Magnetic Resonance Imaging Anatomy of Alar Ligament: A Review of Literature

@#Alar ligament is one of the most important craniocervical junction (CCJ) ligaments; acting as stabilizer of CCJ and limiting axial rotation. It may be involved in various pathological processes including trauma. Magnetic resonance imaging (MRI) is increasingly being used in cervical spine trauma as a supplement to conventional radiography and computed tomography (CT) to detect a wide range of severe cervical spine injuries. MR depiction of alar ligament requires special sequences despite no known established MR sequence is available. However, the role of MRI in minor or moderate trauma, including whiplash injuries, has long been debated, particularly when neurological dysfunction is absent, because no anatomical disruption other than degenerative disc disease have been reported. In this review, we provide detailed account on the current knowledge of MR visualization of normal alar ligament; outlining the variations in its signal intensity, dimension, shape and orientation.

Characterization of Alar Ligament in Young Adult on 3.0T MRI: A Cross-sectional Study in IIUM Medical Centre, Kuantan

@#Introduction: Alar ligament is a paired craniocervical junction ligaments which stabilizes the atlantooccipital and atlantoaxial joints. The main purpose of the study was to compare the normal anatomy of alar ligament on MRI between male and female. The prevalence of alar ligament visualized on MRI and its characteristics were also studied apart from determining the association between the heights of respondents with alar ligament signal intensity and dimensions. Methods: Fifty healthy volunteers were studied using 3.0T MR scanner (Siemens Magnetom Spectra) by 2-mm proton density, T2 and fat-suppression sequences. Alar ligament visualization, dimensions and variability of the ligament courses, shapes and signal intensity characteristics were determined. Results: The orientation of the ligament was laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. Females are 70% less likely to exhibit alar ligament signal inhomogeneity than males. There were positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045 respectively). Conclusion: Tremendous variability of alar ligament shows that clinical and multimodality correlation needs to be exercised, especially in evaluating alar ligament MR signal in male. Taller individuals otherwise tend to have longer and thicker ligaments. Future studies with larger samples of alar ligaments including trauma cases are also recommended to supplant a new classification system of alar ligament injury.

Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study

@#Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review

@#Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.

Development, Validation and Acceptability of a Newly Developed Nutrition Resource Kit for At-Risk and Malnourished Elderly in Health Clinics Setting

@#Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition.

Content identification for the development of a nutrition resource kit for malnourished and at-risk elderly: A review

@#Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.

Exploring women’s perceptions and experiences of menopause among East Coast Malaysian women

@#Background: Menopause signifies the beginning of a non-reproductive phase from the reproductive period. Although it is considered a natural life transition, recent studies have indicated that a woman’s menopausal experience may impact her quality of life. While studies have examined Malaysian women’s knowledge and awareness of menopause, they have focused on the prevalence of menopausal symptoms and sociocultural aspects. These investigations also used a quantitative design that may have limited the information regarding the nature and experience of menopause. Objectives: This study explores women’s perceptions and understanding of their menopausal experience. Methods: A total of 20 menopausal women were recruited using purposive sampling through social media in the state of Pahang, Malaysia. In-depth semi-structured interviews were used to explore how they perceived their menopausal experience. The data were then analyzed using thematic analysis. Results: Three themes that emerged from the findings included perceptions of menopause, biopsychosocial changes and help-seeking behavior. For many Muslim women, menopause was perceived as a time for them to engage in religious commitment more than they had before. Conclusion: The study findings uncovered a knowledge gap and a lack of support for women impacted by menopause. Muslim women regarded their menopause phase as a time for them to engage in religious duty fully. These results indicate the need for a psychosocial intervention and educational program to ensure women a better transition throughout their menopausal phase

Barriers and Opportunities of Nutrition Screening in Elderly Patients in Health Clinic Settings in Kuantan, Pahang: A Qualitative Study

@#Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.

Types of Nutrition Resource Kit Needed by Community Living Elderly in Malaysian Health Clinic Setting: A Qualitative Study

@#Introduction: Elderly population is at high-risk to suffer from malnutrition and nutritional inadequacy. The use of nutrition resource kit which provides nutritional guidance could be helpful to improve their dietary intake. There is no study performed previously on the type of nutrition resource kit that can be used to overcome and prevent malnutrition among Malaysian elderly. Therefore, this study aimed to identify the types of nutrition resource kit needed by community living elderly in Malaysian health clinic setting. Methods: Qualitative study was conducted to explore the types of nutrition resource kit needed by community living elderly in health clinics. Recruitment for in-depth individual interview targeted elderly aged ≥60 years old who met the inclusion and exclusion criteria and received primary healthcare services in four health clinics in Kuantan, Pahang. Interview questions addressed the knowledge on existing nutrition educational materials, preference for types of nutrition resource kit and opinion on technology-based materials. Data were audiotaped, transcribed verbatim and thematically analyzed using NVivo software version 12. Results: 21 participants involved in this study (mean age=67.24 ±6.98 years). Five key themes identified from the data: provision of nutrition resource kit; preference for printed version; eye-friendly; facilitate understanding with diagram; and support for technology-based materials. This study also found that majority of elderly preferred for A5-sized booklet for nutrition resource kit. Conclusion: Future development of nutrition resource kit tailored to the need of elderly is needed to deliver nutritional guidance effectively and served as an important reference for them to overcome malnutrition.

Agreement between body weight perception and body weight status among late adolescents in Kuantan, Malaysia

@#Objectives: Body weight perception may determine the practice of proper weight management. The objective of this study was to measure the agreement between body weight perception and actual body weight status and its associated factors among late adolescents in Kuantan, Malaysia. Methods: A cross-sectional study was conducted from April to October 2018 among 479 adolescents aged 17-19 years old from seven institutions of higher learning in Kuantan. Body weight status was described as body mass index (BMI). Weight and height were measured, and BMI was calculated. Validated, self-administered Figure Rating Scale (FRS) questionnaires were used. Agreement between BMI and body weight perception was calculated using Kappa statistics. Logistic regression was employed to examine the association between body weight perception and sociodemographic variables. Results: More than one-third (35.3%) of the respondents misjudged their own body weight. More than one third of the respondents (38.7%) who were underweight, misperceived themselves as having normal weight whilst 31.7% of obese respondents identified themselves as overweight. The agreement between body weight perception and body mass index was moderate (k0.46, p<0.01). Conclusion: Body weight perception was in moderate agreement with actual weight in late adolescents. Accurate body weight perception is an important factor in late adolescent’s weight management behaviour. Hence, health education related to body weight management should be emphasized among this age group.

Validation Of A New Questionnaire Assessing The Health Impact Of Divorce On Women: An Exploratory Factor Analysis

The aim of this study was to develop a new validated questionnaire to assess the health impact of divorce on women. A cross sectional study was undertaken in a district in Terengganu, using a newly developed self-administered Malay language questionnaire comprising of six domains and 82 items. The questionnaire was constructed based on the literature review and discussions with experts. Exploratory factor analysis was applied in construct validity and internal consistency was used for reliability analysis. A total of 51 respondents were involved in this study. All the consented divorcees were Malays. The mean (SD) age for the divorced women was 35.8 (10.00). Majority (82.4%) of them had secondary education. All the final three domains demonstrated Keiser-Meyer-Olkin (KMO) of more than 0.6, significant Bartlett’s test of Sphericity and Cronbach’s alpha of more than 0.80. The overall Cronbach’s alpha was excellent (0.920). The final questionnaire consisted of two domains. Factor loading for all items in each subdomains were satisfactory. The final functional somatic symptoms domain consisted of 6 subdomains and 19 items with factor loading from 0.402 to 0.914. For emotional instability domain, the final items were 13 items with factor loading from 0.548 to 0.878. The questionnaire was valid and reliable to be used for functional somatic symptoms and emotional instability domains. It is useful to assess the health impact and related intervention of divorced women. A confirmatory factor analysis may further confirm the final model.