A QUALITATIVE STUDY EXPLORING THE IMPACT OF STIGMA IN THE LIVES OF ADULT ASTHMA PATIENTS IN SELANGOR MALAYSIA

Objective: This study aimed to address and explore the issue of stigmatization and its dynamics in asthma patients from hospital and community pharmacy settings.Methods: The qualitative study approach was used to explore the issues of stigma thoroughly and deeply in asthma patients. In this study, eighteen adult asthma patients were approached for interview from two different healthcare service settings i.e. academic hospital and community pharmacy from Selangor, Malaysia. Patients' responses were recorded manually as well as electronically. The tapes were verified for accuracy of transcription. Data obtained was coded independently for the relevant themes.Results: The majority of the interviewees were Malays i.e. 10, 55.6% and remaining 5 (27.7%) and 3 (16.7%) were Indians and Chinese respectively. The mean±SD age of the patients was 49.3 (±11.02) and among these majority were females (n=12, 66.7%). The main findings of study defined three main themes that included stigma of asthma in terms of extent of disclosure about diagnosis status; discrimination felt in the society; patients' feelings affected by stigma and different ways adapted to tackle stigma of asthma.Conclusion: The patients' experiences of stigmatization were common in both study settings i.e. community pharmacy and hospitals. The patients' adaptation to asthma needs to be given an in-depth consideration to deal the psychosocial concerns of stigma. The support from the healthcare professionals, family members, friends and co-workers is the right strategy and way forward to improve psychosocial wellbeing of the asthma patients.Â

STIGMA IN THE LIVES OF ASTHMA PATIENTS: A REVIEW FROM THE LITERATURE

The main purpose of this review article is to synthesize the empirical literature on stigma and how stigma affects the lives of asthma patients. Limited search and strong evidence from the asthma management guidelines and news coverage conveying stigmatizing or destigmatizing messages are the provoking factors to write this review. The stigma associated with asthma is one of the important contributing factors for frequent patient anxieties, delayed diagnosis, denial and limited disclosure of being asthmatic, limited physical activity and avoidance of inhaler use in public.Pubmed (Medline), PsycInfo, Science Direct, Sage Pub and Wiley databases were used to review the work done to date on measuring stigma related to asthma by using the key terms of stigma and asthma combined with stigmatization/stigmatisation, questionnaire and scale. In addition, Google search engine was used to search the national and international guidelines, newspapers and related work done on stigma of asthma that was beyond the scope of publication by research databases. No time limit was used for the year of publication to address the issue of stigma thoroughly and deeply.In total 452 research articles were identified that addressed different dynamics of stigma by using the combination of a forementioned search keywords. Out of these 39 studies were included in this review addressing specifically the asthma related stigma. From these, four studies aimed to develop the questionnaire for the direct assessment of stigma in asthma patients. These instruments required rigorous validation and reliability assessment in the different population. The stigma of asthma has adverse consequences in the lives of asthma patients. Therefore, a vigorously validated and good reliable instrument is required to be developed to understand the dynamics and underlined causes of stigma of asthma in a comprehensive way. The instrument that can reflect and capture the phenomenon of stigma in asthma patients more accurately, may be served for more effective stigma reduction interventions and comparing stigma intensity in diverse populations and communities. Following the review, suggestions were made for future workplace anti-stigma interventions and evaluation for such intervention programs. Furthermore, stigma in the lives of asthma patients is the area for future research and actions for health care professionals and clinical researchers for better asthma management programs.Â

A REVIEW OF HEALTH OUTCOME INSTRUMENTS FOR ASTHMATIC CHILDREN & THEIR CAREGIVERS

There are various developed general-as well as disease-or condition-specific health outcome instruments to assess an impact of asthma among asthmatic children but few of these instruments were developed in paired versions of child and caregiver. The objective of this review was to determine currently available unpaired and paired health outcome instruments for asthmatic children and their caregivers. Systemic search from Medline, Scopus and Science Direct was conducted to identify asthmatic children's and their caregivers' health outcomes tracking instruments that characterize basic properties of instruments such as instrument's developer and the published year, instrument's description, targeted age and time for completion, items and domains, administration way, scoring and scaling of instrument, type of study setting, tested sample size, availability of instrument in different languages, reliability and validity of the instrument. The results showed in total, 21 instruments were identified whereby 16 of them were administered by either asthmatic children or their caregivers, and remaining (n = 5) have paired version that was administered directly to both asthmatic children and their caregivers. Most of these instruments reported good validity and reliability (Cronbach's alpha between 0.60-0.95). There is a need to develop more paired disease-specific health outcome instruments targeted both asthmatic children and their caregivers to get full data of the impact and burden of asthma and its health intervention on the respective respondents.Â

PROGNOSIS IN ADVANCED NON-SMALL CELL LUNG CANCER - A RETROSPECTIVE STUDY EXAMINING ECOG PERFORMANCE STATUS SCORES OF PATIENTS

  Objective: Increasing prevalence and poor survival of advanced incurable non-small cell lung cancer (NSCLC) make it a major health problem globally, especially in developing countries. This awakens need for identification of the strongest prognostic factor that helps in the selection of appropriate treatment and hence palliates symptoms and improves survival. Lung cancer treatment guidelines advise performance status (PS) as the most established prognostic factor in advanced NSCLC patients. This study investigated the prognostic significance of PS.Methods: An observational study was done for 163 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic, Hospital Kuala Lumpur, Malaysia. Demographic and clinical data were recorded. Kaplan-Meier test was used to measure median overall survival (OS) and Cox proportional hazard model to calculate the hazard ratio for different categories of Eastern Cooperative Oncology Group (ECOG) PS.Results: The mean age and body weight were 56.7±10.1 years old and 57.42±13.5 kg, respectively. Majority patients were male (68.7%), Stage IV NSCLC (65.0%), and ECOG PS score of 2 (41.1%). ECOG PS had a significant association with age and body weight. Median OS was least for ECOG PS score of 4 (253 days) and was statistically significant (p=0.003). ECOG PS was a significant independent prognostic factor for survival in advanced NSCLC patients (p<0.001).Conclusion: PS is a strong prognostic factor in advanced NSCLC

SMOKING STATUS AFFECTING SURVIVAL OF ADENOCARCINOMA LUNG CANCER PATIENTS IN KUALA LUMPUR, MALAYSIA

  Objective: Adenocarcinoma (AC) of the lung is now the most common histologic type of non-small cell lung cancer (NSCLC) worldwide since the past 20 years. This study was conducted to investigate survival difference among smoker and non-smoker lung AC patients.Methods: A retrospective observational study was conducted for 81 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic at Hospital Kuala Lumpur, Malaysia. A total of adult 30 Malaysian smokers and 51 non-smokers with lung AC were included. Ex-smokers were not included in the study. Demographic and clinical data were collected and described. For survival analysis, Kaplan–Meier test and log-rank test were used to calculate overall survival (OS) and analyse the difference in the survival curve. Cox proportional hazard model was used to identify prognostic significance of smoking status.Results: Non-smokers showed a significant association with female gender and Stage IV NSCLC. The median OS was higher for non-smokers (493 days) as compared to smokers (230 days). The Cox proportional hazard model showed higher hazard ratio for smokers.Conclusion: Non-smoking is an independent positive prognostic factor in lung AC

Barriers to the provision of asthma services and perceived practice towards asthma management among urban community pharmacists in Selangor, Malaysia

This study aims to assess the perceived practice and barriers towards the provision of asthma management services among urban community pharmacists in Selangor, Malaysia. The study also highlights both pharmacist and patient-related barriers in asthma counseling. One hundred fifty urban community pharmacists in Selangor, Malaysia, were randomly selected and recruited for the present cross sectional baseline study. Previous studies have explored pharmacists’ perception on their roles in asthma management in different parts of the world. The data was collected through self-explanatory questionnaires (containing 47 items). The extracted data from the completed questionnaires were analyzed descriptively and inferentially using Statistical Package for Social Science (SPSS) version 19. Results showed that pharmacists perceived their roles in asthma management along three major dimensions: ‘patient self-management’, ‘medication use’ and ‘asthma control’, mean (±SD) score of the perception towards asthma management was 99.29 ± 4.58 over a maximum possible score of 110 with 90.26%. There were significant differences between the pharmacy education level and perceived practice of asthma management while there were insignificant differences between age, gender, ethnicity, number of practicing year and perceived practice of asthma management among respondents. Most common barriers towards asthma counselling including lack of time, lack of asthma knowledge, lack of counselling space and cost of asthma drugs. Conclusively, urban community pharmacists in Selangor, Malaysia, demonstrate good perceived practice of better management of asthma with multidimensional dimensional role against in disease care

PHYTOCHEMICAL ANALYSIS AND IMMUNO-MODULATORY EFFECT OF MORINGA OLEIFERA FLOWERS

Objective: This study evaluates the anti-inflammatory activities of different solvent extracts of Moringa oleifera flowers using carrageenan-induced mice paw edema.Methods: Soxhlet extraction method was employed in this study to extract the crude phytochemicals. Phytochemical analysis testing of Moringa oleifera extracts was performed to identify the presence of various phytoconstituents based on the standard procedures. The anti-inflammatory activity was evaluated using acute inflammatory model carrageenan-induced paw edema. Three different flower extracts (petroleum ether, chloroform and methanol) of Moringa oleifera at the dose level of 500 mg/kg body weight. The anti-inflammatory activity on the different extracts of Moringa oleifera was determined through the α-carrageenan induced left hind paw oedema method in albino mice. 0.05 ml of 1% w/v carrageenan suspension was reconstituted with normal saline (0.9% NaCl) to give a homogenous solution which then be injected into the subplantar tissue of the left hind paw of each mice to induce acute inflammation.Results: Treatment with three different solvent extracts showed significant (p<0.05) inhibition in carrageenan-induced paw edema. Petroleum ether and chloroform extracts were found to be less effective than methanolic extracts when compared to (Indomethacin) reference standard at the dose of 10 mg/kg body weight. The phytochemical results obtained indicates that anti-edematous action of Moringa oleifera flowers exhibited in this study is due to the presence of potent anti-inflammatory phytoconstituents (flavonoid, alkaloid, tannin) in impeding arachidonic acid metabolism and production of reactive free radicals. A significant (p<0.05) increase of left hind paw thickness after the drug injection was noticed in the negative control mice group as time persisted. It showed the highest paw thickness at the fifth hour with 4.72 mm±0.07. Whereas the indomethacin treated group showed the highest percent oedema inhibition amongst all experimental group with 38.60% at the fifth-hour post-carrageenan induction. It exhibited a significant inhibition of 29.02% against the oedema after the third hour of carrageenan injection.Conclusion: The methanolic extract of Moringa oleifera flowers extract has anti-inflammatory activity. This activity was related to the dose and these results collaborate the potential traditional use of the plant in folk medicine

ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE MALAYSIAN VERSION OF PERCEIVED DIABETES SELF-MANAGEMENT SCALE FOR DIABETES MELLITUS

ABSTRACTObjective: The self-management of the chronic illnesses including diabetes mellitus (DM) contributes directly to the optimum outcomes. The selfmanagementofpatients livingwith DMis essential toachieveoptimal glycemiccontrolandtoavoidor forestallthemyriadtomanage thelong-termnegativeconsequences.This studyaimed toassess psychometricpropertiesoftheMalaysianversionofperceiveddiabetesself-management scale(PDSMS).Methods: This cross-sectional study recruited 314 adult diabetes patients (≥18-years-old; DM Type 1 or 2) attending Endocrine Clinic at KualaLumpur Hospital, Malaysia from July 2014 to January 2015, for the period of 6-month. Permission was obtained from the corresponding authorto translate the English version of PDSMS to Malay language (M-PDSMS). The final version of the questionnaire was self-administered among thepatients living with DM after taking their consent before their participation in this study. Psychometric properties were evaluated using the classicaltest theory: Cronbach's alpha (α), intraclass correlation (ICC), and construct validity by principle component analysis and the modern test theory(MTT): Realtime item reliability, person reliability, and item construct validity.Results: M-PDSMS proved to be internally consistent with good Cronbach α values for both pilot and real study (α=0.69, 0.77), respectively. ICC (0.75)for 1-month test-retest reliability proved the stability of the items. While in MTT, the realtime item reliability values also surpassed the good reliabilityindex of 0.70 for both pilot (α=0.93) and real study (α=0.97).Conclusion: M-PDSMS proved to be a valid and reliable questionnaire to assess the perceived diabetes self-management among the Malaysian DMpatients. The findings of the study should be replicated in other states of Malaysia to ensure the retention of good reliability and validity profile.Keywords: Self-management, Diabetes, Perceived diabetes self-management scale, Reliability, Validity, Modern test theory, Classical test theory, Rasch

AWARENESS OF DIABETES MELLITUS AMONG GENERAL PUBLIC IN SHAH ALAM, MALAYSIA: A CROSS-SECTIONAL STUDY

  Objective: Despite the improved healthcare and frequent community-ridden educational awareness campaigns, the prevalence of diabetes is enormously increasing and 50% of the Malaysian adults with diabetes are still unaware of their disease status. Therefore, this study aimed to assess the awareness of diabetes mellitus (DM) among the general public of Shah Alam, Malaysia.Methods: A cross-sectional study was carried out in five urban areas of Shah Alam. A total of 350 participants were conveniently recruited using a pre-validated questionnaire. The questionnaire comprised two main parts, including the sociodemographic characteristics of the respondents and a 24-item Diabetes Knowledge Questionnaire. The data were analyzed by Statistical Package for the Social Science® using descriptive and inferential statistics.Results: The overall mean (±standard deviation) score of DM knowledge of participants was 11.11±6.09. Among 350 respondents, more than half claimed that medication is more important than lifestyle modification in DM management. 81.7% did not know about the frequent urination and thirst are signs of DM. 82.3% had a misconception that diabetes is caused by failure of the kidneys to keep sugar out of the urine. The knowledge score was statistically significant difference across the categories of level of education, monthly income, occupations, and family history of diabetes.Conclusion: Majority of enrolled respondents possessed moderate level of awareness and misconceptions regarding diabetes and its management. Hence, there is a need for collective efforts toward improving the level of awareness through community awareness campaigns, to improve the self-management of DM

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries