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  1. Balami AD, Said SM, Zulkefli NAM, Norsa'adah B, Audu B
    Malar J, 2018 Oct 12;17(1):359.
    PMID: 30314438 DOI: 10.1186/s12936-018-2518-8
    BACKGROUND: Despite the high prevalence of malaria among pregnant women and its associated complications, the level of compliance with insecticide-treated nets (ITN) remains very low. Motivation and self-efficacy have been reported as important determinants of health behaviour, and may be important factors to consider in developing health intervention programmes. The aim of this study was to determine the knowledge, motivation and self-efficacy of ITN use, and their association with its practice, among pregnant women in a secondary health centre in Maiduguri.

    METHODS: The study utilized a cross-sectional study design, using a structured and pre-tested questionnaire to obtain information from 380 respondents. Respondents were classified as ITN users if they slept under an ITN for at least 3 days in a week, while those who did not at all, or slept under it less frequently were classified as ITN non-users. Chi squared test was performed to test the bivariate association between ITN use and each of the items of the questionnaire. A further multivariate logistic regression was performed to determine the predictors of ITN use.

    RESULTS: The respondents' ages ranged from 15 to 45 years, with median (interquartile range) age of 25 (8) years. Eighty percent of them were aware of ITN, but 50.5% believed ITNs could be dangerous. Only 5.5% and 0.8% respectively felt that sleeping under and ITN was either just bad or very bad for their health. Thirty-five percent of the respondents were ITN users. Not having a previous miscarriage (OR = 2.38; 95% CI 1.41-4.03, p = 0.001), knowledge that ITNs were not to be washed after every 1 month (OR = 3.60; 95% CI 1.18-11.06), significant others thinking they should sleep under an ITN (OR = 3.06; 95% CI 1.35-6.96), ability to effectively persuade others to sleep under an ITN (OR = 2.37; 95% CI 1.14-4.94) were significantly associated with ITN use.

    CONCLUSIONS: A large proportion of pregnant women in this study were not sleeping under ITNs. The development of health promotion interventions aimed at boosting their self-efficacies for ITN use, and improving social support from their spouses are, therefore, recommended. Health education on ITN use should also be incorporated into post-abortal management.

    Matched MeSH terms: Secondary Care Centers*
  2. Ng BW, Azhar AA, Azman MH, Sukri MS, Arvinder-Singh HS, Abdul Wahid AM
    Med J Malaysia, 2020 07;75(4):391-395.
    PMID: 32724000
    INTRODUCTION: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care.

    OBJECTIVES: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia.

    METHODS: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care.

    RESULTS: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care.

    CONCLUSIONS: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.
    Matched MeSH terms: Secondary Care Centers*
  3. Dasgupta E, Yap JLL, Kunjunee KK, Choong XY, Soh WW, Sundaran M, et al.
    Malays Fam Physician, 2021 Mar 25;16(1):93-102.
    PMID: 33948147 DOI: 10.51866/oa1102
    Objective: This study assesses the prevalence of musculoskeletal (MSK) pain in patients attending primary care clinics in a medium-sized town in Malaysia and examines the interventions given for the symptoms and the level of the associated disabilities.

    Method: This investigation comprises a cross-sectional descriptive study of all patients visiting two primary care clinics aged 18 years and above. Patients presenting with joint pain answered a questionnaire assessing demographic data, disabilities (measured by the Stanford HAQ-DI), and treatment options.

    Results: Of 1,074 patients surveyed, 202 (18.8%) had MSK complaints. The mean age of those with MSK pain was 56.1 years. Incidence increased with age, reaching 78.8% of those over 48 years of age. The knee was the most common site of MSK pain (52.2%), with 20.3% requiring referral for specialist assessment. The median HAQ score was 0.375 and 89.6% of those surveyed had mild disability.

    Conclusion: MSK pain is a common problem among patients visiting primary care clinics. The most common site of MSK pain was the knee. On formal assessment, the majority of these patients exhibited mild disability. A significant proportion of patients still required specialist referral. This finding would suggest a need for further training on the management of MSK disease at the primary care level to avoid over-burdening the secondary care services.

    Matched MeSH terms: Secondary Care
  4. Anis Safura R, Wijesinha S, Piterman L
    Malays Fam Physician, 2010;5(1):49-52.
    MyJurnal
    Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary care globally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT (strengths, weaknesses, opportunities and threats) analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.
    Matched MeSH terms: Secondary Care
  5. Ramli AS
    Medical Health Reviews, 2008;2008(1):63-79.
    MyJurnal
    Primary care practice with its defining features of continuity, comprehensiveness and coordination, is the cornerstone to provide high quality community-based chronic disease management. Poor chronic disease prevention and control at the primary care level will lead to the massive burden of treating complications at secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to the loss of human capital. Compelling evidence showed that there are innovative and cost-effective interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. Primary health care systems around the world were developed in response to acute problems and have remained so despite the increasing prevalence of chronic conditions. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases. This paper aims to review the evidence supporting high quality and innovative chronic disease management models in primary care and the applicability of this approach in low and middle income countries.
    Matched MeSH terms: Secondary Care
  6. Hatta Sidi, Marhani Midin, Malini Mat Napes, Mohd Zulkifli Mohd Kasim, Rahima Dahalan, Shuhaila Ahmad, et al.
    Sains Malaysiana, 2013;42(7):1011-1017.
    The complexity of physical, hormonal and psychocological changes in menopause may affect the sexual function in women. This study measured the prevalence of female sexual dysfunction (FSD) in Malaysian menopausal women. The associated factors were also examined in the study. A cross-sectional study involved 310 menopausal (defined as last menstrual period more than 12 months ago) who visited a menopausal clinic in a secondary referral hospital in the East Peninsular Malaysia. The prevalence and associated factors of female sexual dysfunction in the study subjects were determined. Sexual dysfunction was assessed using the Malay version of the female sexual function index (MVFSFI). Possible associated factors were collected in a pre-designed questionnaire. The prevalence of FSD for the menopausal women was 21.3%. Younger age was the only factor significantly associated with FSD in the study subjects (adjusted odds ratio=0.916, 95% CI=0.851-0.987). The prevalence of FSD was low in the Malaysian menopausal women and associated with younger age.
    Matched MeSH terms: Secondary Care Centers
  7. Chuah KH, Hian WX, Teoh AT, Ling JKY, Mahadeva S
    Neurogastroenterol Motil, 2023 Aug;35(8):e14602.
    PMID: 37094070 DOI: 10.1111/nmo.14602
    BACKGROUND: Real-world data on the outcome of routine treatment for disorders of gut-brain interaction (DGBI) in secondary care are lacking.

    METHOD: A longitudinal study of consecutive adult patients with various DGBI attending this institution's gastroenterology clinic was conducted. Following 2 years of treatment, the proportion of patients with symptom improvement, details of clinical therapy, factors associated with and the impact of 'no symptom improvement' were determined.

    RESULTS: A total of 289 patients (median age 68 years; 64.7% females; 28.4% irritable bowel syndrome (IBS), 20.1% functional dyspepsia (FD), 8.7% functional constipation (FC), 42.9% overlap syndrome) were recruited. After 2 years, 66.1% patients reported symptom improvement. Patients with overlap syndrome were less likely to have symptomatic improvement compared to those with a single DGBI (Overlap 55.6% vs IBS 74.4% vs FD 72.4% vs FC 76.0%, p = 0.014). Reassurance was associated with symptom improvement (p care showed symptom improvement. Patients who were reassured had better symptom improvement, while those with an overlap syndrome were associated with a poorer outcome, resulting in greater healthcare consultation and work absenteeism.

    Matched MeSH terms: Secondary Care
  8. Chuah KH, Black CJ, Tee V, Lim SZ, Hian WX, Sahran NF, et al.
    Aliment Pharmacol Ther, 2023 Jul;58(2):168-174.
    PMID: 37259882 DOI: 10.1111/apt.17567
    BACKGROUND: The prevalence of irritable bowel syndrome (IBS) is now known to be similar in various geographical regions, but there has been no study directly comparing characteristics of patients with IBS between populations.

    AIMS: To evaluate clinical and psychological differences between adults with IBS seen in secondary care in the United Kingdom (UK) and Malaysia.

    METHODS: Age- and sex-matched patients with IBS from a single centre in the UK (Leeds) and two centres in Malaysia (Kuala Lumpur and Kota Bharu), who fulfilled Rome III criteria, were recruited prospectively. Demographic characteristics and gastrointestinal and psychological symptoms were compared between both groups.

    RESULTS: A total of 266 (133 UK and 133 Malaysian) age- and sex-matched patients with Rome III IBS were recruited (mean age: 45.1 years Malaysia, vs. 46.5 years UK; 57.9% female). UK patients were more likely to consume alcohol than Malaysian patients (54.1% vs. 10.5%, p care.

    Matched MeSH terms: Secondary Care
  9. Walke SC, Chandrasekaran V, Mayya SS
    J Neurosci Rural Pract, 2018 5 5;9(2):180-185.
    PMID: 29725166 DOI: 10.4103/jnrp.jnrp_312_17
    Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India.

    Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms.

    Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data.

    Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning.

    Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.

    Matched MeSH terms: Secondary Care Centers
  10. Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y
    PLoS One, 2019;14(7):e0219898.
    PMID: 31348784 DOI: 10.1371/journal.pone.0219898
    OBJECTIVES: To provide baseline information on inappropriate prescribing (IP), and to evaluate whether potentially inappropriate medications (PIMs), as defined by STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, were associated with preventable adverse drug events (ADEs) and/or hospitalization.

    METHODS: We prospectively studied older patients (n = 301) admitted to three urban, public-funded hospitals. We scrutinized their medical records and used STOPP-START (Screening Tool to Alert Prescribers to Right Treatment) criteria to determine PIM and potential prescribing omissions (PPO) respectively- together these constitute IP. Prescriptions with PIM(s) were subjected to a pharmacist medication review, aimed at detecting cases of ADE(s). The vetted cases were further assessed by an expert consensus panel to ascertain: i) causality between the ADE and hospitalization, using, the World Health Organization Uppsala Monitoring Centre criteria, and, ii) whether the ADEs were avoidable (using Hallas criteria). Finally, percentages of PIM-associated ADEs that were both preventable and linked to hospitalization were calculated.

    RESULTS: IP prevalence was 58.5% (n = 176). A majority (49.5%, n = 150) had moderate to severe degree of comorbidities (Charlson Comorbidity Index score ≥ 3). Median age was 72 years. Median number of medications was 6 and 30.9% (n = 93) had ≥8 medications. PIM prevalence was 34.9% (117 PIMs, n = 105) and PPO 37.9% (191 PPOs, n = 114). Most PIMs and PPOs involved overuse of aspirin and underuse of both antiplatelets and statins respectively. With every increase in the number of medications prescribed, the likelihood of PIM occurrence increased by 20%, i.e.1.2 fold (OR 1.20, 95% CI: 1.1-1.3). Among the 105 patients with PIMs, 33 ADEs (n = 33); 31 ADEs (n = 31) considered "causal" or "contributory" to hospitalization; 27 ADEs (n = 27) deemed "avoidable" or "potentially avoidable"; and 25 PIM-associated ADEs, preventable, and that induced hospitalization (n = 25), were identified: these equated to prevalence of 31.4%, 29.5%, 25.7%, and 23.8% respectively. The most common ADEs were masked hypoglycemia and gastrointestinal bleed. With every additional PIM prescribed, the odds for ADE occurrence increased by 12 folds (OR 11.8, 95% CI 5.20-25.3).

    CONCLUSION: The majority of the older patients who were admitted to secondary care for acute illnesses were potentially exposed to IP. Approximately a quarter of the patients were prescribed with PIMs, which were plausibly linked with preventable ADEs that directly caused or contributed to hospitalization.

    Matched MeSH terms: Secondary Care
  11. Ogliari G, Ong T, Marshall L, Sahota O
    Bone, 2021 Jun;147:115916.
    PMID: 33737194 DOI: 10.1016/j.bone.2021.115916
    PURPOSE: To investigate the monthly and seasonal variation in adult osteoporotic fragility fractures and the association with weather.

    METHODS: 12-year observational study of a UK Fracture Liaison Service (outpatient secondary care setting). Database analyses of the records of adult outpatients aged 50 years and older with fragility fractures. Weather data were obtained from the UK's national Meteorological Office. In the seasonality analyses, we tested for the association between months and seasons (determinants), respectively, and outpatient attendances, by analysis of variance (ANOVA) and Tukey's test. In the meteorological analyses, the determinants were mean temperature, mean daily maximum and minimum temperature, number of days of rain, total rainfall and number of days of frost, per month, respectively. We explored the association of each meteorological variable with outpatient attendances, by regression models.

    RESULTS: The Fracture Liaison Service recorded 25,454 fragility fractures. We found significant monthly and seasonal variation in attendances for fractures of the: radius or ulna; humerus; ankle, foot, tibia or fibula (ANOVA, all p-values <0.05). Fractures of the radius or ulna and humerus peaked in December and winter. Fractures of the ankle, foot, tibia or fibula peaked in July, August and summer. U-shaped associations were showed between each temperature parameter and fractures. Days of frost were directly associated with fractures of the radius or ulna (p-value <0.001) and humerus (p-value 0.002).

    CONCLUSION: Different types of fragility fractures present different seasonal patterns. Weather may modulate their seasonality and consequent healthcare utilisation.

    Matched MeSH terms: Secondary Care
  12. Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, et al.
    Gut, 2018 Jun;67(6):1071-1077.
    PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852
    OBJECTIVE: Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.

    DESIGN: 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.

    RESULTS: Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).

    CONCLUSION: We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

    Matched MeSH terms: Secondary Care
  13. Nur Hidayah Bahrom, Anis Safura Ramli, Nor Suraya Samsudin, Norliana Dalila Mohamad Ali, Nor Salmah Bakar
    MyJurnal
    This is a case of a 62-year-old Indian man who was diagnosed with a rare type of lung
    neuroendocrine tumour (NET) of atypical carcinoid (AC) subtype which comprises only 0.1%–
    0.2% of pulmonary neoplasms. He initially presented to a private hospital in May 2018 with a
    6-month history of chronic productive cough and haemoptysis. Chest X-Ray (CXR), CT scan,
    bronchoscopy, biopsy and broncho-alveolar lavage were conducted. At this stage, imaging and
    histopathological investigations were negative for malignancy. Diagnosis of bronchiectasis was
    made and he was treated with antibiotic and tranexamic acid. Due to financial difficulties, his
    care was transferred to a university respiratory clinic in June 2018. His condition was monitored
    with CXR at every visit and treatment with tranexamic acid was continued for 6 months.
    However, due to persistent haemoptysis, he presented to the university primary care clinic in
    Dec 2018. Investigations were repeated in January 2019 where his CXR showed increased
    opacity of the left retrocardiac region and CT scan revealed a left lower lobe endobronchial
    mass causing collapse with mediastinal lymphadenopathy suggestive of malignancy.
    Bronchoscopy, biopsy and histopathology confirmed the presence of NET. Although the Ki-67
    index was low, the mitotic count, presence of necrosis and evidence of liver metastases
    favoured the diagnosis of AC. A positron emission tomography Ga-68 DONATOC scan showed
    evidence of somatostatin receptor avid known primary malignancy in the lungs with suspicions
    of liver metastasis. He was subsequently referred to the oncology team and chemotherapy was
    initiated. This case highlights the challenge in diagnosis and management of patients with AC.
    Physicians ought to be vigilant and have a high index of suspicion in patients who present with
    persistent symptoms on multiple visits. Early diagnosis of NET would prevent metastasis and
    provide better prognosis. Continuous follow-up shared care between primary care and
    secondary care physicians is also essential to provide ongoing psychosocial support for
    patients with NET, especially those with metastatic disease
    Matched MeSH terms: Secondary Care
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