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Introduction: Type 2 diabetes mellitus is a chronic disease which is highly prevalent in Malaysia. In managing diabetes, the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) have advocated self-management to be the basic component of diabetes care. However, an ongoing discussion, education and assessment of the patient's diabetic knowledge should be implemented in the patient's empowerment process. There are various assessment tools available worldwide but very few are available in the Malay language. This study is aimed to perform the Malay translation of the Simplified Diabetes Knowledge Test (DKT) questionnaire and validate it. Methods: Forward-backward translation procedure was used to translate the simplified version of the DKT questionnaire. A total of 120 respondents with type 2 diabetes mellitus from a selected government health clinic were recruited to answer the questionnaire which consists of socio-demographic, diabetes characteristics and the 20-item Malay version of simplified DKT questionnaire. Reliability and construct validity were tested with Cronbach's alpha coefficient and Exploratory Factor Analysis. Results: Factor analysis with Varimax rotation identified five meaningful domains for the final 18 items. The Cronbach's alpha for the overall scale of the translated questionnaire was 0.573 with values of each five significant domain's Cronbach's alpha ranged from 0.370 to 0.564. Conclusion: The Malay version of simplified DKT is valid and reliable to be used as a brief assessment of knowledge among Malaysian diabetic patients. [ABSTRACT FROM AUTHOR]

Insulin oedema is a rare condition that may occur after the initiation or rapid intensification of insulin therapy in patients with long-standing hyperglycaemia, commonly with type 1 diabetes mellitus (DM). We reported a case of insulin oedema in a patient with type 2 DM who presented with swelling of the extremities and weight gain of 3 kg 1 week after insulin initiation. A course of furosemide was administered, but no significant immediate improvement was observed; however, the lower limb swelling resolved spontaneously after 3 months of follow-up. The patient also achieved adequate diabetic control with insulin, as shown by the reduction of her HbA1c from 10.7% to 6.9% over 6 months. Insulin oedema is a diagnosis of exclusion after ruling out other differential diagnoses, such as cardiac, renal, or liver failure. Although insulin oedema carries with it a good prognosis, physicians should be aware of the condition to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

The literature had reported the clinical resolution of periodontitis (CRP) in type-2 diabetic patients (T2DM-P) following non-surgical periodontal treatment (NSPT). However, the changes in glycemic control status during NSPT have not been presented clearly. Hence, this study was aimed to evaluate the CRP of T2DM-P under medical- and dental-coordinated care (M-DCC). A 6-month follow-up quasi-experimental study was conducted on 20 T2DM-P patients who underwent M-DCC in Kuantan. M-DCC, which included the standard diabetic care was administered by medical professionals at three health clinics, while NSPT by two periodontal specialists at their respective clinics. The target glycemic control achievement (TGCA), HbA1c = 6.5% - was assessed at 0 and 6 months post-NSPT. Clinical resolution of PD was measured in terms of the following parameters: (1) full mouth bleeding score (FMBS); (2) clinical attachment level (CAL) (mm); (3) probing pocket depth (PPD) (mm); as well as (4) PPDs of < 4 mm, = 4 mm, and = 6 mm at 0, 3, and 6 months post-NSPT respectively. Paired simple t-tests and ANOVA "F" tests were performed to interpret the clinical resolution of periodontitis as well as its relationship with TGCA. Of fifteen (25%) uncontrolled T2DM-P patients, two (10%) patients achieved the TGCA (HbA1c = 6.5%) at 6 months after the completion of NSPT and M-DCC. However, no significant reductions in the overall mean HbA1c values were noted. In spite of that, there were significant differences in the CRP and all periodontal parameters at baseline and 6-month follow-up. Nevertheless, there were no significant changes in the mean CAL (p > 0.05). NSPT, under M-DCC, gave rise to significant changes in the periodontal health of diabetic patients 6 months post-treatment. The effects of NSPT on HbA1c level were inconclusive. (WC:251). [ABSTRACT FROM AUTHOR]

Adolescence is a period of time when the development of personality and psychology is taking place. Studies have shown that religiosity can affect the mental health of a person. Many tools have been developed to assess religiosity of a person; one of them is the Santa Clara Strength of Religious Faith (SCSORF) scale. In this study, a translation and validation for SCSORF Malay Version (SCSORF-M) is done, and subsequently used to look for the association between religiosity and mental health in adolescents. Fifty questionnaire papers have been distributed to 50 students in secondary schools in district of Kuantan. The mean score for depression, anxiety, and stress are 5.83, 5.59, and 8.34 respectively. Only 10 (24.4%) have no depression, 9 (22%) have no anxiety, and 13 (31.7%) have no stress. The mean score for SCSORF -M scale was 35.3 (range 25-40). Family income has shown to correspond negatively with the depression, anxiety, and stress, while religiosity has shown to be correlating negatively with depression and stress, but positive correlation with anxiety. SCSORF-M has positive convergent correlation with Duke's University Religiosity Index Malay Version (DUREL-M) in all domains. SCSORF-M has shown good Cronbach's alpha value (0.84). In conclusion, religiosity is an important factor to contribute to the outcome of mental health among adolescents. SCSORF-M can be used as an assessment tool for religiosity. [ABSTRACT FROM AUTHOR]

Introduction: Islam forbids any forms of tobacco smoking. Prevalence of active smokers in Malaysia is increasing despite availability of stop-smoking clinics. Thus, the practice of healthcare professionals involved in providing smoking cessation intervention needs to be assessed using validated assessment tool. Objective: This study aimed to develop and validate a questionnaire that assesses the knowledge, attitude, and practice of medical doctors based on the national smoking cessation guideline. In addition, we aimed to evaluate factors that contribute to the score. Methods: The 26 items consists of mixture of true/false choice questions and Likert scaling response based on domain of 5A's (ask, assess, advice, assist, arrange) and 5R's (relevant, risks, rewards, roadblocks, repetitions) of the national stop-smoking guideline. The questionnaire was distributed to 141 medical doctors. Reliability was determined using Cronbach's alpha for internal consistency while construct validity was assessed using factor analysis. Results: A high degree of internal consistency was observed for this 26 items (Cronbach's alpha= 0.824) and for practice subscale (Cronbach's alpha 0.83). Subsequently, three items were removed due to poor inter item correlation. Factor analysis extracted seven meaningful components from this remaining 23 items, in which three components with least items were deleted due to overlapping subscale with other components, leaving four meaningful components which consist of (1) practice of ask, advice and assess components and practice of 5R's (total of 10 items); (2) practice of assist components for those willing to quit (two items); (3) knowledge (two items) and (4) attitude (three items).These final 17 items still demonstrate high internal consistency with Cronbach's alpha of 0.832. Conclusion: This study indicates that this questionnaire is a reliable and valid tool to assess the knowledge, attitude, and practice of healthcare professionals on stop smoking guidelines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of Viva QS®, an herbal medication consists of a combination of twelve herbs for smoking cessation in Malaysian adult smokers. Methods: A randomized, double-blind placebo-controlled study was conducted in the industrial factories in Kerteh and Kuantan, Malaysia. The subjects were recruited from those attended mobile smoking cessation programme (MSCP), agreed to sign written consent and fulfilled study criteria. Demographic and smoking history information, modified Fagerstrom test for nicotine dependence (FTND) score and carbon monoxide (CO) level were obtained at baseline. Follow-up was conducted by phone calls and/or face-to-face meetings at three time points. Viva QS® and placebo were supplied for 24 weeks. Results: One hundred and fifty-five subjects were randomized from 1st April 2008 to 26'* October 2008 in the study. Biochemically verified 7-days point prevalence demonstrated Viva QS® significantly increased quit rate vs. placebo; 42.7% vs. 26.2% (p = 0.038) at week 4, 32.0% vs. 16.7% (p = 0.031) at week 12 and 30.7% vs. 13.9% (p = 0.015) at week 24. Adverse events reported were similar between groups. The most frequently reported adverse events were sore throat and dry mouth (36.6% and 17.8%, respectively for Viva QS® vs. 28.8% and 16.9% for placebo). Conclusions: Viva QS is safe and effective to aid smokers quit smoking in this population sample. [ABSTRACT FROM AUTHOR]

Introduction: Unhealthy lifestyle is one of the risks of non-communicable diseases (NCDs) in our population even among the healthcare provider. They should be as the role model for their NCDs patients in the clinics. Therefore, this study was to determine the lifestyle practice and lifestyle-related NCDs (LR-NCDs) status among primary health care staffs. Methods: A cross-sectional survey was done among 69 health-staff (20-physicians (PCPs), 16-nurses and 33-Para-Med) aged between 20-60 years from 3 selected governments primary health care clinics in Kuantan on April 2015. A pre-tested questionnaire is used to the collect history of LR-NCDs, smoking, exercise status and 24-hours-dietary recall. The BMI, systolic and diastolic blood pressure of the participants were also measured. The Nutritionist-Pro-(g) software was used to extract macronutrients (Carbohydrate, Protein and Total-Fat %) and balance-diet (within recommended %). Results: The most common LR-NCDs among health-staff were overweight (34.8%) and followed by obesity (24.6%), DM (8.7%) and hypertension (3.2%). The majority (95.7%) were non-smokers and 69.6% did not exercise regularly. Diet-recall analysis showed that only 8.9% (2-PCPs, 1-nurse & 3-Para-Med) had balanced-diet. The status of the DM, hypertension and smoking and practicing balance-diet were not significantly different (p>0.05) among the PCPs, registered-nurses and Para-Med except for the exercise. Most PCPs (90%) have inadequate exercise compared to registered-nurses (43.8%) and Para-Med (69.7%) (p<0.05). Conclusions: There is a high prevalence of overweight and obesity, inadequate exercise and having an unbalance-diet were noticed among all levels of health-staff. [ABSTRACT FROM AUTHOR]

Introduction: Defaulted appointment in diabetic clinics is a great concern as it affects disease controlled and complications. Geographical location, clinic-types and quality of health services provided are known determinant reasons for defaulting. Thus, this study aimed to identify characteristics and reasons for default between diabetic-patients at public-primary-care-clinics (PPCCs) and public-hospital-diabetic-specialist-clinic (DS-OPD). Methods: A prospective one-year-cohort study was conducted among 405 diabetic patients from two PPCCs and DS-OPD in Kuantan (2015-2016). There were 2-point visits (at 6-month and 12-month) assessing follow-up appointments within one year. Defaulter is defined by at least one-time defaulted either at 6-month or 12-month. Regular-attendees were included as control. Type-1-DM-patients, missing-records, known-deceased and transferout cases were excluded. Background socio-demographic data of diabetic-defaulters were collected from DM-records and reasons for defaulting were traced via 3-times-telephone contacts which 51.6% diabetic-defaulters responded. A stratified cross-analysis was done to compare the prevalence and characteristics between defaulters and regular attendees. Reasons for defaults were analyzed using open-ended-questions analysis method. Results: Prevalence of defaulters was 18% (73/405); higher prevalence was found in DS-OPD than PPCCs (32.4% vs 10.3%). Gender, race, age, education, occupation and the duration of DM were not significantly different between defaulters and regular-attendees at DS-OPD. However, self-employment (25.9%), housewives (25.9%), aged less than 45-years (33.3%) and≥ 55 years-old (44.4%) were significant defaulters in PPCCs. Significant different of reasons for default found at DS-OPD compare to PPCCs for postponing the date (54.5% vs 12.5%), while refusing treatment/used alternative medicine (18.2% vs 43.8%); and movedout/ transferred/referred cases (27.3% vs 31.2%) were more in PPCCs. Conclusions: Distinctive characteristics and diverse reasons for default between DS-OPD and PPCCs among diabetic-patients fortified to set tailored remedial to reduce defaulter-rate in different clinic. [ABSTRACT FROM AUTHOR]

Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition. [ABSTRACT FROM AUTHOR]

Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening. [ABSTRACT FROM AUTHOR]

Introduction: Elderly population is at high-risk to suffer from malnutrition and nutritional inadequacy. The use of nutrition resource kit which provides nutritional guidance could be helpful to improve their dietary intake. There is no study performed previously on the type of nutrition resource kit that can be used to overcome and prevent malnutrition among Malaysian elderly. Therefore, this study aimed to identify the types of nutrition resource kit needed by community living elderly in Malaysian health clinic setting. Methods: Qualitative study was conducted to explore the types of nutrition resource kit needed by community living elderly in health clinics. Recruitment for in-depth individual interview targeted elderly aged =60 years old who met the inclusion and exclusion criteria and received primary healthcare services in four health clinics in Kuantan, Pahang. Interview questions addressed the knowledge on existing nutrition educational materials, preference for types of nutrition resource kit and opinion on technology-based materials. Data were audiotaped, transcribed verbatim and thematically analyzed using NVivo software version 12. Results: 21 participants involved in this study (mean age=67.24 ±6.98 years). Five key themes identified from the data: provision of nutrition resource kit; preference for printed version; eye-friendly; facilitate understanding with diagram; and support for technology-based materials. This study also found that majority of elderly preferred for A5-sized booklet for nutrition resource kit. Conclusion: Future development of nutrition resource kit tailored to the need of elderly is needed to deliver nutritional guidance effectively and served as an important reference for them to overcome malnutrition. [ABSTRACT FROM AUTHOR]