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Aim: The aims of this scoping review were to identify the type of available evidence and map rapidly the key concepts underpinning milk sharing research. Design: Scoping review. Methods: Initially, the Scopus, ScienceDirect and EBSCOhost databases were searched. The keywords used were “milk sharing,” “expressed breastmilk donation,” “peer,” “online” and “internet” and a combination of the Boolean operators “AND” and “OR.” The snowballing technique was used to identify grey literature. The inclusion criteria were citations in English and Malay languages focusing on milk sharing. The review selection was performed by two independent reviewers. Results: The search identified two theses and 23 journal articles from 2010 to December 2019 that varied in terms of subject areas, aims, and methodologies. The majority of studies included were conducted in Western countries. Key findings identified the emerging concept of shared breastmilk, characteristics of donor and recipient mothers, facilitating factors for milk sharing, an individual’s perception versus informed decision and transparency, the perception of “breast is the best” versus a bottle feeding culture, stigma surrounding milk sharing, a lack of involvement of health care providers in decision-making, problems with accessing human milk from the milk bank, and conflicting issues from a religious perspective. Conclusion: Milk sharing is a relatively contemporary infant feeding practice that raises several important issues. However, the existing literature is limited to the exploration of milk sharing practice from a Western perspective. This justifies the need for future research as infant feeding is deeply rooted within religious beliefs and the socio-cultural context.

Background: The healthcare setting is stressful for many people, especially children. Efforts are needed to mitigate children's healthcare-related anxiety. Medical play using the Teddy Bear Hospital (TBH) concept can expose children to healthcare settings and help them develop positive experiences in these settings. In this role-playing game, children bring their soft toys and act as parents to the 'sick' teddies in a pretend hospital or clinic play setting. The objective of this systematic review is to evaluate the effectiveness of the TBH in improving children's health outcomes and well-being. Methods: We searched the reference lists of included studies from four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) from inception until November 2020. We included pre-post, quasiexperimental and case-control studies, as well as randomised controlled trials (RCTs) that discussed medical play using the TBH concept as an intervention. Studies that involved sick patients and used interventions unlike the TBH were excluded. We assessed the quality of the included studies using the Cochrane Collaboration's 'Risk of bias' tool. Results: Ten studies were included in this systematic review. Five specifically investigated the TBH method, while the others involved the same concept of medical play. Only three studies were RCTs. All of the studies report more than one outcome-mostly positive outcomes. Two report lower anxiety levels after intervention. Two found better healthcare knowledge, with one reporting increased feelings of happiness regarding visiting a doctor. Two studies found no change in anxiety or feelings, while another two found increased levels of fear and lowered mood after the medical play (which involved real medical equipment). Conclusions: The practice of TBH has mostly positive outcomes, with lower anxiety levels and improved healthcare knowledge. Its effectiveness should be verified in future studies using a more robust methodology.

Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to

Background: Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. Method: A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. Results: The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). Conclusion: In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include st

Introduction: Metered-dose inhalers (MDI) are the most used inhalers worldwide. However, improper MDI techniques remain a significant problem and cause uncontrolled asthma. Studies worldwide have reported that the causes of inefficient inhaler technique are multifactorial. However, this topic has been less well studied in the Asian population. This study aimed to evaluate the MDI technique and associated factors among adults with asthma in a primary care setting in Malaysia. Method: This was a cross-sectional study with universal sampling conducted between July and October 2017. A total of 146 patients with asthma aged 18 years and older in a primary care clinic in Putrajaya, Malaysia were recruited. Logistic regressions were used for statistical analysis to examine the association between improper MDI techniques and their related factors. Results: The majority (83%) of respondents were female with a median age of 37 (IQR = 30.75-49.25) years, and the median duration of asthma of 20 (IQR = 10-30) years. An improper MDI technique was observed in 100 (71.9%) patients. The most frequently missed step was exhaling gently and fully before inhalation (51.4%). Respondents who were not on an MDI preventer (adjusted OR: 2.487, 95% CI: 1.121-5.519, p = 0 .025) or had used an MDI 5 years or fewer (adjusted OR: 3.369, 95% CI: 1.425-7.964, p = 0.006) were more likely to employ an improper MDI technique. Conclusion: There was a high proportion of improper MDI techniques among patients with asthma. Patients not using an MDI preventer or who had used an MDI less than 5 years were at higher risk of improper MDI technique.

Worldwide studies have reported a drastic increase in child sexual abuse (CSA) involving very young children. In Malaysia, several attempts have been made to combat this problem via educational programs. Teachers have reported a lack of confidence in teaching this topic; hence a less threatening approach is needed. The Teddy Bear Hospital (TBH) is an innovation whereby the children bring their teddies while visiting the volunteers assuming healthcare practitioners’ role. This execution is effective in reducing the children’s anxieties about hospitalization and increasing their health knowledge. Therefore, our objective is to explore healthcare practitioners’ (HCP) views for the content of TBH and its approach as a personal safety module toward preventing CSA. Eighteen in-depth-interviews were conducted. Interviews were thematically analyzed. Participants suggest the TBH method as a good approach to teaching prevention of CSA among preschoolers. Four main themes emerged from this study: (1) educating children about personal safety, (2) moral values and faith as a medium to prevent child sexual abuse, (3) addressing social media use in children, and (4) general approach to content delivery. The involvement of parents is crucial. Addressing moral values and faith and usage of social media platforms are also essential factors to look into.

Introduction: Increased dietary salt intake can cause retention of fluid and subsequently an increase in blood pressure. Excessive salt consumption is one of the main causes of hypertension. This study aims to determine efforts done by medical students to reduce dietary salt intake and its associated factors in Universiti Putra Malaysia (UPM). Methods: This is a cross-sectional study. A self-administered questionnaire looking into efforts to reduce dietary salt intake adapted from the WHO STEPS questionnaire was used. There were six efforts altogether which were; limiting consumption of processed food; looking into sodium contents on food labels; purchasing low salt or sodium alternatives; avoid eating out; using spices when cooking; and doing things specifically to control salt consumption. Other factors in this questionnaire are on socio-demographic, practice of salt consumption, awareness, perception, attitude of dietary salt intake. Results: A total of 362 respondents participated. The majority had good awareness on salt intake (98.1%). A larger proportion of females significantly made the effort to buy low salt alternatives (p=0.003) and avoided eating out (p=0.048). On salt consumption practice, there were a bigger proportion of those that rarely ate processed food, that avoided eating out (p=0.08), bought low salt/sodium alternatives (p <0.001), looked at the sodium contents on labels (p=0.027) and limited the consumption of processed food (p<0.001). Conclusion: There are significant associations between the female gender and practice of eating processed food with efforts to decrease salt intake. More studies are recommended to look into assisting efforts to reduce salt consumption.

Background: Hypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there has been no systematic review and meta-analysis of a multiethnic population such as that of Malaysia. Aim: To determine the trend in prevalence, awareness and control rate of hypertension in Malaysia. Methods: Systematic searches were conducted in six databases (PubMed, Scopus, Ovid, CINAHL, Malaysian Medical Repository and Malaysia Citation Index) for articles published between 1980 and 2018. Two authors reviewed the studies and performed quality assessment and data extraction independently. Pooled estimates of hypertension prevalence, awareness and control rate were calculated using the DerSimonian-Laird random-effects model. Subgroup and sensitivity analyses were performed. Results: We included 56 studies involving a total of 241796 participants. The overall pooled prevalence of hypertension aged ≥ 18 years was 29.7%. The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% confidence interval (CI): 13.4, 19.0), increasing up to 36.8% (95%CI: 6.1, 67.5) in the 1990s, then decreasing to 28.7% (95%CI: 21.7, 35.8) in the 2000s and 26.8% (95%CI: 21.3, 32.3) in the 2010s. The prevalence of awareness was 51.4% (95%CI: 46.6, 56.3), while 33.3% (95%CI: 28.4, 38.2) of those on treatment had achieved control of their blood pressure. Conclusion: In Malaysia, three in ten adults aged ≥ 18 years have hypertension, while four in ten adults aged ≥ 30 years have hypertension. Five out of ten people are aware of their hypertension status and only one-third of those under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve awareness and control of hypertension should be of high priority.

Objective We aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills. Design This is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach. Settings We identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre. Results Ninety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition. Conclusion Children learnt the skills to self manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self management.

Background: Undergo a health check for cardiovascular disease (CVD) is an important strategy to improve cardiovascular (CV) health. Men are reported to be less likely to undergo cardiovascular disease (CVD) health check than women. Gender difference could be one of the factors influencing health seeking behaviour of men and women. We aimed to identify gender differences in factors influencing the intention to undergo CVD health checks. Methods: This was a cross-sectional survey using mall intercept interviews. Malaysians aged ≥30 years without known CVD were recruited. They were asked for their intention to undergo CVD health checks and associated factors. The factors included seven internal factors that were related to individuals’ attitude, perception and preparedness for CVD health checks and two external factors that were related to external resources. Hierarchical ordinal regression analysis was used to evaluate the importance of the factors on intention to undergo CVD health checks, for men and women separately. Results: 397 participants were recruited, 60% were women. For men, internal factors explained 31.6% of the variances in likeliness and 9.6% of the timeline to undergo CVD health checks, with 1.2% and 1.8% added respectively when external factors were sequentially included. For women, internal factors explained 18.9% and 22.1% of the variances, with 3.1% and 4.2% added with inclusion of the external factors. In men, perceived drawbacks of health checks was a significant negative factor associated with likeliness to undergo CVD health checks (coefficient = -1.093; 95%CI:-1.592 to -0.594), and timeline for checks (coefficient = -0.533; 95%CI:-0.975 to -0.091). In women, readiness to handle outcomes following health checks was significantly associated with likeliness to undergo the checks (coefficient = 0.575; 95%CI: 0.063 to 1.087), and timeline for checks (coefficient = 0.645; 95%CI: 0.162 to 1.128). Both external factors 1) influence by significant othe

Introduction: Delayed diagnosis of type 2 diabetes mellitus (T2D) increases the risk of presenting late with microvascular complications due to untreated long-standing hyperglycaemia. This study aimed to determine the prevalence of microvascular complications in newly diagnosed T2D patients in primary healthcare clinics. Methods: This was a cross-sectional study carried out in three government primary healthcare clinics in the state of Selangor, Malaysia. Malaysian aged 18 years and above with newly diagnosed T2D (≤ 6 months of diagnosis) were invited to participate in the study. Data collected included the sociodemographic characteristic and the clinical profile (weight, height, waist circumference, blood pressure, lipid, glycaemic, urine albumin, microalbuminuria and renal profile). The assessment of nephropathy, peripheral neuropathy and retinopathy were performed using standard protocol. Multivariate logistic regression analysis was used to identify the significant factors that contribute to the presence of microvascular complications. Results: A total of 162 newly diagnosed patients were recruited. The majority was women (64%). The mean age was 51 (SD 11) years. About one-third of the patients (27.7%) had developed at least one microvascular complication. Nephropathy was the commonest microvascular complication (19.2%), followed by peripheral neuropathy (8.6%) and retinopathy (6.5%). Poor glycaemic control was found to be a significant factor contributing to the presence of microvascular complications (OR 5.8, 95%CI:1.466, 23.288). Conclusion: There is a high prevalence of microvascular complications among the newly diagnosed T2D. There is a need to develop appropriate strategies to increase the awareness and early detection of T2D.

Background: The prevalence of diabetes mellitus (DM) is steadily increasing worldwide, with a significant DM population in Asian countries. Adherence to medications is important to achieve good glycaemic control among patients with DM. Thus, patients’ adherence to their medication regimen should be determined to optimise DM management. Aims: To determine medication adherence and the relationship between patient profile and medication adherence among patients with type 2 DM (T2DM). Design: Cross-sectional survey. Methods: This study was conducted in a public hospital in Selangor, Malaysia, from December 2016 to June 2017. Data was obtained through administration of the Medication Compliance Questionnaire and an electronic medical records database. Multivariate logistic regression analysis was used to determine the predictors of medication adherence. Results: A total of 232 (95.9% response rate) patients participated in this study. The overall percentage of medication adherence among patients with DM was 55.2%. The majority of participants were female (53.4%), Malay (47.0%), aged 41–64 years (55.2%; mean age, 56.69 years), married (84.5%), unemployed (60.8%) and attended secondary school (53.9%). The factors independently associated with adherence were ethnicity (odds ratio [OR], 1.43; 95% confidence interval [CI]: 1.03–1.99) and haemoglobin A1c (HbA1c) level (OR, 2.71; 95% CI: 1.56–4.72). Conclusions: The medication adherence among patients with DM in a public hospital in Selangor, Malaysia was low. A health intervention emphasising patient-centred care is warranted to improve DM patients’ adherence to prescribed medication. Considering that Malaysia has a multi-ethnic population, the patients’ ethnicity and their HbA1c levels need to be considered in the implementation of any intervention to improve medication adherence. Impact statement: Medication adherence is influenced by individual patients’ characteristics. To improve adherence to the medication regimen, nurse

The way of how teaching and learning is now conducted is way different from how it was done a decade or two before. Gone are the days where the ‘boring’ one- or two-hours lectures by the earlier generations are welcomed. In this era of generation Y learners, teaching needs to be both ‘enjoyable’ and innovative. This presents a huge challenge for a clinician, who now has to teach in a new role as a clinical lecturer. The clinician has spent most of his/her time in consultation rooms or hospitals treating one to one patient but now rather scarily have to face a room full of knowledge-thirsty and tech-savvy young minds. This scenario also applies to medical students, who acquire digital knowledge at an alarming fast rate. As imprinted in the latest Education blueprint, innovative teaching is being outlined as one of the strategies to enhance the teaching methods in order to improve learning (Ministry of Education Malaysia, 2015; 2017).This is to create a learning environment that is more dynamic and conducive so as to improve the overall quality of teaching and learning through a more practical based knowledge curriculum that will equip the young minds with skills to work in an ever challenging environment. Based on the aforesaid context, a new clinical lecturer faces several challenges. Firstly, the clinician lecturer is in an unfamiliar teaching position. Secondly, they face Gen Y learners with different learning expectation who are extremely comfortable with the use of mobile apps and electronic methods of assessment (Eddy, 2011). Thirdly, they are expected to conduct research and publish in high impact journals while facing the increasing workload as a clinician, lecturer and researcher. Given the aforementioned context as clinical lecturers, this chapter will delve into some common challenges and seek possible solutions that may be employed to enhance SoTL.

Introduction: Widespread use of the internet is a relatively recent phenomenon that is affecting different cultures worldwide in both positive and negative ways. This study aimed to determine the gender differences in the inter-net addiction among medical students in public university. Methods: 426 medical students from year one to four were invited to participate in the study. For data collection, we used a self-administered questionnaire consisting of socio-demographic and internet usage questions, the Internet Addiction Test (IAT) and the Depression Anxiety and Stress Scales 21 (DASS-21). Results: There were a total of 426 (270 female and 156 male) medical students included in this study. IA was high in both male and female students. There was a higher proportion of male students (44.9%) found to be addicted compared to female students (32.2%). There were positive correlations between the DASS-21 and IAT scores for both male and female students. For female students, longer hours spent online daily (p-value = 0.02), as well as high anxiety (p-value < 0.001) and depression scores (p-value = 0.037) were found to be most strongly associated with IA. Among male students, factors associated with IA were the availability of internet access at home (p-value=0.02) and high anxiety scores (p<0.001). Conclusion: IA was high in both male and female medical students, with higher anxiety raising the risk in both groups. In female students, a higher depression score was also found to be associated with IA.

Background: Supported self-management, including provision of an asthma action plan (AAP) improves asthma control. However, the concept of self-management and use of AAP among Asian population is relatively new. Aims: To determine the prevalence of AAP ownership among asthma patients and their characteristics in Malaysia primary care. Methods: We randomly sampled 550 asthma patients from five primary care practices between Oct 2017-Jan 2018. The patients were interviewed with pre-tested questionnaires to assess their AAP ownership, socio-demographic and the Asthma Control Test (ACT). Descriptive statistics were used to analyse the data. Results: Asthma control was poor in 143(26%) patients, partially controlled in 137(24.9%) and well-controlled in 270(29.1%). Only 160(29.1%) owned an AAP. These AAP were primarily given by the doctors (95%, n=152) and 5% were given by the allied health (nurses and pharmacists). Among those who owned an AAP, 106(66.2%) were confident to use it. For those using AAP, the mean age was 45.6 years old, predominantly female (67%), of Malay ethnicity (48%), had at least secondary educational level (40%) and had well-controlled asthma (46%). Conclusion: Education, usage and confidence in using an AAP for asthma self-management is sub-optimal among asthma patients in Malaysian primary care. Supported asthma self-management in this population must be strengthened.

Introduction: Depressive disorders are common. As compared to the general population, healthcare personnel are hypothesized to have an above than average risk to develop this condition. The aim of this study is to assess the prevalence of this condition and its contributing factors amongst primary healthcare personnel. Methods: A cross-sectional study was conducted by universally sampling 179 primary healthcare personnel at nine primary healthcare centers across Kuala Lumpur and Selangor in May 2015. Depressive symptoms were screened using self-administered Patient Health Questionnaire-9 (PHQ-9) questionnaire. Socio-demographic and work profile data were also assessed. Results: 92.7% of the 179 personnel agreed to participate. Near half of the respondents were staff nurses (49%), followed by doctors (22%), assistant medical officers (10%), attendants (10%) and the remaining were pharmacists, dieticians, and laboratory technicians (9%). Depression was found to be present in 38% of the participants with one-third found to have moderate to severe depression. Bivariate analysis show that males (p=0.043), assistant medical officers (p=0.048), and working more than 10 hours per day (p=0.019) are significant risk factors. Further analysis by logistic regression shows that working more than 10 hours per day increases the odds of depression by 3.1 (OR 3.1, 95% CI 1.1-8.7, p=0.03). Conclusions: A high prevalence of depression was found within the healthcare personnel population at the primary healthcare centres studied. Being a male, employed as an assistant medical officer, and, prolonged hours at the workplace is a significant risk factor for depression.

Background: To improve individuals’ participation in cardiovascular disease (CVD) screening, it is neces- sary to understand factors that influence their intention to undergo health checks. This study aimed to develop and validate an instrument that assess determinants that influence individ- uals’ intention to undergo CVD health checks. Methods: The concepts and items were developed based on findings from our prior exploratory quali- tative study on factors influencing individuals’ intention to undergo CVD health checks. Con- tent validity of the questionnaire was assessed by a panel of six experts and the item-level content validity index (I-CVI) was determined. After pretesting the questionnaire was pilot tested to check reliability of the items. Exploratory factor analysis was used to test for dimensionality using a sample of 240 participants. Results: The finalized questionnaire consists of 36 items, covering nine concepts. The I-CVI for all items was satisfactory with values ranging from 0.83 to 1.00. The exploratory factor analysis showed that the number of factors extracted was consistent with the theoretical concepts. Correlations values between items ranged from 0.30 to 0.85 and all the factor loadings were more than 0.40, indicating satisfactory structural validity. All concepts showed good internal consistency, Cronbach’s alpha values ranged 0.66–0.85. Conclusions: The determinants for CVD health check questionnaire has good content and structural valid- ity, and its reliability was established. It can be used to assess determinants influencing indi- viduals’ intention to undergo CVD health checks.

Background: Cardiovascular disease (CVD) is the leading cause of death globally. However many individuals are unaware of their CVD risk factors. The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of CVD risk factors screening. Methods: A systematic search was conducted through Pubmed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials. Additional articles were located through cross-checking of the references list and bibliography citations of the included studies and previous review papers. We included intervention studies with controlled or baseline comparison groups that were conducted in primary care practices or the community, targeted at adult populations (randomized controlled trials, non-randomized trials with controlled groups and pre- and post-intervention studies). The interventions were targeted either at individuals, communities, health care professionals or the health-care system. The main outcome of interest was the relative risk (RR) of screening up take rates due to the intervention. Results: We included 21 studies in the meta-analysis. The risk of bias for randomization was low to medium in the randomized controlled trials, except for one, and high in the non-randomized trials. Two analyses were performed; optimistic (using the highest effect sizes) and pessimistic (using the lowest effect sizes). Overall, interventions were shown to increase the uptake of screening for CVD risk factors (RR 1.443; 95% CI 1.264 to 1.648 for pessimistic analysis and RR 1.680; 95% CI 1.420 to 1.988 for optimistic analysis). Effective interventions that increased screening participation included: use of physician reminders (RR ranged between 1.392; 95% CI 1.192 to 1.625, and 1.471; 95% CI 1.304 to 1.660), use of dedicated personnel (RR ranged between 1.510; 95% CI 1.014 to 2.247, and 2.536; 95% CI 1.297 to 4.960) and provision of financial incentives for screening (RR 1.462; 95%

There are many treatment options for localized prostate cancer, and there is clinical equipoise in relation to the treatment outcomes. This study aimed to explore doctors’ approaches to decision support in counselling patients with localized prostate cancer in a country with a less established system of support and care delivery for cancer treatment. Four in-depth interviews and three focus group discussions were conducted with seven government policy makers/consultant urologists, three oncologists, four private urologists and six urology trainees in Malaysia between 2012 and 2013. Doctors facilitated the treatment decision by explaining about the disease and the treatment options, which included monitoring, side effects and complications of each treatment option. Paper-based (charts and diagram drawings) or electronic (ipad apps and websites) illustrations and physical models were used as patient education aids. Further reading materials and websites links were often provided to patients. Patients were given time till subsequent follow up to decide on the treatment and family involvement was encouraged. Referral to other healthcare professionals (oncologist, radiotherapist or other urologist) for second opinion was offered to the patients. The doctors would recommend patients to speak to prostate cancer survivors for peer support but official support groups were not easily accessible. This study highlighted a multi-faceted approach to support patients with localized prostate cancer in making a treatment decision. It not only involved the doctors (urologist or oncologist) themselves, but also empowered the patients and their social network to support the decision making process.

A persistent and increasing prevalence of diagnosed and undiagnosed diabetes mellitus has recently been reported in the National Health and Morbidity Survey 2015. This commentary recapitulates the relevant and valuable lessons in the Malaysian national diabetes registries to inform the healthcare stakeholders and policy makers on potential areas of clinical practice improvement and future researches. Under performance of the process measures and sub-optimal control of HbA1c, blood pressure and lipids profile were prevalent (<40% achieved treatment targets). Although these had improved slightly from 2009 to 2012, diabetes co-morbidities (hypertension and dyslipidaemia) and complications had also increased. Prevalence of insulin use had doubled, and lipid lowering agent use had increased about 50% in 2012 compared to 2009. We identified six clinical areas for urgent attention and improvement, and three potential areas for future research.

Background: The aim of this study is to explore the challenges faced by healthcare professionals (HCPs) in Malaysia in supporting patients with early prostate cancer in making treatment decisions. Methods: Four in-depth individual interviews and three focus group discussions were conducted with urologists (n=11), urology trainees (n=5), oncologists (n=3) and policy makers (n=1) in Malaysia in 2012-2013. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyze the data. Results: Challenges reported by HCPs in supporting patients in making decisions about prostate cancer treatment consisted of patient, social, healthcare professionals and health system factors. Patient-related challenges were: distrust of HCPs, difficulty in communicating information, preconceptions, attitudes to treatment, preparedness for decision making, viewing prostate cancer as taboo and fear of treatment complications, or side-effects. Social factors, such as influence of family or others, also posed a problem for HCPs seeking to support patients’ decision-making. HCP-related challenges included: differences of opinion among HCPs, uncertainty about the best treatment option and lack of interdisciplinary cooperation. Healthcare system factors challenges included: lack of support staff, time constraints, treatment availability and treatment costs. HCPs suggested that delivery of care by multi-disciplinary teams, and more use of audio-visual media, would help patients to make decisions. Conclusions: HCPs faced various challenges in supporting patients with prostate cancer in making decisions about treatment. Delivery of care by a supportive team in a specialist centre may improve the support patients receive in making decisions.

Objective: To examine impressions of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Design: Cross-sectional study. Setting: This study is part of a larger national study on the perception of Malaysian public healthcare professionals on FMSs (PERMFAMS). Participants: PHCPs from three categories of health facility: hospitals, health clinics and health offices. Main outcome measures: Qualitative analyses of written comments of respondents' general impression of FMSs. Results: The participants' response rate was 58.0% (780/1345), with almost equal proportions from each public healthcare facility. A total of 23 categories for each of the 648 impression comments were identified. The six emerging themes were: (1) importance of FMSs; (2) roles of FMSs; (3) clinical performance of FMSs; (4) attributes of FMSs; (5) FMS practice challenges; (6) misconception of FMS roles. Overall, FMS practice was perceived to be safe and able to provide effective treatments in a challenging medical discipline that was in line with the current standards of medical care and ethical and professional values. The areas of concern were in clinical performance expressed by PHCPs from some hospitals and the lack of personal attributes and professionalism among FMSs mentioned by PHCPs from health clinics and offices. Conclusions: FMSs were perceived to be capable of providing effective treatment and were considered to be important primary care physicians. There were a few negative impressions in some areas of FMS practice, which demanded attention by the FMSs themselves and the relevant authorities in order to improve efficiency and safeguard the fraternity's reputation.

This study examined the factors associated with follow-up non-attendance (FUNA) and mortality among the adult patients with type 2 diabetes mellitus (T2DM). Data on 57780 T2DM patients from the 2009 diabetes registry were analyzed using multinomial logistic mixed model. Out of 57780 patients, 3140 (5.4%) were lost to follow-up and 203 (0.4%) patients had died. Compared with patients who were under active follow-up, men (OR 1.37), neither on insulin (OR 1.72), nor on antiplatelet agents (OR 1.47), having higher HbA1c (OR 1.15), higher LDL-C (OR 1.18) and complications (OR 1.33) were associated with FUNA. Older age (OR 1.09) and higher LDL-C (OR 2.27) have higher mortality. Across the four different health facilities, medication use (insulin and anti-platelet agents) to achieve better disease control in the younger age when diabetes complication is absent would not cause FUNA and might reduce mortality.