Knowledge, Attitude and Factors associated with Self-efficacy in Screening and Treatment of Hepatitis C among Primary Care Doctors in Selangor

Introduction

Primary care doctors (PCDs) play an increasingly important role in the management of hepatitis C. It is essential for PCDs to have good self-efficacy in screening and treating hepatitis C to achieve good outcomes. This study aimed to determine the knowledge and attitude towards and other factors associated with self-efficacy in screening and treating hepatitis C.

Methods

This cross-sectional study was conducted using an online Google Form. PCDs working at primary healthcare clinics were selected via simple random sampling. The online form contained items on sociodemographic and practice characteristics and a validated questionnaire on knowledge, attitude and self-efficacy towards screening and treating hepatitis C. Data were statistically analysed.

Results

A total of 242 PCDs were included in the analysis. The median age was 35 years (interquartile range [IQR]=5). The majority of the PCDs were women (83.9%) and Malay (71.9%) and had a median working experience of 6 years (IQR=6). The mean self-efficacy score was 12.67 (standard deviation=3.38). The factors associated with a higher level of self-efficacy in screening and treating hepatitis C were postgraduate qualification, training within the last one year, better knowledge and attitude scores and prior experience in treating hepatitis C.

Conclusion

The identified factors are crucial in improving the self-efficacy among PCDs in hepatitis C care services. Policymakers are suggested to implement training programmes and encourage continuous medical education, exposure to patient management and postgraduate certification in family medicine to help PCDs in treating hepatitis C better.

Prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in urban Selangor, Malaysia: a cross-sectional study

BACKGROUND

Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.

METHODS

A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.

RESULTS

The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).

CONCLUSIONS

As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

Prevalence of Problematic Internet Use and its Association with Psychological Distress and Coping Strategies among Universiti Teknologi Mara Students during the COVID-19 Pandemic

Introduction: The COVID-19 pandemic is affecting our day-to-day life and brings a serious impact on public mental health. Due to the practice of physical distancing, the Internet technology is being used to accommodate our daily interactions. In view of the increasing dependency towards this technology, its impact on our mental health well-being is indeterminate. This study aimed to examine the association between problematic Internet use, psychological distress, and the type of coping strategies used among Universiti Teknologi MARA students during this pandemic. Materials and Methods: A cross-sectional online survey was conducted using Internet Addiction Test, Kessler Psychological Distress Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory. Data was analysed using SPSS version 26. Results: Of the 444 respondents, 32.2% were noted to have problematic Internet use with 61.3% reported psychological distress. Problematic Internet use was associated with higher level of psychological distress (OR = 1.04, 95% CI: 1.01 – 1.08), and the coping strategies of self-distraction (OR = 1.24, 95% CI: 1.04 – 1.47) and behavioural disengagement (OR = 1.29, 95% CI: 1.07 – 1.55). Conclusion: A high prevalence of psychological distress and its association with problematic Internet use and maladaptive coping among students during this pandemic was evident in this study. Hence, the findings from this study could help to provide insight on the state of the psychological well-being of students in higher education institutions as well as to assist the stakeholders in taking measures to help the students dealing with the pandemic.

Elder abuse and hospitalization in rural Malaysia

Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.

Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia

Introduction

Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.

Methods

A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.

Results

Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).

Conclusions

The majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.

A PARADOXICAL PROPOSITION OF CONNECTEDNESS TO NATURE, RECYCLING BEHAVIOUR AND PSYCHOLOGICAL RESTORATION RELATIONSHIP IN URBAN PARK CONTEXT: A PATH ANALYSIS EVIDENCE

About 29.2% of Malaysians have been diagnosed with psychological distress, especially young adults. The B40 low-income group is most afflicted due to financial restrictions and limiting access to medication. Therefore, urban parks’ connectedness and pro-environmental behaviour towards psychological restoration are inexpensive ways to alleviate distress. This study examines the relationship between Connectedness to Nature (CN), Pro-Environmental Behaviour (PEB), and Psychological Restoration (PR). Three hypotheses were used to create a structural model to guide the cross-sectional methodology used for the study. A total of 161 students responded to the Google Form questionnaire. SPSS v21 and Smart-PLS 3.2.7 were used to examine the model relationship. The results showed that all hypotheses were supported by substantial statistical evidence. This study provides an important direction to motivate people to utilize urban parks for obtaining psychological restoration benefits costeffectively. Green behaviour is also beneficial for humans and the environment in promoting healthy living.

The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study

The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants’ responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.

Views on Unassisted Childbirth among Mothers at a Teaching Hospital in Kuala Lumpur, Malaysia

A cross-sectional study was conducted among mothers visiting antenatal clinic in UKMMC from 1st to 19th August 2016 to acquire opinions on unassisted childbirth and the determinant factors among mothers at a teaching hospital. Structured questionnaires were used in assessing their opinions on unassisted childbirth. A total of 259 respondents were recruited, 229 of them who met the inclusion criteria were included for analysis. Majority (87.3%) was Malay and 98.7% of respondents were more than 25 years old. The prevalence for mothers who agreed with unassisted childbirth was 6.6%. Bivariate analysis showed Malay (p=0.013) and non-working mothers (p=0.000) are the significant factors. There was no significant association between opinions on unassisted childbirth and quality of government healthcare services. Multivariate analysis showed middle income and non-working mothers were the significant factors contributing to opinions on unassisted childbirth. The outcome showed minority of mothers agreed with unassisted childbirth, middle income group and non-working mothers agreed on unassisted childbirth. Dissatisfaction to the quality of care at government healthcare services was not found to be the reason for unassisted childbirth. However, there could be other factors contributing to opinions on unassisted childbirth delivery which were not studied. Community-based study should be conducted to determine the other factors.

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management.

OBJECTIVE

This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective.

METHODS

A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach.

RESULTS

Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting.

CONCLUSIONS

Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Global serum metabolomics profiling of colorectal cancer

Accurate diagnosis of colorectal cancer (CRC) relies on the use of invasive tools such as colonoscopy and sigmoidoscopy. Non-invasive tools are less sensitive in detecting the disease, particularly in the early stage. A number of researchers have used metabolomics analyses on serum/plasma samples of patients with CRC compared with normal healthy individuals in an effort to identify biomarkers for CRC. The aim of the present review is to compare reported serum metabolomics profiles of CRC and to identify common metabolites affected among these studies. A literature search was performed to include any experimental studies on global metabolomics profile of CRC using serum/plasma samples published up to March 2018. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to assess the quality of the studies reviewed. In total, nine studies were included. The studies used various analytical platforms and were performed on different populations. A pathway enrichment analysis was performed using the data from all the studies under review. The most affected pathways identified were protein biosynthesis, urea cycle, ammonia recycling, alanine metabolism, glutathione metabolism and citric acid cycle. The metabolomics analysis revealed levels of metabolites of glycolysis, tricarboxylic acid cycle, anaerobic respiration, protein, lipid and glutathione metabolism were significantly different between cancer and control samples. Although the majority of differentiating metabolites identified were different in the different studies, there were several metabolites that were common. These metabolites include pyruvic acid, glucose, lactic acid, malic acid, fumaric acid, 3-hydroxybutyric acid, tryptophan, phenylalanine, tyrosine, creatinine and ornithine. The consistent dysregulation of these metabolites among the different studies suggest the possibility of common diagnostic biomarkers for CRC.

Metabolomics Profiling on Different Stages of Colorectal Cancer: A Systematic Review

Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide. Early diagnosis and accurate staging of the disease is vital to improve the prognosis. Metabolomics has been used to identify changes in metabolite profiles in the different stages of cancer in order to introduce new non-invasive molecular tools for staging. In this systematic review, we aim to identify the common metabolite changes in human biological samples and the dominant metabolic pathways associated with CRC progression. A broad systematic search was carried out from selected databases. Four reviewers screened and reviewed the titles, abstracts, and full-text articles according to the inclusion and exclusion criteria. Quality assessment was conducted on the eight articles which met the criteria. Data showed that the metabolites involved with redox status, energy metabolism and intermediates of amino acids, choline and nucleotides metabolism were the most affected during CRC progression. However, there were differences in the levels of individual metabolites detected between the studies, and this might be due to the study population, sample preparation, analytical platforms used and statistical tools. In conclusion, this systematic review highlights the changes in metabolites from early to late stages of CRC. Moreover, biomarkers for prognosis are important to reduce CRC-related mortality.

Profiles and Factors Associated with Poor Glycemic Control Among Inpatients with Diabetes Mellitus Type 2 as a Primary Diagnosis in a Teaching Hospital

CONTEXT

Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme.

AIMS

This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease.

SETTINGS AND DESIGN

A cross-sectional study was conducted in UKM Medical Centre.

METHODS AND MATERIAL

Medical records of patient with E11 ICD-10 code were collected using Case Report Form.

STATISTICAL ANALYSIS USED

Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression.

RESULTS

The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7%) with secondary level of education (41.7%). Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3%) and significant association was found with tertiary level of education [AOR = 0.10, 95%CI = 0.01-0.96] and with type of anti-diabetic therapy [AOR = 15.90, 95%CI=1;2.03-124.30].

CONCLUSIONS

In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome.