Prevalence of depression and associated factors among tuberculosis patients in primary care in the district of Kuching, Sarawak

Depression in tuberculosis (TB) increases the risks of adverse health outcomes. However, little is known about depression in tuberculosis patients in Malaysia. The aim of this study was to determine the prevalence and associated factors of depression in tuberculosis patients in primary care clinics. A cross-sectional study was adapted for this study. A total of 235 TB patients were recruited in six primary care clinics in the district of Kuching, Sarawak in Malaysia using convenience sampling method. A self-administered questionnaire, Patient Health Questionnaire-9 (PHQ-9), was used to screen for depression, and social support was accessed using Multidimensional Scale of Perceived Social Support, MSPSS. This study showed that the prevalence of depression among TB patients was 7.7%. Socio-demographic factors, tuberculosis-related clinical data and social support are not significantly associated with participant’s depressive states. Findings also showed that there is no different in terms of social support received by depressive and non-depressive tuberculosis patients. Conclusively, depression in TB patients is considered low; however, screening for depression in TB patients should not be neglected because it can lead to better treatment outcomes

Explorative survey on the usage and needs of Mobile Health Applications (mhealth) amongst caregivers in taking care of stroke survivors

Mobile health (mHealth) applications may assist stroke caregivers in answering the unmet needs of inadequate information and support from healthcare professionals. This study aimed to explore the usage and needs of mHealth applications among stroke caregivers and its associated factors. This cross-sectional study involved 207 stroke caregivers attending hospital and community-based stroke clinics in Kuala Lumpur between December 2020 until March 2021. The survey was done through newly developed self-administered bilingual questionnaires using face to face interviews, telephone interviews and Google form. Most caregivers (77.8%) used at least one mHealth application for self-care or during the caregiving process. The three most types of mHealth applications were contacting healthcare professionals (89.9%), disease monitoring (89.4%) and health information (89.4%). The three most features of mHealth applications were free to download/use (94.7%), simple interface (93.7%) and data security/privacy (93.7%). Chi-square test of association showed managing appointment (χ2 (1) = 5.65, p = 0.017), health information (χ2 (1) = 6.72, p = 0.01), disease monitoring (χ2 (1) = 9.58, p = 0.002), contacting healthcare professional (χ2 (1) = 6.27, p = 0.012) and patient disability level (χ2 (1) = 4.29, p = 0.038) were significantly associated with specific types of mHealth applications. In conclusion, the overall usage of mHealth applications among stroke caregivers was high, with the need of specific types and features in mHealth applications among stroke caregivers

Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography.

OBJECTIVE: To describe and explain stroke survivors and informal caregivers' experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. DESIGN: Systematic review and meta-ethnography. DATA SOURCES: Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). ELIGIBILITY CRITERIA: Primary qualitative studies focused on adult community-dwelling stroke survivors' and/or informal caregivers' experiences of primary care and/or community healthcare services. DATA SYNTHESIS: A set of common second order constructs (original authors' interpretations of participants' experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods' criteria. RESULTS: 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. LIMITATIONS: Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. CONCLUSIONS: Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2015:CRD42015026602

Second Order Learning Algorithm for Back Propagation Neural Networks

Training of artificial neural networks (ANN) is normally a time consuming task due to iteratively search imposed by implicit nonlinearity of the network behavior.  In this work an improvement to ‘batch-mode’ offline training methods, gradient based or gradient free is proposed. The new procedure computes and improves the search direction along the negative gradient by introducing the ‘gain’ value of the activation functions and calculating the negative gradient on error with respect to the weights as well as ‘gain’ values in minimizing the error function. The main advantage of this new procedure is that it is easy to implement into other faster optimization algorithms such as conjugate gradient method and Quasi-Newton method. The pperformance of the proposed method implemented into conjugate gradient method and Quasi-Newton method is demonstrated by comparing the simulation results to the neural network toolbox for the chosen benchmark. The results show that the proposed method considerably improves the convergence rate significantly faster the learning process of the general back propagation algorithm because of it new efficient search direction

Cause and effect prediction in manufacturing process using an improved neural networks

The limitations of the existing Knowledge Hyper-surface method in learning cause and effect relationships in the manufacturing process is explored. A new approach to enhance the performance of the current Knowledge Hyper-surface method has been proposed by constructing midpoints between each primary weight along each dimension by using a quadratic Lagrange interpolation polynomial. The new secondary-weight values, generated due to the addition of midpoints, were also represented as a linear combination of the corresponding primary/axial weight values. An improved neural networks in learning from examples have also been proposed where both of the proposed algorithms able to constrain the shape of the surface in two-dimensional and multidimensional cases and produced more realistic and acceptable results as compared to the previous version. The ability of the proposed approach to models the exponential increase/decrease in the belief values by using high-ordered polynomials without introducing 'over-fitting' effects was investigated. The performance of the proposed method in modelling the exponential increase/decrease in belief values was carried out on real cases taken from real casting data. The computed graphical results of the proposed methods were compared with the current Knowledge Hyper-surface and neural-network methods. As a result, the proposed methods correctly predict the sensitivity of process-parameter variations with the occurrence of a defect and very important area of research in a robust design methodology

Cause and Effect Prediction in Manufacturing Process Using an Improved Neural Networks

The limitations of the existing Knowledge Hyper-surface method in learning cause and effect relationships in the manufacturing process is explored. A new approach to enhance the performance of the current Knowledge Hyper-surface method has been proposed by constructing midpoints between each primary weight along each dimension by using a quadratic Lagrange interpolation polynomial. The new secondary-weight values, generated due to the addition of midpoints, were also represented as a linear combination of the corresponding primary/axial weight values. An improved neural networks in learning from examples have also been proposed where both of the proposed algorithms able to constrain the shape of the surface in two-dimensional and multi-dimensional cases and produced more realistic and acceptable results as compared to the previous version. The ability of the proposed approach to models the exponential increase/decrease in the belief values by using high-ordered polynomials without introducing ‘over-fitting’ effects was investigated. The performance of the proposed method in modelling the exponential increase/decrease in belief values was carried out on real cases taken from real casting data. The computed graphical results of the proposed methods were compared with the current Knowledge Hyper-surface and neural-network methods. As a result, the proposed methods correctly predict the sensitivity of process-parameter variations with the occurrence of a defect and very important area of research in a robust design methodology.

Prevalence of needle stick injuries and compliance to infection control guidelines among health care workers in a teaching hospital, Malaysia

Introduction: Health care workers (HCW) are constantly exposed to blood-borne illnesses through needle stick injuries (NSI). Despite the increasing trend of NSI, evidence regarding the actual practice of universal precautions among these HCWs is lacking. This study assessed the practice of universal precautions towards prevention of NSI among HCWs in a teaching hospital setting. Methods: This cross-sectional survey involved a newly-designed self-completed questionnaire assessing demographic data, exposure to NSI and practice of universal precautions. Questionnaires were distributed to every ward and completed questionnaires were collected after a period of 7 days. Results: A total of 215 HCWs responded to the survey. 35.8% were exposed to bodily fluid, with 22.3% had NSI in the last 12 months. Blood taking was the commonest procedure associated with NSI. Of practices of universal precautions, recapping needle and removing needle from syringe were still wrongly practiced by the HCWs assessed. Conclusion: NSI among HCW are still common despite the introduction of universal precautions in our hospital. Incorrect practices in handling sharps should be looked into in order to reduce the incidence of blood-borne illnesses through NSI in the hospital

Clinical features and risk factors for HIV encephalopathy in children

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology / Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n=10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group

A malnourished post-stroke man with multi-morbidity and sarcopenia risk in a long-term stroke clinic: A case report

A 78-year-old post-stroke man with multiple comorbidities who was activity of daily living-dependent developed aspiration pneumonia associated with nasogastric tube (NGT) blockage. He presented with malnutrition and risk of sarcopenia with hypoalbuminaemia, small calf circumference (CC), low body mass index and small mid upper arm circumference. He showed symptoms of moderate-to-severe vascular dementia with behavioural psychological stress disorder, resulting in carer stress. Psychoeducation among the carers and referral to a neuro-psychiatrist were ensued after outpatient-based team meeting discussion. Herein, we highlight the importance of screening for sarcopenia and nutritional status in post-stroke patients with the use of the CC and serum albumin level as well as the involvement of a multidisciplinary team in the primary care setting to improve patient outcomes. Percutaneous endoscopic gastrostomy tubes are more suitable than NGTs for post-stroke patients who require enteral feeding to improve the nutritional status