White finger millet starch: Hydrothermal and microwave modification and its characterisation

White finger millet (WFM) starch was modified by hydrothermal (HS) and microwave (MS) methods. Modification methods had a significant change in the b* value observed in the HS sample, and it caused the higher chroma (∆C) value. The treatments have not significantly changed the chemical composition and water activity (aw) of native starch (NS) but reduced the pH value. The gel hydration properties of modified starch enhanced significantly, especially in the HS sample. The least NS gelation concentration (LGC) of 13.63 % increased to 17.74 % in HS and 16.41 % in MS. The pasting temperature of the NS got reduced during the modification process and altered the setback viscosity. The starch samples exhibit the shear thinning behavior and reduce starch molecules' consistency index (K). FTIR results exhibit that the modification process highly altered the short-range order of starch molecules more than the double helix structure. A significant reduction in relative crystallinity was observed in the XRD diffractogram, and the DSC thermogram depicts the significant change in the hydrogen bonding of starch granules. It can be inferred that the HS and MS modification method significantly alters the properties of starch, which can increase the food applications of WFM starch.

Development of a scale to measure shared problem-solving and decision-making in mental healthcare

OBJECTIVES

The aim of this study was to create a measure of collaborative processes between healthcare team members, patients, and carers.

METHODS

A shared decision-making scale was developed using a qualitative research derived model and refined using Rasch and factor analysis. The scale was used by staff in the hospital for four consecutive years (n = 152, 121, 119 and 121) and by two independent patients' and carers' samples (n = 223 and 236).

RESULTS

Respondents had difficulty determining what constituted a decision and the scale was redeveloped after first use in patients and carers. The initial focus on shared decision-making was changed to shared problem-solving. Two factors were found in the first staff sample: shared problem-solving and shared decision-making. The structure was confirmed on the second patients' and carers' sample and an independent staff sample consisting of the first data-points for the last three years. The shared problem-solving and decision-making scale (SPSDM) demonstrated evidence of convergent and divergent validity, internal consistency, measurement invariance on longitudinal data and sensitivity to change.

CONCLUSIONS

Shared problem-solving was easier to measure than shared decision-making in this context.

PRACTICE IMPLICATIONS

Shared problem-solving is an important component of collaboration, as well as shared decision-making.

Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study

BACKGROUND

There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia.

METHODS

In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers.

RESULTS

The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute).

CONCLUSIONS

This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.

Barriers and enablers to collaboration in the mental health system in Sabah, Malaysia: towards a theory of collaboration

BACKGROUND

The systems that help people with mental disorders in Malaysia include hospitals, primary care, traditional and religious systems, schools and colleges, employers, families and other community members.

AIMS

To better understand collaboration between and within these systems and create a theoretical framework for system development.

METHOD

A total of 26 focus groups and 27 individual interviews were undertaken with patients, carers, psychiatric hospital staff, primary care and district hospital staff, religious and traditional healers, community leaders, non-governmental organisation workers, and school and college counsellors. Grounded theory methods were used to analyse the data and create a theory of collaboration.

RESULTS

Three themes both defined and enabled collaboration: (a) collaborative behaviours; (b) motivation towards a common goal or value; and (c) autonomy. Three other enablers of collaboration were identified: (d) relatedness (for example trusting, understanding and caring about the other); (e) resources (competence, time, physical resources and opportunities); and (f) motivation for collaboration (weighing up the personal costs versus benefits of acting collaboratively).

CONCLUSIONS

The first three themes provided a definition of collaboration in this context: 'two or more parties working together towards a common goal or value, while maintaining autonomy'. The main barriers to collaboration were lack of autonomy, relatedness, motivation and resources, together with the potential cost of acting collaboratively without reciprocation. Finding ways to change these structural, cultural and organisational features is likely to improve collaboration in this system and improve access to care and outcomes for patients.

Using Ethnotaxonomy to Assess Traditional Knowledge and Language Vitality: A Case Study with the Vaie People of Sarawak, Malaysia

This article demonstrates the potential of using ethnotaxonomy and nomenclature to assess the vitality status of indigenous languages and traditional knowledge at the ecosystem level. We collaborated with the Vaie people of Sarawak, Malaysia, applying a mixed methodology approach that relies on free-listing to a large extent. We applied the Traditional Knowledge and Language Vitality (TraLaVi) index to assess traditional knowledge and language vitality against five major parameters, specifically: language priority, retrieval of information, knowledge erosion, lexical recognition, and social support for exchange of traditional knowledge.  The results show that with a TraLaVi score of 0.84, the Vaie language can be considered “safe”. Individuals practicing the traditional occupation of fishing fared better (mean=0.90) than those of the non-fishermen group (mean=0.77). However, when the language vitality was assessed using the Language Vitality and Endangerment assessment tool of UNESCO, the results indicate that the Vaie language could potentially be in the “unsafe” zone, highlighting the differences between the ecosystem based approach of the TraLaVi and the macro-approach of UNESCO. However, these approaches can be applied in a complementary manner to generate a more accurate portrayal of the language vitality scenario.

Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia

BACKGROUND

A better understanding is needed about how people make decisions about help seeking.

MATERIALS

Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members.

DISCUSSION

Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment.

CONCLUSION

Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.