Factors associated with improper metered-dose inhaler technique among adults with asthma in a primary care clinic in Malaysia

@#Introduction: Metered-dose inhalers (MDI) are the most used inhalers worldwide. However, improper MDI techniques remain a significant problem and cause uncontrolled asthma. Studies worldwide have reported that the causes of inefficient inhaler technique are multifactorial. However, this topic has been less well studied in the Asian population. This study aimed to evaluate the MDI technique and associated factors among adults with asthma in a primary care setting in Malaysia. Method: This was a cross-sectional study with universal sampling conducted between July and October 2017. A total of 146 patients with asthma aged 18 years and older in a primary care clinic in Putrajaya, Malaysia were recruited. Logistic regressions were used for statistical analysis to examine the association between improper MDI techniques and their related factors. Results: The majority (83%) of respondents were female with a median age of 37 (IQR = 30.75–49.25) years, and the median duration of asthma of 20 (IQR = 10–30) years. An improper MDI technique was observed in 100 (71.9%) patients. The most frequently missed step was exhaling gently and fully before inhalation (51.4%). Respondents who were not on an MDI preventer (adjusted OR: 2.487, 95% CI: 1.121–5.519, p = 0 .025) or had used an MDI 5 years or fewer (adjusted OR: 3.369, 95% CI: 1.425–7.964, p = 0.006) were more likely to employ an improper MDI technique. Conclusion: There was a high proportion of improper MDI techniques among patients with asthma. Patients not using an MDI preventer or who had used an MDI less than 5 years were at higher risk of improper MDI technique.

Efforts on Reducing Dietary Salt Intake and its Associated Factors Among Medical Students in Universiti Putra Malaysia

@#Introduction: Increased dietary salt intake can cause retention of fluid and subsequently an increase in blood pressure. Excessive salt consumption is one of the main causes of hypertension. This study aims to determine efforts done by medical students to reduce dietary salt intake and its associated factors in Universiti Putra Malaysia (UPM). Methods: This is a cross-sectional study. A self-administered questionnaire looking into efforts to reduce dietary salt intake adapted from the WHO STEPS questionnaire was used. There were six efforts altogether which were; limiting consumption of processed food; looking into sodium contents on food labels; purchasing low salt or sodium alternatives; avoid eating out; using spices when cooking; and doing things specifically to control salt consumption. Other factors in this questionnaire are on socio-demographic, practice of salt consumption, awareness, perception, attitude of dietary salt intake. Results: A total of 362 respondents participated. The majority had good awareness on salt intake (98.1%). A larger proportion of females significantly made the effort to buy low salt alternatives (p=0.003) and avoided eating out (p=0.048). On salt consumption practice, there were a bigger proportion of those that rarely ate processed food, that avoided eating out (p=0.08), bought low salt/sodium alternatives (p<0.001), looked at the sodium contents on labels (p=0.027) and limited the consumption of processed food (p<0.001). Conclusion: There are significant associations between the female gender and practice of eating processed food with efforts to decrease salt intake. More studies are recommended to look into assisting efforts to reduce salt consumption.

Prevalence of Microvascular Complications in Newly Diagnosed Type 2 Diabetes Mellitus in Primary Healthcare Clinics

@#Introduction: Delayed diagnosis of type 2 diabetes mellitus (T2D) increases the risk of presenting late with microvascular complications due to untreated long-standing hyperglycaemia. This study aimed to determine the prevalence of microvascular complications in newly diagnosed T2D patients in primary healthcare clinics. Methods: This was a cross-sectional study carried out in three government primary healthcare clinics in the state of Selangor, Malaysia. Malaysian aged 18 years and above with newly diagnosed T2D (≤ 6 months of diagnosis) were invited to participate in the study. Data collected included the sociodemographic characteristic and the clinical profile (weight, height, waist circumference, blood pressure, lipid, glycaemic, urine albumin, microalbuminuria and renal profile). The assessment of nephropathy, peripheral neuropathy and retinopathy were performed using standard protocol. Multivariate logistic regression analysis was used to identify the significant factors that contribute to the presence of microvascular complications. Results: A total of 162 newly diagnosed patients were recruited. The majority was women (64%). The mean age was 51 (SD 11) years. About one-third of the patients (27.7%) had developed at least one microvascular complication. Nephropathy was the commonest microvascular complication (19.2%), followed by peripheral neuropathy (8.6%) and retinopathy (6.5%). Poor glycaemic control was found to be a significant factor contributing to the presence of microvascular complications (OR 5.8, 95%CI:1.466, 23.288). Conclusion: There is a high prevalence of microvascular complications among the newly diagnosed T2D. There is a need to develop appropriate strategies to increase the awareness and early detection of T2D.