Objective: The Snaith-Hamilton Pleasure Scale (SHAPS) is a self-assessment scale designed to evaluate anhedonia in various psychiatric disorders. To facilitate its use in Malaysian settings, our current study aimed to examine the validity of the Simplified-Chinese translated version of the SHAPS (SHAPS-SC) in a group of subjects at a university out-patient clinic. Method: A total of 40 depressed patients were recruited in this cross sectional study. They were given both the Simplified Chinese and Malay versions of SHAPS, General Health Questionnaire 12 (GHQ-12) and Beck Depression Inventory (BDI) to assess their hedonic state, general mental health condition and level of depression. Results: Our study showed that SHAPS-SC had impressive internal consistency (Cronbach’s alpha 0.84) and concurrent validity, and fair parallel-forms reliability (Pearson’s correlation 0.39). Conclusion: SHAPS-SC demonstrated good psychometric properties in the evaluation of hedonic state among a group of Chinese speaking depressed patients in an out-patient setting. It is easy to administer and suitable as a valid and reliable questionnaire in assessing anhedonia among depressed patients in Malaysia. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 66-71.
Study site: psychiatric out-patient clinic, University
Malaya Medical Centre (UMMC)
OBJECTIVE: The aim of this study was to assess the patients' knowledge and awareness of sexually transmitted infections (STIs).
SUBJECTS AND METHODS: A face-to-face interview was conducted among the patients visiting the Venereal Diseases Outpatient Department of the General Hospital of Pulau Pinang (Malaysia). A 19-item questionnaire was used. A total of 116 patients participated in the study and 107 patients had valid responses. The reliability and internal consistency of the questionnaire tool was estimated on the basis of Cronbach's alpha (= 0.81). The Statistical Package for Social Sciences (SPSS 13.0(R)) was used for data analysis. Student's t test and analysis of variance were used to analyse the knowledge differences among the groups.
RESULTS: Of the 107 patients, 82 (76.6%) were diagnosed with syphilis; AIDS was the most commonly known STI among the patients. Of the 107 patients, 35 were sexually active and of these 23 (65.7%) had more than 1 sexual partner. The most popular source of knowledge was newspapers (51 patients, 47.7%), with hospitals (3 patients, 2.8%) being the least popular one. Overall mean score on knowledge questions was 12.21 out of the maximum of 33 points. Knowledge about causative organisms, risk groups, transmission, symptoms, prevention and treatment of STIs was inadequate. The knowledge level was significantly related to gender (p = 0.03), religion (p = 0.005), educational level (p = 0.000), marital status (p = 0.000) and income level (p = 0.036).
CONCLUSION: This study demonstrated evidence of poor knowledge of STIs amongst the patients attending an STI service in the General Hospital of Pulau Pinang (Malaysia). Hence there is an immediate need for efforts towards improving patient knowledge of STIs.
Study site: Venereal Diseases Outpatient Department, General Hospital Pulau Pinang, Malaysia
Introduction: Good control of glycaemia negates potential maternal and fetal complications. A diet suitable for women with gestational diabetes mellitus (GDM) is a first line approach. However, little is said about suitable exercise in pregnancy that will potentially help control glycaemia. This pilot study seeks to understand the perceived barriers to exercise in women with GDM.
Materials and Methods: This crosssectional study recruited patients with GDM on diet control at the antenatal clinic of Hospital Sultanah Aminah Johor Bahru, Malaysia between October 2017 and January 2018. Those who fulfilled the recruitment criteria were approached and 89 women consented to participate. Data was obtained from antenatal records and a self-administered questionnaire.
Results: The mean age of the participants was 33.3 years. More than 80% were Para 1 and above. 69.6% were either overweight or obese at booking of pregnancy. 80.9% were aware that exercise was necessary for women with GDM. Only 6.7% say that healthcare professionals were their source of information on exercise in pregnancy. 77.3% of the women with low physical activity had full time jobs. Housewives (64.5%) had the highest level of physical activity. Tiredness (43.8%), childcare duties (38.2%) and lack of time (27.0%) were the most common perceived barriers to exercise. Nulliparity was significantly associated with tiredness.
Conclusion: Main barriers to exercise are tiredness and childcare duties. Health care professionals did little in educating women with GDM on suitable exercise.
Objectives: To examine the descriptive epidemiology of the patient population referred to paediatric rheumatology centres (PRCs) in Southeast Asia (SEA) and to compare the frequency of conditions encountered with other PRC populations.
Methods: A web-based Registry for Childhood Onset Paediatric Rheumatic Diseases was established in 2009 and seven PRCs in four SEA countries, where paediatric rheumatologists are available, participated in a prospective 24 month data collection (43 months for Singapore).
Results: The number of patients analysed was 4038 (788 from Malaysia, 711 from the Philippines, 1943 from Singapore and 596 from Thailand). Over 70% of patients evaluated in PRCs in Malaysia, the Philippines and Thailand had rheumatic diseases (RDs), as compared with one-half of the proportion seen in Singaporean PRCs, which was similar to the Western PRC experience. Among RDs diagnosed (n = 2602), JIA was the most common disease encountered in Malaysia (41%) and Thailand (61%) as compared with systemic vasculitides in the Philippines (37%) and Singapore (35%) among which Henoch-Schönlein purpura was the most prevalent. SLE and related diseases were more common, but idiopathic pain syndrome and abnormal immunological laboratory tests were rarer than those seen in the West. JIA subtype distributions were different among countries. Among non-RDs (n = 1436), orthopaedic and related conditions predominated (21.7-59.4%).
Conclusion: The frequencies of RDs seen by SEA PRCs were different from those in the West. Systemic vasculitides and SLE were common in addition to JIA. Paediatric rheumatologist availability and healthcare accessibility partially explain these observed discrepancies.
Study site: multination + Selayang Hospital, Malaysia
A high frequency of bronchopulmonary infections complicating rheumatoid arthritis has been described in reports of case series. This study was undertaken to confirm and compare these finding in patients with RA and control. 117 patients with RA and 103 patients with OA/soft tissue rheumatism as controls. Study subjects were studied using their medical records available from hospitals' casenotes and GP data base. Details of all documented bronchopulmonary infections for the preceding year including lower and upper respiratory tract infections were recorded. Details of hospital admissions due to bronchopulmonary infection, antibiotic usage and functional capacity were also recorded. Mean age for RA was 56 and 59 for control. There were 34 males and 83 females in RA group, however, 14 males and 55 females in control group. There were at least 1 episodes of BPI in 66.7% (p<0.05) patients with RA and 48.5% in control. 69.2% (p<0.05) of subgroup patients with RA were noted to have poorer functional capacity compared to 50% in control. More RA patients with BPI (15%) (p<0.05) were admitted to hospital compared to control (3.8%). Significance findings were noted in terms of prevalence of BPI in RA patients compared to controls as well as patients with RA have severe course of BPI warranting hospitalization. RA patients with poorer functional capacity also noted to have high incidence of BPI.
Study site: Rheumatology clinic, Hospital Alor Setar, Kedah, Malaysia
PIP:
A total of 552 women in 1983 have undergone laparoscopic sterilization under local anesthesia with sedation in the family planning clinic at Maternity Hospital and the Specialist Center at Batu Complex. A review was made to evaluate the risks, benefits, and safety of outpatient surgery in view of the shortage of anesthetic personnel, operating theaters and costs to patients if general anesthesia were to be used instead. Anesthetic complications (0.9%) were found to be of a very minor nature, not requiring hospitalization. Surgical complication was higher at 3.8%. There was a high rate (21%) of difficulties encountered at operation, 15% for medical officers and trainees but only 6% for specialists. In summary, a very low complication rate was encountered with local anesthetics. The use of local anesthesia with sedation is advocated. This cuts down on costs, hospitalization and recovey time and overcomes the perennial problem of shortage of anesthetic staff and operating theaters. The rate of the surgical complications was related to the surgeon's experience.
Study site: family planning clinic at Maternity Hospital and the Specialist Center at Batu Comple
Adverse drug reaction (ADR) primarily caused by many drugs including antibiotics. At present, the incidence and pattern of ADR caused by antibiotics have remained as neglected area in Malaysia. This study was conducted to determine the incidence and analyze the pattern of ADR caused by antibiotics among patients in a tertiary care hospital. It is a 2-year retrospective observational study conducted at Hospital Pulau Pinang, Malaysia. All eligible patients who had antibiotic prescribed belonging to any age group either from outpatient or inpatient that had experienced ADR was included in this study. The outcomes were measured with the aid of Naranjo's and Hartwig's scales. The incidence of the ADRs among patients prescribed with antibiotics in Hospital Pulau Pinang is about 1.1%. Vancomycin and Trimethoprim/Sulfamethoxazole both are considered to be the major contributors to ADR incidences. The skin was the most affected organ by ADRs followed by gastrointestinal system. Most of the severe ADRs were caused by Penicillin. The causality relationship of all the severe reactions was mostly probable. General Medicine unit had reported the highest number of ADRs caused by antibiotics. The common manifestations of ADRs are acute kidney injury and exanthem. In addition, majority of the ADRs caused by antibiotics were reversible. A large multicenter study is suggested to confirm the present findings.
Accepted 07 August 2011.
Introduction Chronic kidney disease (CKD) has emerged as a major medical illness that drew the attention of the community. This research focused on the prevalence of five contributing factors to the progression of CKD, namely blood pressure control, glycaemic control, lipid control, smoking and alcohol intake, and explored significant association between these variables. This was a crosssectional study that examined the progression of CKD based on the worsening of CKD stages.
Methods This study was conducted among CKD patients with type 2 diabetes mellitus who attended Nephorology Clinic, UKMMC from April to May 2011. The progression of CKD was observed for 3 consecutive visits with 3 months intervals between the visits. Information regarding demographic data and social history were obtained through face-to-face interview, followed by case note review of the blood results. Data collected was analysed using SPSS version 19.0.
Results A total of 201 respondents were investigated, which included 39.3% (n=79) female and 60.7% (n=122) male. The mean age for the respondents was 66.9 years old (±SD 9.00). Among the respondents, 71.5% had poor glycaemic control; 59.7% had poor blood pressure control; 65.2% had poor lipid control; 19.9% smoked and 3.5% consumed alcohol. There was poor correlation, there were statistically significant association between systolic blood pressure control with the glomerular filtration rate (GFR) (p=0.001; r=-0.229). From this research, high systolic blood pressure was associated with low GFR, which indicated poor kidney function and resulted in progression of CKD.
Conclusions This study has clearly demonstrated that the control of blood pressure was essential in delaying the progression of CKD.
BACKGROUND: Studies from both developed and developing countries have demonstrated a considerable fluctuation in the average cost of TB treatment. The objective of this study was to analyze the medical resource utilization among new smear positive pulmonary tuberculosis patients. We also estimated the cost of tuberculosis treatment from the provider and patient perspectives, and identified the significant cost driving factors.
METHODS: All new smear positive pulmonary tuberculosis patients who were registered at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were invited to participate in the study. Provider sector costs were estimated using bottom-up, micro-costing technique. For the calculation of costs from the patients' perspective, all eligible patients who agreed to participate in the study were interviewed after the intensive phase and subsequently at the end of the treatment by a trained nurse. PASW was used to analyze the data (Predictive Analysis SoftWare, version 19.0, Armonk, NY: IBM Corp.).
RESULTS: During the study period, 226 patients completed the treatment. However, complete costing data were available for 212 patients. The most highly utilized resources were chest X-ray followed by sputum smear examination. Only a smaller proportion of the patients were hospitalized. The average provider sector cost was MYR 992.34 (i.e., USD 325.35 per patient) whereby the average patient sector cost was MYR 1225.80 (i.e., USD 401.90 per patient). The average patient sector cost of our study population accounted for 5.7% of their annual family income. In multiple linear regression analysis, prolonged treatment duration (i.e., > 6 months) was the only predictor of higher provider sector costs whereby higher patient sector costs were determined by greater household income and persistent cough at the end of the intensive phase of the treatment.
CONCLUSION: In relation to average provider sector cost, our estimates are substantially higher than the budget allocated by the Ministry of Health for the treatment of a tuberculosis case in Malaysia. The expenses borne by the patients and their families on the treatment of the current episode of tuberculosis were not catastrophic for them.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia
Death among tuberculosis patients is one of the major reasons for non-attainment of 85% treatment success target set by World Health Organization. In this short paper, we evaluated whether the overall mortality rate in pulmonary tuberculosis is being affected by other comorbid conditions. All new smear positive pulmonary tuberculosis patients (N =336), who started their treatment at the chest clinic of the Penang General Hospital, between March 2010 and February 2011, were followed-up until December 2011. Tuberculosis treatment outcomes were reported according to six treatment outcome categories recommended by World Health Organization. The outcome category 'died' was defined as 'a patient who died due to tuberculosis or other cause during tuberculosis treatment'. Our findings showed that out of 336 smear positive pulmonary tuberculosis patients, 59 (17.6%) died during treatment (mortality rate = 1.003 cases per 1000 person-days of follow-up). Among the deceased patients, the mean age was 55.8 years (SD =16.17) and 49 were male. According to the mortality review forms, 29 deaths were tuberculosis-related, while the remaining 30 patients died due to reasons other than tuberculosis. Cerebrovascular accident (n =7), septicaemia shock (n =4) and acute coronary syndrome (n =4) were the most common non-tuberculosis related reasons for mortality in the patients. If the 30 patients, for whom tuberculosis was incidental to death, are excluded from the final cohort, the proportion of patients in the 'died' outcome category could be reduced to 9.5%. The treatment outcome criterion (i.e., died) set by World Health Organization has limitations. Therefore, it requires improvement for more objective evaluation of the performance of the National Tuberculosis Program.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia
BACKGROUND: The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients.
DESIGN: All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health.
RESULTS: A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health.
CONCLUSION: The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.
Study site: Respiratory clinic, Hospital Pulau Pinang, Malaysia
BACKGROUND: With evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.
METHODS: This was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.
RESULTS: When compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, p = 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, p = 0.029, η2 = 0.06], time [F (2, 168) = 139.50, p = < 0.001, η2 = 0.62] and group x time interaction [F (2, 168) = 13.89, p = < 0.001, η2 = 0.14].
CONCLUSIONS: This study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.
Study site: Five chest clinics, Hospitals in Pulau Pinang, Bukit Mertajam, Seberang Jaya, Sungai Bakap, and Institut Perubatan Respirotori, Malaysia
INTRODUCTION: Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM). Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
METHODS: This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13-91 years. Youden's index was used to identify the optimal cut-off points.
RESULTS: The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5-91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m², and that for low level high-density lipoprotein cholesterol was 22.9 kg/m². For males, the corresponding cut-off points were 86.5-91.0 cm for WC and 20.75-25.5 kg/m² for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
CONCLUSION: WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI.
OBJECTIVE: Non-adherence is a serious issue among the participants in pulmonary rehabilitation program (PRP). Till date, no clinical tool is available to screen participants who will show poor adherence towards PRP. This study aimed to develop and validate a tool called "Adherence to Pulmonary Rehabilitation Questionnaire (APRQ)", a self-administered questionnaire to screen the risk of non-adherence to PRP among the patients with chronic obstructive pulmonary disease. APRQ comprises of 6 main constructs such as disease management behaviour, perceived treatment benefits, emotional factors, perceived severity of disease, barriers towards treatment and coping attitude.
MATERIALS AND METHODS: This was a preliminary validity study carried out in the physiotherapy department and respiratory clinic in an university teaching hospital. A total of 109 patients with average age of 58.8 ± 1 year participated in the study. The inclusion criteria for subjects were: patients diagnosed with chronic obstructive pulmonary diseases (COPD) (Stage II and III). Exclusion criteria include those COPD patients with mental problems and disabled patients. The tool was developed based on thematic analysis and in-depth interview with focus group and literature search on the factors that lead to non-adherence among the PRP's participants. Principal component analysis was carried out to examine the construct validity and content validity of APRQ.
RESULTS: A total of 20 items were created under 6 constructs. However, 2 items (smoking and hospital admission) were eliminated due to poor correlations. Thus, the final version of APRQ was developed and validated with 18 items. Reliability was measured using internal consistency and achieved Cronbach's Alpha of 0.762.
CONCLUSIONS: The findings from this preliminary study supports that APRQ may be a valid and reliable tool to screen adherence towards PRP among chronic lung disease patients.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Low back pain (LBP) is a major medical and social problem associated with disability and work absenteeism. Since the effect on unawareness on back care among hospital staff may affect the smooth running of the services to the public and patients, it is the objective of this study to identified the awareness of back care among nurses so that preventive measures can be taken. About 80 nurses working in the outpatient clinic was survey using self addressed questionnaires which were adapted from Zutphen Physical Activity Questionnaire at Queen Elizabeth Hospital, Kota Kinabalu. Demographic analysis demonstrated that among the eighty nurses that responded, 37.5% (n=30) are Malays, 25% (n=25) Chinese and 37.5% (n=30) ( to include other Sabahan tribes). Their age group varies between 23 to 55 years of age. A total of 72 nurses, both agreed (45%,n=36) and strongly agreed (45%,n=36) that understanding good postures is important to prevent LBP. They felt strongly (55%, n=44) about the importance of correct lifting techniques, and having a well-designed workplace (50%,n=40). Regarding factors that cause LBP, 55% (n=44) of them strongly agreed that good lifting technique can prevent LBP while 56 (70%) agreed that prolong sitting doing computer work can cause LBP. About 60% (n=48) also agreed that LBP can cause stress and that 45% (n=36) of them strongly agreed that being overweight than average can worsen LBP. However, 40% (n=32) provide a neutral answer to whether height have any influence on LBP while 50% (n=40) agreed that weak back muscles can worsen the backache further. However, 45% (n=36) agreed that games that involved back movement have high risks and 55% (n=44) agreed that swimming helps to strengthen back muscle. The environmental factors addresses issues of footwear and soft mattress where 60%(n=48) agreed while 15%(n=12) strongly agreed that good footware and appropriate use of soft mattresses 60% (n=48) can prevent LBP. This study have demonstrated that the nurses that participated had a clear understanding and knowledge on back care even though a wider study need to be carried out to ensure validity of study finding.
Study site:outpatient clinic, Queen Elizabeth Hospital, Kota Kinabalu
INTRODUCTION: Although the Feldenkrais method of rehabilitating chronic obstructive pulmonary disease (COPD) patients have been suggested, its use among practitioners is not widespread owing to preference of the more familiar standard program presently available. Several advantageous of the Feldenkrais Method have been suggested which includes improving the efficiency of movement, posture and, breathing. However how this compares to the standard rehabilitation protocol or pulmonary rehabilitation program (PRP) have not been previously demonstrated. The present study was thus conducted to compare the effectiveness of the Feldenkrais Method to the standard PRP using Borg score and 6 minute walked distance (6MWD) as outcome measurement tools.
RESULTS: There were 17 subjects in the Feldenkrais group (FG) and 19 subjects in the pulmonary group (PG), both of which received therapy for 8 weeks and assessed before and after receiving therapy. There were no improvements observed in the Borg score for the FG (after and before; 6.06+ 1.09 vs. 6.00+0.94). However, improvements in the PG group could be seen (after and before; 3.58+ 1.17 vs. 5.84 +1.01). Improvements in the 6MWD was observed in both groups with no significance differences noted (FG vs. PG; 379+129m vs. 374+80m).
CONCLUSION: The Feldenkrais method does not offer any advantage over the present PRP and in fact the latter offers better improvement in terms of the Borg score. However in view of the small study sample, further study would be needed before a final conclusion can be made.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
BACKGROUND: This study was proposed to develop a composite of outcome measures using forced expiratory volume percentage of predicted, exercise capacity and quality of life scores for assessment of chronic obstructive pulmonary disease (COPD) severity.
MATERIALS AND METHODS: Eighty-six patients with COPD were enrolled into a prospective, observational study at the respiratory outpatient clinic, National University Hospital Malaysia (Hospital Universiti Kebangsaan Malaysia--HUKM), Kuala Lumpur.
RESULTS: Our study found modest correlation between the forced expiratory volume in 1 s (FEV(1)), 6 min walk distance and the SGRQ scores with mean (SD) values of 0.97 (0.56) litres/s, 322 (87) m and 43.7 (23.6)%, respectively. K-Means cluster analysis identified four distinct clusters which reached statistical significance which was refined to develop a new cumulative staging system. The SAFE Index score correlated with the number of exacerbations in 2 years (r = 0.497, p<0.001).
CONCLUSION: We have developed the SGRQ, Air-Flow limitation and Exercise tolerance Index (SAFE Index) for the stratification of severity in COPD. This index incorporates the SGRQ score, the FEV(1) % predicted and the 6 min walk distance. The SAFE Index is moderately correlated with the number of disease exacerbations.
Study site: Respiratory clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.
Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,
INTRODUCTION: Malaysia has a high rate of smoking prevalence and the figure is increasing. Although there has been many local and regional studies on the prevalence and symptomatology of chronic obstructive pulmonary disease patients, data is lacking on the degree of compliance to national management guidelines in the treatment of chronic obstructive pulmonary disease.
METHODS: 86 patients who attended the respiratory outpatient clinic of the Hospital Universiti Kebangsaan Malaysia were enrolled into a prospective, observational study.
RESULTS: 88 percent of the patients were male and the majority was ethnically Chinese (65 percent). The majority of patients were in the moderate to very severe categories, with a mean FEV1 of 0.97 +/- 0.56 L/sec and predicted mean FEV1 percentage of 43.1 +/- 21.3 percent. 58 percent of the patients were on long-acting beta-agonist, 65 percent were on inhaled steroids, and only 16 percent were on scheduled pulmonary rehabilitation.
CONCLUSION: The low uptake rate for long-acting beta-agonist and pulmonary rehabilitation could be attributed to several factors. Financial cost, the need for strict compliance to a structured rehabilitation regime, lack of significant social support and clear up-to-date guidelines are possible reasons.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia