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  1. Supramaniam P, Beh YS, Junus S, Devesahayam PR
    BMC Public Health, 2024 Dec 19;24(1):3542.
    PMID: 39702047 DOI: 10.1186/s12889-024-21056-w
    BACKGROUND: Mobile health applications (mHealth apps) offer potential benefits for improving diabetes management, such as better glucose monitoring and patient engagement, but their widespread adoption faces challenges, including privacy concerns and user adherence. This research investigates mHealth app usage among patients living with diabetes in Kinta District, Perak, exploring experiences, challenges and patient perceptions regarding diabetes management using mHealth apps.

    METHODOLOGY: A cross-sectional community survey was conducted in September till November 2020 across nine government health clinics focusing on diabetes mellitus (Type 1 or Type 2) patients, aged 18 years and older, receiving Diabetes Medication Adherence Counseling (DMTAC) services and able to use smart devices. A self-developed questionnaire with four sections was used to gather demographic information, explore mHealth apps usage and understand both users and non-users' experiences and perceptions. The questionnaire was tested through cognitive debriefing, translated into Malay, pre-tested and finalized by the expert committee. The questionnaire was digitally implemented using Google® Form and QR code. After obtaining informed consent, data collection was performed by the trained DMTAC pharmacists. Statistical analyses involved descriptive and inferential analyses.

    RESULTS: The study analyzed the engagement of 295 patients living with diabetes with mHealth apps. Females (54.9%), of Malay ethnicity (58.3%) and with a mean age of 53.8 years (SD: 12.38) constituted the majority. Diabetes duration had a median of 6 years (IQR: 3.0, 10.0) with prevalent comorbidities like hypertension (58.0%) and dyslipidemia (42.7%). Most patients were employed (44.7%) and their primary source of diabetes management information was through healthcare providers (92.5%). Despite the high app use for social interaction, only 13.6% used mHealth apps for disease management. Users were influenced by social media (65.0%) and favored for wellness apps and disease monitoring. Users perceived the mHealth app as useful (97.5%), yet faced challenges over the app initiation, charges and data security. Non-users cited lack of awareness (70.2%), struggled with app startup (22.4%) and preference for conventional healthcare visits (22.0%). In multivariable analysis, longer diabetes duration reduced mHealth app usage (p = 0.046), while multimorbidity increased the likelihood (p = 0.001). Awareness of the availability of health apps significantly influenced the usage of mHealth apps (p 

  2. Supramaniam P, Junus S, Hashim L, Chiew SC, Devesahayam PR
    BMC Public Health, 2024 Jun 06;24(1):1520.
    PMID: 38844906 DOI: 10.1186/s12889-024-19027-2
    BACKGROUND: This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths.

    METHODOLOGY: The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia.

    RESULTS: This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic.

    CONCLUSION: The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

  3. Misron K, Tengku Kamalden TMI, Misron LH, Devesahayam PR, Misron SNF
    Cochlear Implants Int, 2021 09;22(5):291-295.
    PMID: 33794747 DOI: 10.1080/14670100.2021.1905975
    INTRODUCTION: Cochlear implant (CI) requires lifelong financial commitments to ensure that the devices always operate optimally.

    OBJECTIVE: We estimated the long-term maintenance costs of CI including repair of speech processors, replacement of damaged parts, and battery requirements.

    RESULTS: Forty-one parents of children who received CIs in Malaysian government hospitals were enrolled. The first 2 years of CI usage were covered by warranty. The cost increased three-fold from by 4 years of CI usage and then doubled by 8 years of usage. About 75% of parents commented that the costs were burdensome.

    CONCLUSION: Our findings will be useful for parents whose children receive CI and will allow medical personnel to counsel the parents about the costs.

  4. Leong EL, Chew CC, Ang JY, Lojikip SL, Devesahayam PR, Foong KW
    BMC Health Serv Res, 2023 Jun 13;23(1):627.
    PMID: 37312146 DOI: 10.1186/s12913-023-09660-9
    BACKGROUND: Admission to an intensive care unit (ICU) is a stressful experience for patients and their family members. While the focus of management is primarily on medical care, there can be other areas which are overlooked. The purpose of this study was to investigate the needs and experiences of ICU patients and family members.

    METHOD: This qualitative study involved four trained researchers conducting in-depth interviews (IDI) based on a semi-structured interview guide. The participants were ICU patients and family members. All IDIs were audio-recorded and transcribed verbatim. Four researchers independently analyzed the data via thematic analysis with the aid of QDA Miner Lite®. The themes and subthemes were generated and confirmed by literature and expert opinion.

    RESULTS: Six IDIs were conducted with three patients and three family members, whose ages ranged from 31 to 64 years old. One pair of participants consisted of a patient and his respective family member, while the other four participants did not have a familial relationship with each other. Three main themes emerged from the analysis: (I) critical care services; (II) physical spaces; and (III) monitoring technology. Medical, psychological, physical, and social needs for critical care services were expressed by both patients and family members. Patients' needs in clinical spaces were highlighted as a conducive ICU environment with ambient temperature and controlled noise levels. In non-clinical spaces, family members expressed a need for more chairs in the waiting area. Participants expressed the need for call bells as well as patients' negative perceptions of medical equipment alarms in the ICU when it pertained to monitoring technology.

    CONCLUSION: This study provides an in-depth view at the needs and experiences of ICU patients and family members who have a variety of unmet needs. This understanding is critical for guiding ICU personnel and stakeholders in their efforts to humanize ICU care.

  5. Lim XJ, Chew CC, Chang CT, Supramaniam P, Ding LM, Devesahayam PR, et al.
    PLoS One, 2023;18(6):e0286638.
    PMID: 37279237 DOI: 10.1371/journal.pone.0286638
    This exploratory qualitative study investigates older adults' unmet needs in the age-friendly city of Ipoh, Malaysia. Seventeen participants were interviewed, including ten older adults residing in Ipoh City for at least six months, four carers, and three professional key informants. Interviews were conducted using semi-structured questions based on the WHO Age-Friendly Cities Framework. A 5P framework for active ageing based on the ecological ageing model was adapted for data analysis. The 5P framework consists of domains of person (micro), process (meso), place (macro), policymaking (macro), and prime, which allows for the dissection of older adults' unmet needs in planning for multilevel approaches, which were employed for analysis. Person: the personal needs requiring improvement included digital divide disparity, inadequate family support, and restricted sports activities attributed to physical limitations. Process: There were fewer social activities and a lack of low-cost and easily accessible venues for seniors. Economic challenges include expensive private healthcare services, variation in the quality of care in older residential care facilities, and limited savings for retirement. Place issues include unequal distribution of exercise equipment, public open spaces, the need for more conducive parking for seniors, and a place for social activities. Difficulties assessing public transportation, digitalized services, and unaffordable e-hailing services are common among seniors. Housing issues for seniors include a lack of barrier-free housing design and unaffordable housing. Policymaking: Insufficient private sector commitment to improving services to older adults, lack of policy governance on the quality of nursing homes, and insufficient multidisciplinary governance collaboration. Prime: Health promotion for preventing age-related illness is required to preserve health in old age, and full-time family caregivers' psychological well-being is often overlooked.
  6. Wei Ling S, Lim CC, Mohd Damanhuri Shah MFSB, Devesahayam PR
    J Int Adv Otol, 2024 Sep 26;20(5):458-461.
    PMID: 39391172 DOI: 10.5152/iao.2024.231292
    Granular myringitis is a chronic inflammatory condition of the tympanic membrane that does not involve the middle ear. Various treatment modalities have been proposed for the treatment of granular myringitis, but there is no standard treatment regime. A 60-year-old woman had left persistent ear discharge for 4 months. Examination revealed diffuse granulation tissue, forming a pseudomembrane at the medial aspect of the ear canal and obstructing the tympanic membrane. An audiogram revealed mild-to-moderate left-sided conductive hearing loss. She was treated with multiple courses of ear drop antibiotics but had no improvement. The decision for surgical intervention was driven by the presence of a grade IV medial meatal stenosis, the potential risks associated with prolonged medical management, the distressing impact on the patient's life, and a shared decision-making process. A combined transcanal and postauricular endoscopic approach whereby excision of the granulation tissue, canalplasty, and myringoplasty were performed. She exhibited complete symptom resolution and reported an improved quality of life. This approach yielded successful symptom resolution, highlighting its potential in managing refractory chronic granular myringitis. We aimed to carefully weigh the risks of surgery against its potential benefits in a refractory chronic case, acknowledging the inherent risks and disadvantages of surgical interventions. Further studies are warranted to evaluate the long-term outcomes and benefits of this approach.
  7. Abdul Rahim NS, Lim XJ, Leong EL, Lim SY, Amri NA, Lim CC, et al.
    BMC Public Health, 2025 Mar 07;25(1):920.
    PMID: 40055620 DOI: 10.1186/s12889-025-21765-w
    BACKGROUND: Previous studies indicated that the SARS-CoV-2 virus and COVID-19 vaccines may contribute to idiopathic sudden sensorineural hearing loss (ISSNHL). This nationwide study sought to evaluate the correlation between COVID-19 infection and vaccination with ISSNHL.

    METHODS: This case-control study analysed samples from adults aged 18 years and older who visited the otorhinolaryngology department in 32 government hospitals in Malaysia for pure tone audiometry(PTA) between January 25, 2020 and June 30, 2022. Cases comprised patients diagnosed with ISSNHL, while controls consisted of individuals with normal PTA assessments presenting for other otorhinolaryngology-related symptoms during the same period. Patients with known causes of hearing loss were excluded. Cases and controls were matched in a 1:5 ratio based on age (± 5 years) and index date (± 10 days). The study investigated the association between ISSNHL and both COVID-19 vaccination and COVID-19 infection using conditional logistic regression, with statistical significance set at P 

  8. Lim XJ, Ambigapathy S, Leong EL, Marmuji LZ, Phan AP, Hamdan FA, et al.
    BMC Pediatr, 2025 Mar 06;25(1):169.
    PMID: 40045227 DOI: 10.1186/s12887-025-05423-z
    BACKGROUND: In the Malaysian primary healthcare setting, neonatal jaundice (NNJ) screening uses either Kramer's Rule (KR), a visual assessment, or a combination with non-invasive transcutaneous bilirubin (TcB). However, data on the quantification of the need for total serum bilirubin (TSB) sampling between these approaches are limited. This study aimed to compare the frequency of blood draws required between the two cohorts, alongside investigating disparities in phototherapy initiation and severe hyperbilirubinemia occurrences.

    METHODS: This multicentre retrospective cohort study enrolled neonates from six primary healthcare clinics, with three using KR plus TcB and three using KR only for NNJ screening. Neonates with a gestational age of ≥ 35 weeks and without prior phototherapy or exchange transfusion for hyperbilirubinemia were included in the study until reaching either day 10 of life or hospitalization for any reason, defining the study endpoint. The minimum sample size required was 379 neonates in each cohort. Generalized Poisson regression was used to compare the number of blood draws required for TSB sampling between the two cohorts.

    RESULTS: Of 765 neonates included, the cohort using KR alongside TcB showed a 74% reduction in blood draw risk compared to KR alone cohort (IRR 0.26, 95% CI 0.23-0.39). There were no significant differences between cohorts in phototherapy initiation (25.5% vs. 24.4%), severe hyperbilirubinemia occurrence (0.0% vs. 0.0%) or rapid bilirubin level rise (0.3% vs. 0.8%).

    CONCLUSION: Incorporating TcB alongside KR for NNJ screening significantly reduces the need for TSB sampling without causing an escalation in phototherapy initiation or severe hyperbilirubinemia occurrences, suggesting the potential to optimize NNJ management in the local primary care setting.

  9. Lee SH, Yeoh ZX, Sachlin IS, Gazali N, Soelar SA, Foo CY, et al.
    Sci Rep, 2022 02 08;12(1):2111.
    PMID: 35136124 DOI: 10.1038/s41598-022-06029-6
    Alterations in the three chemosensory modalities-smell, taste, and chemesthesis-have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.Study Registration: NMRR-20-934-54803 and NCT04390165.
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