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Fulltext Using the modified socio-ecological model to address stigma against non-suicidal self-injury among adolescents in Malaysia

Thum CC, Dahlan R, Wong YJ

Front Psychiatry, 2023;14:1204704.
PMID: 37398591 DOI: 10.3389/fpsyt.2023.1204704
Engaging community pharmacists in tuberculosis-directly observed treatment: a mixed-methods study

Wong YJ, Thum CC, Ng KY, Lee SWH

Prim Health Care Res Dev, 2023 Mar 22;24:e21.
PMID: 36946302 DOI: 10.1017/S1463423623000105

AIM: This study aimed to evaluate the feasibility of implementing community pharmacy-based tuberculosis-directly observed treatment (TB-DOT) in Malaysia.
BACKGROUND: Tuberculosis (TB) eradication is one of the top priorities in the public health agenda in Malaysia. While public-private mix (PPM) initiatives have been launched, community pharmacists remain undervalued assets in TB management.
METHODS: A two-phase mixed-methods study targeting community pharmacists was conducted in Malaysia between March and October 2021. The first phase was an online self-administered survey developed according to the Consolidated Framework for Implementation Research (CFIR). The second phase was a semi-structured interview to allow deeper understanding on the quantitative results. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using thematic analysis with a semi-inductive approach. The data were triangulated to enhance comprehensiveness and credibility of the findings.
FINDINGS: The survey was completed by 388 community pharmacists, and 23 pharmacists participated in the interview. Most community pharmacists indicated their willingness to serve as TB-DOT supervisors (70.1%). Qualitative results supported the findings. Community pharmacy-based TB-DOT service was perceived as an avenue to improve TB management and outcomes and to enhance the professional role of pharmacists in TB service at primary care settings. This was also perceived as a feasible intervention with the potential to strengthen the National TB Control programme. This initiative needs be reinforced with adequate support from the public healthcare sector for a strong partnership in ensuring success.
Fulltext A Microbial-Based Approach to Mental Health: The Potential of Probiotics in the Treatment of Depression

Johnson D, Letchumanan V, Thum CC, Thurairajasingam S, Lee LH

Nutrients, 2023 Mar 13;15(6).
PMID: 36986112 DOI: 10.3390/nu15061382

Probiotics are currently the subject of intensive research pursuits and also represent a multi-billion-dollar global industry given their vast potential to improve human health. In addition, mental health represents a key domain of healthcare, which currently has limited, adverse-effect prone treatment options, and probiotics may hold the potential to be a novel, customizable treatment for depression. Clinical depression is a common, potentially debilitating condition that may be amenable to a precision psychiatry-based approach utilizing probiotics. Although our understanding has not yet reached a sufficient level, this could be a therapeutic approach that can be tailored for specific individuals with their own unique set of characteristics and health issues. Scientifically, the use of probiotics as a treatment for depression has a valid basis rooted in the microbiota-gut-brain axis (MGBA) mechanisms, which play a role in the pathophysiology of depression. In theory, probiotics appear to be ideal as adjunct therapeutics for major depressive disorder (MDD) and as stand-alone therapeutics for mild MDD and may potentially revolutionize the treatment of depressive disorders. Although there is a wide range of probiotics and an almost limitless range of therapeutic combinations, this review aims to narrow the focus to the most widely commercialized and studied strains, namely Lactobacillus and Bifidobacterium, and to bring together the arguments for their usage in patients with major depressive disorder (MDD). Clinicians, scientists, and industrialists are critical stakeholders in exploring this groundbreaking concept.
Innovative psychological first aid (PFA) in the new normal for frontliners

Thum CC, Chai YC, Zaman Huri S, Wan Nawawi WZ, Ibrahim N

Perspect Psychiatr Care, 2021 Apr;57(2):965-967.
PMID: 32770539 DOI: 10.1111/ppc.12600

PURPOSE: Psychological first aid (PFA) is utilized in the direct aftermath of crisis events. As the world grappled with Covid-19, PFA was provided for staff members in Hospital Sultan Ismail. In adherence to the New Normal, innovative approaches had to be taken. We engaged clients through virtual communication methods. PFA Solat was organized to assist Muslim staff fulfil religious obligations while being on the frontlines.
CONCLUSIONS: PFA may be useful in helping frontline staff manage stress associated with the increased workload and general anxiety relating to the pandemic.
PRACTICE IMPLICATIONS: It is recommended all staff members, especially those involved in frontline duty, to be provided PFA.
Health system preparedness in infectious diseases: perspective of Malaysia, a middle-income country, in the face of monkeypox outbreaks

Tao CC, Lim XJ, Amer Nordin A, Thum CC, Sararaks S, Periasamy K, et al.

Trop Med Health, 2022 Nov 21;50(1):87.
PMID: 36404319 DOI: 10.1186/s41182-022-00479-4

The World Health Organization declared monkeypox as a Public Health Emergency of International Concern on July 23, 2022. As of July 25th, 2022, there were 16,016 laboratory-confirmed cases reported worldwide with 5 deaths. Malaysia's Health Ministry has developed a five-point strategy to prepare for the impending threat of the infectious disease, encompassing early detection of monkeypox, consolidation of laboratory diagnostic facilities, case management and treatment, cluster management, and strengthening public awareness. Crisis and disaster preparedness within a nation's health system is paramount to preventing disease spread. Various strategies for developing resilience in the face of global infectious disease spread were discussed. The current disease preparedness and response framework and guidelines in Malaysia have established a health system that is proactive and responsive to any potential infectious disease outbreaks. Despite this, the future remains unpredictable, and ongoing fortification is required as events unfold.
Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study

Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, et al.

J Pharm Policy Pract, 2023 Oct 19;16(1):122.
PMID: 37858273 DOI: 10.1186/s40545-023-00630-4

INTRODUCTION: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.
AIM: To develop a list of medications to facilitate appropriate prescribing among older adults.
METHODS: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.
RESULTS: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.
CONCLUSIONS: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.