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Fulltext Prevalence and associated factors of undiagnosed glycaemic disorders in men with erectile dysfunction attending a primary care clinic

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
Development of a Sexually Transmitted Disease Client-friendly Unit at a Primary Care Clinic in Malaysia: Lessons Learnt

Pannir Selvam SB, Khoo EM, Chow SY, Wong PF, Mohsin SS, Abdullah A, et al.

Sex Transm Dis, 2019 02;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*
Fulltext The atypical presentation of rheumatoid arthritis in an elderly woman: a case report

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
Fulltext Reliability and validity of the malay version of Edinburgh Postpartum Depression Scale (EPDS) when administered to postpartum mothers at two points in time

Nursazila Asikin MA, Siti Norhani S, Nur Arzuar AR, Azam OE

International Medical Journal Malaysia, 2019;18:65-72.

Introduction: Edinburgh Postpartum Depression Scale (EPDS) is a tool used to assess the risk of postpartum depression (PPD). In this study we determined the reliability and validity of the Malay version of EPDS when administered at two different time points in the postpartum period.
Materials and Methods: This cross-sectional study design was carried out between May and September 2017 at three government primary healthcare clinics located in Batang Padang district, a suburban area of Perak state in Peninsular Malaysia. We recruited a total of 89 women; 41 women were in the early postpartum period (1-30 days) and 48 women were in the late postpartum period (31-120 days). Cronbach's alpha coefficient, inter-item correlation, and corrected item-total correlation were used to assess the internal consistency. The concurrent validity was assessed using Spearman's correlation. The data were analyzed using SPSS version 20 and R 3.4.2.
Results: The Cronbach's alpha for the first and second group was 0.78 and 0.62, respectively, which indicated satisfactory reliability. At both time periods, removing Item 2 from the scale resulted in a significant increase in Cronbach's alpha (to 0.847 and 0.709, respectively). As expected, the EPDS scores correlated moderately with the BDI-II scores (1-30 days: Spearman's rho = 0.65, p < 0.01; 31-120 days: Spearman's rho = 0.73, p < 0.01).
Conclusion: The Malay version of the EPDS is a reliable screening instrument for detecting postpartum depression. It showed reasonability and feasibility and can be used in postpartum clinical settings or for assessing intervention effects in research studies. Furthermore, as our results indicated, removing Item 2 from the Malay version would increase the internal consistency of the EPDS. © 2019 Default.
Study site: Klinik Kesihatan, Perak, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Zika outbreak emergency preparedness and response of Malaysian private healthcare professionals: are they ready?

Rajiah K, Maharajan MK, Yin PY, Yee YW, Lin WW, Kean CH

Microorganisms, 2019;7.
DOI: 10.3390/microorganisms7030087

Zika virus has been declared as a public health emergency of international concern. The Center for Disease Control and Prevention has issued guidelines reminding healthcare workers about the importance of taking steps to prevent the spread of Zika virus, how to test and isolate patients suspected of carrying the Zika virus, and how to protect themselves from infection. Therefore, it is of utmost importance for healthcare professionals to be fully aware of Zika virus preparedness, and response measures should an outbreak occur in Malaysia in order to quickly and efficiently contain the outbreak, ensure the safety of individual or healthcare personnel safety, as well as to prevent further spreading of the disease. This research aims to show how prepared Malaysian healthcare professionals are against Zika virus and how well can they respond during an outbreak. In total, 504 healthcare professionals (128 general practitioners, 215 community pharmacists, 161 nurses) from private health clinics were the target population of the four states of Malaysia where Zika cases suspected. The sample size of each category was calculated by using a formula for estimating the population proportion. An additional 10% of the calculated sample size was added to compensate the non-response rate. The Center For Disease Control and Prevention and World Health Organisation provided a checklist to assess how prepared healthcare professionals are for an Zika outbreak. This checklist was modified to a questionnaire in order to assess health care professionals' preparedness and response to the Zika outbreak. Community pharmacists are still lacking in their preparedness and perceived response to the Zika outbreak compared to the general practitioners in the private sector. Hence community pharmacists should attend training given by the Ministry of Health Malaysia as a continuing education, which may help them to respond during a Zika outbreak.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Nurses' knowledge, beliefs and practices regarding the screening and treatment of postpartum depression in maternal and child health clinics: A cross-sectional survey

Kang PS, Mohazmi M, Ng YM, Liew SM

Malays Fam Physician, 2019;14(1):18-25.
PMID: 31289627

Background: Postpartum depression (PPD) affects 10-15% of women worldwide, and screening is recommended by clinical guidelines. In Malaysia, nurses in maternal and child health (MCH) clinics provide postpartum care.

Aim: To determine nurses' level of knowledge, beliefs and practices regarding PPD and factors associated with screening practices.

Methods: A cross-sectional study using universal sampling was conducted on nurses from seven government MCH clinics in Malaysia. Data was collected from March until April 2016 through a self-reported questionnaire. Univariate and multivariate analyses were performed to identify factors associated with having ever performed PPD screening.

Results: Of the 108 nurses, 55.6% scored above the median total knowledge score (17 out of 24 points). Despite a high proportion of nurses believing that they were responsible for PPD screening (72.2%), counselling depressed mothers (72.2%) and referring mothers for further treatment (87.0%), only 64.8% and 51.9% were confident in recognizing PPD and counselling depressed mothers, respectively. Only 25.9% had ever practiced PPD screening, which was associated with beliefs concerning screening taking too much time (adjusted odds ratio [AOR]=0.13, 95% confidence interval [CI]= 0.02-0.74, P=0.022) and that screening is their responsibility (AOR=14.12, 95%CI=1.65-120.75, P=0.016).

Conclusion: More than half of the nurses scored above the median total knowledge score and had positive beliefs towards PPD screening. However, PPD screening practices were poor, and this outcome was associated with their beliefs regarding time and responsibility.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Effectiveness and prescription pattern of lipid-lowering therapy and its associated factors among patients with type 2 diabetes mellitus in Malaysian primary care settings

Elnaem MH, Mohamed MHN, Huri HZ, Shah ASM

Ther Clin Risk Manag, 2019;15:137-145.
PMID: 30705590 DOI: 10.2147/TCRM.S182716

Background: Cardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors.

Methods: A multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality.

Results: The overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects.

Conclusion: There is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Awareness of colorectal cancer among the urban population in the Klang Valley

Sindhu CK, Nijar AK, Leong PY, Li ZQ, Hong CY, Malar L, et al.

Malays Fam Physician, 2019;14(3):18-27.
PMID: 32175037

Background: Colorectal cancer (CRC) is the second most common cancer in Malaysia. Awareness of risk factors, symptoms and warning signs of CRC will help in early detection. This paper presents the level of CRC awareness among the urban population in Malaysia.
Method: A cross-sectional study was conducted from November 2015 till December 2016 at three government clinics in the Klang Valley. The validated Bowel Cancer Awareness Measure questionnaire in both English and Malay was used. The mean knowledge scores for the warning signs and risk factors of CRC in different socio-demographic groups were compared using ANOVA in SPSS version 23. Statistical significance was set at p<0.05 and a 95% confidence level.
Results: Of the 426 respondents, 29.1% were unable to recall the warning signs and symptoms of CRC. Average recall was less than two warning signs and symptoms (mean 1.62, SD 1.33). The mean total knowledge score for CRC was 9.91 (SD 4.78), with a mean knowledge scores for warning signs and risk factors at 5.27 (SD 2.74) and 4.64 (SD 2.78), respectively. Respondents with a higher level of education were found to have higher level of knowledge regarding the warning signs of CRC. There was a significant positive association between knowledge score for warning signs and level of confidence in detecting warning signs. Regarding the total knowledge score for CRC, 3.3% of respondents scored zero. For warning signs and risk factors, 8.2% and 8.5% of respondents had zero knowledge scores, respectively.
Conclusions: Generally, awareness of CRC is poor among the urban population of Klang Valley. Greater education and more confidence in detecting warning signs are significantly associated with better knowledge of warning signs. CRC awareness programs should be increased to improve awareness.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext The self-care profiles and its determinants among adults with hypertension in primary health care clinics in Selangor, Malaysia

Salim H, Lee PY, Sazlina SG, Ching SM, Mawardi M, Shamsuddin NH, et al.

PLoS One, 2019;14(11):e0224649.
PMID: 31693677 DOI: 10.1371/journal.pone.0224649

INTRODUCTION: Self-care has been shown to improve clinical outcome of hypertension. Gauging the level of self-care among patients with hypertension enables the design of their personalized care plans. This study aimed to determine the self-care profiles and its determinants among patients with hypertension in the Malaysian primary care setting.
METHODS: This was a cross sectional study conducted between 1 October 2016-30 April 2017 in three primary care clinics in the state of Selangor, Malaysia. All adults aged 18 years and above with hypertension for at least 6 months were recruited with a systematic random sampling of 1:2 ratio. The participants were assisted in the administration of the structured questionnaire, which included socio-demographic information, medical information and the Hypertension Self-Care Profile (HTN SCP) tool. Statistical analysis was done using SPSS version 20.0. Multiple linear regression was performed to determine the determinants for self-care.
RESULTS: The mean age of the participants was 59.5 (SD10.2) years old. There were more women (52.5%) and most were Malays (44.0%) follow by Chinese (34%) and Indians (21%). Majority (84.2%) had secondary or primary school level of education. A third (30.7%) had a family history of hypertension. The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180. The significant determinants that influenced the HTN-SCP scores included being men (B-4.5, P-value0.008), Chinese ethnicity (B-14.7, P-value<0.001), primary level education/no formal school education level (B-15.7, P-value<0.001), secondary level education (B-9.2, P-value<0.001) and family history of hypertension (B 4.4, P-value 0.014).
CONCLUSIONS: The overall hypertension self-care profile among patients in this multi-ethnic country was moderate. Being men, Chinese, lower education level and without family history of hypertension were associated with lower hypertension self-care profile score. Healthcare intervention programmes to address self-care should target this group of patients.

Matched MeSH terms: Ambulatory Care Facilities/statistics & numerical data*
Fulltext Proportion of women with history of gestational diabetes mellitus who performed an oral glucose test at six weeks postpartum in Johor Bahru with abnormal glucose tolerance

Fatin A, Alina TI

Malays Fam Physician, 2019;14(3):2-9.
PMID: 32175035

Introduction: Glucose testing at six weeks postpartum has been recommended by the World Health Organization as the earliest period in which to detect abnormal glucose tolerance among women with a history of gestational diabetes mellitus (GDM). This study aimed to determine the outcomes of six weeks postpartum glucose testing and its associated factors among women with a history GDM who attended government primary health clinics in Johor Bahru.
Methods: The study was a cross sectional study which was conducted among women with a history of GDM who registered from January to June 2016 at primary health clinics in Johor Bahru and underwent an oral glucose tolerance test at six weeks postpartum. Secondary data were obtained from Maternal Health Records (clinic copy). Data were analyzed using SPSS Version 23.0. Descriptive statistics and simple logistic regression analysis were used.
Results: One hundred and twenty-two women with a history of GDM completed the postpartum glucose testing. Approximately 12% of these women were reported to have abnormal glucose tolerance. Insulin usage (OR:5.44; 95% CI:1.53, 19.43; p=0.009), abnormal glycated hemoglobin (OR:8.70; 95% CI:2.68,26.27; p<0.01), hospital follow-up (OR:3.38; 95% CI: 1.11, 10.34; p=0.033) and neonatal intensive care unit admission (OR:3.96; 95% CI: 1.16, 13.54; p=0.028) were found to have significant associations with abnormal glucose tolerance at six weeks postpartum.
Conclusion: The proportion of women with a history of GDM and abnormal glucose tolerance at six weeks postpartum in Johor Bahru was 12% and was associated with insulin usage, abnormal glycated hemoglobin, hospital follow-up and neonatal intensive care unit admission. Screening during the postpartum period offers a window of opportunity for early identification of diabetes and prediabetes, as women with history of GDM are at increased risk of future glucose intolerance.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial

Chew BH, Vos RC, Fernandez A, Shariff Ghazali S, Shamsuddin NH, Ismail M, et al.

Ther Adv Endocrinol Metab, 2019;10:2042018819853761.
PMID: 31210922 DOI: 10.1177/2042018819853761

Background: Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control).
Methods: VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect.
Results: Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ.
Conclusions: Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified.
Trial registration: NCT02730078; NMRR-15-1144-24803.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Vitamin D deficiency during pregnancy and its associated factors among third trimester Malaysian pregnant women

Woon FC, Chin YS, Ismail IH, Batterham M, Abdul Latiff AH, Gan WY, et al.

PLoS One, 2019;14(6):e0216439.
PMID: 31233513 DOI: 10.1371/journal.pone.0216439

BACKGROUND: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.

METHODS: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30-50 nmol/L), and sufficient (≥ 50 nmol/L).

RESULTS: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93-0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05-0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.

CONCLUSION: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Parent’s knowledge on healthy lifestyle for children under-5 years [Abstract]

Mohamed Nasir AD, Mohd Kassim AB

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):68.
MyJurnal

ABSTRACTS FOR INTERNATIONAL FAMILY HEALTH CONFERENCE 2019 (I-FaH 2019). Health Intervention Towards Community Wellness, Held at Oriental Crystal Hotel, Kajang, Selangor, Malaysia .4-5th September, 2019
Introduction: Obesity, a major risk factor for chronic disease, is a growing problem in Malaysia. Current data from the National Health Morbidity Survey (NHMS) shows that prevalence of overweight for children under five years has increased from 6.5% (NHMS 2011) to 7.6 % (NHMS 2015). Childhood obesity needs to be addressed as studies also have shown that childhood obesity contributes to adult chronic disease. Increase in chronic diseases will cause an increase in health care cost. Intervention programmes are available and currently target schoolchildren and adults. No programme yet targeting at children under five years. This survey was conducted to understand parents level of knowledge with regards to healthy lifestyle among children under-5 years.
Methods: Parents attending Health Clinics in the state of Perak were given self-administered questionnaire.
Results: Twenty two (22) Health Clinics from 11 districts in Perak were involved in the survey. A total of 600 parents or care givers participated. Majority were unaware of good sleep hygiene and screen time limitation.
Conclusion: Awareness of healthy lifestyle for children under 5 years has not been given due attention. Health intervention via promotion is needed for prevention of obesity.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Diabetes literacy and knowledge among patients with type 2 diabetes mellitus attending a primary care clinic in Seremban, Malaysia

Lee CL, Chee WSS, Arasu K, Kwa SK, Mohd Ali SZ

Malays J Nutr, 2019;25(4):435-444.
MyJurnal DOI: 10.31246/mjn-2019-0031

Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively.
Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy
and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants.
Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.
Keywords: Diabetes literacy, diabetes knowledge, type 2 diabetes

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study

Idris I, Tohid H, Muhammad NA, A Rashid MR, Mohd Ahad A, Ali N, et al.

BMJ Open, 2018 12 22;8(12):e025125.
PMID: 30580276 DOI: 10.1136/bmjopen-2018-025125

OBJECTIVES: This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors.
DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing.
RESULTS: The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia.
CONCLUSION: Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

TRIAL REGISTRATION NUMBER: NMRR-15-660-24324.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Early suboptimal ART adherence was associated with missed clinical visits in HIV-infected patients in Asia

Jiamsakul A, Kerr SJ, Kiertiburanakul S, Azwa I, Zhang F, Chaiwarith R, et al.

AIDS Care, 2018 12;30(12):1560-1566.
PMID: 30021450 DOI: 10.1080/09540121.2018.1499859

Missed clinic visits can lead to poorer treatment outcomes in HIV-infected patients. Suboptimal antiretroviral therapy (ART) adherence has been linked to subsequent missed visits. Knowing the determinants of missed visits in Asian patients will allow for appropriate counselling and intervention strategies to ensure continuous engagement in care. A missed visit was defined as having no assessments within six months. Repeated measures logistic regression was used to analyse factors associated with missed visits. A total of 7100 patients were included from 12 countries in Asia with 2676 (37.7%) having at least one missed visit. Patients with early suboptimal self-reported adherence <95% were more likely to have a missed visit compared to those with adherence ≥95% (OR = 2.55, 95% CI(1.81-3.61)). Other factors associated with having a missed visit were homosexual (OR = 1.45, 95%CI(1.27-1.66)) and other modes of HIV exposure (OR = 1.48, 95%CI(1.27-1.74)) compared to heterosexual exposure; using PI-based (OR = 1.33, 95%CI(1.15-1.53) and other ART combinations (OR = 1.79, 95%CI(1.39-2.32)) compared to NRTI+NNRTI combinations; and being hepatitis C co-infected (OR = 1.27, 95%CI(1.06-1.52)). Patients aged >30 years (31-40 years OR = 0.81, 95%CI(0.73-0.89); 41-50 years OR = 0.73, 95%CI(0.64-0.83); and >50 years OR = 0.77, 95%CI(0.64-0.93)); female sex (OR = 0.81, 95%CI(0.72-0.90)); and being from upper middle (OR = 0.78, 95%CI(0.70-0.80)) or high-income countries (OR = 0.42, 95%CI(0.35-0.51)), were less likely to have missed visits. Almost 40% of our patients had a missed clinic visit. Early ART adherence was an indicator of subsequent clinic visits. Intensive counselling and adherence support should be provided at ART initiation in order to optimise long-term clinic attendance and maximise treatment outcomes.

Matched MeSH terms: Ambulatory Care Facilities/organization & administration
Fulltext Home blood pressure control status in 2017-2018 for hypertension specialist centers in Asia: Results of the Asia BP@Home study

Kario K, Tomitani N, Buranakitjaroen P, Chia YC, Park S, Chen CH, et al.

J Clin Hypertens (Greenwich), 2018 12;20(12):1686-1695.
PMID: 30444315 DOI: 10.1111/jch.13415

A self-measured home blood pressure (BP)-guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well-controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white-coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.

Matched MeSH terms: Ambulatory Care Facilities/statistics & numerical data
Fulltext Patterns of pre-pregnancy care usage among reproductive age women in Kedah, Malaysia

Abu Talib R, Idris IB, Sutan R, Ahmad N, Abu Bakar N

Iran J Public Health, 2018 Nov;47(11):1694-1702.
PMID: 30581786

Background: This cross-sectional was aimed to assess the prevalence of pre-pregnancy care services usage and its determinant factors among women of reproductive age in Kedah, Malaysia.

Methods: Overall, 1347 respondents who attended 24 government health clinics, were chosen using systematic multistage random sampling. A validated self-administered questionnaire which consisted of sections including socio-demographic characteristics, social support, knowledge on pre-pregnancy care, perception on risk of pregnancy, health status, as well as intention and awareness on pre-pregnancy care services were distributed.

Results: The prevalence of utilization of pre-pregnancy care services was still low i.e. 44.0%. Bivariate and multivariate analysis showed consistent significant level between all factors and pre-pregnancy care usage except for family planning practice. The factors that showed significant difference with the usage of pre-pregnancy care services were age of more than 35 (P<0.001), high education level (P<0.001), non-working mothers (P<0.001), multipara (P=0.001), awareness on the existence of pre-pregnancy care services in government health facilities (P<0.001), intention to use the services (P=0.0030), having medical illness (P=0.005), having social support (P=0.001), high knowledge (P<0.001), and positive perception (P<0.001).

Conclusion: Low usage of pre-pregnancy care services can be improved through health screening on reproductive-aged women with positive determinant factors at the triage level in integrated clinics. Information and knowledge on pre-pregnancy services should be disseminated among community members through various means including roadshows and pre-wedding workshops.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Prevalence of prehypertension and its associated factors among adults visiting outpatient clinic in Northeast Malaysia

Rafan SN, Zakaria R, Ismail SB, Muhamad R

J Taibah Univ Med Sci, 2018 Oct;13(5):459-464.
PMID: 31435362 DOI: 10.1016/j.jtumed.2018.06.005

Objectives: Prehypertension refers to a systolic blood pressure of 120-139 mmHg systolic or a diastolic blood pressure of 80-89 mmHg. Estimation of the prevalence of prehypertension in the population and identification of cardiovascular associated factors are important to reduce progression to hypertension. This study aimed to determine the prevalence of prehypertension and its associated factors among Malaysian adults.
Methods: In 2015, a cross-sectional study was conducted among adults visiting an outpatient clinic in Northeast Malaysia. Face-to-face interviews were conducted using Malay and English versions of the Malaysia Non-Communicable Disease surveillance questionnaire. This instrument captured information about sociodemographic, lifestyle status, and anthropometric data. Blood pressure was measured three times with a sphygmomanometer, the first measurement value was discarded, and an average of blood pressure from the second two readings was recorded for further data analysis. Logistic regression was performed to analyse factors associated with prehypertension.
Result: A total 151 adults participated in the study, and the prevalence of prehypertension was 37.1% (95% confidence interval [CI]: 29.29, 44.69). Factors associated with prehypertension in this study were age (adjusted odds ratio [aOR] = 1.06 95% CI: 1.02, 1.11; p = 0.007), male sex (aOR = 4.44 95% CI: 1.58, 12.44; p = 0.005), and abnormal waist circumference (aOR = 31.65 95% CI: 11.25, 89.02; p

Matched MeSH terms: Ambulatory Care Facilities
Fatalism, faith and fear: A case study of self-care practice among adults with type 2 diabetes in urban Malaysia

Saidi S, Milnes LJ, Griffiths J

J Clin Nurs, 2018 Oct;27(19-20):3758-3767.
PMID: 29893043 DOI: 10.1111/jocn.14559

AIMS AND OBJECTIVES: To explore self-care and self-care support in patients with Type 2 diabetes in urban Malaysia.
BACKGROUND: The prevalence of Type 2 diabetes in Malaysia and associated long-term and life-changing complications is increasing. With effective self-care and self-care support, severe complications of the condition can be avoided or reduced. Prior to this study, no evidence existed about Malaysian patients' management of the condition or support for self-care from the healthcare system.
DESIGN: A single embedded qualitative case study.
METHODS: Semistructured interviews with 18 patients with Type 2 diabetes aged 28-69 years, healthcare professionals (n = 19), observations (n = 13) of clinic appointments from two urban settings in Malaysia and a documentary analysis. Recordings were transcribed verbatim, field notes were made during observations and the data analysed and synthesised within and across case using Framework analysis.
FINDINGS: Three main themes explained self-care and self-care support in Malaysia: fatalism, faith and fear. Patients were fatalistic about developing diabetes - they perceived it as inevitable because it is so common in Malaysia. However, faith in God, coupled with fear of the consequences of diabetes, motivated them to engage in self-care practices. The fear was largely induced by diabetes healthcare professionals working in overcrowded clinics, and stretched thinly across the service, who used a direct and uncompromising approach to instil the importance of self-care to avoid severe long-term complications.
CONCLUSION: This study provided important insight on how people in Malaysia developed diabetes, their responses to the disease and the approach of healthcare professionals in supporting them to engage with self-care.
RELEVANCE TO CLINICAL PRACTICE: Any future development of self-care programmes in Malaysia needs to recognise the factors that motivate patients to self-care and include components that build self-efficacy.
Study site: three outpatient clinics (one in primary care and two in secondary care), Malaysia

Matched MeSH terms: Ambulatory Care Facilities

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