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

A clinical audit on the care of adult tuberculosis contacts in a public primary care clinic, Malaysia

The National Clinical Practice Guideline in Tuberculosis (TB) was designed to improve the quality of tuberculosis care. However, it remains unknown whether primary care doctors adhere to it well. This audit aims to assess the quality of care in the process of TB contact tracing in a primary care setting. Methods: Data on TB contact tracing from 1st February 2013 to 15th February 2013 was obtained retrospectively from all medical records of diagnosed pulmonary TB in a public primary care clinic. All patients who fulfilled the inclusion and exclusion criteria were included in the study. Results: A total of 102 medical records of adult TB contacts were recruited. The median age of the TB contact was 34 (IQR=10) years and 65 % were male. Seventy two percent of the adult TB contact had a TBIS 10C3 form created, and 95% of the medical records were fully documented. History taking and physical examination were recorded on 97% and 99% of patients respectively during the first follow-up at the polyclinic. Eighty five percent and 100% of the patients had a chest-x-ray and sputum direct smear for acid-fast bacilli done respectively. The turn-up rate for the first, second, third and fourth visit was 100% to 32%, 10% and 2% respectively. Conclusion: The quality of care for adult TB contacts tracing in this clinical audit was found to be suboptimal. There is a difference between the current national guidelines and practice in the clinic. Certain measures to improve the quality of care for adult TB contact tracing are urgently needed

Delay in diagnosis of lung cancer: a case report

This case report highlights delay in the diagnosis of adenoma carcinoma of the lung in a female patient who has never smoked. It took three months to reach the diagnosis of stage IV lung carcinoma despite the presence of symptoms and an abnormal chest radiograph finding from the beginning. The clinical characteristics and predictors of missed opportunities for an early diagnosis of lung cancer are discussed. In this case, patient and doctor factors contributed to the delay in diagnosis. Thus, early suspicions of lung cancer in a woman with the presence of respiratory symptoms despite being a non-smoker are important in primary care setting

Does use of pooled cohort risk score overestimate the use of statin?: a retrospective cohort study in a primary care setting

BACKGROUND: Initiation of statin therapy as primary prevention particularly in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends initiation of statin by estimating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the new pooled cohort risk score. This paper examines the use of the pooled cohort risk score and compares it to actual use of statins in daily clinical practice in a primary care setting. METHODS: We examined the use of statins in a randomly selected sample of patients in a primary care clinic. The demographic data and cardiovascular risk parameters were captured from patient records in 1998. The pooled cohort risk score was calculated based on the parameters in 1998. The use of statins in 1998 and 2007, a 10-year interval, was recorded. RESULTS: A total of 847 patients were entered into the analysis. Mean age of the patients was 57.2 ± 8.4 years and 33.1% were male. The use of statins in 1998 was only 10.2% (n = 86) as compared to 67.5% (n = 572) in 2007. For patients with LDL 70-189 mg/dl and estimated 10-year ASCVD risk ≥7.5% (n = 190), 60% (n = 114) of patients were on statin therapy by 2007. There were 124 patients in whom statin therapy was not recommended according to ACC/AHA guideline but were actually receiving statin therapy. CONCLUSIONS: An extra 40% of patients need to be treated with statin if the 2013 ACC/AHA blood cholesterol guideline is used. However the absolute number of patients who needed to be treated based on the ACC/AHA guideline is lower than the number of patients actually receiving it in a daily clinical practice. The pooled cohort risk score does not increase the absolute number of patients who are actually treated with statins. However these findings and the use of the pooled cohort risk score need to be validated further

Prevalence and factors associated with mild cognitive impairment on screening in older Malaysians

Objective: This study was aimed to determine the prevalence and predictors of mild cognitive impairments (MCIs) in Malaysia. Method: This is a cross-sectional community-based study among elderlies aged 60 years and above in the four states of Malaysia - Perak, Kelantan, Selangor and Johor. A multi-stage stratified random sampling method was used for the data collection. Mini Mental State Examination score ?22 was used to diagnosed MCI and analyzed by using multivariate logistic regression. Results: A total of 2112 participants were recruited into this study. Mean age of the participants was 69.2±18.8 years, and 51.4% of them were females. The ethnic distribution was 63.4% Malaysian, 31.4% Chinese, 5.0% Indians, and 0.2% others. The overall prevalence of MCI was 68% (n=1436/2112). In multivariate logistic regression analysis, participant who were older (OR 1.02, 95% CI 1.00-1.04), did not receive formal education (OR 6.85, 95% CI 4.58-10.25), had primary education (OR 2.35 95% CI 1.84-3.00), were lonely (OR 1.18 95% CI 1.05-1.32), and had low level of life satisfaction (OR 1.68 95% CI 1.02-2.67), had significant positive correlations with MCI. Conclusion: MCI is present in seven out of ten elderly Malaysians. Aging population, presence of low education level, loneliness and low life satisfaction level seem to facilitate development of MCI

Determinants of left ventricular hypertrophy among elderly hypertensive in Malaysia

Left ventricular hypertrophy (LVH) has high prognostic value on cardiovascular mortality and morbidity. However, echocardiography is not routinely performed among elderly hypertensives in the primary-care setting due to limited resources. The aim of this study was to determine the prevalence of LVH and its associated risk factors in a multi- ethnic elderly hypertensive population in a primary-care clinic in Malaysia. This study was a sub-analysis of a cross-sectional study of 359 patients with hypertension in a primary-care clinic. All test subjects recruited for the study were hypertensive patients aged 60 and above. Blood pressure, height and weight were measured. All patients underwent an echocardiogram examination for diagnosis of LVH. One hundred and ninety-nine patients were studied for the analysis. The mean age and duration of hypertension was 64.8 (SD 2.9) and 10.4 (SD 7.7) years, respectively. The study found that 44.7% of respondents achieved target blood pressure. The prevalence of LVH was 23.6%. Using multiple logistic regression, factors associated with LVH among elderly patients with hypertension were diabetes (odds ratio [OR] 3.346, 95% confidence interval [CI] 1.458-7.676), higher diastolic blood pressure (OR: 1.088; 95% CI: 1.024-1.156), higher body mass index (OR: 1.113; 95% CI: 1.031-1.203) and poorer blood pressure control was 23.6%. Using multiple logistic regression, factors associated with LVH among elderly patients with hypertension were diabetes (odds ratio [OR] 3.346, 95% confidence interval [CI] 1.458-7.676), higher diastolic blood pressure (OR: 1.088; 95% CI: 1.024-1.156), higher body mass index (OR: 1.113; 95% CI: 1.031-1.203) and poorer blood pressure control (OR: 2.924; 95% CI: 1.180-7.258). Poor hypertension control, higher diastolic blood pressure, presence of diabetes and obesity are the predictors for the development of LVH in elderly hypertensive

Validation of an Asian cerebrovascular risk prediction model in multiethnic country population

Objective: The importance of using risk prediction instruments to control cerebrovascular risk factors has been emphasized in most of the latest evidenced-based stroke prevention guidelines. The value of inclusion of stroke in cardiovascular risk prediction instruments are increasingly recognized as part of the outcome cluster. However, the lacking of validation of these cerebrovascular risk models in a multiethnic population limits its use in primary stroke prevention, particular in a multiethnic country. This study aimed to evaluate the validity of the Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score. Design and method: Patients aged 35–59 were randomly selected and included in this 10-year retrospective cohort study. Patient medical records such as baseline demographic characteristics, comorbidities and cerebrovascular risk parameters were documented. The 10-Year risk scores according to Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score were computed. Results: A total of 622 patients were studied. The actual number of stroke that occurred in the 10 years was 20 (20/662 = 3.0%) whereas the predicted was 21 (3.2%). The actual event in the low-risk group (20%); the actual event and the predicted event were 0 (0%) and 2 (29.7%) respectively. The Chinese 10-Year risk score has a poor discrimination index in this studied population as the area under the curve (AUC) is 0.43, with p value of 0.310. There was good calibration with Hosmer-Lemeshow test X2 = 4.48, P = 0.48. Conclusions: The risk score appears to underestimate stroke risk in low-risk group whereas it appears overestimate in the intermediate and high risk group. The results suggest that this risk model is unlikely to provide an appropriate stroke risk estimation. Future validation study with a larger population sample size is therefore advised

Willingness to receive a COVID-19 booster vaccine and its associated factors among adults with chronic disease: A cross-sectional study in Putrajaya, Malaysia

Introduction: Booster vaccination has been shown to reduce transmission and serious infection with COVID-19. This study examined the willingness to receive a COVID-19 booster vaccine and its associated factors among high-risk patients at Klinik Kesihatan Putrajaya Presint 9. Methods: A cross-sectional study was conducted among patients aged ≥18 years attending Klinik Kesihatan Putrajaya Presint 9 with a high risk of contracting COVID-19 recruited via systematic random sampling. Data were collected using a self-administered questionnaire. A multiple logistic regression analysis was performed to identify the associated factors. Results: The response rate for this study was 97.4% (N=489). The median patient age was 55 years. Approximately 51.7% were men, and 90.4% were Malays. Approximately 81.2% were willing to receive a COVID-19 booster vaccine. The patients who perceived COVID-19 as a serious illness (Adjusted Odd Ratio, AOR=2.414), those who perceived COVID-19 booster vaccines as beneficial (AOR=7.796), those who disagreed that COVID-19 booster vaccines have many side effects (AOR=3.266), those who had no doubt about the content of COVID-19 vaccines (AOR=2.649) and those who were employed (AOR=2.559) and retired (AOR=2.937) were more likely to be willing to receive a booster vaccine than those who were unemployed and those who did not have close friends or family members who contracted severe COVID-19 (AOR=2.006). Conclusion: The majority of the participants were willing to receive a COVID-19 booster vaccine. Healthcare authorities should take initiatives to design targeted public intervention programmes to increase the willingness for COVID-19 booster vaccination

Female sexual dysfunction among contraceptive user in Malaysia

Background: Women in reproductive age are at risk of getting female sexual dysfunction (FSD). Contraception has been recognized as one of the causes of FSD. This study aims to determine the prevalence of FSD and types of FSD among contraceptive user. Methods: This is a cross-sectional study involving 262 women who were on contraception in eleven primary care clinics in Malaysia. Malay version of Female Sexual Function Index (MVFSFI) was used in this study. Results: The prevalence of FSD among contraceptive user in Malaysia was 9.5% (n=25). The highest types of female sexual dysfunction in this study were sexual dissatisfaction (29.8%, n=78) and sexual desire disorder (29.4%, n=77). Majority of the participants were Malay (83.6%). Of twenty-five women with FSD, one-third of them was Indian ethnic. Most of the women (11.2%) with FSD had received education up to secondary school and non- employed (11.6%). Twenty-two (9.9%) women with FSD were practising hormonal contraception and most of them were dissatisfied with their marital relationship (35.7%, n=5). Conclusions: The result indicates that one in ten contraceptive users had FSD. The highest percentage of female sexual dysfunction domain was sexual dissatisfaction and sexual desire disorder. Hormonal contraception was the most common method used among women with FSD. Further research is needed to determine the associated factor of female sexual dysfunction among women using contraception

Visit-to-visit SBP variability and cardiovascular disease in amultiethnic primary care setting:10-year retrospective cohort study

Objectives: The current study aims to determine the relationship of long-term visit-to-visit variability of SBP to cardiovascular disease (CVD) in a multiethnic primary care setting. Method: This is a retrospective study of a cohort of 807 hypertensive patients over a period of 10 years. Three-monthly clinic blood pressure readings were used to derive blood pressure variability (BPV), and CVD events were captured from patient records. Results: Mean age at baseline was 57.2 ± 9.8 years with 63.3% being women. The BPV and mean SBP over 10 years were 14.7 ± 3.5 and 142 ± 8 mmHg, respectively. Prevalence of cardiovascular event was 13%. In multivariate logistic regression analysis, BPV was the predictor of CVD events, whereas the mean SBP was not independently associated with cardiovascular events in this population. Those with lower SBP and lower BPV had fewer cardiovascular events than those with the same low mean SBP but higher BPV (10.5 versus 12.8%). Similarly those with higher mean SBP but lower BPV also had fewer cardiovascular events than those with the same high mean and higher BPV (11.6 versus 16.7%). Other variables like being men, diabetes and Indian compared with Chinese are more likely to be associated with cardiovascular events. Conclusion: BPV is associated with an increase in CVD events even in those who have achieved lower mean SBP. Thus, we should prioritize not only control of SBP levels but also BPV to reduce CVD events further