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- PublicationSocial support in maintaining mental health and quality of life among community-dwelling older people with functional limitations in Malaysia: a population-based cross-sectional study(2024)Objective: This study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia. Setting The Malaysian National Health Morbidity Survey 2018: Elderly Health was a cross-sectional health community survey among adults aged 50 and above. Participants: 3977 community-dwelling older Malaysians aged 60 and above. Outcome measures Functional limitations were defined as personal activities of daily living (PADL) and instrumental activities of daily living (IADL), tested in separate paths in all analyses. PADL was measured using the Barthel Index, while IADL was measured using the Lawton and Brody scale. Perceived social support, depressive symptoms and quality of life were measured using the Duke Social Support Index, Geriatric Depression Scale-14 and Control, Autonomy, Self-Realisation and Pleasure-19 tools. We used mediation analysis through structural equation modelling to explore the role of perceived social support. Results: Perceived social support mediated the relationship between PADL and IADL with depressive symptoms, with the indirect effects at −0.079 and −0.103, respectively (p<0.001). Similarly, perceived social support mediated the relationship between PADL and IADL with quality of life, with the indirect effects at 0.238 and 0.301, respectively (p<0.001). We performed serial multiple mediation analysis and found that perceived social support and depressive symptoms mediated the path between PADL and IADL with quality of life, with the indirect effects at 0.598 and 0.747, respectively (p<0.001). The relationship between functional limitations and all outcomes remained significant in all mediation analyses. Conclusion: The present study provides evidence that perceived social support relieves the influence of functional limitations on depressive symptoms and declining quality of life among older people. Therefore, it is imperative to establish a social support system to improve the overall well-being of older people.
- PublicationGiving meaning to quality of healthcare in Malaysia(2024)Ensuring quality in healthcare calls for a coordinated, systematic, congruous, and sustained approach. Nevertheless, it demands defining what the quality of healthcare means in the local context. Presently, the Malaysian healthcare system utilizes various definitions of quality of healthcare across the different initiatives and levels of healthcare, which can lead to fragmented or ineffective quality improvement. The study aims to describe the process undertaken in developing an explicit definition of the quality of healthcare tailored to the Malaysian context, which is currently lacking. A pluralistic method was used to explore the different perspectives. Three distinct approaches were used to understand how quality is defined among the different stakeholder groups: (i) interactive policy-makers engagement sessions, (ii) a review of local quality related documents, and (iii) an online survey engaging the public. The domains depicting quality of healthcare that emerged through these three approaches were mapped against a framework and synthesized to form the local definition of quality. A national quality-related technical working group convened on several sessions to achieve consensus and finalize the definition of quality of healthcare. Quality healthcare in Malaysia is defined as providing high-quality healthcare that is safe, timely, effective, equitable, efficient, people-centred, and accessible [STEEEPA] which is innovative and responsive to the needs of the people, and is delivered as a team, in a caring and professional manner in order to improve health outcomes and client experience. The consensus-driven local definition of healthcare quality will guide policies and ensure standardization in measuring quality, thereby steering efforts to improve the quality of healthcare services delivered in Malaysia.
- PublicationModelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia(2024)Background: Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). Methods: A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. Results Findings showed that the most expensive strategy, which is implementing 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost effectiveness of the replacement strategies. Conclusions: The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
- PublicationStudy protocol for a mixed methods approach to optimize colorectal cancer screening in Malaysia: Integrating stakeholders insights and knowledge-to-action framework(2024)Introduction : Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program. Methods: This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in sup porting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program. Discussion: Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.
- PublicationThe use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia(2024)Background: The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak’s inaugural multidisciplinary geriatric telemedicine service, TELEG. Methods: This cross-sectional study took place at the Sarawak Heart Centre’s geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG’s utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants’ acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson’s correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5. Results: Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n=40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean=4.9, SD=0.65, on a scale of 1 to 6). Notably, care personnel concern (B=0.256; p<0.001) had the most significant impact on overall acceptance. Conclusion: This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users’ experiences are crucial to further enhance acceptance. What is already known? • Telemedicine among the elderly has also shown significant economic benefits by reducing medical costs and societal costs. • Telemedicine among geriatric patients had been found to improve their quality of life, enhance accessibility to healthcare services, reduce hospitalization rates, and facilitate early detection of abnormalities among the patients. What this paper adds? • This is the first paper that evaluate the use and acceptability of geriatric telemedicine in a developing country in the Southeast Asia region. • TELEG is the leading multi-disciplinary geriatric telemedicine service implemented in Malaysia. • The findings are important for policymakers in revising the existing legal and regulatory framework to govern the implementation and expansion of geriatric telemedicine in the region.
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- PublicationEffectiveness of a community-based intervention for weight loss on cardiometabolic risk factors among overweight and obese women in a low socio-economic urban community: findings of the MyBFF@home(2018)Background: The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group. Methods: A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA. Results: Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (− 0.26 mmol/L [95% CI: – 0.47 to − 0.06], p < 0.01) compared to the control group (− 0.06 mmol/L [95% CI: – 0.28 to 0.17]) at 12 months. At 6 months, TC was reduced significantly in both groups but only intervention group retained the reduction in maintenance phase while, the level increased significantly in the control group (0.22 mmol/L [95% CI: 0.06 to 0.38]). This attributed to significant increase in TC/HDL-C ratio in the control group during maintenance phase (0.32 [95% CI: 0.15 to 0.50], p < 0.001). The intervention group also showed trend of reduction in FPG at 6 months and further decreased during maintenance phase (− 0.19 mmol/L [95% CI: – 0. 32 to − 0.06], p < 0.01). At 6 months HDL-C was maintained in the intervention group but reduced significantly in the control group (− 0.05 mmol/L [95% CI: – 0.10 to − 0.01], p < 0.05). No significant difference was detected in both markers when compared between groups. Conclusions: In the context of low socio-economic communities, this study supports that weight loss related lifestyle modifications over a 6-month period could improve selected cardiometabolic risk factors, particularly fasting glucose, TC and HDL-C in overweight and obese women with favourable sustainability over a 12-month period.
- PublicationUnplanned Pregnancy and Its Associated Factors(2018)INTRODUCTION: Unplanned pregnancy is a major public health concern globally. Numerous studies found various factors that can predict or determine unplanned pregnancy. However, there were no studies that reported this problem in Malaysia. The objective of this study is to determine the prevalence of unplanned pregnancy in Malaysia and the associated factors. METHODS: This nationwide cross-sectional study targeted to women at postpartum period at government primary health care clinics throughout Malaysia. Structured questionnaire with face-to-face interview was used for data collection. The factors studied included mothers’ age, husband’s age, ethnicity, religion, marital status, education, occupation, household income, polygamous marriage, family support, contraception used, and disagreement of husband on contraception, smoking and alcohol consumption. History of emotional, physical and sexual intimate partner violence (IPV) were also studied. RESULTS: A total of 5727 Malaysian postpartum mothers were involved in this survey. The prevalence of unplanned pregnancy was 42.9% (95% CI: 38.6, 47.4). The multivariate logistic regression revealed that older mothers aged 45-49 years old (aOR: 8.010; 95%CI: 1.909, 33.013) and Muslim mothers (aOR: 2.465; 95%CI: 1.432-4.241) were significantly associated with unplanned pregnancy. In terms of household income, mothers with less than RM1000 per month were 1.712 (95% CI: 1.080, 2.713) times more likely to have unplanned pregnancy. The other significant associated factor was history of emotional intimate partner violence; aOR [1.720 (95% CI: 1.011, 2.925)]. CONCLUSIONS: Unplanned pregnancies were observed to be higher among older Muslim women from low income family. A possibility of unmet need for family planning should be considered and appropriate intervention strategies planned for these at-risk population.
- PublicationPredictors of Recurrent Ischemic Stroke in Obese Patients With Type 2 Diabetes Mellitus: A Population-based Study(Elsevier, 2020)Background: Diabetes and obesity are established risk factors for stroke. The current study aimed to assess risk factors of ischemic stroke recurrence in diabetic patients based on their body mass index (BMI). Methods: A total of 4005 diabetic patients who had a history of ischemic stroke were identified in a retrospective cross-sectional dataset from the Malaysian National Neurology Registry. Patients were classified based on BMI, and multivariable regression analysis was used to evaluate the association between risk factors and recurrent ischemic stroke. Results: Among obese patients, those with ischemic heart disease (aOR, 1.873; 95% CI, 1.131–3.103), received formal education (aOR, 2.236; 95% CI, 1.306–3.830), and received anti-diabetic medication (aOR, 1.788; 95% CI, 1.180–2.708) had a higher stroke recurrence risk, while receiving angiotensin receptors blockers (aOR, 0.261; 95% CI, 0.126–0.543) lowered the odds of recurrence. Overweight patients with hypertension (aOR, 1.011; 95% CI, 1.002–1.019) for over 10 years (aOR, 3.385; 95% CI, 1.088–10.532) and diabetes prior to the first stroke (aOR, 1.823; 95% CI, 1.020–3.259) as well as those received formal education (aOR, 2.403; 95% CI, 1.126–5.129) had higher odds of stroke recurrence, while receiving angiotensin-converting enzyme inhibitors (aOR, 0.244; 95% CI, 0.111–0.538) lowered the recurrence risk. Normal weight East Malaysians (aOR, 0.351; 95% CI, 0.164–0.750) receiving beta-blockers (aOR, 0.410; 95% CI, 0.174–0.966) had lower odds of stroke recurrence. Conclusions: Ischemic heart disease, hypertension, receiving anti-hypertensive agents, and educational level were independent predictors of recurrent stroke in obese patients. Managing the modifiable risk factors can decrease the odds of stroke recurrence.
- PublicationSpecial pathology and therapeutics of the diseases of domestic animals: Volume III - diseases of the urinary organs, blood and blood producing organs, spleen, metabolism, nervous system, organ of locomotion, and skin(1938)Ruminants continue to be important in their traditional role in agricultural research and teaching. They are now also extensively used for studies in molecular biology; genetic engineering; and biotechnology for basic science, agricultural and clinical applications. Concern and interest for the welfare for these species and improved understanding of their biology and behavior have continued and are reflected in changing husbandry and management systems. This chapter addresses at high levels basic biology, husbandry, and the more common or important diseases of the three ruminant species used most commonly in the laboratory, namely sheep, goats and cattle.
- PublicationHLA in the Immune Response(Kuala Lumpur: Institute for Medical Research, 2012)When foreign antigen gains entry into the bod several important changes may by initiated , collectively known as the immune response , which result in the elimination of the alien antigen A remarkable feature of this phenomenon is the ability of the adult mammal to distinguish between its own antigens ( known as self antigen) and those external or foreign origin ( known as non self antigens) This means that as a general rule, antibody is selectively produced in response to foreign substances yet it is not produced to antigens that are recognized as "self