Diabetes empowerment scores among type 2 diabetes mellitus patients and its correlated factors: a cross-sectional study in a primary care setting in Malaysia

Background: There are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting. Aim: To assess the diabetes empowerment scores and its correlated factors among type 2 diabetes patients in a primary care clinic in Malaysia. Methods: This is a cross sectional study involving 322 patients with type 2 diabetes mellitus (DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale (DES) questionnaire was used to measure patient empowerment. It consists of three domains: (1) Managing the psychosocial aspect of diabetes (9 items); (2) Assessing dissatisfaction and readiness to change (9 items); and (3) Setting and achieving diabetes goal (10 items). A score was considered high if it ranged from 100 to 140. Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores. Results: The median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range (IQR) = 10]. The median scores of the three subscales were 40 with (IQR = 4) for "Managing the psychosocial aspect of diabetes"; 36 with (IQR = 3) for "Assessing dissatisfaction and readiness to change"; and 34 with (IQR = 5) for "Setting and achieving diabetes goal". According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level (P < 0.001), diabetes education exposure (P = 0.003), lack of ischemic heart disease (P = 0.017), and lower glycated hemoglobin (HbA1c) levels (P < 0.001). Conclusion: Diabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1c

Breastfeeding practice, support, and self- efficacy among working mothers in a rural health clinic in Selangor

Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed. This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22. Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p <0.01). Age, religion, ethnicity, educational level and place of employment were found to be not associated with breastfeeding practices. Conclusion: This study highlights the importance of workplace support and self-efficacy with workplace breastfeeding practices. Policymakers and stakeholders should provide a conducive and supportive environment to enhance breastfeeding among working mothers

Healthcare professionals’ views for the content of the teddy bear hospital for a child sexual abuse prevention module

Worldwide studies have reported a drastic increase in child sexual abuse (CSA) involving very young children. In Malaysia, several attempts have been made to combat this problem via educational programs. Teachers have reported a lack of confidence in teaching this topic; hence a less threatening approach is needed. The Teddy Bear Hospital (TBH) is an innovation whereby the children bring their teddies while visiting the volunteers assuming healthcare practitioners’ role. This execution is effective in reducing the children’s anxieties about hospitalization and increasing their health knowledge. Therefore, our objective is to explore healthcare practitioners’ (HCP) views for the content of TBH and its approach as a personal safety module toward preventing CSA. Eighteen in-depth-interviews were conducted. Interviews were thematically analyzed. Participants suggest the TBH method as a good approach to teaching prevention of CSA among preschoolers. Four main themes emerged from this study: (1) educating children about personal safety, (2) moral values and faith as a medium to prevent child sexual abuse, (3) addressing social media use in children, and (4) general approach to content delivery. The involvement of parents is crucial. Addressing moral values and faith and usage of social media platforms are also essential factors to look into

The primary health care performance initiative (PHPCI): issues and challenges for Malaysia as a trailblazer country / Anis Safura Ramli … [et al.]

A strong and robust Primary Health Care system is essential to achieving universal health coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs Profiles (VSP). However, the VSP project requires an honest and transparent data collection and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in support of Primary Health Care reform. This is a huge commitment and can only be materialised if there is a collaborative partnership between Primary Care and Public Health providers. Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and ‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system. This review aims to differentiate between Primary Care, Primary Health Care and Public Health, describe the relationships between the three entities and redefine the role of Primary Care and Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care system

Occupational asthma as a differential diagnosis of adult-onset asthma – a case report

Bronchial asthma causes great morbidity and mortality worldwide. Certain occupations especially those exposed to known triggers of asthma such as animal fur, dusts or solvents may trigger asthma attacks in a previously undiagnosed individual or worsen its’ control in a known asthmatic. This is especially true for adult-onset asthma. This may in turn the health of the affected workers and affect their productivity. Affected workers may be given job reassignment and eligible for medical compensation from Social Security Organisation (SOSCO). This case report will look at how two individuals in very distinct occupation were diagnosed with suspected occupational asthma

Mortality in children under 5: prevalence of congenital malformations and its associated demographic variables

Introduction Congenital malformations (CM) comprise a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin. It has contributed to a significant proportion of infant morbidity and mortality. The aims of this study were to determine the extent and investigate the relationship between CM and its associated demographic variables. Methods Data was extracted from Ministry of Health (MOH) database compiled from the reports on Stillbirth & Under 5 Mortality from year 2013 to 2014. Results Out of 9,827 child death, 2,840 (28.9%) were classified under CM as defined under ICD-10 classification. Majority of those with CMs died at neonatal stage (62.7%) and among mothers aged between 20 to 35 years old (67.3%). The mean age of mothers among CM children was 30.8±6.5 years old. Approximately 5.8%, 6.7% and 3.3 % of total CM were neural tube defects, heart defects and hydrops fetalis respectively. The prevalence of CM in males was 15% higher than females. The difference were evident between CM and age of death of children under 5 years old (p<0.001) as well as between CM and maternal age groups (p<0.001). Conclusions CM is responsible for 28.9% of total causes of child death with higher occurrence of malformation in males. A significantly higher risk of CMs among mother aged between 20 to 35 years old was observed. This emphasises the importance of raising awareness and the need to strengthen appropriate response for surveillance and prevention program of common CM in Malaysia

Effectiveness of pretend medical play in improving children’s health outcomes and well-being: a systematic review

Background The healthcare setting is stressful for many people, especially children. Efforts are needed to mitigate children’s healthcare-related anxiety. Medical play using the Teddy Bear Hospital (TBH) concept can expose children to healthcare settings and help them develop positive experiences in these settings. In this role-playing game, children bring their soft toys and act as parents to the ‘sick’ teddies in a pretend hospital or clinic play setting. The objective of this systematic review is to evaluate the effectiveness of the TBH in improving children’s health outcomes and well-being.Methods We searched the reference lists of included studies from four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) from inception until November 2020. We included pre-post, quasiexperimental and case–control studies, as well as randomised controlled trials (RCTs) that discussed medical play using the TBH concept as an intervention. Studies that involved sick patients and used interventions unlike the TBH were excluded. We assessed the quality of the included studies using the Cochrane Collaboration’s ‘Risk of bias’ tool.Results Ten studies were included in this systematic review. Five specifically investigated the TBH method, while the others involved the same concept of medical play. Only three studies were RCTs. All of the studies report more than one outcome—mostly positive outcomes. Two report lower anxiety levels after intervention. Two found better healthcare knowledge, with one reporting increased feelings of happiness regarding visiting a doctor. Two studies found no change in anxiety or feelings, while another two found increased levels of fear and lowered mood after the medical play (which involved real medical equipment).Conclusions The practice of TBH has mostly positive outcomes, with lower anxiety levels and improved healthcare knowledge. Its effectiveness should be verified in future studies using a more robust methodology.PROSPERO registration number CRD42019106355

Factors associated with motivation to volunteer among lecturers in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

Introduction: Volunteerism is an act that should be encouraged especially among the medical and health sciences community. In this study the motivation to volunteer among lecturers and its associated factors were assessed. Materials and Methods: This is a cross-sectional questionnaire study involving 91 lecturers who fulfilled the inclusion and exclusion criteria in the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (FMHS, UPM) between May and July 2018. The Voluntary Function Inventory (VFI) was used to evaluate the motivations to volunteer. It consists of six subscales; values, understanding, social, career, protective, enhancement. Scoring is on a Likert scale of 1 to 7. Higher scores of each subscale indicates higher motivation. Results: The proportion of lecturers who do voluntary work is 85.7%. There were no significant association between the socio-demographic factors and volunteerism. The younger age group had a significant association with “career” subscale (median score = 4.6(IQR=1.8)) compared to the older age group (median score = 3.4(IQR=2.7)) (p=0.047). Female lecturers scored significantly higher for “protective” subscale (median score = 4.6(IQR=19)) compared to male lecturers (median score = 3.8 (IQR=2.6)) (p=0.021). Those who volunteered scored significantly higher for “values” subscale compared to those that didn’t volunteer, with a median scores of 5.9 (IQR= 0.8) and 5.4 (IQR 1.1) respectively, (p=0.027). There were no significant association between ethnicity and the income with other subscales. Conclusion: The motivations to volunteer for “career motive” were higher for the younger lecturers. Female lecturers scored higher for “protective motive.” Lecturers who were volunteers scored higher for “value motives” as compared to those who were non-volunteers

The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up : a cluster randomized controlled trial

Background: Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants’ emotions (attention-control). Methods: VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect. Results: Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1–2.5, respectively), significantly more in the attention-control group [adjusted difference −0.6, 95% confidence interval (CI) −1.1, −0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0–200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ. Conclusions: Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified. Trial registration: NCT02730078; NMRR-15-1144-24803

Study Protocol : an exploration of health professional support for breastfeeding - a primary care study

Even though there has been substantial evidence on the benefits of breastfeeding, Malaysia has one of the lowest rates of breastfeeding in Asia. The Malaysia Third National and Health Morbidity Survey (NHMS III) 2006 showed that less than 155 of infants below six months were breastfed exclusively in 2006; and the prevalence of continued breastfeeding up to two years old in Malaysia was 37.4% which is among the lowest compared to the prevalence in other countries in South East Asia. The role of health professionals in promoting and supporting breastfeeding has been increasingly emphasized. However, data on health professional's perspectives on breastfeeding in Malaysia has been lacking. The aim of this study is to understand health professionals' perspectives on breastfeeding, their knowledge and attitudes towards breastfeeding and their self-efficacy in dealing with breastfeeding issues, as well as perceived barriers to providing support and issues around breastfeeding education