A QUALITATIVE STUDY EXPLORING THE IMPACT OF STIGMA IN THE LIVES OF ADULT ASTHMA PATIENTS IN SELANGOR MALAYSIA

Objective: This study aimed to address and explore the issue of stigmatization and its dynamics in asthma patients from hospital and community pharmacy settings.Methods: The qualitative study approach was used to explore the issues of stigma thoroughly and deeply in asthma patients. In this study, eighteen adult asthma patients were approached for interview from two different healthcare service settings i.e. academic hospital and community pharmacy from Selangor, Malaysia. Patients' responses were recorded manually as well as electronically. The tapes were verified for accuracy of transcription. Data obtained was coded independently for the relevant themes.Results: The majority of the interviewees were Malays i.e. 10, 55.6% and remaining 5 (27.7%) and 3 (16.7%) were Indians and Chinese respectively. The mean±SD age of the patients was 49.3 (±11.02) and among these majority were females (n=12, 66.7%). The main findings of study defined three main themes that included stigma of asthma in terms of extent of disclosure about diagnosis status; discrimination felt in the society; patients' feelings affected by stigma and different ways adapted to tackle stigma of asthma.Conclusion: The patients' experiences of stigmatization were common in both study settings i.e. community pharmacy and hospitals. The patients' adaptation to asthma needs to be given an in-depth consideration to deal the psychosocial concerns of stigma. The support from the healthcare professionals, family members, friends and co-workers is the right strategy and way forward to improve psychosocial wellbeing of the asthma patients.Â

STIGMA IN THE LIVES OF ASTHMA PATIENTS: A REVIEW FROM THE LITERATURE

The main purpose of this review article is to synthesize the empirical literature on stigma and how stigma affects the lives of asthma patients. Limited search and strong evidence from the asthma management guidelines and news coverage conveying stigmatizing or destigmatizing messages are the provoking factors to write this review. The stigma associated with asthma is one of the important contributing factors for frequent patient anxieties, delayed diagnosis, denial and limited disclosure of being asthmatic, limited physical activity and avoidance of inhaler use in public.Pubmed (Medline), PsycInfo, Science Direct, Sage Pub and Wiley databases were used to review the work done to date on measuring stigma related to asthma by using the key terms of stigma and asthma combined with stigmatization/stigmatisation, questionnaire and scale. In addition, Google search engine was used to search the national and international guidelines, newspapers and related work done on stigma of asthma that was beyond the scope of publication by research databases. No time limit was used for the year of publication to address the issue of stigma thoroughly and deeply.In total 452 research articles were identified that addressed different dynamics of stigma by using the combination of a forementioned search keywords. Out of these 39 studies were included in this review addressing specifically the asthma related stigma. From these, four studies aimed to develop the questionnaire for the direct assessment of stigma in asthma patients. These instruments required rigorous validation and reliability assessment in the different population. The stigma of asthma has adverse consequences in the lives of asthma patients. Therefore, a vigorously validated and good reliable instrument is required to be developed to understand the dynamics and underlined causes of stigma of asthma in a comprehensive way. The instrument that can reflect and capture the phenomenon of stigma in asthma patients more accurately, may be served for more effective stigma reduction interventions and comparing stigma intensity in diverse populations and communities. Following the review, suggestions were made for future workplace anti-stigma interventions and evaluation for such intervention programs. Furthermore, stigma in the lives of asthma patients is the area for future research and actions for health care professionals and clinical researchers for better asthma management programs.Â

A REVIEW OF HEALTH OUTCOME INSTRUMENTS FOR ASTHMATIC CHILDREN & THEIR CAREGIVERS

There are various developed general-as well as disease-or condition-specific health outcome instruments to assess an impact of asthma among asthmatic children but few of these instruments were developed in paired versions of child and caregiver. The objective of this review was to determine currently available unpaired and paired health outcome instruments for asthmatic children and their caregivers. Systemic search from Medline, Scopus and Science Direct was conducted to identify asthmatic children's and their caregivers' health outcomes tracking instruments that characterize basic properties of instruments such as instrument's developer and the published year, instrument's description, targeted age and time for completion, items and domains, administration way, scoring and scaling of instrument, type of study setting, tested sample size, availability of instrument in different languages, reliability and validity of the instrument. The results showed in total, 21 instruments were identified whereby 16 of them were administered by either asthmatic children or their caregivers, and remaining (n = 5) have paired version that was administered directly to both asthmatic children and their caregivers. Most of these instruments reported good validity and reliability (Cronbach's alpha between 0.60-0.95). There is a need to develop more paired disease-specific health outcome instruments targeted both asthmatic children and their caregivers to get full data of the impact and burden of asthma and its health intervention on the respective respondents.Â

SMOKING STATUS AFFECTING SURVIVAL OF ADENOCARCINOMA LUNG CANCER PATIENTS IN KUALA LUMPUR, MALAYSIA

  Objective: Adenocarcinoma (AC) of the lung is now the most common histologic type of non-small cell lung cancer (NSCLC) worldwide since the past 20 years. This study was conducted to investigate survival difference among smoker and non-smoker lung AC patients.Methods: A retrospective observational study was conducted for 81 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic at Hospital Kuala Lumpur, Malaysia. A total of adult 30 Malaysian smokers and 51 non-smokers with lung AC were included. Ex-smokers were not included in the study. Demographic and clinical data were collected and described. For survival analysis, Kaplan–Meier test and log-rank test were used to calculate overall survival (OS) and analyse the difference in the survival curve. Cox proportional hazard model was used to identify prognostic significance of smoking status.Results: Non-smokers showed a significant association with female gender and Stage IV NSCLC. The median OS was higher for non-smokers (493 days) as compared to smokers (230 days). The Cox proportional hazard model showed higher hazard ratio for smokers.Conclusion: Non-smoking is an independent positive prognostic factor in lung AC

PROGNOSIS IN ADVANCED NON-SMALL CELL LUNG CANCER - A RETROSPECTIVE STUDY EXAMINING ECOG PERFORMANCE STATUS SCORES OF PATIENTS

  Objective: Increasing prevalence and poor survival of advanced incurable non-small cell lung cancer (NSCLC) make it a major health problem globally, especially in developing countries. This awakens need for identification of the strongest prognostic factor that helps in the selection of appropriate treatment and hence palliates symptoms and improves survival. Lung cancer treatment guidelines advise performance status (PS) as the most established prognostic factor in advanced NSCLC patients. This study investigated the prognostic significance of PS.Methods: An observational study was done for 163 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic, Hospital Kuala Lumpur, Malaysia. Demographic and clinical data were recorded. Kaplan-Meier test was used to measure median overall survival (OS) and Cox proportional hazard model to calculate the hazard ratio for different categories of Eastern Cooperative Oncology Group (ECOG) PS.Results: The mean age and body weight were 56.7±10.1 years old and 57.42±13.5 kg, respectively. Majority patients were male (68.7%), Stage IV NSCLC (65.0%), and ECOG PS score of 2 (41.1%). ECOG PS had a significant association with age and body weight. Median OS was least for ECOG PS score of 4 (253 days) and was statistically significant (p=0.003). ECOG PS was a significant independent prognostic factor for survival in advanced NSCLC patients (p<0.001).Conclusion: PS is a strong prognostic factor in advanced NSCLC

AWARENESS OF DIABETES MELLITUS AMONG GENERAL PUBLIC IN SHAH ALAM, MALAYSIA: A CROSS-SECTIONAL STUDY

  Objective: Despite the improved healthcare and frequent community-ridden educational awareness campaigns, the prevalence of diabetes is enormously increasing and 50% of the Malaysian adults with diabetes are still unaware of their disease status. Therefore, this study aimed to assess the awareness of diabetes mellitus (DM) among the general public of Shah Alam, Malaysia.Methods: A cross-sectional study was carried out in five urban areas of Shah Alam. A total of 350 participants were conveniently recruited using a pre-validated questionnaire. The questionnaire comprised two main parts, including the sociodemographic characteristics of the respondents and a 24-item Diabetes Knowledge Questionnaire. The data were analyzed by Statistical Package for the Social Science® using descriptive and inferential statistics.Results: The overall mean (±standard deviation) score of DM knowledge of participants was 11.11±6.09. Among 350 respondents, more than half claimed that medication is more important than lifestyle modification in DM management. 81.7% did not know about the frequent urination and thirst are signs of DM. 82.3% had a misconception that diabetes is caused by failure of the kidneys to keep sugar out of the urine. The knowledge score was statistically significant difference across the categories of level of education, monthly income, occupations, and family history of diabetes.Conclusion: Majority of enrolled respondents possessed moderate level of awareness and misconceptions regarding diabetes and its management. Hence, there is a need for collective efforts toward improving the level of awareness through community awareness campaigns, to improve the self-management of DM

ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE MALAYSIAN VERSION OF PERCEIVED DIABETES SELF-MANAGEMENT SCALE FOR DIABETES MELLITUS

ABSTRACTObjective: The self-management of the chronic illnesses including diabetes mellitus (DM) contributes directly to the optimum outcomes. The selfmanagementofpatients livingwith DMis essential toachieveoptimal glycemiccontrolandtoavoidor forestallthemyriadtomanage thelong-termnegativeconsequences.This studyaimed toassess psychometricpropertiesoftheMalaysianversionofperceiveddiabetesself-management scale(PDSMS).Methods: This cross-sectional study recruited 314 adult diabetes patients (≥18-years-old; DM Type 1 or 2) attending Endocrine Clinic at KualaLumpur Hospital, Malaysia from July 2014 to January 2015, for the period of 6-month. Permission was obtained from the corresponding authorto translate the English version of PDSMS to Malay language (M-PDSMS). The final version of the questionnaire was self-administered among thepatients living with DM after taking their consent before their participation in this study. Psychometric properties were evaluated using the classicaltest theory: Cronbach's alpha (α), intraclass correlation (ICC), and construct validity by principle component analysis and the modern test theory(MTT): Realtime item reliability, person reliability, and item construct validity.Results: M-PDSMS proved to be internally consistent with good Cronbach α values for both pilot and real study (α=0.69, 0.77), respectively. ICC (0.75)for 1-month test-retest reliability proved the stability of the items. While in MTT, the realtime item reliability values also surpassed the good reliabilityindex of 0.70 for both pilot (α=0.93) and real study (α=0.97).Conclusion: M-PDSMS proved to be a valid and reliable questionnaire to assess the perceived diabetes self-management among the Malaysian DMpatients. The findings of the study should be replicated in other states of Malaysia to ensure the retention of good reliability and validity profile.Keywords: Self-management, Diabetes, Perceived diabetes self-management scale, Reliability, Validity, Modern test theory, Classical test theory, Rasch

PHYTOCHEMICAL ANALYSIS AND IMMUNO-MODULATORY EFFECT OF MORINGA OLEIFERA FLOWERS

Objective: This study evaluates the anti-inflammatory activities of different solvent extracts of Moringa oleifera flowers using carrageenan-induced mice paw edema.Methods: Soxhlet extraction method was employed in this study to extract the crude phytochemicals. Phytochemical analysis testing of Moringa oleifera extracts was performed to identify the presence of various phytoconstituents based on the standard procedures. The anti-inflammatory activity was evaluated using acute inflammatory model carrageenan-induced paw edema. Three different flower extracts (petroleum ether, chloroform and methanol) of Moringa oleifera at the dose level of 500 mg/kg body weight. The anti-inflammatory activity on the different extracts of Moringa oleifera was determined through the α-carrageenan induced left hind paw oedema method in albino mice. 0.05 ml of 1% w/v carrageenan suspension was reconstituted with normal saline (0.9% NaCl) to give a homogenous solution which then be injected into the subplantar tissue of the left hind paw of each mice to induce acute inflammation.Results: Treatment with three different solvent extracts showed significant (p<0.05) inhibition in carrageenan-induced paw edema. Petroleum ether and chloroform extracts were found to be less effective than methanolic extracts when compared to (Indomethacin) reference standard at the dose of 10 mg/kg body weight. The phytochemical results obtained indicates that anti-edematous action of Moringa oleifera flowers exhibited in this study is due to the presence of potent anti-inflammatory phytoconstituents (flavonoid, alkaloid, tannin) in impeding arachidonic acid metabolism and production of reactive free radicals. A significant (p<0.05) increase of left hind paw thickness after the drug injection was noticed in the negative control mice group as time persisted. It showed the highest paw thickness at the fifth hour with 4.72 mm±0.07. Whereas the indomethacin treated group showed the highest percent oedema inhibition amongst all experimental group with 38.60% at the fifth-hour post-carrageenan induction. It exhibited a significant inhibition of 29.02% against the oedema after the third hour of carrageenan injection.Conclusion: The methanolic extract of Moringa oleifera flowers extract has anti-inflammatory activity. This activity was related to the dose and these results collaborate the potential traditional use of the plant in folk medicine

Economic Burdens of Uncomplicated Malaria in Primary Health Care (PHC) Facilities of Plateau State, Nigeria: Patients' Perspectives

Objectives: This study aims at evaluating the costs incurred by patients in Primary Healthcare facilities of Plateau State, Nigeria, due to uncomplicated malaria management. Methods: Patients’ information on resources used and absence from the labour market due to uncomplicated malaria illness were collected using the self-reported cost of illness instruments across 24 selected Primary Health Care (PHC) facilities in Plateau State. The collated data were used to estimate the direct medical and non-medical costs incurred by patients through the summation of the various costs paid out of pocket for the services; while the indirect cost was estimated using the human capital theory. All analyses were conducted through Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS®) version 23 software. Results: The average direct cost per episode of uncomplicated malaria was estimated at NGN 2808.37/USD 7.39, while the indirect average money equivalence of the time lost due to the ailment was estimated at NGN 2717/USD 7.55, giving an average cost of treating uncomplicated malaria borne by patients in Plateau State per episode to be NGN 5525.37/USD 14.94. The projected annual cost of the disease was NGN 9, 921,671,307.22 (USD 27, 560,198.08). Conclusions: The study showed substantial financial costs borne by patients due to uncomplicated malaria in Plateau State, comprising 50.83% of direct cost and 49.17% of the indirect cost of medications