Reframing services for Malaysian students in schools: time to bring occupational therapy into the classroom

Autism spectrum disorder is a developmental disability that has gained increasing attention in Malaysia. Much effort is now being taken to include children with autism spectrum disorder in the school system, either in inclusive settings or in special educational settings. However, this endeavor raises many challenges for the children with autism spectrum disorder, their families and for service providers. The current study uses a qualitative approach to investigate parents’ perceptions of problems faced by their children with autism spectrum disorder in issues related to academic skills. A face-to-face interview was performed with parents of children with autism spectrum disorders who were receiving occupational therapy services for their difficulties in academic related skills. Findings indicate that most of the difficulties faced by these children are related to skills needed to be accepted at school, such as ability to communicate and socialize and this often limit their performance at school. These findings not only raise and discuss important implications for service providers such as teachers, health care professionals and policy makers, but also lead to suggestions for future research

Adaptation, validation and reliability testing of sensory processing measure home form Malay version for children with autism

Inappropriate responses towards sensory input received from the environment, also known as sensory processing difficulties (SPD) may affect daily living activities of the children with Autism Spectrum Disorder (ASD). Sensory Processing Measure Home Form (SPM Home Form) as a parent report measure for SPD is available in English and other foreign languages. To enhance the applicability and meaningfulness of SPM Home Form for the Malay speaking population, a study that focuses on translating, adapting, and validating the SPM Home Form into the Malay language was conducted. The development of the Malay version of the SPM Home Form (SPM-MV Home Form) involved three steps: 1) Item evaluation, 2) Forward and backward translation, and 3) Expert review and content validity. The process of translation and adaptation of the form was performed according to standard guidelines. No item was excluded from the original SPM Home Form as all the items were considered by the expert panel as appropriate and relevance to evaluate the activity and social participation among children in Malaysia. Content validity as measured by 10 experts in occupational therapy is high. The mean of sub-scales I-CVI is between 0.96 and 1.00. The total S-CVI of the form is 0.95 with sub-scales S-CVI range between 0.82 and 1.00. Cronbach’s alpha for internal consistency was reported at 0.80 and ICC for test-retest reliability ranged from 0.80 to 0.97. The SPM-MV Home Form has high potential to be used for assessing SPD among children ages 5-12 years in Malaysia

Cabaran dalam pembelajaran kursus neurologi, strategi mengatasinya dan cadangan penambahbaikan dalam kalangan pelajar sains rehabilitasi di Universiti Kebangsaan Malaysia

Neurologi telah dikenalpasti sebagai kursus yang mencabar dalam pengajian perubatan dan sains kesihatan. Persepsi pelajar perlu diterokai bagi mengenalpasti isu berkaitan pembelajaran kursus neurologi. Namun, kajian melibatkan pelajar sains rehabilitasi masih terhad. Kajian kualitatif ini bertujuan meneroka persepsi pelajar sains rehabilitasi terhadap kursus neurologi dan pembelajarannya di Universiti Kebangsaan Malaysia (UKM). Sejumlah 12 pelajar cemerlang dari empat disiplin sains rehabilitasi iaitu fisioterapi, terapi cara kerja, sains pertuturan serta audiologi telah menyertai kajian ini. Semua peserta menjalani perbincangan kumpulan fokus (PKF) selama satu jam dan sebanyak dua sesi di satu bilik senyap di Fakulti Sains Kesihatan, UKM. Sesi PKF dilaksanakan oleh seorang penyelidik pelajar terlatih dan menggunakan protokol temubual yang telah diuji. Skop perbincangan merangkumi persepsi terhadap kursus neurologi, cabaran dalam proses pembelajarannya dan strategi bagi mengatasi cabaran. Data terakam dari PKF ditranskripsi secara verbatim dan dianalisis menggunakan pendekatan analisis bertema. Hasil analisis menunjukkan neurologi sememangnya dianggap kursus paling sukar dalam pengajian sains rehabilitasi. Cabaran yang dihadapi pelajar termasuklah melalui sesi kuliah yang membosankan, sesi amali yang tidak mencukupi, cabaran sepanjang penempatan klinikal dan situasi peperiksaan yang mencabar. Peserta kajian menggunakan beberapa strategi tersendiri bagi mengatasi cabaran yang dialami. Penambahbaikan terhadap beberapa aspek pengajaran telah dicadangkan bagi mengurangkan cabaran dan tahap kesukaran kursus neurologi. Kesimpulannya, neurologi dilihat sebagai kursus yang mencabar dan pendekatan pengajaran sedia ada perlu ditambahbaik bagi meningkatkan keberhasilan pembelajaran kursus ini

Does neurophobia exist among rehabilitation sciences students? A survey at Universiti Kebangsaan Malaysia

Neurophobia, defined as ‘the fear of neural sciences and neurology’ is reported among medical students, which threatened their performance in neurology course. This phenomenon has not been studied among rehabilitation sciences students despite the significance of neurology as an area for rehabilitation. In this study we aim to assess the perceptions of neurology course and the possibility of neurophobia existence among rehabilitation sciences students of Universiti Kebangsaan Malaysia (UKM). We also aimed to identify learning methods which are regarded as useful among the students. A survey using self-administered questionnaires was conducted among 73 students from School of Rehabilitation Sciences of the university. Questions in the questionnaire were adapted from previous studies, in which neurophobia was indicated by poor knowledge and low confidence level in managing neurology course. Results showed that the percentage of participants who perceived having good knowledge of neurology was significantly higher than the percentage who claimed of having poor knowledge level (90.4% versus 9.6%, p < 0.01). Similarly, the percentage of participants who claimed having high confidence to handle neurology cases was higher than the percentage who expressed lack of confidence (79.2% versus 20.8%, p = 0.03). However, neurology course was perceived as difficult by majority of the participants (78.1%) when compared to other courses. Majority of the participants (97.3%) perceived clinical teaching as a useful method of learning rehabilitation science courses including neurology followed by problem-based learning (90.4%). While limited exposure to neurology cases was claimed as the main reason to why neurology is difficult. In conclusion, although neurology is perceived as a difficult course among rehabilitation sciences students, the students did not report lack of knowledge and confidence in the course. This implies that neurophobia does not exist among UKM rehabilitation students. Enhancement of learning methods may assist in reducing the level of difficulty of neurology course among the students

Cultural adaptation and validation of the performance assessment of self-care skills among older people in community

The Performance Assessment of Self-care Skills (PASS-Home) is a client-centered, performance-based, criterion-reference, observational form designed to capture client’s performance skills in completing daily task activities. The aim of the study was to describe the process of translating, adapting and validating the PASS-Home from English language version into a Malay language version. The development of the translated Malay version of the PASS-Home consisted of two stages. Stage one involved the exclusion of the items that were not culturally relevant to the Malaysian culture. Stage two involved the translation process. The five steps of the cross-cultural adaptation process were followed: (1) initial forward version; (2) a summary of recommendations by the expert panels; (3) the back-translation; (4) modifications of the translated Malay version of PASS and a summary of problems found during the pre-testing, and (5) the final version of the PASS Malay Version (M-PASS). A total of five items from the PASS-Home were omitted in the Malay version (M-PASS) and another five items that were considered as suitable in Malaysian context were added in the M-PASS. The Content Validation Index (CVI) showed perfect agreement with an average of I-CVI was reported at 0.99 and S-CVI/universal agreement (S-CVI/UA) was at 0.93. Test-retest reliabilty showed that the M-PASS were highly reliable reported of its three main constructs of Independence (ICC=0.706), Safety (ICC=0.906) and Adequacy (ICC=0.950). M-PASS showed strong evidence as a valid and reliable assessment in evaluating the functional level of older people who live independently in community

Cultural adaptation and validation of the performance assessment of self-care skills among older people in community

The Performance Assessment of Self-care Skills (PASS-Home) is a client-centered, performance-based, criterion-reference, observational form designed to capture client’s performance skills in completing daily task activities. The aim of the study was to describe the process of translating, adapting and validating the PASS-Home from English language version into a Malay language version. The development of the translated Malay version of the PASS-Home consisted of two stages. Stage one involved the exclusion of the items that were not culturally relevant to the Malaysian culture. Stage two involved the translation process. The five steps of the cross-cultural adaptation process were followed: (1) initial forward version; (2) a summary of recommendations by the expert panels; (3) the back-translation; (4) modifications of the translated Malay version of PASS and a summary of problems found during the pre-testing, and (5) the final version of the PASS Malay Version (M-PASS). A total of five items from the PASS-Home were omitted in the Malay version (M-PASS) and another five items that were considered as suitable in Malaysian context were added in the M-PASS. The Content Validation Index (CVI) showed perfect agreement with an average of I-CVI was reported at 0.99 and S-CVI/universal agreement (S-CVI/UA) was at 0.93. Test-retest reliabilty showed that the M-PASS were highly reliable reported of its three main constructs of Independence (ICC=0.706), Safety (ICC=0.906) and Adequacy (ICC=0.950). M-PASS showed strong evidence as a valid and reliable assessment in evaluating the functional level of older people who live independently in community

Self-care skills between institutionalised and home dwelling older adults: a preliminary study

Self-care is defined as activities performed by individuals, families, and communities to enhance their health, prevent diseases, limit illnesses, and restore health. Previous research has mainly focused on self-care skills of older adults in either institution or residential homes separately but limited studies have compared between both these settings. This study aimed to compare the self-care skills between institutionalised and home dwelling older adults at selected area in Malaysia. A total of 43 participants aged 60 years old and above were recruited in our study; (23 participants were home-dwelled older adults and 19 participants were recruited from institutionalised older adults located in Kuala Lumpur). The Malay Version of Performance Assessment of Self-Care Skills (M-PASS-HOME) 4.0 was used focusing on four main subtests of self-skills; oral hygiene, trimming toenails, house mobility and shower mobility. The differences in self-care skills between institutionalised and home dwelling older adults are statistically significant (p<0.01) in the aspects of independency for all self-care activities. The results of this study revealed that home dwelling older adults group are more independent in self-care activities of oral hygiene, trimming toenails, house mobility and shower mobility compared to institutionalised group

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Review on the effects of occupational therapy intervention in improving handwriting skills among preschool children

The development of writing ability is not only important in building a child’s self-esteem, but also essential for academic success in school. Handwriting is an important skill that could affect students’ performance in most academic areas. This study aimed to review the effect of occupational therapy intervention in improving handwriting skills among preschool children. Relevant studies were systematically searched by using standardized keywords across three databases. The initial search identified 1,386 references. Of these studies, there were five quantitative studies that met the inclusion criteria and were methodologically appraised using the McMaster Critical Review Form–Quantitative Studies. All studies reported that preschool children with or without disabilities showed significant improvements in handwriting skills after receiving occupational therapy intervention. One study involved collaboration between teachers and occupational therapists in implementing intervention program to preschool students. Collaboration between teachers and occupational therapists was able to provide teachers with tools and skills that they can use to help students, with or without direct presence of occupational therapists. Overall, findings of this review indicated that preschool children could gain improvement in handwriting skills regardless of their conditions after receiving occupational therapy intervention programs