Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study

BACKGROUND

Finding innovative methods to enhance Tuberculosis treatment adherence in Malaysia is imperative, given the rising trend of non-adhere TB patients. Direct Observed Therapy (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy is developed that connects three users the patient, supervisor, and administrator, allowing drug monitoring and patient loss to follow up with the patient tracking system. Thus, the objective of this study is to determine the impact of Gamified Real-time Video Observed Therapy (GRVOTS) mobile apps on patient medication adherence rates and motivation.

METHODS

71 patients from 18 facilities participated in the 8-week single-arm intervention study. GRVOTS mobile apps were installed in their mobile apps, and patients were expected to fulfill tasks such as providing Video Direct Observe Therapy (VDOTS) daily as well as side effect reporting. At 3-time intervals of baseline,1-month, and 2-month intervals, the number of VDOT taken, the Malaysian Medication Adherence Assessment Tool (MyMAAT), and the Intrinsic Motivation Inventory (IMI) questionnaire were collected. One-sample t-test was conducted comparing the VDOT video adherence to the standard rate of 80%. RM ANOVA was used to analyze any significant differences in MyMAAT and IMI scores across three-time intervals.

RESULTS

This study involved 71 numbers of patients from 18 healthcare facilities who showed a significantly higher treatment adherence score of 90.87% than a standard score of 80% with a mean difference of 10.87(95% CI: 7.29,14.46; p < 0.001). The participants' MyMAAT and IMI scores significantly increased over 3-time intervals with the IMI Interest domain showing the highest mean difference 19.76 (95% CI: 16.37, 21.152: p < 0.001).

CONCLUSIONS

By utilizing GRVOTS, a mobile application based on gamification and real-time features, we can enhance motivation and medication adherence among TB patients, while also addressing the limitations of physical DOTS.

TRIAL REGISTRATION

IRCT20230308057657N1, Registered on (15/03/23).

Moderate temperature deposition of RF magnetron sputtered SnO2-based electron transporting layer for triple cation perovskite solar cells

The perovskite solar cells (PSCs) are still facing the two main challenges of stability and scalability to meet the requirements for their potential commercialization. Therefore, developing a uniform, efficient, high quality and cost-effective electron transport layer (ETL) thin film to achieve a stable PSC is one of the key factors to address these main issues. Magnetron sputtering deposition has been widely used for its high quality thin film deposition as well as its ability to deposit films uniformly on large area at the industrial scale. In this work, we report on the composition, structural, chemical state, and electronic properties of moderate temperature radio frequency (RF) sputtered SnO₂. Ar and O₂ are employed as plasma-sputtering and reactive gases, respectively. We demonstrate the possibility to grow a high quality and stable SnO₂ thin films with high transport properties by reactive RF magnetron sputtering. Our findings show that PSC devices based on the sputtered SnO₂ ETL have reached a power conversion efficiency up to 17.10% and an average operational lifetime over 200 h. These uniform sputtered SnO₂ thin films with improved characteristics are promising for large photovoltaic modules and advanced optoelectronic devices.

A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study

BACKGROUND

The success rate of tuberculosis (TB) treatment in Malaysia remains below the recommended World Health Organization target of 90% despite the implementation of directly observed therapy, short-course, a physical drug monitoring system, since 1994. With increasing numbers of patients with TB in Malaysia defaulting on treatment, exploring another method to improve TB treatment adherence is vital. The use of gamification and real-time elements via video-observed therapies in mobile apps is one such method expected to induce motivation toward TB treatment adherence.

OBJECTIVE

This study aimed to document the process of designing, developing, and validating the gamification, motivation, and real-time elements in the Gamified Real-time Video Observed Therapies (GRVOTS) mobile app.

METHODS

The modified nominal group technique via a panel of 11 experts was used to validate the presence of the gamification and motivation elements inside the app, which were assessed based on the percentage of agreement among the experts.

RESULTS

The GRVOTS mobile app, which can be used by patients, supervisors, and administrators, was successfully developed. For validation purposes, the gamification and motivation features of the app were validated as they achieved a total mean percentage of agreement of 97.95% (SD 2.51%), which was significantly higher than the minimum agreement score of 70% (P<.001). Further, each component of gamification, motivation, and technology was also rated at 70% or more. Among the gamification elements, fun received the lowest scores, possibly because the nature of serious games does not prioritize the fun element and because the perception of fun varies by personality. The least popular element in motivation was relatedness, as stigma and discrimination hinder interaction features, such as leaderboards and chats, in the mobile app.

CONCLUSIONS

It has been validated that the GRVOTS mobile app contains gamification and motivation elements, which are intended to encourage medication adherence to TB treatment.

Study of wide bandgap SnOx thin films grown by a reactive magnetron sputtering via a two-step method

In the present work, we report on the microstructural and optoelectronic properties of SnO_x thin films deposited by a reactive radio frequency magnetron sputtering. After SnO_x growth by sputtering under O₂/Ar flow, we have used three different treatment methods, namely (1) as deposited films under O₂/Ar, (2) vacuum annealed films ex-situ, and (3) air annealed films ex-situ. Effects of the O₂/Ar ratios and the growth temperature were investigated for each treatment method. We have thoroughly investigated the structural, optical, electrical and morphology of the different films by several advanced techniques. The best compromise between electrical conductivity and optical transmission for the use of these SnO_x films as an n-type TCO was the conditions O₂/Ar = 1.5% during the growth process, at 250 °C, followed by a vacuum post thermal annealing performed at 5 × 10^–4 Torr. Our results pointed out clear correlations between the growth conditions, the microstructural and optoelectronic properties, where highly electrically conductive films were found to be associated to larger grains size microstructure. Effects of O₂/Ar flow and the thermal annealing process were also analysed and discussed thoroughly.

Characteristics and determinants of loss to follow-up among tuberculosis (TB) patients who smoke in an industrial state of Malaysia: a registry-based study of the years 2013-2017

Background

The increased risk of loss to follow-up among TB smokers raises concern over the secondary spread within the community. This study aimed to determine the factors associated with loss to follow-up among TB patients who smoke.

Methods

All registered TB patients who smoke in the state of Selangor between 2013 and 2017 via the Malaysian Tuberculosis Information System (MyTB) database were included for analysis. TB patients who smoke were considered those who are “current smoker” during the notification, while loss to follow-up was defined as a TB patient who had interrupted treatment for 2 months or longer. There were 3 main variable domains included for analysis: sociodemographic profiles, disease profiles, and comorbidities. Logistic regression analysis was used to identify determinants of loss to follow-up among TB patients who smoke.

Results

A total of 14.1% (N = 813) of TB patients who smoke loss to follow-up. The determinants of loss to follow-up among TB smokers were working age population aged 32-41 and 42-53 years old (AOR 1.08; 95%CI 1.23,2.08) and (AOR 1.44; 95%CI 1.11,1.87) respectively, Malaysian nationality (AOR 2.34; 95%CI 1.66,3.30), patients staying in urban area (AOR 1.55; 95% CI 1.23,1.97), income level less than RM2160 (AOR 1.59; 95% CI 1.14,2.20), un-employed (AOR 1.30; 95%CI 1.09-1.55), have low education level i.e., secondary school education, primary school education and no formal education (AOR 1.60; 95%CI 1.22,2.10), (AOR 1.73; 95%CI 1.16,2.57) and (AOR 2.29; 95% CI 1.57,3.33) respectively, previously treated TB cases (AOR 2.19; 95% CI 1.71,2.81), active TB case detection methods (AOR 2.06; 95%CI 1.40,3.02), moderate lesion x-ray (AOR 1.60; 95%CI 1.13,2.27) and HIV positive (AOR 1.36; 95%CI 1.02,1.82). All the significant factors gave rise to the final model of determinants, with a predictability of 67.2% (95% CI 65.0,69.3).

Conclusions

The high proportion of loss to follow-up among TB patients who smoke highlight the importance of providing early risk detection that examines the three main domains of risk factors such as socioeconomic, disease profiles and comorbidities. Potential integrated intervention should aim to reduce the proportion of smoking among TB patients through the stop smoking programme together with directly observed therapy (DOT).

Phytochemical Screening and High-performance Thin-layer Chromatography Quantification of Vitex trifolia Leaves Hydro-alcoholic Extract: Potential Anti-inflammatory Properties

Aims: The present study aims to evaluate the phytochemical composition of Vitex trifolia (V. trifolia) leaves hydro-alcoholic extract and to report for the first time, its phenolic content using a validated high-performance thin-layer chromatography (HPTLC) method. Study Design:  Qualitative phytochemical analysis and HTLC densitometric quantitative analysis. Place and Duration of Study: The study was carried out at the Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Malaysia, from March 2020 to December 2020. Methodology:  The preliminary phytochemical screening was carried out qualitatively. The HPTLC analysis was performed on glass-backed 60 F254 silica gel plates using a two steps gradient elution method of the mobile phase. In the first step, methanol was used to develop the plates until 40 mm of developing distance, while in the second step, plates were developed with n-hexane:ethyl acetate:acetic acid (20:9:1, v/v/v) until 80 mm of developing distance. Detection and quantification were performed by densitometric analysis at 254 nm. The method was validated as per the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) guideline in terms of linearity, precision, accuracy, the limit of detection (LOD), and the limit of quantification (LOQ). Results: The preliminary phytochemical screening of V. trifolia leaves hydro-alcoholic extract showed the presence of alkaloids, flavonoids, phenols, phytosterols, and terpenoids. The developed HPTLC method was proved to be linear, precise, and accurate. The LOD and LOQ of the method were determined to be 2.01 µg/band and 6.08 µg/band, respectively. The total phenolic content of the extract was calculated from the standard gallic acid calibration plot and found to be 136.94 ± 4.02 mg gallic acid equivalent (GAE)/g of dried extract. Conclusion:  This preliminary study revealed that V. trifolia has a considerable amount of phenolic compounds, which can potentially contribute to its anti-inflammatory, antioxidant, and anticancer activities. Further pharmacological investigations are being carried out to support the folkloric claims.

Parents' Experiences and Perspectives Toward Tuberculosis Treatment Success Among Children in Malaysia: A Qualitative Study

Introduction: The trends of tuberculosis (TB) treatment success rate among children in Malaysia plateaued at 90% from 2014 to 2017. Malaysia sets a higher treatment success target of 95% to be achieved in line with an affordable, accessible, and holistic approach in managing TB among children. Objective: This study aims to explore the parents' experiences and perspectives toward achieving treatment success among children who were diagnosed with TB in two districts in Selangor state, Malaysia. Methods: The study was conducted using phenomenology study design via an in-depth interview of 15 mothers who were purposively sampled from the list of pediatric TB cases in the MyTB version 2.1 database in Klang and Petaling Districts of Selangor state. The R-based qualitative data analysis package of R version 0.2-8 was used to perform the thematic analysis. Results: Two main themes were identified from this study. The first theme was trust toward the healthcare services with the subthemes of acceptance, self-efficacy, holistic care, and perceived benefits. The second theme was the motivation to take or continue medication. The subthemes were support from family, healthcare workers' (HCWs') support, the convenience of healthcare services, community support, personal strength, and child's character. Conclusion: TB treatment success for children can be achieved when parents develop trust in healthcare services and have strong motivational factors to remain steadfast in achieving a successful treatment goal. Psychosocial support should be provided to the primary caregiver who faced any difficulty, while good relationships between parents and HCWs should be maintained. These results will inform the TB program managers to strengthen the holistic approach and identify the motivational factors among parents of children with TB disease.

Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years

Background

Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia.

Methods

Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants.

Results

In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children.

Conclusions

The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.

Multidetector CT (MDCT) Findings Of Primary Hepatic Lymphoma

OBJECTIVE

The aim of this study was to describe the triphasic multidetector CT (MDCT) finding of primary hepatic lymphoma (PHL).

MATERIALS AND METHODS

This retrospective study included eighteen patients. Each patient presented with primary hepatobiliary lymphoma without associated lymphadenopathy or other visceral involvement. Triphasic CT scanning was performed on one of two systems (64 MD CT) in 12 patients and (6 MDCT) in 6 patients. All eighteen patients underwent ultrasound percutaneous trucut liver biopsy using 18-gauge biopsy needle. Pathology was confirmed on all cases.

RESULTS

Four of eighteen patients presented with a single focal lesion. Thirteen of eighteen patients presented with multiple well defined focal lesions. One patient presented with a diffuse hepatic involvement. On triphasic CT, three patients showed gradual progressive contrast enhancement. Lesions remained isodense to the liver on the arterial phase with mild enhancement in the portal phase and showed washout on the delayed phase in two patients. The remaining thirteen patients showed multiple hypodense non-enhancing lesions.

CONCLUSIONS

PHL presents a wide spectrum of imaging findings on triphasic MDCT with no characteristic imaging pattern. MDCT can be used for detection of the lesion and biopsy is used for diagnosis. PHL should always be considered in the differential diagnosis of a liver focal lesion either single or multiple.

Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D

Glucose metabolism was studied in a patient with vitamin D deficiency during its treatment with small doses of vitamin D. A continuous infusion of glucose test was performed to assess glucose tolerance and insulin sensitivity and beta-cell function were derived by mathematical modelling. Fasting glucose was 5.6 mmol/l and achieved glucose after the infusion was 10.4 mmol/l confirming diabetes. The test was repeated 0.5, 1, 3 and 5 months after starting treatment. Serum calcium increased glucose intolerance from 1.76 to 2.0, 2.08, 1.96 and 2.0 mmol/l, respectively; vitamin D reached supraphysiological levels initially and returned to normal levels, and parathyroid hormone levels were normalized. Her weight did not change during treatment. Glucose tolerance improved during treatment and achieved glucose was 9.4, 8.6, 9.2 and 9.0 mmol/l at 0.5, 1, 3 and 5 months, respectively; insulin sensitivity did not change. Beta-cell function improved from 101% at diagnosis to 126%, 147%, 173% and 198% at 0.5, 1, 3 and 5 months, respectively. Improvement in beta-cell function and consequently in glucose tolerance is likely to have been due to correction of hypocalcaemia, vitamin D deficiency and secondary hyperparathyroidism.