Displaying publications 141 - 160 of 506 in total

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  1. Elmqvist T, Siri J, Andersson E, Anderson P, Bai X, Das PK, et al.
    Sustain Sci, 2018;13(6):1549-1564.
    PMID: 30546487 DOI: 10.1007/s11625-018-0611-0
    Cities are currently experiencing serious, multifaceted impacts from global environmental change, especially climate change, and the degree to which they will need to cope with and adapt to such challenges will continue to increase. A complex systems approach inspired by evolutionary theory can inform strategies for policies and interventions to deal with growing urban vulnerabilities. Such an approach would guide the design of new (and redesign of existing) urban structures, while promoting innovative integration of grey, green and blue infrastructure in service of environmental and health objectives. Moreover, it would contribute to more flexible, effective policies for urban management and the use of urban space. Four decades ago, in a seminal paper in Science, the French evolutionary biologist and philosopher Francois Jacob noted that evolution differs significantly in its characteristic modes of action from processes that are designed and engineered de novo (Jacob in Science 196(4295):1161-1166, 1977). He labeled the evolutionary process "tinkering", recognizing its foundation in the modification and molding of existing traits and forms, with occasional dramatic shifts in function in the context of changing conditions. This contrasts greatly with conventional engineering and design approaches that apply tailor-made materials and tools to achieve well-defined functions that are specified a priori. We here propose that urban tinkering is the application of evolutionary thinking to urban design, engineering, ecological restoration, management and governance. We define urban tinkering as:A mode of operation, encompassing policy, planning and management processes, that seeks to transform the use of existing and design of new urban systems in ways that diversify their functions, anticipate new uses and enhance adaptability, to better meet the social, economic and ecological needs of cities under conditions of deep uncertainty about the future.This approach has the potential to substantially complement and augment conventional urban development, replacing predictability, linearity and monofunctional design with anticipation of uncertainty and non-linearity and design for multiple, potentially shifting functions. Urban tinkering can function by promoting a diversity of small-scale urban experiments that, in aggregate, lead to large-scale often playful innovative solutions to the problems of sustainable development. Moreover, the tinkering approach is naturally suited to exploring multi-functional uses and approaches (e.g., bricolage) for new and existing urban structures and policies through collaborative engagement and analysis. It is thus well worth exploring as a means of delivering co-benefits for environment and human health and wellbeing. Indeed, urban tinkering has close ties to systems approaches, which often are recognized as critical to sustainable development. We believe this concept can help forge much-closer, much-needed ties among engineers, architects, evolutionary ecologists, health specialists, and numerous other urban stakeholders in developing innovative, widely beneficial solutions for society and contribute to successful implementation of SDG11 and the New Urban Agenda.
    Matched MeSH terms: Government
  2. Lee, Toh Chin, Ng, Chong Guan, Benedict Francis, Tan, Shean Yen
    MyJurnal
    We are aware of the shortage of psychiatrists in Malaysia.
    However, there is no formal report on the distribution and ratio of
    psychiatrists in each state in Malaysia. We aim to do a detailed count of the
    number of psychiatrists in the country. Methods: We obtained the figures for
    the psychiatrists practicing in the government, private and university settings
    by accessing the Ministry of Health database, information from the
    Malaysian Psychiatric Association, Malaysian Mental Health Association,
    National Specialist Register and websites of the respective Universities. The
    total number and ratio of psychiatrists per 100,000 population are calculated.
    Results: There was a total of 410 registered psychiatrists in Malaysia in the
    private universities, private clinics, public universities and government
    hospitals. The state with the highest number of psychiatrists is Wilayah
    Persekutuan Kuala Lumpur with a total of 94 psychiatrists which has a ratio
    of 5.24 per 100, 000 population followed by Wilayah Persekutuan Putrajaya
    with 3.38 per 100,000 population. The states with the least ratio of
    psychiatrists are Sabah with 0.54 and Kedah with 0.55 per 100, 000
    population. Conclusion: There is a discrepancy in the geographical
    distribution of psychiatrists in Malaysia. People living in larger, urban states
    have better access to mental health care whereas the smaller states face a
    serious lack of psychiatrists. More effort should be taken to improve mental
    healthcare in Malaysia as recommended by WHO with one psychiatrist for
    every 10, 000 population.
    Matched MeSH terms: Government
  3. K C B, Heydon S, Norris P
    PMID: 31171973 DOI: 10.1186/s40545-019-0172-3
    Improving access to medicines is a major healthcare challenge for low-income countries because the problem traverses health systems, society and multiple stakeholders. The Annapurna region of Nepal provides a valuable case study to investigate the interplay between medicines, society and health systems and their effects on access to and use of medicines. Government health facilities and international aid organizations provide some healthcare in the region, communities participate actively in healthcare organization and delivery, there is an important tourism sector and a mostly rural society. This study investigates access to and use of medicines through health facility and household-based studies using standardised tools and through a series of structured key informant interviews with various stakeholders in health. Overall, access to essential medicines at public health facilities was good, but this was not benefitting households as much as it should. People were using the private sector for medicines because of their perception about the quality and limited numbers of government-supplied free medicines. They utilised money from remittances and tourism, and subsidised healthcare from non-government organizations (NGOs) to access healthcare and medicines. A pluralistic healthcare system existed in the villages. Inappropriate use of medicines was found in households and was linked to the inadequate health system, socioeconomic and sociocultural practices and beliefs. Nevertheless, the often disadvantaged Dalit users said that they did not face any discrimination in access to health services and medicines. The government as the main stakeholder of health was unable to meet people's health services and medicines needs; however, health aid agencies and the local community supported these needs to some extent. This study shows that the interconnectedness between medicines, society and health systems impacts the way people access and use medicines. Improving access to medicines requires an improvement in public's perception about quality, actual coverage and appropriate use of medicines and health services via collaborative contributions of all stakeholders.
    Matched MeSH terms: Government
  4. Gafoor AM, Reynu R, Kirubakaran M, Vimal Kumar V, Nik Ritza NM, Tikfun G, et al.
    Med J Malaysia, 2021 03;76(2):229-232.
    PMID: 33742633
    The rise in obesity has fuelled the current debate of its classification as a disease. Contrary to just being a medical condition or a risk factor for other diseases, obesity is a complex disease with multifaceted aetiology as well as its own disabling capacities, pathophysiology, and comorbidities. The problem of obesity in Malaysia is serious and calls for active intervention by all stakeholders ranging from government agencies to insurers and healthcare providers. To aid efforts to curb obesity, this consensus statement for bariatric surgery provides a basis for inclusion and exclusion criteria as well as the types of procedures accepted as the norm in Malaysia. This consensus statement was initiated by the Society of Endoscopic and Laparoscopic Surgeons of Malaysia and was collaborated with representatives from the Ministry of Health Malaysia.
    Matched MeSH terms: Government Agencies
  5. Tilley A, Dos Reis Lopes J, Wilkinson SP
    PLoS One, 2020;15(11):e0234760.
    PMID: 33186386 DOI: 10.1371/journal.pone.0234760
    Small-scale fisheries are responsible for landing half of the world's fish catch, yet there are very sparse data on these fishing activities and associated fisheries production in time and space. Fisheries-dependent data underpin scientific guidance of management and conservation of fisheries systems, but it is inherently difficult to generate robust and comprehensive data for small-scale fisheries, particularly given their dispersed and diverse nature. In tackling this challenge, we use open source software components including the Shiny R package to build PeskAAS; an adaptable and scalable digital application that enables the collation, classification, analysis and visualisation of small-scale fisheries catch and effort data. We piloted and refined this system in Timor-Leste; a small island developing nation. The features that make PeskAAS fit for purpose are that it is: (i) fully open-source and free to use (ii) component-based, flexible and able to integrate vessel tracking data with catch records; (iii) able to perform spatial and temporal filtering of fishing productivity by fishing method and habitat; (iv) integrated with species-specific length-weight parameters from FishBase; (v) controlled through a click-button dashboard, that was co-designed with fisheries scientists and government managers, that enables easy to read data summaries and interpretation of context-specific fisheries data. With limited training and code adaptation, the PeskAAS workflow has been used as a framework on which to build and adapt systematic, standardised data collection for small-scale fisheries in other contexts. Automated analytics of these data can provide fishers, managers and researchers with insights into a fisher's experience of fishing efforts, fisheries status, catch rates, economic efficiency and geographic preferences and limits that can potentially guide management and livelihood investments.
    Matched MeSH terms: Government
  6. Bhaumik S, Dash S, Kakkar K
    Indian J Med Ethics, 2020 12 10;V(3):219-221.
    PMID: 33295290 DOI: 10.20529/IJME.2020.067
    Coronavirus disease (Covid-19), which originated in China, is now a full-blown pandemic which has thrown governments and societies off-track in an unprecedented manner. War metaphors have been used widely to describe the scenario, but many critics decry them as harmful narratives. In this piece, we discuss the utility of the war metaphor to build solidarity and fraternity, which will be essential to get through the crisis. We also explain how concerns regarding increased authoritarianism and state excesses due to the use of these narratives are misplaced. We then tease out the colonial era concept of war that guides the arguments against the use of war metaphors in pandemics. We argue that in the post-modern world and in South Asian and African philosophies, wars are seen through the prism of the larger cause of dharma or ubuntu and that individual losses or gains in these contexts are part of a larger cause. The use of war metaphors reflects the need to get together for a societal cause. These metaphors are largely understood across societies while other alternatives are exclusionary, poetic and tangential in nature.

    Keywords : Covid-19, pandemics, war metaphors, communication, philosophy, SARS-CoV-2

    .
    Matched MeSH terms: Government
  7. Alam MM, Wei H, Wahid ANM
    Aust Econ Pap, 2020 Nov 27.
    PMID: 33349733 DOI: 10.1111/1467-8454.12215
    The outbreak of COVID-19 has weakened the economy of Australia and its capital market since early 2020. The overall stock market has declined. However, some sectors become highly vulnerable while others continue to perform well even in the crisis period. Given this new reality, we seek to investigate the initial volatility and the sectoral return. In this study, we analyse data for eight sectors such as, transportation, pharmaceuticals, healthcare, energy, food, real estate, telecommunications and technology of the Australian stock market. In doing so, we obtain data from Australian Securities Exchange (ASX) and analysed them based on 'Event Study' method. Here, we use the 10-days window for the event of official announcement of the COVID-19 outbreak in Australia on 27 February 2020. The findings of the study show that on the day of announcement, the indices for food, pharmaceuticals and healthcare exhibit impressive positive returns. Following the announcement, the telecommunications, pharmaceuticals and healthcare sectors exhibit good performance, while poor performance is demonstrated by the transportation industry. The findings are vital for investors, market participants, companies, private and public policymakers and governments to develop recovery action plans for vulnerable sectors and enable investors to regain their confidence to make better investment decisions.
    Matched MeSH terms: Government
  8. Fatimah Sham, Lailatul Hazzliza Musa, Nor Marini Mohamed, Norjah Othman
    Scientific Research Journal, 2018;15(2):67-79.
    MyJurnal
    Disasters are defined as extraordinary events which occur abruptly, bringing great damage or harm, loss, and destruction to people and the environment. Nurses may have a more conflict and difficulties in disaster decision making where the victim condition need to be treated in disaster place. Nurses play a key role in hospital as a leaders and managers in the disaster operation and command center but limited data shows that the nurses experience in disaster management. The aim of this study is to evaluate the perception of knowledge and skills on the preparedness in disaster management among nurses in community clinics. A descriptive cross-sectional study was conducted in 27 government clinics in one of the states in Malaysia with a convenient sampling, 260 participants are selected. The questionnaire consisted of three sections; socio-demographic characteristics, the perception of knowledge and skill towards preparedness for disaster management rated on a Likert scale. In the effort to collect the intended data, a self-report questionnaire adapted and modified from Disaster Preparedness Evaluation Tool (DPET) was implemented (Alrazeeni, 2015). This study revealed that Nurses in these community clinics were moderate in terms of the perception of knowledge (Mean= 3.65, SD= 0.61) and the perceived skills (Mean= 3.68, SD= 0.56) on the preparedness in Disaster Management. Nevertheless, they were interested in disaster preparedness management training (n=227, 87.3%) and were confident as first responders of disaster (Mean= 3.88, SD= 0.61). However, they were not much involved in disaster preparedness plan (Mean= 3.23, SD= 0.90) and claimed that there was a lack of leadership figure in disaster situation (Mean= 3.06, SD= 0.92). In conclusion, nurses in community clinics need to gain knowledge and skills by involving themselves in disaster planning and drills as the preparation for disaster management for them to be the first responders in helping and managing people in this situation.
    Matched MeSH terms: Government
  9. Vaka M, Walvekar R, Rasheed AK, Khalid M
    J Clean Prod, 2020 Nov 10;273:122834.
    PMID: 32834565 DOI: 10.1016/j.jclepro.2020.122834
    COVID'19 pandemic has devastated several industries and solar energy is no exception. In its economic relief package, Malaysia has announced approximately US$ 2.9 billion in expenditure for the installation of new grids, LED street lights and rooftop solar panels. The Government will also open the tender for a 1400 MW solar power project in the year 2020, which is expected to generate 5 billion ringgit (US$1.1 billion) in investments. As these measures are intended to sustain the existing growth of solar energy potential in the country, it is vital to assess its status quo. Hence, this paper aims to review the current status of renewable energy in Malaysia as well as the initiatives taken before the pandemic to promote solar photovoltaic (PV) technology to meet the energy demands through the low-carbon pathway.
    Matched MeSH terms: Government
  10. Sharifah Darmia Sharif Adam
    MyJurnal
    This paper discusses the roles and challenges of the national language, which is Malay as a language in
    uniting the various ethnic groups in Sabah. On September 16, 1963, the Federation of Malaysia was
    officially declared which comprised of the Malay States, Singapore, Sabah and Sarawak. In line with
    that, the special provisions on the national language in Sabah are contained in Article 161 of the
    national constitution. Although the provision of the constitution clarify that Sabah was given a 10-year
    period to use Malay and English as the official languages but later on September 16, 1973 the Malay language was declared the sole official language for the state of Sabah. Hence, various efforts have
    been made by the government to ensure the national language can play its role as a language that can
    unite the various ethnic groups in Sabah. However, ethnic diversity with their own ethnic mother
    tongue languages has resulted in the Malay language as a national language as well as the language of
    unity to face many challenges. Therefore, the discussion in this paper is focused on policies undertaken
    by the government to strengthen the national language in various fields in Sabah and the challenges
    faced by the national language to foster unity among the various ethnic communities in the state. This
    study was conducted using a qualitative analysis approach and used archive study methods as well as
    library study to obtain research information sources. This study will produce an analysis that can be
    used as a reference to improve or formulate policies particularly in matters that benefit in strengthening
    the multi-ethnic communities in Sabah.
    Matched MeSH terms: Government
  11. Mohd Ferous Alias, Yusof Ibrahim
    MyJurnal
    Introduction: Clinical wastes produced by health facilities were considered as scheduled waste listed in the First Scheduled of the Environmental Quality (Scheduled Waste) Regulation 1989. The management of clinical waste in all government hospitals in Sabah were outsourced to private concession company. Until now, there was no research being done in Sabah to evaluate it. Methods: This cross-sectional study was carried out on eight concessionaire com-panies located inside accredited non-specialist government hospitals in West Coast Division & Interior Division of Sabah. Data collected through Clinical Waste Management (CWM) Scores and Questionnaires. CWM scores adopt 5 elements of accreditation standard produced by Malaysian Society Quality in Health (MSQH). Questionnaires were used to collect concessionaire staff’s basic personal data, services and activities related to clinical wastes ac-cording to MSQH standard. Response from questionnaires were used to compare and support result gained from CWM scores. Descriptive analysis was used to analyze the data. Results: Two concessionaire companies got overall CWM scores ranging between 86% - 90%, while the other six companies were above 95%. It happened because both companies gained 81% and 73.3% on Policies and Procedures element. Result from questionnaires answered by 67 concessionaire staffs showed 98% of staffs had attended meeting, 97% had received an orientation, 97% had received training related to clinical wastes, 95% agreed that their work was monitored and no occupational disease and injury recorded between January to April 2019. These result correlate with CWM scores gained under Orga-nization Management element (99.6%), Human Resource Management element (90.1%), Facilities and equipment element (97%) and Safety & Quality Improvement element (100%). Conclusions: All concessionaire companies were implementing excellent clinical waste management in hospitals. CWM scores can be used to rank individual conces-sionaire company and provide pattern of uniformity or non-uniformity of the clinical waste management in Sabah.
    Matched MeSH terms: Government
  12. Musiun, Aldrin Alexander
    MyJurnal
    Infectious disease remains a public health concern in Malaysia. Efficient public health infectious disease surveillance is needed in order to address the issues posed by infectious disease. The main goal of public health infectious disease surveillance is to facilitate the control and prevention of the infectious diseases. For that, infectious disease surveillance needs involvement of multidiscipline either in government or non-government/private to ensure its success. General practitioners (GPs) have an important role in public health infectious disease surveillance considering their role and position as one of the main front liner medical personnel.
    Matched MeSH terms: Government
  13. Halim ZA, Zolkefli MN, Kusairi S, Nor SM, Zawawi NHM, Sukemi MN
    Data Brief, 2021 Feb;34:106700.
    PMID: 33490327 DOI: 10.1016/j.dib.2020.106700
    Since the launch of the InvestSmart™ initiative in 2014, the government agencies in Malaysia have been actively engaging community and university students via their outreach programs to promote investment literacy. Given this background, the state of the investment literacy of Malaysian undergraduates and their readiness to invest is intriguing. Therefore, this article offers a dataset of Malaysian undergraduates' readiness to invest and the role that investment literacy and social influence play in their readiness to invest. Using a non-probability sampling technique, 500 undergraduate students in Malaysia were engaged to participate voluntarily in this survey. Descriptive statistics are presented in this paper. The dataset provides insights into the current state of investment literacy among Malaysian undergraduates, the sources of information on stock investment, and the readiness of these undergraduates to participate in the stock market.
    Matched MeSH terms: Government Agencies
  14. Salahuddin L, Ismail Z, Abd Ghani MK, Mohd Aboobaider B, Hasan Basari AS
    J Eval Clin Pract, 2020 Oct;26(5):1416-1424.
    PMID: 31863517 DOI: 10.1111/jep.13326
    OBJECTIVES: The objective of this study was to identify the factors influencing workarounds to the Hospital Information System (HIS) in Malaysian government hospitals.

    METHODS: Semi-structured interviews were conducted among 31 medical doctors in three Malaysian government hospitals on the implementation of the Total Hospital Information System (THIS) between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes.

    RESULTS: Five themes emerged as the factors influencing workarounds to the HIS: (a) typing skills, (b) system usability, (c) computer resources, (d) workload, and (e) time.

    CONCLUSIONS: This study provided the key factors as to why doctors were involved in workarounds during the implementation of the HIS. It is important to understand these factors in order to help mitigate work practices that can pose a threat to patient safety.

    Matched MeSH terms: Government
  15. Syaza Zainudin, Mohd Amiruddin Mohd Kassim, Nor Nadia Mohamad Ridza
    Borneo Epidemiology Journal, 2020;1(2):145-156.
    MyJurnal
    Background and Objective: Countries all over the world respect the election process as one of the fundamental steps in forming a government. However, the exponential spread of COVID-19 has been deeply alarming, with a high number of positive cases and total deaths, forcing World Health Organization to declare it as a pandemic on 11thMarch 2020. During these unprecedented events, governments have had a tough decision to balance between the constitutional obligation to hold an election and the safety of the people. As such, electoral commissions have implemented numerous approaches to allow election to proceed in a safe and controlled setting during the pandemic.
    Methods: The preventative measures and standard operating procedures in the Sabah state of Malaysia, NewZealand and the United States elections are discussed, as well as COVID-19 post-election situation in respective countries. Innovative approaches and election flexibilities shall be considered to allow voting in the safest way possible, following the new normal.
    Discussion:Nevertheless, countries need to evaluate its strength of public health response when deciding to hold elections due to potential devastating outbreaks following elections despite measures taken.
    Conclusion: The election is a fundamental process in a democracy. Countries are required to be flexible and innovative in their approach to hold a safe election. Nevertheless, it may be prudent for countries with fewer resources and poor pandemic control to postpone election as a rise in cases will be catastrophic, putting many lives at risk.
    Matched MeSH terms: Government
  16. Han Shiou Feng, Nur Aida Hashim, Nur Adila Kamaruddin, Nur Syahida Wadhihah Kamarudin, Norasmah Basari
    MyJurnal
    Dengue fever and dengue haemorrhagic fever are diseases caused by dengue virus transmitted by Aedes mosquitoes. Dengue fever has caused a high rate of mortalities among Malaysians every year. Even though many campaigns had been conducted by the government to reduce dengue cases, the number of infected people in this country is still high. We conducted this survey to determine the status of dengue fever awareness among residents in Kuala Terengganu. For data collection, face-to-face interviews were conducted, and a questionnaire was administered. There were three categories of respondents, namely urban area residents, rural area residents and university students. Results showed that respondents across the three groups were knowledgeable regarding dengue fever issues and there was no significant difference between the three categories of respondents in the number of residents who had been involved in dengue awareness programmes. However, most of the respondents regarded the dengue awareness programmes as moderately effective and could be overcome if prevention efforts and approaches were being carried out on a continuous basis.
    Matched MeSH terms: Government
  17. R.U GOBITHAASAN, NUR FARHANA SYAHIRA CHE HAMID
    MyJurnal
    Sentiment analysis is a field of research that has a significant impact on today’s nations, politics and businesses. It is an algorithmic process to comprehend the opinions of a given subject based on the Natural Language Processing (NLP) methodologies. It has received much attention in recent years and is proven vital in various fields, e.g., online product reviews and social media analysis (Twitter, Facebook, etc.). This paper reports the outcome of sentiment analysis to investigate people’s acceptance of Pakatan Harapan, as the new Malaysian government, spearheaded by Tun Dr. Mahathir Mohamad and Dr. Wan Azizah, with an influence of Dato Seri Anwar Ibrahim. The objective is to classify tweets into three types of sentiments; positive, neutral and negative using Naïve Bayes method which is readily available in Python. The first step is tweets extraction for a month (March to April 2019) using search queries: {Pakatan Harapan, Mahathir, Anwar Ibrahim, Wan Azizah}. It is followed by tweets wrangling using NLP library and lastly output visualization in the form of a word cloud. A word cloud is a visual representation of text data with various font sizes depending on its probabilities. Final results showed that the tweets related to new government consist of neutral sentiment (41%) followed by positive sentiment (30%) and negative sentiment (29%). Malaysians do prefer the new government. However careful mitigation steps must be crafted to overcome controversial issues such as the ‘Rome Statute’ to avoid negative digital footprint, hence winning the Malaysians’ heart.
    Matched MeSH terms: Government
  18. Ngu, Seng Ling, Jerome, Kueh
    MyJurnal
    Nowadays, gold prices have been volatile, and the wealth of gold investors depend on the movement of gold prices. The purpose of this study is to examine the relationship between gold prices, crude oil prices, inflation rate, real interest rate and stock prices in United States. This study uses monthly data covering the period ranging from January 1990 to August 2018. The Johansen and Juselius (JJ) Cointegration test and Vector Error Correction Model (VECM) are conducted in this study. The result shows that there is a long-run relationship among gold prices, crude oil prices, inflation rate, real interest rate and stock prices. The results show that inflation rate and crude oil prices are significance and positively related to gold prices, while stock prices and real interest rate are negatively affecting gold prices. There are three unidirectional Granger causality and one bidirectional Granger causality in the short run. Only inflation rate Granger cause gold price, which means that inflation rate directly affects the gold prices. This study allows community such as central bank, government, financial institution, economist, investor and policy makers in manipulating and controlling the movement of the gold prices so that they have a better decision making to diversify their risks.
    Matched MeSH terms: Government
  19. Khan NN, Yahya B, Abu Bakar AK, Ho RC
    BJPsych Int, 2015 May;12(2):40-42.
    PMID: 29093848
    The Malaysian Mental Health Act 2001 did not come into effect until the Mental Health Regulations 2010 came into force. The Act provides a framework for the delivery of comprehensive care, treatment, control, protection and rehabilitation of those with mental disorders. The Act governs the establishment of private and government psychiatric hospitals, psychiatric nursing homes and community mental health centres. This paper outlines the provisions of the Act and the Regulations.
    Matched MeSH terms: Government
  20. Russell V, Loo CE, Walsh A, Bharathy A, Vasudevan U, Looi I, et al.
    BMJ Open, 2021 06 30;11(6):e043923.
    PMID: 34193478 DOI: 10.1136/bmjopen-2020-043923
    OBJECTIVES: To explore primary care clinician perceptions of barriers and facilitators in delivering care for common mental disorders (CMD) before and after implementation of a consultation-liaison psychiatry service (Psychiatry in Primary Care (PIPC)) in government-operated primary care clinics and to explore the clinicians' experience of the PIPC service itself.

    DESIGN: This longitudinal qualitative study was informed by the Normalisation Process Model and involved audiotaped semi-structured individual interviews with front-line clinicians before (Time 1) and after (Time 2) the PIPC intervention. The Framework Method was used in the thematic analysis of pre/post interview transcripts.

    SETTING: Two government-operated primary care clinics in Penang, Malaysia.

    PARTICIPANTS: 17 primary care medical, nursing and allied health staff recruited purposely to achieve a range of disciplines and a balanced representation from both clinics.

    INTERVENTION: Psychiatrists, accompanied by medical students in small numbers, provided one half-day consultation visit per week, to front-line clinicians in each clinic over an 8-month period. The service involved psychiatric assessment of patients with suspected CMDs, with face-to-face discussion with the referring clinician before and after the patient assessment.

    RESULTS: At Time 1 interviewees tended to equate CMDs with stress and embraced a holistic model of care while also reporting considerable autonomy in mental healthcare and positively appraising their current practices. At Time 2, post-intervention, participants demonstrated a shift towards greater understanding of CMDs as treatable conditions. They reported time pressures and the demands of key performance indicators in other areas as barriers to participation in PIPC. Yet they showed increased awareness of current service deficits and of their potential in delivering improved mental healthcare.

    CONCLUSIONS: Despite resource-related and structural barriers to implementation of national mental health policy in Malaysian primary care settings, our findings suggest that front-line clinicians are receptive to future interventions designed to improve the mental healthcare capacity.

    Matched MeSH terms: Government
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