Missing an osteoporotic vertebral fracture.

This case illustrates an 80-year-old lady who presented with acute low back pain and finally succumbed from complications of osteoporotic vertebral fracture. Among the contributing factors are delayed diagnosis and a lack of continuity of care. It reminds the practitioners of the importance to look out for red flag symptoms and to have a high index of suspicion for vertebral fracture in high risk patients presenting with low back pain

Prevalence of rubella susceptibility among pregnant mothers in a community-based antenatal clinic in Malaysia: A cross-sectional study.

Introduction: Routine rubella antibody screening is not done for antenatal mothers in community health clinics in Malaysia. However, congenital rubella syndrome has persisted with its associated health burden. Objectives: To determine the prevalence of rubella susceptibility among pregnant mothers and its associated risk factors. Methodology: A cross-sectional study was carried out in the Petaling district, Selangor, Malaysia, where 500 pregnant mothers were recruited, and face-to-face interviews were conducted. Rubella IgG tests were performed. Results: The prevalence of rubella susceptibility among pregnant mothers was 11.4%. Using logistic regression, a history of not having received rubella vaccination or having unknown rubella vaccination status was found to be a significant predictor for mothers to be rubella susceptible (odds ratio = 2.691; 95% confidence interval = 1.539-4.207). Conclusions: Routine rubella IgG screening tests need to be offered to all antenatal mothers in view of the high prevalence found

Quality of care for adult Type 2 diabetes mellitus at a University Primary Care Centre in Malaysia.

Background: Type 2 Diabetes Mellitus (T2D) with its concurrent cardiovascular risk factors such as hypertension and dyslipidaemia and its complications has now accounted for the majority of national and global morbidity and mortality. Aims & Objective: The study aimed to determine the prevalence of complications appearing in diabetic patients despite therapy, addressing to an urban academic primary care centre. Methods: This was a sub-analysis of a cross-sectional study on 212 patients with Type 2 diabetes mellitus (T2D) conducted from June to September 2006. Patients aged ≥ 30 years, non-smokers and under follow-up care of senior doctors were recruited. The average of the three most recent readings of fasting plasma sugar, HbA1c, systolic and diastolic blood pressure, and lipid profiles was taken as measures of respective disease control. Results: Two thirds of the patients were female. The mean age was 62.7 (SD± 10.8) years and the duration of T2D was 11.74 (SD± 6.7) years. A total of 23.6% achieved HbA1c ≤ 7.0%, 26.2% attained LDL-C ≤ 2.6 mmol/L and 24.5% achieved target blood pressure < 130/ 80 mmHg. The most prevalent co-morbid condition was hypertension (77.3%). A total of 27.2% patients had diabetic complications, out of which 86.5% had one complication. Proteinuria < 1gm/L and coronary artery disease were the two most common complications. There were only 16% on subcutaneous insulin and this was significantly associated with fasting plasma glucose (t = 5.38, df= 204, p < 0.0001) and HbA1c (t = 4.31, df= 206, p < 0.0001). Conclusions: Many T2D patients at this centre did not achieve treatment goals. Insulin and lipid-lowering drugs use should be optimized to improve control rates. More structured care processes are urgently needed in order to achieve good glycaemic control

Menstrual-Related Attitudes and Symptoms Among Multi-racial Asian Adolescent Females

Abstract Background Menstruation has important implications on the physical and emotional well-being of adolescents&apos; reproductive health. Purpose This study aimed to investigate the perception towards menstruation and premenstrual syndrome (PMS), to provide insight into menstrual-related education information in order to help adolescent girls manage the physical and psychological changes associated with menstruation. Methods This cross-sectional study included 1,092 adolescent females from 94 schools in the Federal Territory of Kuala Lumpur, Malaysia. A self-administered semistructured questionnaire was used in the data collection. Results The results showed the mean scores on the menstrual attitude questionnaire to be 2.80 (SD ±1.88) out of six. A total of 80.7% and 83.6% of the participants experienced one or more affective and somatic symptoms respectively in the premenstrual phase. Irritability, mood swing and tension were the three most frequently reported affective symptoms, while fatigue and menstrual cramps were highly prevalent somatic symptoms in both the premenstrual and menstrual phases. The effects on functional impairment and quality of life, in order of importance, include poor class concentration, restriction of social and recreational activities, difficulty to mingle with friends, and poor class performance. Despite the evident impact, only 10.3% of adolescent girls consulted doctors for PMS symptoms, while one-third did nothing about their condition. There were ethnic differences in the seeking of treatment for PMS. Conclusion The study calls for an education program related to PMS and menstrual-related disorders to provide information and support to adolescents. This will help them to cope better with menstrual-related problems, and encourage positive attitudes to menstruation

Chronic respiratory disease in low-income and middle-income countries: From challenges to solutions

In 2019, the British Thoracic Society (BTS) launched a Global Health Group in partnership with the Pan African Thoracic Society (PATS). Each year, this group proposes a symposium at the BTS Winter meeting exploring issues of respiratory disease and care which are most relevant to respiratory health across the life course in low- and middle-income countries (LMICs). The first symposium, offered in February 2021, described the burden of five key respiratory exposures/diseases of interest in LMICs, including childhood pneumonia, air pollution, post-TB lung diseases, asthma, and chronic obstructive pulmonary disease, and a summary of the discussion has previously been published in the PATS journal. The second symposium, conducted in November 2021, discussed barriers to the management of chronic respiratory diseases (CRDs) in LMICs, with perspectives presented from Malaysia, The Gambia, Kenya, and sub-Saharan Africa more broadly. These presentations highlighted the challenges of chronic respiratory care in LMICs, while a presentation from the World Health Organization (WHO) officer for CRDs described the role and remit of the WHO in providing leadership and guidance in this area. A summary of this second symposium is presented here, and we discuss the pathways from challenges to solutions for CRD care in low- and middle-income countries

The impact of caregiving on caregivers of older persons and its associated factors: A cross-sectional study

Introduction Many older people rely on caregivers for care. Caregiving for older people could pose significant burdens on caregivers yet may also have positive effects. This study aimed to assess the impact of caregiving on caregivers and to determine the associated factors of caregivers who were burdened. Methods This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers aged > 21 years and who provided at least 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire which included The COPE Index and the EASY-Care Standard 2010 Independence Score. The COPE Index was used to assess the impact of caregiving. A caregiver who was highly burdened is one who scores for all three COPE subscales were positive for burden. Care-recipients' independence was assessed using the Independence Score of the EASY-Care Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden. Results Seventy three (19%) caregivers were burdened, of which two were highly burdened. The median scores of the positive value, negative impact and quality of support scales were 13.0, 9.0, and 12.0 respectively. Care-recipients' median independence score was 18.0. Ethnicity and education levels were found to be factors associated with caregiver burden. Conclusions Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with caregiver being burdened

Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations

Chronic obstructive pulmonary disease; Discharge protocol; ExacerbationMalaltia pulmonar obstructiva crònica; Protocol d'alta; ExacerbacióEnfermedad pulmonar obstructiva crónica; Protocolo de alta; ExacerbaciónDischarge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient’s discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation.This article was funded by AstraZeneca

Chronic respiratory disease in low-income and middle-income countries: From challenges to solutions

In 2019, the British Thoracic Society (BTS) launched a Global Health Group in partnership with the Pan African Thoracic Society (PATS). Each year, this group proposes a symposium at the BTS Winter meeting exploring issues of respiratory disease and care which are most relevant to respiratory health across the life course in low- and middle-income countries (LMICs). The first symposium, offered in February 2021, described the burden of five key respiratory exposures/diseases of interest in LMICs, including childhood pneumonia, air pollution, post-TB lung diseases, asthma, and chronic obstructive pulmonary disease, and a summary of the discussion has previously been published in the PATS journal. The second symposium, conducted in November 2021, discussed barriers to the management of chronic respiratory diseases (CRDs) in LMICs, with perspectives presented from Malaysia, The Gambia, Kenya, and sub-Saharan Africa more broadly. These presentations highlighted the challenges of chronic respiratory care in LMICs, while a presentation from the World Health Organization (WHO) officer for CRDs described the role and remit of the WHO in providing leadership and guidance in this area. A summary of this second symposium is presented here, and we discuss the pathways from challenges to solutions for CRD care in low- and middle-income countries