Health-related quality of life as a predictor of tuberculosis treatment outcomes in Iraq

Summary ObjectivesTo determine how tuberculosis (TB) treatment affects the health-related quality of life (HRQL) of patients with pulmonary TB and to identify the predictors of favourable TB treatment outcomes in Baghdad, Iraq. MethodsThe Functional Assessment of Chronic Illness Therapy – Tuberculosis (FACIT-TB), a new TB-specific quality of life instrument derived from the internationally recognized FACIT measurement system for the assessment of HRQL, was administered. The mean total and subscale scores of the FACIT-TB at baseline, end of the intensive phase, and end of TB treatment were compared. ResultsAfter the 2-month intensive phase, physical well-being, functional well-being, and the overall total scores were significantly increased (p<0.01). Furthermore, at completion of TB treatment, there were significant improvements in the overall HRQL as indicated by the FACIT-TB total score and all subscales, except social and economic well-being and spiritual well-being. In a direct logistic regression model, only the FACIT-TB total score made a statistically significant contribution towards predicting the likelihood that a patient would have a favourable TB treatment outcome. ConclusionsTherapeutic intervention had a positive impact on patient HRQL. We conclude that FACIT-TB is a reliable tool to monitor HRQL during the course of TB treatment.Universiti Sains Malaysia, Research University Postgraduate Research Grant Scheme (USM-RU-PRGS; grant number 1001/PFARMASI/845040)

Assessment of awareness, knowledge, attitude, and the practice of vitamin D among the general public in Malaysia

Introduction: Vitamin D deficiency is becoming a global epidemic, which is still undertreated despite increased treatment availability and increase in therapeutic options. This study aimed to explore the awareness, knowledge, attitude and practices regarding Vitamin D among the general public in Malaysia. Methods: A cross-sectional survey was carried out in a public area using a convenience sampling technique to recruit participants around Selangor and Kuala Lumpur shopping malls area. An anonymous self-administered questionnaire was used for data collection and it was circulated to 603 Malaysian. A total of 400 participants were completed and returned to the researchers.   Result: Although 90.5% of the participants have heard/learnt about Vitamin D. About 78.0% of them showed limited knowledge about some aspects of Vitamin D with (mean ± SD = 1.78 ± 0.894). Additionally, there was a negative attitude towards Vitamin D and sunlight exposure. For instance, nearly 70.0% of the respondents did not like to expose themselves to sunlight.  Only 30.0% of the participants had taken Vitamin D supplement before. There is a small, positive correlation between the knowledge score and education level, rho = 0.124, n = 400, P = 0.013, with a higher score associated with higher education level. Conclusion: The findings provided a piece of contemporary real-world evidence on the lack of knowledge and practices about Vitamin D among the general public. Therefore, extensive health educational campaigns for the public should be implemented by the government to raise their knowledge on the importance of Vitamin D. Keywords: knowledge; practice; vitamin D; public; Malaysia DOI: https://doi.org/10.3126/jkahs.v2i3.2664

Cost-effectiveness of anti-retroviral adherence interventions for people living with HIV: A systematic review of decision analytical models

Background: Although safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions. Methods: The review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis. Results: Fifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported. Conclusion: Counselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods

Exploring the Capability of the Hospital Pharmacists in Conducting Pharmacy Practice Research: A Study from Malaysia

The engagement of pharmacists in research activities is pivotal in the advancement of the pharmacy practice. The study aims to evaluate the confidence and competence of Malaysian hospital pharmacists in conducting clinical and practice-based research. A cross-sectional study was carried out between September 2019 and April 2020 using an online survey. Pharmacists from eight different hospitals in Malaysia were involved in the study. The survey link was sent to all pharmacists of the included hospitals via email. Data were analysed using SPSS version 25. A total of 226 pharmacists participated in this study, and their average age was 28 years old. About 82 % of the participants reported that they did not have any previous research experience, and around 62% of them indicated that the research training during their undergraduate study was inadequate. At least 60% of the participants reported inadequate competence and/or confidence in developing research protocols, critically appraising the literature, undertaking and applying appropriate statistical techniques, and interpreting research findings. There is an urgent need to reinforce undergraduate and postgraduate research training in the institutions among potential and current pharmacists to build competence in research techniques such as literature reviews and scholarly participation

Managing Pain in Low Resource Settings: Healthcare Professionals’ Knowledge, Attitude and Practice Regarding Pain Management in Western Nepal

Background: Pain is a public health problem and affects millions of people globally. Effective pain management is possible through comprehensive pain management guidelines, adequate facilities, and trained healthcare professionals. Therefore, this study aims to analyze the healthcare professionals’ knowledge, attitude, and practice regarding pain management in Western Nepal. Methods: A cross-sectional study was carried out in hospitals of Pokhara, Nepal. Healthcare professionals, including doctors, pharmacists, and nurses, were enrolled. Tools for the study were “The Knowledge and Attitudes Survey Regarding Pain (KASRP)” and a validated practice-based questionnaire. Frequencies and descriptive statistics were used to describe the outcomes. Kruskal– Wallis H-test and Mann-Whitney U-test were used to analyze the association between the mean rank of KASRP score and sample characteristics. A p-value of <0.05 was considered significant for all statistical tests. Results: A total of 336 healthcare professionals were enrolled in this study (108 medical doctors, 150 nurses, and 78 pharmacists). The mean KASRP scores (% ± SD) obtained by doctors, pharmacists, and nurses were 58.48±8.98, 53.01±7.80, and 52.26±6.39, respectively. A significant difference was found between the KASRP score and sample characteristics (p<0.001). The pain assessment tool is used by 96 (29%) healthcare professionals every time they meet the patients. Doctors and nurses used it more frequently as compared to pharmacists. Many of the pharmacists, 40 (51%), reported that they counsel the patients on the prescribed medicine (analgesics, NSAIDs, and opioids) every time. As only few participants had already attended a training on pain management, most healthcare professionals, 110 (33%), agreed and 198 (59%) strongly agreed that training related to pain management is needed in Nepal Conclusion: Adequate training and support are required to enhance the knowledge, attitude and ultimately better practice for healthcare professionals regarding pain management in Nepal

Cost–effectiveness analysis of pharmacist adherence interventions in people living with HIV/AIDS in Pakistan

Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost–effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost–effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan

Clinical Modalities And Therapeutic Outcomes; Between Ever-Smokers Versus Never-Smokers Of Tuberculosis Patients In Penang, Malaysia.

Aim: There is consistent evidence that tobacco smoking has been implicated as a risk factor for tuberculosis infection, disease and death. Study was aimed to identify the impact of smoking on Tuberculosis (TB) clinical characteristics and treatment outcome and to emphasize this association thus may be useful in the management of TB cases. Method: The retrospective, observational and cross-sectional cohort survey was done to compare disease characteristic and clinical presentation during treatment of TB. Result: Five hundred twenty four TB patients were consecutively recruited during the period of the study. Of this, 250 [47.7%] were never smokers. Ever smoking TB patients accounted for 274 [52.3%]. There were significant relationships between smoking status of TB patient with race and initial Mantoux test. But there were no significant association between smoking habit and marital status, patients&apos; identities, history of chronic disease, history of contact to pulmonary TB patients and BCG scar. Ever smoker TB patients&apos; were four times more likely to have slower smear conversion at two months compared to non-smoker tuberculosis patients&apos;. Conclusion: We found a high risk of death from smoking induce tuberculosis. Treatment outcomes were not statistically significant with/without smoking. It was seen that smoking is consider as a risk factor for unfavorable outcomes among TB patients registered in DOTS program in term of therapeutic compliance

Awareness and use of electronic cigarettes: Perceptions of health science programme students in Malaysia

Objectives: In recent years, electronic nicotine delivery systems (ENDS) or e-cigarettes appear to be gaining in popularity despite controversy over their health effects and public health impacts. This paper is the first in Malaysia to assess sociodemographic and behavioural characteristics associated with ENDS awareness, perceptions and use among students enrolled in health science programmes. Design: Online self-reported use and perceptions of ENDS were assessed using a cross-sectional design. Setting: The study was conducted at the International Medical University, Malaysia. Method: An anonymous Internet-based, cross-sectional survey was conducted among a cohort of 404 undergraduate students at International Medical University, Malaysia, in September 2016. Data were collected over a period of 6 weeks. A 31-question web-based survey was developed to assess sociodemographic and behavioural characteristics associated with ENDS awareness, perceptions and use. Logistic regression analysis was performed to assess the impact of a set of predictors on e-cigarette use. Results: Almost 95% of respondents were aware of e-cigarettes, 13.8% reported ever-use and students had varied perceptions towards e-cigarettes. Characteristics associated with greater likelihood of ever-use included gender, ethnicity and parents educational level. Other correlates included prior conventional cigarette smoking, prior hookah smoking, parents’ tobacco use and higher sensation-seeking behaviour total score. Conclusion: In this sample of young adults, e-cigarette awareness was high and ever-use was evident especially among ever cigarette smokers. Nearly half of ever-users had not used an e-cigarette in the past 30 days of the survey and mostly reported flavoured over unflavoured e-cigarette use. These findings highlight the importance of e-cigarette surveillance and health promotion interventions targeting young adults