Payment methods and patient satisfaction among type-2 diabetes patient at a teaching hospital in Malaysia

Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors’ service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction

Efficient uptake of mannosylated proteins by a human Schwann cell line

Complex carbohydrate structures are essential molecules of infectious microbes and host cells, and are involved in cell signaling associated with inflammatory and immune responses. The uptake of mannose-tailed glycans is usually carried out by macrophages, dendritic cells (DCs), and other professional phagocytes to trigger MHC class I- and MHC class II-restricted antigen presentation, and to promote T cell effector responses. Since Schwann cells (SCs) have been proposed as immunocompetent cells, we investigated whether a human cell line (ST88-14 cells) could bind mannosylated ligands in a specific manner. The saturation of uptake of mannosylated molecules by ST88-14 cells and the internalization and distribution pathway of these ligands were tested by cytometry and confocal plus electron microscopy, respectively. This uptake showed a dose-dependent increase, the saturation point being reached at high concentrations of mannosyl residues/240mM mannose. Merging of man/BSA-FITC and S100 labeling showed their partial, but, significant colocalization. Ultrastructural analysis of ST88-14 cells after incubation with HRP-colloidal gold, without or with subsequent chasing at 37°C, showed an initial location on the cell surface and temperature- and time-dependent internalization of the probe. Our findings suggest an efficient mannosylated ligand uptake system through putative lectin(s) that may be operational in inflammatory and immune responses