Purpose: Intimate partner violence (IPV) is a serious public health concern that demands a multidisciplinary healthcare approach. Primary healthcare providers (PHCPs) hold a vital position as they are at the forefront of preventing, detecting, and managing IPV within the healthcare setting. This study aimed to cross-culturally adapt and evaluate the psychometric properties of the Malay version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS-Malay) tool, which was previously developed for measuring physicians’ knowledge, attitudes, and preparedness to manage IPV. Methods: The cross-cultural adaptation of the PREMIS involved content validation among health experts (n=8), forward backward translation by bilingual translators (n=4), face validation (pre-testing) and cognitive debriefng among PHCPs (n=6). An online survey was administered to a sample of Malaysian PHCPs (n=190) to assess the psychometric properties (construct validity, internal consistency, and test-retest reliability) of the PREMIS-Malay. Results: Principal component analysis (PCA) of the modifed “Opinions” items found a seven-factor structure (workplace/self-efcacy, staf preparation, legal requirements, staf constraints, alcohol/drugs, IPV enquiry/screening, victim understanding) accounting for 70.57% of the total variance. The “Background” and “Opinions” subscales indicated acceptable to good levels of internal consistency, with Cronbach’s alpha ranged between 0.59 and 0.98. The intraclass correlation coefcients of these subscales ranged from 0.52 to 0.85, indicating a satisfactory to high level of test-retest reliability. Conclusions: This study provides evidence that the PREMIS-Malay demonstrated acceptable psychometric properties for evaluating PHCPs’ preparedness to address IPV. Future validation studies to support the use of this instrument using larger and more representative samples are recommended.

Aim: Elder abuse is a significant public health problem. This study aims to estimate its prev-alence and associated factors, using representative national Malaysian data.Methods: A nationwide population-based survey involving 3977 community-dwelling olderpersons aged ≥60 years was conducted via face-to-face interview, of whom 3466 older personswere eligible for screening using a locally validated tool. Elder abuse was defined as any oneoccurrence of neglect, financial, psychological, physical or sexual abuse perpetrated by some-one in a position of trust that was experienced in the past 12 months.Results: About 9.0% of older persons in Malaysia have experienced elder abuse in the past12 months, with neglect being the commonest type experienced (7.5%; 95% confidenceinterval [CI]: 5.54, 10.07). There is no significant difference by age group and geographicallocation. Males (adjusted odds ratio [aOR] 1.7; 95% CI: 1.06, 2.60), poorer social support(aOR 5.0; 95% CI: 2.25, 11.22), dependency in activities of daily living (aOR 2.1; 95% CI:1.23, 3.44) and a previous history of abuse (aOR 10.1; 95% CI: 4.50, 22.86) show higher oddsof experiencing elder abuse. Almost 5% of abused older persons reported experiencing multi-ple types of abuse. Reporting is low at 19.3% with none reporting to healthcare personnel.Conclusions: The prevalence of elder abuse in this study is lower than global estimates, butsimilar to local studies. Preventive measures and programs are crucial to overcoming elderabuse and need to be carried out at multiple levels – the individual, community, healthcareand other stakeholders.

Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

Excess mortalities are a more accurate indicator of true COVID-19 disease burden. This study aims to investigate levels of excess all-cause mortality and their geographic, age and sex distributions between January 2020-September 2021. National mortality data between January 2016 and September 2021 from the Department of Statistics Malaysia was utilised. Baseline mortality was estimated using the Farrington algorithm and data between 1 January 2016 and 31 December 2019. The occurrence of excess all-cause mortality by geographic-, age- and sex-stratum was examined from 1 January 2020 to 30 September 2021. A sub-analysis was also conducted for road-traffic accidents, ethnicity and nationality. Malaysia had a 5.5–23.7% reduction in all-cause mortality across 2020. A reversal is observed in 2021, with an excess of 13.0–24.0%. Excess mortality density is highest between July and September 2021. All states and sexes reported excess trends consistent with the national trends. There were reductions in all all-cause mortalities in individuals under the age of 15 (0.4–8.1%) and road traffic accident-related mortalities (36.6–80.5%). These reductions were higher during the first Movement Control Order in 2020. Overall, there appears to be a reduction in all-cause mortality for Malaysia in 2020. This trend is reversed in 2021, with excess mortalities being observed. Surveillance of excess mortalities can allow expedient detection of aberrant events allowing timely health system and public health responses.

Background: Patients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia. Methods: This was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD. Results: Among 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2–21.0) of patients without CVD and 45.8% (95% CI: 44.8–46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend. Conclusions: The LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C.

The prevalence of diabetes in Malaysia is increasing, and identifying patients with higher risk of complications is crucial for effective management. The use of machine learning (ML) to develop prediction models has been shown to outperform non-ML models. This study aims to develop predictive models for Type 2 Diabetes (T2D) complications in Malaysia using ML techniques.Design and methods:This 10-year retrospective cohort study uses clinical audit datasets from Malaysian National Diabetes Registry from 2011 to 2021. T2D patients who received treatment in public health clinics in the southern region of Malaysia with at least two data points in 10 years are included. Patients with diabetes complications at baseline are excluded to ensure temporality between predictors and the target variable. Appropriate methods are used to address issues related to data cleaning, missing data imputation, data splitting, feature selection, and class imbalance. The study uses 7 ML algorithms, including logistic regression, support vector machine, k-nearest neighbours, decision tree, random forest, extreme gradient boosting, and light gradient boosting machine, to develop predictive models for four target variables: nephropathy, retinopathy, ischaemic heart disease, and stroke. Hyperparameter tuning is performed for each algorithm. The model training is performed using a stratified k-fold cross-validation technique. The best model for each algorithm is evaluated on a hold-out dataset using multiple metrics. Expected impact of the study on public health: The prediction model may be a valuable tool for diabetes management and secondary prevention by enabling earlier interventions and optimal resource allocation, leading to better health outcomes.

Our study aims at describing mortality among reported elder abuse experiences in rural Malaysia. This is a population-based cohort study with a multistage cluster sampling method. Older adults in Kuala Pilah (n = 1,927) were interviewed from November 2013 to May 2014. Mortality was traced after 2 years using the National Registration Department database. Overall, 139 (7.2%) respondents died. Fifteen (9.6%) abuse victims died compared to 124 (7.0%) not abused. Mortality was highest with financial abuse (13%), followed by psychological abuse (10.8%). There was a dose-response relationship between mortality and clustering of abuse: 7%, 7.7%, and 14.0% for no abuse, one type, and two types or more, respectively. Among abuse victims, 40% of deaths had ill-defined causes, 33% were respiratory-related, and 27% had cardiovascular and metabolic origin. Results suggest a link between abuse and mortality. Death proportions varied according to abuse subtypes and gender. Keywords: Abuse outcome; Malaysia; descriptive study; effects of elder abuse; elder mistreatment; exploratory; family violence; mortality.

The actual prevalence of diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D) in Malaysia is unknown. We aimed to determine the prevalence of DKD and its associated risk factors among T2D patients in Malaysia. An analytical cross-sectional study was conducted using the year 2022 clinical audit dataset from the National Diabetes Registry. DKD was defined as albuminuria, a decreased glomerular filtration rate, or both. Among 80,360 patients, 62.2% were female, 68.4% were Malay, and the mean age was 61.4 years. A total of 56.7% (95% CI 56.4–57.1%) of patients were found to have DKD. Increasing age, male sex, Malay ethnicity, longer duration of diabetes, overweight, obesity, hypertension, diabetic retinopathy, diabetic foot ulcer, nontraumatic lower-extremity amputation, ischaemic heart disease, stroke, insulin, higher numbers of antihypertensive agents, antiplatelet agents, poorer HbA1c control, higher systolic blood pressure, non-achievement of triglyceride target, and non-attainment of HDL-cholesterol goal were independent risk factors associated with DKD. Clinicians, program managers, and health policymakers should target modifiable factors to manage DKD and prevent its progression to end-stage kidney disease in Malaysia.

(1) Background: The prevalence of overweight and obesity among children has increased tremendously in the ASEAN region, including Malaysia. In Malaysia, the National Strategic Plan for Non-Communicable Diseases (2015–2025) provides the overall framework for its response to the non communicable diseases (NCD) epidemic. Preventing childhood obesity is one of the key strategies for early intervention to prevent NCDs. The objective of this research is to examine the current status of policy interventions in addressing childhood obesity in Malaysia. (2) Methods: A panel of 22 stakeholders and experts from Malaysia, representing the government, industry, academia and non-governmental organizations, were sampled using a modified Delphi technique. Data were collected using a modified NCD scorecard under four domains (governance, risk factors, surveillance and research and health systems response). A heat map was used to measure the success of the four realms of the NCD scorecard. For each domain of the NCD scorecard, the final score was grouped in quintiles. (3) Results: A total of 22 participants responded, comprising of eight (36.4%) males and 14 (63.4%) females. All the domains measured in implementing policies related to childhood obesity were of low progress. Nine governance indicators were reported as 22.5% (low progress), four in the risk factors domain, and two in the surveillance. This shows that timely and accurate monitoring, participatory review and evaluation, and effective remedies are necessary for a country’s surveillance system. (4) Conclusion: Although Malaysia has published several key strategic documents relating to childhood obesity and implemented numerous policy interventions, we have identified several gaps that must be addressed to leverage the whole-of-government and whole-of-society approach in addressing childhood obesity in the country.

Purpose: Healthcare providers’ (HCPs) readiness to respond to intimate partner violence (IPV) is crucial for early detection and management of patients experiencing IPV. This systematic review aims to identify currently available tools for assessing HCPs’ readiness to respond to IPV, evaluate their measurement properties, and summarize the quality of evidence to facilitate the selection of appropriate instrument. Methods: A systematic search was performed in PubMed, CINAHL, Ovid, Web of Science, Scopus, and the Cochrane Library from inception to October 2022, supplemented by hand searching and gray literature searches. Two authors independently screened studies based on predefned criteria and completed data extraction. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used for methodological quality assessment. Results: Of 34 studies included in this review, nine measurement tools were identifed for the evaluation of measurement properties and overall quality ratings. Internal consistency (31 studies), content validity (29 studies), and structural validity (21 studies) were the most reported psychometric properties. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool is the most widely used instrument for assessing HCPs’ readiness to respond to IPV, with moderate to high evidence for sound psychometric quality. Conclusions: The identifed tools vary in psychometric properties depending on the assessment’s context, target population, and study setting. The PREMIS is the most cross-culturally adapted instrument across various countries and is promising for assessing HCPs’ readiness to respond to IPV. However, further psychometric evaluation prior to utilization in diferent healthcare populations and settings is recommended.

Abstract Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and ‘others’ ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.