogammaglobulinemia with complete absence of B cells and reduced CD4/CD8 ratio. The patient responded well to monthly intravenous immunoglobulin replacement therapy, with no further episodes of infection since then. The immunoglobulin level doubled after 1 year of treatment. However, as the patient refused further intravitreal and CMV-targeted treatment, his vision did not recover. CONCLUSIONS Clinicians should be aware that thymoma can precede the onset of immunodeficiency. Clinical suspicion should be heightened in at-risk patients who present with multiple bouts of infection, particularly in thymoma cases with adult-onset immune dysfunction. It is of paramount importance to follow up those patients with annual clinical reviews and immunodeficiency screening.

Matched MeSH terms: Humans
The differences in hemoglobin levels before and after consuming ambon bananas in students

Sadiman S, Islamiyati I, Poddar S

Enferm Clin, 2020 06;30 Suppl 5:115-118.
PMID: 32713547 DOI: 10.1016/j.enfcli.2019.11.035

The purpose of this study is to determine whether there are differences in hemoglobin levels before and after consuming ambon bananas in students of Prodi Kebidanan Metro. The specific purpose of this study was to determine hemoglobin levels before consuming ambon bananas, hemoglobin levels after consuming ambon bananas and the differences in hemoglobin levels before and after consuming ambon bananas in female students at Prodi Kebidanan Metro. This research is an intervention research with quasi experiment design with The One Group Pretest - posttest design. The population in this study were students in the first and second grade in Prodi Kebidanan Metro who lived in the dormitory as many as 149 female students. A sample of 49 people will take a portion of the population using simple random sampling technique. Data analysis used dependent sample t tests to test the mean increase in Hb levels before and after consuming ambon bananas. The results showed an average Hb level before consuming bananas at 12.51g/dl and an the average hb level after consuming bananas was 12.89g/dl, so the average increase in Hb levels was 0.39g/dl. The results of the analysis using the t-test dependent test obtained p value=0.000, which means that there are significant differences in Hb levels of students before and after consuming ambon banana.

Matched MeSH terms: Humans
Fulltext Corticosteroid Plus Tocilizumab in COVID-19: When Two Is Better Than One

Kow CS, Hasan SS

Chest, 2021 05;159(5):2108-2109.
PMID: 33965134 DOI: 10.1016/j.chest.2020.11.073
Matched MeSH terms: Humans
Fulltext Penetrating ocular trauma by nail of a badminton feather shuttle cock: A rare case report

Das S, Singh V, Saurabh K

Indian J Ophthalmol, 2020 06;68(6):1209-1211.
PMID: 32461485 DOI: 10.4103/ijo.IJO_1681_19

Sports-related ocular traumas may be rare, but can have devastating and disabling consequences. The causes of eye-related injuries depend on the type of sports popular in a particular area or country. Badminton is a popular sport played by all age groups and socioeconomic segments and is popular in many parts of the world. It is most popular in South-East Asia, accounting for two-thirds of all ocular sports injury in Malaysia. In India, badminton has become quite popular in recent years. Shuttlecocks in badminton have been shown to be responsible for a high number of outpatient ocular sports-related, mostly blunt injuries. We report an unusual case of penetrating ocular injury due to a feather shuttlecock and its surgical management.

Matched MeSH terms: Humans
A multifunctional nanomedicine platform for co-delivery of methotrexate and mild hyperthermia towards breast cancer therapy

Ong YS, Bañobre-López M, Costa Lima SA, Reis S

Mater Sci Eng C Mater Biol Appl, 2020 Nov;116:111255.
PMID: 32806240 DOI: 10.1016/j.msec.2020.111255

Methotrexate (MTX), an anti-neoplastic agent used for breast cancer treatment, has restricted clinical applications due to poor water solubility, non-specific targeting and adverse side effects. To overcome these limitations, MTX was co-encapsulated with an active-targeting platform known as superparamagnetic iron oxide nanoparticles (SPIONs) in a lipid-based homing system, nanostructured lipid carrier (NLC). This multi-modal therapeutic regime was successfully formulated with good colloidal stability, bio- and hemo-compatibility. MTX-SPIONs co-loaded NLC was time-dependent cytotoxic towards MDA-MB-231 breast cancer cell line with IC50 values of 137 μg/mL and 12 μg/mL at 48 and 72 h, respectively. The MTX-SPIONs co-loaded NLC was internalized in the MDA-MB-231 cells via caveolae-mediated endocytosis in a time-dependent manner, and the superparamagnetic properties were sufficient to induce, under a magnetic field, a localized temperature increase at cellular level resulting in apoptotic cell death. In conclusion, MTX-SPIONs co-loaded NLC is a potential magnetic guiding multi-modal therapeutic system for the treatment of breast cancer.

Matched MeSH terms: Humans
Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Bapat RA, Parolia A, Chaubal T, Dharamadhikari S, Abdulla AM, Sakkir N, et al.

Biomater Sci, 2021 May 04;9(9):3244-3283.
PMID: 33949464 DOI: 10.1039/d1bm00233c

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Matched MeSH terms: Humans
Fulltext Disseminated talaromycosis in an HIV-infected patient

Chang CY, Wahid AA, Ong ELC

Rev Soc Bras Med Trop, 2021 03 22;54:e0896-2020.
PMID: 33759937 DOI: 10.1590/0037-8682-0896-2020
Matched MeSH terms: Humans
Fulltext Whole genome analysis of multidrug-resistant Citrobacter freundii B9-C2 isolated from preterm neonate's stool in the first week

Yap PSX, Ahmad Kamar A, Chong CW, Yap IKS, Teh CSJ

J Glob Antimicrob Resist, 2020 06;21:246-251.
PMID: 32304769 DOI: 10.1016/j.jgar.2020.03.024

BACKGROUND: Resistance to colistin, the last line therapy for infections caused by multidrug-resistant Gram-negative bacteria, represents a major public health threat. Citrobacter freundii B9-C2 which was isolated from the stool of preterm neonate on the first week of life, displayed resistance to almost all major antibiotics, including colistin. Through whole genome sequencing (WGS), we characterised the genome features that underline the antibiotic-resistance phenotype of this isolate.
METHODS: Genome of C. freundii B9-C2 was sequenced on an Illumina MiSeq platform. The assembled genome was annotated and deposited into GenBank under the accession number CP027849.
RESULTS: Multiple antimicrobial resistance genes including blaCMY-66 were identified. Further, the presence of 15 antibiotic efflux pump-encoding resistance genes, including crp, baeR, hns, patA, emrB, msbA, acrA, acrB, emrR, mdtC, mdtB, mdtG, kdpE, mdfA and msrB, were detected and likely to account for the observed cephalosporins, carbapenems, aminoglycosides and monobactams resistance in C. freundii B9-C2. The isolate also presented unique virulence genes related to biofilm formation, motility and iron uptake. The genome was compared to publicly available genomes and it was closely related to strains with environmental origins.
CONCLUSION: To the best of our knowledge, this is the first report of intestinal carriage of colistin-resistant C. freundii from the stool of a neonate in Malaysia. Using genomic analysis, we have contributed to the understanding of the potential mechanism of resistance and the phylogenetic relationship of the isolates with draft genomes available in the public domain.

Matched MeSH terms: Humans
Fulltext Via-less electromagnetic band-gap-enabled antenna based on textile material for wearable applications

Ashyap AYI, Elamin NIM, Dahlan SH, Abidin ZZ, See CH, Majid HA, et al.

PLoS One, 2021;16(1):e0246057.
PMID: 33508025 DOI: 10.1371/journal.pone.0246057

A compact fabric antenna structure integrated with electromagnetic bandgap structures (EBGs) covering the desired frequency spectrum between 2.36 GHz and 2.40 GHz for Medical Body-Area Networks (MBANs), is introduced. The needs of flexible system applications, the antenna is preferably low-profile, compact, directive, and robust to the human body's loading effect have to be satisfied. The EBGs are attractive solutions for such requirements and provide efficient performance. In contrast to earlier documented EBG backed antenna designs, the proposed EBG behaved as shielding from the antenna to the human body, reduced the size, and acted as a radiator. The EBGs reduce the frequency detuning due to the human body and decrease the back radiation, improving the antenna efficiency. The proposed antenna system has an overall dimension of 46×46×2.4 mm3. The computed and experimental results achieved a gain of 7.2 dBi, a Front to Back Ratio (FBR) of 12.2 dB, and an efficiency of 74.8%, respectively. The Specific Absorption Rate (SAR) demonstrates a reduction of more than 95% compared to the antenna without EBGs. Moreover, the antenna performance robustness to human body loading and bending is also studied experimentally. Hence, the integrated antenna-EBG is a suitable candidate for many wearable applications, including healthcare devices and related applications.

Matched MeSH terms: Humans
Optic Canal Analysis in Syndromic Craniosynostosis: Volumetric and Surface Area Validation Study Using Different Measurement Modalities

Hariri F, Zainudin NAA, Anuar AMS, Ibrahim N, Abdullah NA, Aziz IA, et al.

J Craniofac Surg, 2020 11 7;32(1):355-359.
PMID: 33156163 DOI: 10.1097/SCS.0000000000006981

BACKGROUND: In syndromic craniosynostosis (SC), unlike persistent corneal irritation due to severe exophthalmos and increased intracranial pressure, optic canal (OC) stenosis has been scarcely reported to cause visual impairment. This study aimed to validate the OC volumetric and surface area measurement among SC patients.
METHODS: Sixteen computed tomography scan of SC patients (8 months-6 years old) were imported to Materialise Interactive Medical Image Control System (MIMICS) and Materialise 3-matics software. Three-dimensional (3D) OC models were fabricated, and linear measurements were obtained. Mathematical formulas were used for calculation of OC volume and surface area from the 3D model. The same measurements were obtained from the software and used as ground truth. Data normality was investigated before statistical analyses were performed. Wilcoxon test was used to validate differences of OC volume and surface area between 3D model and software.
RESULTS: The mean values for OC surface area for 3D model and MIMICS software were 103.19 mm2 and 31.27 mm2, respectively, whereas the mean for OC volume for 3D model and MIMICS software were 184.37 mm2 and 147.07 mm2, respectively. Significant difference was found between OC volume (P = 0.0681) and surface area (P = 0.0002) between 3D model and software.
CONCLUSION: Optic canal in SC is not a perfect conical frustum thus making 3D model measurement and mathematical formula for surface area and volume estimation not ideal. Computer software remains the best modality to gauge dimensional parameter and is useful to elucidates the relationship of OC and eye function as well as aiding intervention in SC patients.

Matched MeSH terms: Humans
Gender and medical education authorship: Moving forward comfortably with necessary conversations

V Nadarajah VD

Med Educ, 2021 06;55(6):670-672.
PMID: 33617662 DOI: 10.1111/medu.14478
Matched MeSH terms: Humans
Association between dietary intake and risk of ovarian cancer: a systematic review and meta-analysis

Khodavandi A, Alizadeh F, Razis AFA

Eur J Nutr, 2021 Jun;60(4):1707-1736.
PMID: 32661683 DOI: 10.1007/s00394-020-02332-y

PURPOSE: It is unclear how dietary intake influences the ovarian cancer. The present paper sets out to systematically review and meta-analyze research on dietary intake to identify cases having high- or low-risk ovarian cancer.
METHODS: Scopus, PubMed, and Wiley Online Libraries were searched up to the date November 24, 2019. Two reviewers were requested to independently extract study characteristics and to assess the bias and applicability risks with reference to the study inclusion criteria. Meta-analyses were performed to specify the relationship between dietary intake and the risk of ovarian cancer identifying 97 cohort studies.
RESULTS: No significant association was found between dietary intake and risk of ovarian cancer. The results of subgroup analyses indicated that green leafy vegetables (RR = 0.91, 95%, 0.85-0.98), allium vegetables (RR = 0.79, 95% CI 0.64-0.96), fiber (RR = 0.89, 95% CI 0.81-0.98), flavonoids (RR = 0.83, 95% CI 0.78-0.89) and green tea (RR = 0.61, 95% CI 0.49-0.76) intake could significantly reduce ovarian cancer risk. Total fat (RR = 1.10, 95% CI 1.02-1.18), saturated fat (RR = 1.11, 95% CI 1.01-1.22), saturated fatty acid (RR = 1.19, 95% CI 1.04-1.36), cholesterol (RR = 1.13, 95% CI 1.04-1.22) and retinol (RR = 1.14, 95% CI 1.00-1.30) intake could significantly increase ovarian cancer risk. In addition, acrylamide, nitrate, water disinfectants and polychlorinated biphenyls were significantly associated with an increased risk of ovarian cancer.
CONCLUSION: These results could support recommendations to green leafy vegetables, allium vegetables, fiber, flavonoids and green tea intake for ovarian cancer prevention.

Matched MeSH terms: Humans
Fulltext Embedded research to advance primary health care

Swaminathan S, Sheikh K, Marten R, Taylor M, Jhalani M, Chukwujekwu O, et al.

BMJ Glob Health, 2020 12;5(12).
PMID: 33355263 DOI: 10.1136/bmjgh-2020-004684
Matched MeSH terms: Humans
Fulltext The Internal Realities of Individuals With Type 2 Diabetes: Mediators Influencing Self-Management Beliefs via Grounded Theory Approach

Swarna Nantha Y, Haque S, Paul Chelliah AA, Md Zain AZ, Kim Yen G

J Prim Care Community Health, 2020 2 6;11:2150132719900710.
PMID: 32009509 DOI: 10.1177/2150132719900710

Background: There has been an unabated rise in the prevalence of type 2 diabetes (T2D) worldwide. Although T2D is highly preventable, these trends suggest that a paradigm change is much needed in the way both clinicians and policy makers view what effective T2D strategies conventionally entail. Hence, it is becoming increasingly clear that T2D patients require more than just a pharmacological approach to their disease. Evidence indicate that culturally specific mediators can help foster better self-management practices. We intend to discover psychosocial mediators that influence and support self-management beliefs in T2D patients. Methods: We adopted the grounded theory approach to guide in-depth interviews with T2D patients and health care professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling method to examine the inner psychological narratives about how they perceive and what they believe beliefs about the disease. Two focus group discussions were also were conducted for data triangulation. Results: A functional framework for the psychosocial mediators influencing self-management beliefs in T2D patients was designed and characterized by 4 major processes: (1) health promotion, (2) personal expectations, (3) person-centered care, and (4) psychosocial support. The fulfillment of patients' personal expectations is central to better self-management beliefs. Conclusions: Positive emotional states are important in providing a positive environment to nurture self-management practices. A person-centered consultation that focuses on empathy and cultural sensitivities has the potential to foster behavioral change required to sustain self-care practices.

Matched MeSH terms: Humans

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