Should identical CVD risks in young and old patients be managed identically? Results from two models

OBJECTIVES: To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk. DESIGN: Modelling based on population data. METHODS: Potential years of life lost from a 5-year treatment delay were estimated for patients of different ages but with the same cardiovascular risk (either 5% or 10% 5-year risk). Two models were used: an age-based residual life expectancy model and a Markov simulation model. Age-specific case fatality rates and time preferences were applied to both models, and competing mortality risks were incorporated into the Markov model. RESULTS: Younger patients had more potential life years to lose if untreated, but the maximum difference between 35 and 85 years was <1 year, when models were unadjusted for time preferences or competing risk. When these adjusters were included, the maximum difference fell to about 1 month, although the direction was reversed with older people having more to lose. CONCLUSIONS: Surprisingly, age at onset of treatment has little impact on the likely benefits of interventions that reduce cardiovascular risk because of the opposing effects of life expectancy, case fatality, time preferences and competing risks. These findings challenge the appropriateness of recommendations to use lower risk-based treatment thresholds in younger patients

The views and experiences of Malaysian primary care doctors in managing patients with chronic low back pain: a qualitative study

Background: Chronic low back pain (CLBP) is a common and often difficult to treat condition in the primary care setting. Research involving in-depth exploration on the views and experiences faced by primary care doctors in managing patients with CLBP in Malaysia is limited. Objective: To explore the primary care practitioners’ views and experiences in managing patients with CLBP. Study design: A qualitative approach was employed using focus group discussions (FGD) at an academic primary care clinic in Kuala Lumpur, Malaysia. Twenty-three primary care doctors were purposively selected. Data were collected through audio-recorded interviews, which were transcribed verbatim and checked for accuracy. Data saturation was reached by the third FGD. An additional FGD was included to ensure completeness. A thematic approach using the one sheet of paper (OSOP) method was used to analyse the data. Results: Participants view managing patients with CLBP as challenging. This is mainly due to the difficulty in balancing the doctors’ expectations with the patients’ perceived expectations during consultation. Barriers identified include lack of awareness and conflicting views regarding the usefulness of the local clinical practice guideline (CPG) in clinical practice. Other barriers include time constraints and perceived lack of support from multidisciplinary teams in managing these patients. Conclusion: Managing patients with CLBP is still a challenge for Malaysian primary care doctors. Any intervention should target identified barriers to improve the management of patients with CLBP

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

Knowledge and practice of colorectal cancer screening in an urban setting : cross-sectional survey of primary care physicians in government clinics in Malaysia.

INTRODUCTION: Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor. METHODS: A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening. RESULTS: The response rate was 86.4% (n = 197/228). Less than half (39.1%) of respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 20.7% of PCPs screened over 50% of all eligible patients and only 5.2% of PCPs screened over 75% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69-6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01-3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185). CONCLUSION: Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening

Health innovation in cardiovascular diseases

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Despite efforts to tackle CVD, its prevalence continues to escalate in almost every country. The problem requires an exploration of novel ways to uncover solutions. Health innovations that embrace new knowledge and technology possess the potential to revolutionize the management of CVD. Using findings from published studies on CVD, researchers generated innovations in the areas of global risk assessment, home and remote monitoring and bedside testing. The use of pharmacogenetics and methods to support lifestyle changes represent other potential topics for innovations. Gaps in existing knowledge and practice of CVD provide opportunities for the development of new ideas, practices and technology. However, healthcare professionals need to be cognisant of the limitations of health innovations and advocate for safeguarding patients’ wellbeing

Health literacy research in Malaysia: a systematic review

Introduction: Health literacy has emerged as an important determinant of health and a key component of self-care and patient centered medicine. In Malaysia, the recent National Health Morbidity Survey found that the adult l health literacy level was worryingly low. Local research in health literacy is urgently needed. The aim of this systematic review is to identify and synthesize research publications on health literacy carried out in Malaysia. Methods: The search was conducted up to February 2017 using the MEDLINE, Scopus and Malaysian Medical Repository databases. The free text search terms used were “health literacy” (all fields) and Malaysia (all fields). Inclusion criteria were that the study population was Malaysian and the study reported on health literacy. There was no restriction on study designs in order to maximize the scope of the review. Two reviewers independently selected the articles based on the titles and abstracts, followed by full-text screening. Study quality was not assessed. The following data were extracted from the full-text articles independently by two reviewers: year of publication, name of authors, geographical location, research focus, and key findings. Any disagreement was resolved by consensus. Results: In total, 10 articles were eligible for inclusion in the review with the earliest article published in 1985. Six were on general health literacy, two on medication literacy and two on mental health. Most were quantitative studies (n=9) with only one qualitative study eligible for inclusion. The number of studies increased over time with most studies being published in 2016 (n=3). Validated health literacy tools, such as the Newest Vital Signs (NVS) and HLS-EU-Q47 were used in studies published after 2015. Three studies used NVS to measure health literacy levels and the prevalence of limited health literacy levels ranged from 79.4 to 94.2%. HLS-EU-Q47 was used in two studies: a validation study of its’ Malay version and as an outcome measure in a study protocol. The majority of the studies (n=7) were conducted in central urban regions namely Kuala Lumpur, Selangor and Negeri Sembilan. The qualitative study explored the mental illness literacy among caregivers and found care givers have some understanding on mental illness and consider doctors as the primary source of health information. Conclusions: Even though the first paper was published nearly 32 years ago, much work remains to be done for health literacy research in Malaysia. The use of locally validated tools for the assessment of health literacy is recommended for future research

The changing face of primary care: a cross sectional study in Malaysia

There has been an epidemiological transition in morbidity and mortality patterns in developing countries. This study aimed to determine whether there was an accompanying change in disease presentation in primary care. This was a cross-sectional study conducted at 12 public primary care clinics in Malaysia. Outpatient medical records were randomly selected and reviewed to identify patients’ reasons for encounter. The overall retrieval of records was 99.1% (n=1,753; range 95.7-100.0%). The mean age was 33.1 (SD 22.2) years. For all ages, the most common reasons for patient encounter (RFE) were cough (21.1%; 95% CI 16.5, 25.8), follow-up care for chronic diseases (19.6%; 95% CI 12.7, 26.6) and fever (18.4%; 95% CI 14.2, 22.5). The top RFE in West Malaysia was follow-up care for chronic diseases while in East Malaysia, the most common RFE was cough (25.2%; 95% CI 16.8, 33.6) and fever (21.7%; 95% CI 14.3, 29.0). In conclusion, there is a change in the presentation of diseases, with chronic disease emerging as one of the top RFE in primary care. In adults, for all age groups over 40 years old, care for chronic diseases has overtaken acute disease care. However, acute respiratory problems remain the overall top RFE at public primary care clinics in Malaysia. There are major differences in morbidity patterns and reasons for encounter for different age groups and geographical areas and this could be utilized for better health care planning

Health literacy research in Malaysia: a scoping review

Research on health literacy is expanding worldwide. Health literacy has been recognised as a critical determinant of health at the 2016 Shanghai Declaration. Little is known about health literacy research in Malaysia. This scoping review aims to identify and summarise published studies on health literacy in Malaysia. PubMed, Scopus and the Malaysian Medical Repository (MyMedR) databases were searched for published work by Malaysian researchers. Searches were conducted up to November 2019. The search terms used are related to ‘health literacy’ and ‘Malaysia’. Studies included were those involving Malaysian citizens and reporting on various aspects of health literacy. Studies were reviewed by two independent reviewers to determine their eligibility. Data extraction for the year of publication, name of authors, geographical location, research focus, and summary of findings from the full-text articles was carried out independently and any disagreement was resolved by consensus. A total of 29 articles were included with the earliest article published in 1985. Fifteen of the articles are on general health literacy, four on medication literacy, five on mental health literacy, three on media and e-health literacy and four on oral health literacy. Four articles are qualitative studies and the rest are quantitative studies. A few of the studies used validated health literacy tools such as Newest Vital Signs and HLS-EU-Q47. Therefore, we can conclude that there are only a limited number of articles published in the field of health literacy in Malaysia. Future work using validated international tools to allow comparison of the findings should be considered

Perceptions of childhood asthma and its control among Malays in Malaysia: a qualitative study

Children with poor asthma control have poor health outcomes. In Malaysia, the Malays have the highest asthma prevalence and poorest control compared to other ethnicities. We aimed to explore Malay children with asthma and their parents’ perceptions on asthma and its control. We conducted focus group discussions (FGD) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Sixteen children and parents (N = 32) participated. The perception of asthma was based on personal experience, cultural and religious beliefs, and there was mismatch between children and parents. Parents perceived mild symptoms as normal, some had poor practices, raising safety concerns as children were dependent on them for self-management. Conflicting religious opinions on inhaler use during Ramadhan caused confusion in practice. Parents perceived a lack of system support towards asthma care and asthma affected quality of life. Urgent intervention is needed to address misconceptions to improve asthma care in children