Gender differences in the associations between knee pain and urinary incontinence in older adults: Cross-sectional analysis from the Malaysian Elders Longitudinal Research Study (MELoR).

INTRODUCTION: The common assumption that urinary incontinence occurs in osteoarthritis (OA) due to poor mobility is supported by limited evidence. The influence of gender in such associations is also yet to be elucidated. OBJECTIVE: This study, therefore, identified any potential associations between knee OA symptoms and urinary incontinence and further explore sex differences in the associations. DESIGN: Cross-sectional study. SETTING: University Hospital. PARTICIPANTS: This was a cross-sectional study from a longitudinal research study comprising 1221 community-dwelling older persons (57% women), mean age (SD) 68.95 (7.49) years. MAIN OUTCOME MEASURE(S): Presence of urinary incontinence: mixed, stress and urge symptoms. Physical performance and C-reactive protein levels were also assessed. RESULTS: Two hundred and seventy-seven (22.83%) individuals reported the presence of urinary incontinence: mixed (41.5%), stress (30%), and urge (28.5%) symptoms. In an unadjusted analysis, stratified by gender, the association between knee pain and urinary incontinence was only present in women with mixed symptoms. After further adjustment of demographics differences and body mass index, the association between knee pain with any urinary incontinence and mixed symptoms remained significant with the odds ratios (95% confidence interval): 1.48 (1.02-2.15) and 1.73 (1.06-2.83), respectively. This relationship was attenuated after further adjustment for waist circumference and impaired lower limb mobility. CONCLUSION: Our study refutes previous assumptions that urinary incontinence in individuals with OA is attributed to impaired mobility alone, but introduces the role of abdominal obesity in this relationship, particularly in women. Future studies should assess the temporal relationship between body fat distribution and OA with urinary incontinence.

A systematic review of health sciences students' online learning during the COVID-19 pandemic.

BACKGROUND: This study aims to analyse the effectiveness of distance learning during the COVID-19 pandemic among undergraduate health sciences students using systematic review. Online learning has been chosen as the best approach to continue offering education in this pandemic era. METHOD: The screening process was done using Scopus, ScienceDirect and PubMed based on the eligibility criteria. Out of 1486 studies, 1269 were screened. A total of 64 eligible studies obtained were included in the quantitative analysis. Results were categorized into i) student attitudes (perceptions/satisfactions/engagements), and ii) student learning outcomes, and compared to the Kirkpatrick model. RESULTS: Although facing difficulties, 50% of the studies was moderately satisfied with distance learning, while 36% was highly satisfied and 17% dissatisfied. Most studies (26%) reported flexibility in online learning. Internet issues (19%) and low interaction between learners and instructors (19%) were the most prevalent problems mentioned. Online education engages students better than traditional learning. The learning outcome was assessed using two categories: i) academic performance and ii) skill development. Most studies (72%) stated that online learning improves academic performance, 14% reported a drop, and 14% stated no effect, while an increase in clinical skills and communication skills were reported. Kirkpatrick evaluation revealed 80% of the studies obtained was evaluated at level 1 (reaction), 8% at level 2 (learning), 12% at level 3 (behaviour) and none at level 4 (results). CONCLUSION: Overall, this systematic review found that the online learning performed better than expected during COVID-19, but the data gained is insufficient to say it is beneficial when compared to other types of teaching approaches.

A Meta-synthesis on Technology-Based Learning Among Healthcare Students in Southeast Asia.

Healthcare education providers are eager to apply technologies in teaching and learning activities; however, students are the consumers in higher education, and their opinion and experience should be considered. We performed a meta-synthesis of qualitative studies to help inform our understanding of Southeast Asian healthcare students' perceptions and experience of technology-based teaching and learning in their education. Our search strategy located 1599 articles from a dozen electronic research databases. Articles were analyzed for quality using the Hawker's Evidence Appraisal Tool, and 23 qualitative studies were included in the final meta-synthesis. Technologies investigated largely involved online or blended learning, with fewer exploring virtual reality, simulations, telehealth, game-based learning, and videos. Three overarching themes were synthesized: (i) culture does matter in the implementation of technology-based learning; (ii) the values and limitations of technology used for learning; and (iii) technology is part of daily life and creates new challenges in education. Technology is an asset to enhance the learning experience, but educators must be aware of its limitations. Pre-coronavirus disease 2019 (COVID-19) studies were more focused on technology and product, and were optimistically reported, whereas COVID-19-spanning studies focused on life experience and paid more attention to reporting on the inherent challenges. The educational approaches, theories, cultural aspects, and availability of facilities all play a vital role in steering successful technology use in learning.

Asian medical students' attitudes towards professionalism.

Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between pre-clinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, IrelandMethods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used.Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students.Conclusion: Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.

Validation of the Brief Ageing Perceptions Questionnaire (B-APQ) in Malaysia.

Objectives: The Brief Ageing Perceptions Questionnaire (B-APQ) has five domains that explore views about own ageing. The aim of this study was to validate the B-APQ for use among older adults in Malaysia and to explore socio-demographic variations in ageing self-perceptions.Method: Older adults aged 50 years and above were randomly selected to complete a set of questionnaires. Cronbach's α was used to measure internal consistency, while corrected item-total correlations and correlation with DASS-21 and the CASP-19 scores were employed to assess convergent and discriminant validity. Confirmatory Factor Analysis (CFA) was conducted to confirm the factorial structure of the B-APQ. Difference in self-perceptions of ageing across socio-demographic variables was assessed.Results: Internal consistency for each of the domains was good. Item-total correlations within each domain were strong (>0.6) or very strong (>0.8). Convergent and discriminant validity were supported by significant correlations with DASS-21 depression and CASP-19 scores. CFA results indicated good model fit with the original B-APQ model. Presence of chronic illness also has a significant impact on B-APQ domain scores.Conclusion: The B-APQ is a valid and reliable instrument which can be used to assess self-perceptions of ageing among older Malaysian adults.

Validation of the Malay Version of the De Jong Gierveld Loneliness Scale.

OBJECTIVE: This study aims to determine the psychometric properties of the Bahasa Malaysia (BM) version of the 6-item De Jong Gierveld Loneliness Scale (DJGLS) among older adults in Malaysia. METHODS: A total of 200 participants aged 50 years and older completed the questionnaire in which 81 participants completed in BM. A subsample of 30 participants was retested after a period of 2 weeks. RESULTS: The DJGLS showed good internal consistency (Cronbach's alpha 0.71) and high test-retest reliability (r = 0.93). Convergent validity was demonstrated by moderate positive correlation between total DJGLS loneliness score and UCLA loneliness scale (ULS-8) (r = 0.56, n = 81, P < 0.001). Significant associations were found between loneliness and sex, ethnicity, geographic area and marital status. CONCLUSION: The BM version of the 6-item DJGLS is a reliable and valid loneliness measure for use among older adults in Malaysia.

Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians.

Knee pain is often underreported, underestimated and undertreated. This study was conducted to estimate the prevalence, burden and further identify socioeconomic factors influencing ethnic differences in knee pain and symptoms of OA among older adults aged 55 years and over in Greater Kuala Lumpur (the capital city of Malaysia). The sample for the Malaysian Elders Longitudinal Research (MELoR) was selected using stratified random sampling, by age and ethnicity from the electoral rolls of three parliamentary constituencies. Information on knee pain was available in 1226 participants, mean age (SD) 68.96 (1.57) years (409 Malay, 416 Chinese, 401 Indian). The crude and weighted prevalence of knee pain and self-reported knee OA symptoms were 33.3% and 30.8% respectively. There were significant ethnic differences in knee pain (crude prevalence: Malays 44.6%, Chinese 23.5% and Indians 31.9%, p<0.001). The presence of two or more non-communicable diseases (NCD) attenuated the increased risk of knee pain among the ethnic Indians compared to the ethnic Chinese. The prevalence of knee pain remained significantly higher among the ethnic Malays after adjustment for confounders. While the prevalence of knee pain in our older population appears similar to that reported in other published studies in Asia, the higher prevalence among the ethnic Malays has not previously been reported. Further research to determine potential genetic susceptibility to knee pain among the ethnic Malays is recommended.

Long-Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study.

BACKGROUND: A barrier to gastrostomy feeding exists among Asian clinicians and caregivers due to negative perceptions regarding complications. We compared clinical and nutrition outcomes in older dysphagic Asian patients with nasogastric (NG) or gastrostomy tube feeding using a pragmatic study design. METHODS: The choice of enteral tube access was determined by managing clinicians and patients/caregivers. Comparisons of tube feeding methods were made during a 4-month period, adjusting statistically for inherent confounders. RESULTS: A total of 102 participants (NG: n = 52, gastrostomy: n = 50) were recruited over 2 years from 2013 to 2015. Subjects on long-term NG tube feeding were older (82.67 ± 7.15 years vs 76.88 ± 7.37 years; P < .001) but both groups had similar clinical indications (stroke: 63.5% NG vs 54% gastrostomy; P = .33). After adjustment for confounders, gastrostomy feeding was associated with fewer tube-related complications (adjusted odds ratio [aOR] = 0.19; 95% confidence interval [CI] = 0.06-0.60) and better complication-free survival rate (aOR = 0.32; 95% CI = 0.12-0.89) at 4-month follow-up. Anthropometric and biochemical nutrition parameters improved significantly in both groups at 4 months, but no significant differences were observed at the end of the study. CONCLUSION: Gastrostomy feeding is associated with a greater 4-month complication-free survival and lower tube-related complications compared with long-term NG feeding in older Asians with dysphagia. However, no differences in nutrition outcomes were observed between NG and gastrostomy feeding at 4 months.

Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial.

OBJECTIVE: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia. DESIGN: Pragmatic, randomized-controlled trial. SETTING: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia. PARTICIPANTS: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months. INTERVENTION: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall. RESULTS: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups. CONCLUSION: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations. TRIAL REGISTRATION: ISRCTN Registry no. ISRCTN11674947.

Vitamin D deficiency is associated with ethnicity and knee pain in a multi-ethnic South-East Asian nation: Results from Malaysian Elders Longitudinal Research (MELoR).

AIM: To determine the association between vitamin D and knee pain among participants of the Malaysian Elders Longitudinal Research (MELoR) study. METHOD: This was a cross-sectional study from the MELoR study consisting of a representative group of 1011 community-dwelling older persons (57% female), mean age 86.5 (54-94) years; 313 were Malays, 367 Chinese and 330 Indians. Participants were asked if they had knee pain. Levels of serum 25-hydroxy cholecalciferol (25-[OH]D), an indicator of vitamin D status, were measured using routine laboratory techniques. RESULTS: In unadjusted analysis, presence of knee pain was significantly associated with vitamin D deficiency (odds ratio [OR] 1.42; 95% confidence interval (CI) 1.08-1.85, P 0.011). Vitamin D levels were significantly associated with ethnicity differences where Malays (OR 7.08; 95% CI 4.94-10.15) and Indians (OR 6.10; 95% CI 4.28-9.71) have lower levels of vitamin D compared to Chinese. Subsequent multivariate analysis revealed that the association between vitamin D deficiency and knee pain was confounded by ethnic differences. CONCLUSION: A previous study suggested that vitamin D deficiency was associated with knee pain. This relationship was reproduced in our study, but we further established that the association was explained by ethnic variations. As vitamin D status is dependent on skin tone, diet and sunlight exposure, which are all effected by ethnicity, future studies are now required to determine whether a true relationship exists between vitamin D and knee pain.

Systematic review of qualitative and quantitative studies on the attitudes and barriers to percutaneous endoscopic gastrostomy feeding.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is now commonly used in long-term care and community settings. However, regional variations exist in the acceptability of PEG tube feeding with long-term nasogastric feeding still commonplace in many Asian nations. AIMS: To evaluate the evidence relating to attitudes towards PEG feeding and to determine potential barriers to the acceptance of PEG tube feeding. METHODS: We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and CINAHL databases. The search for the studies was performed without restrictions by using the terms "PEG", "percutaneous endoscopic gastrostomy", "enteral feeding", "attitude", "perception" and "opinion". Qualitative and quantitative studies were included. Quality of studies was assessed with the Alberta checklists. RESULTS: From 981 articles, 17 articles were included in the final analysis. Twelve qualitative and four quantitative studies were considered of good quality. Seven of the 14 studies reported positive attitudes towards PEG. Three major themes were identified in terms of barriers to PEG feeding: lack of choice (poor knowledge, inadequate competency and skills, insufficient time given, not enough information given, lack of guidelines or protocol, resource constraints), confronting mortality (choosing life or death, risk of procedure) and weighing alternatives (adapting lifestyle, family influences, attitudes of healthcare professionals (HCPs), fear and anxiety). CONCLUSIONS: Only half of the reviewed studies reported positive perceptions towards PEG feeding. The themes identified in our systematic review will guide the development of interventions to alter the current attitudes and barriers towards PEG tube feeding.