Zuraidah Mohd Yusoff

General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications

Background: Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Aim: Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. Results: One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions could be appreciably reduced. Conclusion: Further programs are needed to educate GPs and patients about antibiotics building on current initiatives.

Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study

AIMS The aim of this study was to evaluate the knowledge about GDM and its corresponding relation with glycaemic level in GDM patients. METHOD A cross-sectional study was conducted in antenatal clinic of Hospital Pulau Pinang, Malaysia from June 2013 to December 2013 using Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) on the sample of 175 GDM patients. Three most recent fasting plasma glucose (FPG) values (mmol/l) were taken from patients profiles and mean was calculated. RESULTS A total of 166 patients were included in final analysis. A total mean knowledge score of 166 patients was 10.01±3.63 and total mean FPG value was 5.50±1.13. Knowledge had a significant negative association with FPG (r=- 0.306, P<0.01). Among different knowledge domains, highest mean score was seen for diet/food values domain and lowest for management of GDM. Educational level seems to be the most significant predictor of GDM knowledge and glycaemic control. Highest mean knowledge score and lowest mean glycaemic levels were recorded for patients aged 25-29 years, Malay ethnicity, working women and family history of DM. CONCLUSION Higher Knowledge about GDM is related to better glycaemic control. New educational strategies should be developed to improve the lower health literacy.

‘Why I do not want to take insulin shots’: Findings from a qualitative study among diabetic patients in Malaysia

AimTo gain insight into type-2 diabetic patients’ perceptions and beliefs about the use of insulin, to explore barriers to initiation of insulin and to evaluate the impact of a short educational intervention regarding patients’ resistance to using insulin injections.Subjects and methodsThis is an exploratory qualitative study. One-to-one in-depth interviews were conducted with a purposive sample of type-2 diabetic patients. Then, a short educational intervention was conducted with the participants. After the intervention, the participants were interviewed to evaluate their acceptance of insulin initiation. The interviews were audio-taped and transcribed verbatim. Thematic content analysis was conducted and the analysis was reviewed independently by two researchers.ResultsA total of 13 diabetic patients were included in the study. Before the intervention, 11 subjects refused initiation of insulin. Resistance to initiation of insulin was influenced by misconceptions about insulin therapy, psychological barriers and fear, lack of self-efficacy and fear of adverse effects. All subjects perceived that insulin should only be initiated in very severe diabetes. Some participants demonstrated lack of belief in insulin efficacy. Psychological barriers and fears such as fear of self-injection and personal phobia about blood, needle and pain as well as perceived side effects also hindered insulin acceptance.ConclusionThe study findings revealed that misconceptions about insulin use and psychological barriers played a major role in patients’ resistance to initiation of insulin therapy. The study demonstrated, however, that a short educational intervention could dispel patients’ fears and erroneous beliefs and help them to start insulin therapy.

Impact of chemotherapy on hypercalcemia in breast and lung cancer patients.

INTRODUCTION Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. METHODS We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. RESULTS Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. CONCLUSION Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

Gestational diabetes mellitus: Pilot study on patient's related aspects

Objective: Gestational diabetes mellitus (GDM) is a common complication during pregnancy and if not managed properly, it can lead to many harmful effects on mother or fetus/baby. Management of GDM largely depends on patient′s thoughts, perception and understanding of disease. This study was conducted to evaluate the knowledge, attitude, and treatment satisfaction of GDM patients toward their disease. Methods: This was a descriptive cross-sectional study conducted during the period of month July 2013 at Penang General Hospital, Penang, Malaysia. The sample consists of 30 established patients of GDM who were diagnosed at least 1 month prior to enrolment. Data were collected by means of self-designed Gestational Diabetes Mellitus Knowledge Questionnaire, modified version of Diabetes Integration Scale (ATT-19) and Diabetes Treatment Satisfaction Questionnaire. Descriptive analysis was used for data elaboration by using SPSS 20. Results: The results showed that of 30 patients, 23 patients (76.6%) had adequate knowledge. Only, 7 (23.3%) patients had inadequate knowledge. For attitude, 23 (76.66%) of patients had a negative attitude toward disease and only 7 (23.3%) had a positive attitude. In terms of satisfaction, 25 (83.33%) patients were satisfied with the given treatment and 5 (16.66%) were unsatisfied. Conclusion: We conclude that although participants obtained good score on knowledge and treatment satisfaction, their attitude did not change so as to more effectively cope with their disease.

A study exploring the association of attitude and treatment satisfaction with glycaemic level among gestational diabetes mellitus patients

AIMS The aim of this study was to evaluate attitude and treatment satisfaction of women suffering from GDM and their association with glycaemic level. METHODS A cross sectional study was conducted in antenatal clinic of Hospital Pulau Pinang, Malaysia from June to December 2013 on the sample of 175 patients. Data was collected through modified version of Diabetes Integration Scale (ATT-19) and Diabetes Treatment Satisfaction Questionnaires (DSTQs). Glycaemic level was evaluated in terms of Fasting Plasma Glucose (FPG). Three most recent values of FPG (mmol/l) were taken from patients medical profiles and their mean was calculated. Descriptive and inferential statistics were used for data analysis. RESULTS A total of 166 patients were included in final analysis. Only 35 (21.1%) patients had positive attitude and 122 (73.5%) of patients had adequate treatment satisfaction. There was no significant association of total mean ATT-19 score with age, ethnicity, educational level, occupational status, family history and type of therapy. For treatment satisfaction statistically significant association was present only between total mean treatment satisfaction score and educational level. Patients with negative attitude and inadequate treatment satisfaction had higher mean glycaemic level. CONCLUSIONS It is concluded that more than two folds of patients were satisfied with their ongoing treatment but majority of the patients were feeling difficulty in active coping measures for the management of GDM.

A Close Look at Neutropenia among Cancer Patients — Risk Factor and Management

Neutrophils are a major type of white blood cell (WBC), and they represent about 45%-70% of 11 all WBC. Neutrophils can also be referred to as poly-morphonucleat leucocytes or granulo‐ 12 cytes, as their cytoplasm contains granules, which contains glycogen and antibacterial 13 substances [2]. Neutrophils are synthesized and produced by hematopoietic stem cells in bone 14 marrow. It takes 10 – 14 days to produce mature neutrophils. Neutrophils were first thought 15 to have a short viability period of only 6-10 hours [2, 3], but in the late 1990s, it was that 16 neutrophils may survive much longer. In addition, recent evidence has suggested that 17 neutrophils may produce anti-inflammatory molecules and may promote the resolution of 18 inflammation [4]. Moreover, it has been found that during inflammation or infection, neutro‐ 19 phils will migrate to the inflamed tissues, phagocytosis and remain active at site for about 2-6 20 days [2, 4, 5]. 21

694 THE EVALUATION OF PREVALENCE AND AWARENESS TOWARDS HYPERTENSION CONTROL AMONG HEALTHCARE EMPLOYEES IN THE KERIAN DISTRICT

Objective: The aim of this study was to evaluate the prevalence and assess the awareness, adherence and of and control of hypertension among the healthcare employees in a rural district, Malaysia. Materials & Methods: A cross-sectional drop-off survey was conducted using a validated questionnaire. The studied populations were all government healthcare employees in Kerian District, Malaysia. Respondents were assessed on awareness, knowledge, adherence and treatment received. Assessment of their blood pressure was also undertaken two times using a validated digital blood pressure monitor by a trained staff. Results: A total of 444 participants were approached for this study. Of this, 374 consented to participate (response rate of 84.2%). Mean age of respondents were 36.4 years. Prevalence of hypertension and prehypertension among employees were found to be 16% and 29.1%. Among 61 hypertensive respondents, only 72% were aware of their status and from 109 prehypertensive, only 28.3% were aware of their high-normal blood pressure status. A considerable knowledge gap related to hypertension was found among the population, in which 35% of them were found to have poor knowledge. Only half (54%) of the hypertensive employees were on antihypertensive agent, with blood pressure control rate of 70%.The remaining was either exercising non-pharmacological approach or not treated due to unawareness of the disease. Majority (75.8%) of employees who received treatment had ‘poor’ to ‘medium’ adherence. Conclusion: The high prevalence of prehypertension and inadequate blood pressure control showed that even healthcare workers in the country are having problems in managing their diseases.

Neutropenia onset, Severity and their Association with Solid CancerDiseases

Background: Neutropenia is a decreased in the absolute neutrophil count lower than the normal that is < 1500 cell/ μl. It has a detrimental effect on cancer patients’ quality of life, also possibly resulting in a reduction in the chemotherapy dose which could lead to an increment in the size of a cancer. There are so many causative factors for neutropenia like hematological disorders, autoimmune diseases and infection, drugs reactions and chemotherapy or radiotherapy. So the main aim of this study is to find the association between solid cancer diseases with onset and severity of neutropenia. Methods: This an observational retrospective study conducted on 117 solid cancer patients who received chemotherapy as a treatment and as a result of that they suffer from neutropenia, this study retrospectively cover the period between 1 January 2003 and 31 December 2006. Statistical analysis methods used were Chi-square test, Fisher’s Exact test. The level of significance was set at P < 0.05. Results: The total number of the patients involve was 117 neutropenic patients they suffer from 19 th different solid cancer diseases. Breast cancer was the predominant once it was found (75, 64.1%) followed by nasopharyngeal cancer 9 (7.7%), rectal cancer 9 (7.7%) and many others. The main finding of this study was insignificant association between solid cancer diseases with both onset and severity of neutropenia since the P values for both tests >0.05. Conclusion: Solid tumor is not considered as a risk factor for neither onset nor severity of neutropenia not like the hematological cancer diseases which play a risk role in these cases. Then the main risk factor for neutropenia within solid cancer patients is the chemotherapy intensity they receive for as a treatment.