Knowledge, Attitude and Factors associated with Self-efficacy in Screening and Treatment of Hepatitis C among Primary Care Doctors in Selangor.

Introduction: Primary care doctors (PCDs) play an increasingly important role in the management of hepatitis C. It is essential for PCDs to have good self-efficacy in screening and treating hepatitis C to achieve good outcomes. This study aimed to determine the knowledge and attitude towards and other factors associated with self-efficacy in screening and treating hepatitis C. Methods: This cross-sectional study was conducted using an online Google Form. PCDs working at primary healthcare clinics were selected via simple random sampling. The online form contained items on sociodemographic and practice characteristics and a validated questionnaire on knowledge, attitude and self-efficacy towards screening and treating hepatitis C. Data were statistically analysed. Results: A total of 242 PCDs were included in the analysis. The median age was 35 years (interquartile range [IQR]=5). The majority of the PCDs were women (83.9%) and Malay (71.9%) and had a median working experience of 6 years (IQR=6). The mean self-efficacy score was 12.67 (standard deviation=3.38). The factors associated with a higher level of self-efficacy in screening and treating hepatitis C were postgraduate qualification, training within the last one year, better knowledge and attitude scores and prior experience in treating hepatitis C. Conclusion: The identified factors are crucial in improving the self-efficacy among PCDs in hepatitis C care services. Policymakers are suggested to implement training programmes and encourage continuous medical education, exposure to patient management and postgraduate certification in family medicine to help PCDs in treating hepatitis C better.

Prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in urban Selangor, Malaysia: a cross-sectional study.

BACKGROUND: Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia. METHODS: A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively. RESULTS: The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21). CONCLUSIONS: As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

Elder abuse and hospitalization in rural Malaysia.

Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9-9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.

Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia.

INTRODUCTION: Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients' sociodemographic and economic factors. METHODS: A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients' sociodemographic characteristics and economic factors. RESULTS: Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of

The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study.

The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants' responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.

Global serum metabolomics profiling of colorectal cancer.

Accurate diagnosis of colorectal cancer (CRC) relies on the use of invasive tools such as colonoscopy and sigmoidoscopy. Non-invasive tools are less sensitive in detecting the disease, particularly in the early stage. A number of researchers have used metabolomics analyses on serum/plasma samples of patients with CRC compared with normal healthy individuals in an effort to identify biomarkers for CRC. The aim of the present review is to compare reported serum metabolomics profiles of CRC and to identify common metabolites affected among these studies. A literature search was performed to include any experimental studies on global metabolomics profile of CRC using serum/plasma samples published up to March 2018. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to assess the quality of the studies reviewed. In total, nine studies were included. The studies used various analytical platforms and were performed on different populations. A pathway enrichment analysis was performed using the data from all the studies under review. The most affected pathways identified were protein biosynthesis, urea cycle, ammonia recycling, alanine metabolism, glutathione metabolism and citric acid cycle. The metabolomics analysis revealed levels of metabolites of glycolysis, tricarboxylic acid cycle, anaerobic respiration, protein, lipid and glutathione metabolism were significantly different between cancer and control samples. Although the majority of differentiating metabolites identified were different in the different studies, there were several metabolites that were common. These metabolites include pyruvic acid, glucose, lactic acid, malic acid, fumaric acid, 3-hydroxybutyric acid, tryptophan, phenylalanine, tyrosine, creatinine and ornithine. The consistent dysregulation of these metabolites among the different studies suggest the possibility of common diagnostic biomarkers for CRC.

Metabolomics Profiling on Different Stages of Colorectal Cancer: A Systematic Review.

Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide. Early diagnosis and accurate staging of the disease is vital to improve the prognosis. Metabolomics has been used to identify changes in metabolite profiles in the different stages of cancer in order to introduce new non-invasive molecular tools for staging. In this systematic review, we aim to identify the common metabolite changes in human biological samples and the dominant metabolic pathways associated with CRC progression. A broad systematic search was carried out from selected databases. Four reviewers screened and reviewed the titles, abstracts, and full-text articles according to the inclusion and exclusion criteria. Quality assessment was conducted on the eight articles which met the criteria. Data showed that the metabolites involved with redox status, energy metabolism and intermediates of amino acids, choline and nucleotides metabolism were the most affected during CRC progression. However, there were differences in the levels of individual metabolites detected between the studies, and this might be due to the study population, sample preparation, analytical platforms used and statistical tools. In conclusion, this systematic review highlights the changes in metabolites from early to late stages of CRC. Moreover, biomarkers for prognosis are important to reduce CRC-related mortality.

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. OBJECTIVE: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. METHODS: A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. RESULTS: Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting. CONCLUSIONS: Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Profiles and Factors Associated with Poor Glycemic Control Among Inpatients with Diabetes Mellitus Type 2 as a Primary Diagnosis in a Teaching Hospital.

CONTEXT: Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme. AIMS: This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease. SETTINGS AND DESIGN: A cross-sectional study was conducted in UKM Medical Centre. METHODS AND MATERIAL: Medical records of patient with E11 ICD-10 code were collected using Case Report Form. STATISTICAL ANALYSIS USED: Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression. RESULTS: The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7%) with secondary level of education (41.7%). Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3%) and significant association was found with tertiary level of education [AOR = 0.10, 95%CI = 0.01-0.96] and with type of anti-diabetic therapy [AOR = 15.90, 95%CI=1;2.03-124.30]. CONCLUSIONS: In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome.