A cross-sectional study on public belief, knowledge and practice towards antibiotic use in the state of Perak, Malaysia.

INTRODUCTION: Inappropriate use of antibiotics has led to antimicrobial resistance, a major public health challenge worldwide. This study aimed to explore beliefs, knowledge, and practice on antibiotic use among general public. METHODOLOGY: Cross-sectional study was conducted at 13 hospitals and 44 primary health clinics in Perak from May to July 2017. Adults above 18 years, literate, and had experience in antibiotics consumption were selected through sequential sampling method. Data was collected using a self-administered questionnaire which included the three study domains i.e. belief, knowledge and practice. The questionnaire was pilot on 30 subjects. RESULTS: Out of 2850 distributed questionnaires, 2773 returned and 2632 were included for analysis. Mean age of the respondents was 39.7 ± 14.5 years old. Most respondents were female (58.6%), Malay (74.7%) and underwent upper secondary school (45.6%). Mean score were generated for each domain with belief: 5.87 ± 3.00 (total score: 12), knowledge: 15.82 ± 3.85 (total score: 24), practice: 6.91 ± 2.07 (total score: 12). In the belief domain, 63.2% of respondents believed that antibiotics would help them to recover faster. In the knowledge domain, 52.7% of respondents inappropriately thought that antibiotics could work on viral infections. In the practice domain, 70% of respondents expected doctors to prescribe antibiotics if suffered from symptoms. CONCLUSION: Majority of the respondents expect doctors to prescribe antibiotics for their illness, and most believes that antibiotics can speed up recovery of illness. Lack of awareness on antibiotic resistance was found to be a significant factor associated with inappropriate antibiotic use.

Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit.

AIM: To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries. METHODS: A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period. RESULTS: Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70. CONCLUSION: Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

ISPOR Code of Ethics 2017 (4th Edition).

As the leading health economics and outcomes research (HEOR) professional society, ISPOR has a responsibility to establish a uniform, harmonized international code for ethical conduct. ISPOR has updated its 2008 Code of Ethics to reflect the current research environment. This code addresses what is acceptable and unacceptable in research, from inception to the dissemination of its results. There are nine chapters: 1 - Introduction; 2 - Ethical Principles respect, beneficence and justice with reference to a non-exhaustive compilation of international, regional, and country-specific guidelines and standards; 3 - Scope HEOR definitions and how HEOR and the Code relate to other research fields; 4 - Research Design Considerations primary and secondary data related issues, e.g., participant recruitment, population and research setting, sample size/site selection, incentive/honorarium, administration databases, registration of retrospective observational studies and modeling studies; 5 - Data Considerations privacy and data protection, combining, verification and transparency of research data, scientific misconduct, etc.; 6 - Sponsorship and Relationships with Others (roles of researchers, sponsors, key opinion leaders and advisory board members, research participants and institutional review boards (IRBs) / independent ethics committees (IECs) approval and responsibilities); 7 - Patient Centricity and Patient Engagement new addition, with explanation and guidance; 8 - Publication and Dissemination; and 9 - Conclusion and Limitations.

Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ).

OBJECTIVE: (i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. METHODS: Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach's alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ. RESULTS: The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (test-retest) reliability was good. The overall Cronbach' s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated. CONCLUSIONS: This study is the first to develop and establish the reliability and validity of the Pharmacy Value-Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients' intention to adopt pharmacy value-added services to collect partial medicine supply.

Pharmacist intervention in improving hypertension-related knowledge, treatment medication adherence and health-related quality of life: a non-clinical randomized controlled trial.

OBJECTIVE: The study evaluated whether a pharmaceutical care intervention can result in better understanding about hypertension, increase medication adherence to antihypertensive therapy and improve overall health-related quality of life. METHODS: A non-clinical randomized control trial was conducted whereby participants received an educational intervention through hospital pharmacists. Hypertension knowledge, medication adherence and health-related quality of life were measured by means of self-administered questionnaires. Descriptive statistics were used to describe the demographic and disease characteristics of the patients. Inferential statistics were used for inter- and intragroup comparisons. SPSS 17 was used for data analysis. RESULTS: Three hundred and eighty-five hypertensive patients were randomly assigned (192 in the control group and 193 in the intervention group) to the study. No significant differences were observed in either group for age, gender, income, locality, education, occupation or duration of disease. There was, however, a significant increase in the participants' levels of knowledge about hypertension and medication adherence among the interventional group after completing the intervention. Significantly lower systolic and diastolic blood pressure levels were also observed among the interventional group after completion of the intervention. The interventional group, however, reported decreased yet significant health-related quality of life at the end of the interventional programme. CONCLUSION: Pharmacist intervention can significantly increase disease-related knowledge, blood pressure control and medication adherence in patients with hypertension. However, further research is needed to address the decreased health-related quality of life after completion of the study.

Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care.

BACKGROUND: Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol. METHODS/DESIGN: A pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated. DISCUSSION: Results from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia. TRIAL REGISTRATION: ClinicalTrials.gov NCT01545401.

Assessing quality of a worksite health promotion programme from participants' views: findings from a qualitative study in Malaysia.

BACKGROUND: An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme. OBJECTIVE: To explore the participants' perceptions of the quality and effectiveness of the 'Love Your Heart Programme'. DESIGN: A qualitative study using semi-structured interviews with a purposive sample of participants of the 'Love Your Heart' programme. Interviews were based on an interview guide that grouped questions into four main subgroups: structure, process, immediate outcomes and impact. The interviews were audio-recorded, transcribed verbatim and analysed using the principles of grounded theory. RESULTS: A total of 17 interviews were conducted. The participants were satisfied with the structural aspects of the programme. Different opinions arose regarding the ideal frequency and duration of the programme. The content of the seminars was thought to be too general. There was also a lack of interest in the 'Road to a Healthy Heart' booklet. All of the respondents had positive opinions about the communication skills and attitude of the health educator. The potential advantages and disadvantages of participating in the programme were discussed. Finally, the respondents expressed their satisfaction with the programme and the impact it had on them. DISCUSSION AND CONCLUSIONS: In general, the participants who were interviewed held the programme, and the health educator conducted the programme in high regard. The suggestions that were received can be used to further improve the acceptability and feasibility of the programme.

Economic evaluation of enhanced asthma management: a systematic review.

OBJECTIVES: To evaluate and compare full economic evaluation studies on the cost-effectiveness of enhanced asthma management (either as an adjunct to usual care or alone) vs. usual care alone. METHODS: Online databases were searched for published journal articles in English language from year 1990 to 2012, using the search terms '"asthma" AND ("intervene" OR "manage") AND ("pharmacoeconomics" OR "economic evaluation" OR "cost effectiveness" OR "cost benefit" OR "cost utility")'. Hand search was done for local publishing. Only studies with full economic evaluation on enhanced management were included (cost consequences (CC), cost effectiveness (CE), cost benefit (CB), or cost utility (CU) analysis). Data were extracted and assessed for the quality of its economic evaluation design and evidence sources. RESULTS: A total of 49 studies were included. There were 3 types of intervention for enhanced asthma management: education, environmental control, and self-management. The most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals. In general, the studies had a fair quality of economic evaluation with a mean QHES score of 73.7 (SD=9.7), and had good quality of evidence sources. CONCLUSION: Despite the overall fair quality of economic evaluations but good quality of evidence sources for all data components, this review showed that the delivered enhanced asthma managements, whether as single or mixed modes, were overall effective and cost-reducing. Whilst the availability and accessibility are an equally important factor to consider, the sustainability of the cost-effective management has to be further investigated using a longer time horizon especially for chronic diseases such as asthma.

Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use.

OBJECTIVE: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). METHODS: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy's management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. RESULTS: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. CONCLUSIONS: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel's at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.

Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use / Manejo de casos de malaria en farmacias comunitarias de Pakistán: amenaza al uso racional de medicamentos

Objective: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). Method: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy’s management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. Results: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. Conclusion: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel’s at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies (AU)

Objetivo: Documentar el manejo de casos de malaria no complicada en farmacias comunitarias situadas en las dos principales ciudades de Pakistán: Islamabad (la capital) y Rawalpindi (ciudad gemela). Método: Se diseñó un estudio comparativo transversal para documentar el manejo de la malaria no complicada en las farmacias comunitarias de las ciudades gemelas de Pakistán mediante visitas de pacientes simulados. Se realizaron visitas a 238 farmacias aleatoriamente seleccionadas para pedir consejo en un caso de un paciente simulado con malaria. El manejo de la farmacia se puntuó en un listado que incluía la recogida del historial y la provisión de asesoramiento e información. Se utilizaron los tests de Kruskal-Wallis y de Mann-Whitney U para comparar el manejo de los casos de malaria no complicada por los dispensadores trabajando en farmacias comunitarias gestionadas por diferentes proveedores y en diferentes localizaciones de las ciudades gemelas. Resultados: Los pacientes simulados fueron atendidos por vendedores (74,8%, n=178), farmacéuticos (5,4%, n= 13), y diplomados (19,8%, n=47). Se dispensó medicación en el 83,1% (n=198) de las visitas, pero pocos de los casos tratados estaban de acuerdo con las recomendaciones para el tratamiento de la malaria. Sin embargo, en el 14,8% de los casos (n=53) los pacientes simulados fueron remitidos directamente al médico. Hubo diferencia significativa en el proceso de recogida del historial entre los diferentes dispensadores (p.e. farmacéuticos, auxiliares de farmacia, diplomados en farmacia, y vendedores), mientras que no hubo diferencias significativas en la provisión de asesoramiento entre los diferentes dispensadores. Los farmacéuticos, si estaban disponibles en la farmacia, estaban más involucrados en el proceso de recogida del historial. Por otro lado, no se apreciaron diferencias significativas en el manejo del caso (recogida del historial y provisión de asesoramiento) para el tratamiento de la malaria entre las farmacias comunitarias de diferentes localizaciones de las ciudades gemelas (p.e. cerca de un hospital/supermercado/mercadillo). Conclusión: Los resultados del estudio revelaron que el proceso general de manejo de la malaria no complicada en farmacias comunitarias no estaba de acuerdo con las recomendaciones nacionales de tratamiento de malaria. Los pacientes fueron atendidos por personal de las farmacias sin entrenamiento en las farmacias sin ninguna idea de remisión al médico. Sin embargo, los farmacéuticos estaban más involucrados en la recogida del historial, aunque su disponibilidad en las farmacias comunitarias era baja (AU)

Stages of change and health-related quality of life among employees of an institution.

BACKGROUND: Transtheoretical Model of change has been used successfully in promoting behaviour change. OBJECTIVE: To examine the relationships between health-related quality of life (HRQoL) scores with the stages of change of adequate physical activity and fruit and vegetables intake. DESIGN: This was a cross-sectional study conducted among employees of the main campus and Engineering campus of Universiti Sains Malaysia (USM) during October 2009 and March 2010. MAIN VARIABLES STUDIED: Data on physical activity and fruit and vegetable intake was collected using the WHO STEPS instrument for chronic disease risk factors surveillance. The Short Form-12 health survey (SF-12) was used to gather information on participants' HRQoL. The current stages of change are measured using the measures developed by the Pro-Change Behaviour Systems Incorporation. STATISTICAL ANALYSIS: One way ANOVA and its non-parametric equivalent Kruskal-Wallis were used to compare the differences between SF-12 scores with the stages of change. RESULTS: A total of 144 employees were included in this analysis. A large proportion of the participants reported inadequate fruits and vegetable intake (92.3%) and physical activity (84.6%). Mean physical and mental component scores of SF-12 were 50.39 (SD = 7.69) and 49.73 (SD = 8.64) respectively. Overall, there was no statistical significant difference in the SF-12 domains scores with regards to the stages of change for both the risk factors. CONCLUSIONS: There were some evidence of positive relationship between stages of change of physical activity and fruit and vegetable intake with SF-12 scores. Further studies need to be conducted to confirm this association.

A cross sectional assessment of health related quality of life among patients with Hepatitis-B in Pakistan.

OBJECTIVE: The study aims to assess Health Related Quality of Life (HRQoL) among Hepatitis B (HB) patients and to identify significant predictors of the HRQoL in HB patients of Quetta, Pakistan. METHODS: A cross sectional study by adopting European Quality of Life scale (EQ-5D) for the assessment of HRQoL was conducted. All registered HB patients attending two public hospitals in Quetta, Pakistan were approached for study. Descriptive statistics were used to describe demographic and disease related characteristics of the patients. HRQoL was scored using values adapted from the United Kingdom general population survey. EQ-5D scale scores were compared with Mann-Whitney and Kruskal-Wallis test. Standard multiple regression analysis was performed to identify predictors of HRQoL. All analyses were performed using SPSS v 16.0. RESULTS: Three hundred and ninety HB patients were enrolled in the study. Majority of the participants (n = 126, 32.3%) were categorized in the age group of 18-27 years (36.07 ± 9.23). HRQoL was measured as poor in the current study patients (0.3498 ± 0.31785). The multivariate analysis revealed a significant model (F(10, 380) = 40.04, P < 0.001, adjusted r(2) = 0.401). Educational level (ß = 0.399, p = 0.025) emerged as a positive predictor of HRQoL. Age, gender, occupation, income and locality were not predictive of better quality of life in HB patients. CONCLUSIONS: Hepatitis B has an adverse affect on patients' well-being and over all HRQoL. The study findings implicate the need of health promotion among HB patients. Improving the educational status and imparting disease related information for the local population can results in better control and management of HB.

A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan.

BACKGROUND: Hepatitis B (HB) is a serious global public health problem. This study aims to evaluate Knowledge, Attitude and Practice (KAP) towards Hepatitis B (HB) among healthy population of Quetta city, Pakistan. METHODS: A cross sectional, descriptive study was undertaken. One thousand healthy individuals (aged 18 years and above) were approached for the study. KAP towards HB was assessed by using a pre validated questionnaire. Descriptive statistics were used for elaborating patients' demographic characteristics. Inferential statistics (Mann-Whitney U test and Kruskal Wallis test) were used for comparison while Spearman's rho correlation was used to identify association between the study variables. All analyses were performed using SPSS 16.0. RESULTS: Out of 1000 distributed questionnaires, 780 were returned with a response rate of 78.0%. Four hundred and twenty (53.8%) respondents were male with mean age of 32.76 ± 9.40 year. Two hundred and eight (26.7%) had intermediate level of education and 354 (45.4%) were unemployed. Mean scores for knowledge, attitude and practice were 8.74 ± 2.7, 3.72 ± 1.2 and 2.76 ± 1.1 respectively. Significant and positive linear correlations between knowledge-attitude (r = 0.296, p < 0.01) knowledge-practice (r = 0.324, p < 0.01) and attitude-practice (r = 0.331, p < 0.01) were observed. Area of residence (locality) was the only variables significantly associated with mean KAP of the study respondents. CONCLUSION: Results from the current study heighted poor KAP of healthy population towards HB. The positive linear correlations reaffirms that better knowledge can lead to positive attitude and subsequently in good practices. This will further help in prevention and management of HB. Therefore, extensive health educational campaign should be provided to general population and especially to the residents of rural areas.

Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes.

BACKGROUND: Most of interventions that have attempted to improve medication adherence in type 2 diabetes have been educational; on the assumption that knowledge regarding diabetes might affect patients' adherence to their treatment regimen. OBJECTIVES: The purpose of the study was to investigate any association of knowledge and medication adherence with glycemic control in patients with type 2 diabetes mellitus. Setting The study was conducted at the Diabetes Outpatients Clinic, Hospital Pulau Penang. METHODS: A cross-sectional study was conducted with a convenience sample of 540 adult patients with type 2 diabetes attending the clinic. A questionnaire including previously validated Michigan Diabetes Knowledge Test and Morisky Medication Adherence Scale was used and the patients' medical records were reviewed for haemoglobin A1C (HbA1C) levels and other disease-related information. A total of 35 (6.48%) patients were excluded after data collection due to lack of HbA1C results. RESULTS: Five hundred and five patients were included in the final analysis, with a mean age of 58.15 years (SD = 9.16), 50.7% males and median HbA1C of 7.6 (IQR was 6.7-8.9). The median total knowledge score was 7.0 (IQR was 5.0-10.0) while the median adherence score was 6.5 (IQR was 4.75-7.75). Significant correlations were found between the three variables (HbA1C, knowledge and adherence). A significantly higher score for knowledge and adherence (P < 0.05) was found in those patients with lower HbA1C. Higher diabetes knowledge, higher medication adherence and using mono-therapy were significant predictors of good glycemic control in the multivariate analysis. CONCLUSION: Patients' knowledge about diabetes is associated with better medication adherence and better glycemic control. In addition to other factors affecting medication adherence and glycemic control, healthcare providers should pay attention to knowledge about diabetes that the patients carry towards medication adherence.

A qualitative exploration of Malaysian cancer patients' perspectives on cancer and its treatment.

BACKGROUND: Cancer patients' knowledge about cancer and experiences with its treatment play an important role in long-term adherence in their disease management. This study aimed to explore cancer patients' knowledge about cancer, their perceptions of conventional therapies and the factors that contribute to medication adherence in the Malaysian population. METHODS: A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by cancer patients. Twenty patients were interviewed using a semi-structured interview guide. A saturation point was reached after the 18th interview, and no new information emerged with the subsequent 2 interviews. All interviews were transcribed verbatim and analysed by means of a standard content analysis framework. RESULTS: The majority of patients related the cause of their cancer to be God's will. Participants perceived conventional therapies as effective due to their scientific methods of preparations. A fear of side effects was main reasons given for delay in seeking treatment; however, perceptions were reported to change after receiving treatment when effective management to reduce the risk of side effects had been experienced. CONCLUSIONS: This study provides basic information about cancer patients' perceptions towards cancer and its treatment. These findings can help in the design of educational programs to enhance awareness and acceptances of cancer screening. Priorities for future research should focus on patients who refused the conventional therapies at any stage.

The eight-item Morisky Medication Adherence Scale MMAS: translation and validation of the Malaysian version.

AIMS: To translate and examine the psychometric properties of the Malaysian version of the Morisky Medication Adherence Scale (MMAS) among patients with type 2 diabetes. METHODS: A standard "forward-backward" procedure was used to translate MMAS into Malay language. It was later validated on a convenience sample of 223 type 2 diabetes outpatients between May and September 2009. Reliability was tested for internal consistency. Validity was confirmed using convergent and known group validity. RESULTS: Employing the recommended scoring method, the mean±SD of MMAS scores was 6.13±1.72. Moderate internal consistency was found (Cronbach's α=0.675), the test-retest reliability value was 0.816 (p<0.001). A positive correlation between the eight- and four-item MMAS was found (r=0.792; p<0.01). A significant relationship between MMAS categories and HbA1c categories (χ(2)=20.261; p≥0.001) was found. The MMAS sensitivity and specificity, with positive and negative predictive values were 77.61%, 45.37%, 46.84% and 76.56%, respectively. CONCLUSIONS: The findings of this validation study indicate that the Malaysian version of the MMAS is a reliable and valid measure of medication adherence which can now be used.

Willingness to pay for a pharmacist’s dispensing service: a cross-sectional pilot study in the state of Penang, Malaysia / Voluntad de pagar por un servicio de dispensación farmacéutica: estudio piloto transversal en el estado de Penang, Malasia

Objective: The aim of this pilot study was to assess the value of the dispensing service of pharmacists from the general public's perspective using the contingent valuation technique in the State of Penang, Malaysia. Methods: Participants were conveniently sampled from malls and were given a self-completed questionnaire that collected the patient's demographic information and their knowledge about the pharmacist's dispensing service. They were then presented with a description of the pharmacist's dispensing service, the risk of medication errors in prescriptions and their consequences, and the risk reduction of medication errors associated with pharmacist intervention. The willingness to pay (WTP) of the participants was later assessed using a contingent valuation interview that asked the likelihood and maximum amount they were willing to pay. Results: In the study, 100 people participated, and 57% were aged between 18 and 35 years. Of these participants, 51% were women, and 46% of them earned more than 1000 MYR (285.71USD) per month. In addition, 8% of the participants had never visited a community pharmacy. Finally, 67% of the participants were willing to pay for the pharmacists' dispensing service, and the median amount that the participants were willing to pay was 10 MYR (2.86USD). The WTP amount was moderately correlated with their knowledge of the community pharmacist's dispensing services (r=0.377, p=0.02). Conclusion: Generally, the public valued the pharmacist's dispensing service. Their acceptance can be further improved by educating the public on the role of the pharmacist (AU)

Objetivo: El objetivo de este estudio piloto fue evaluar el valor del servicio de dispensación de los farmacéuticos desde la perspectiva del público general utilizando la técnica de evaluación del contingente en el estado de Penang, Malasia. Métodos: Se muestreó convenientemente a los participantes en los centros comerciales y se les dio un cuestionario de auto-cumplimentación que recogía información demográfica del paciente y sus conocimientos del servicio de dispensación de los farmacéuticos. Se les presentaba una descripción del servicio de dispensación farmacéutica, el riesgo de os errores de medicación y sus consecuencias, y la reducción del riesgo de errores de medicación asociada con la intervención del farmacéutico. La voluntad de pagar (VDP) de los participantes se evaluaba después utilizando una entrevista de evaluación del contingente que preguntaba la probabilidad y la cantidad máxima que estaban dispuestos a pagar. Resultados: 100 personas participaron en el estudio y el 57% estaban entre 18 y 35 años. De estos participantes, el 51% eran mujeres y el 46% de ellos ganaba más de 1000MYR (285,71USD) al mes. Además, el 8% de los participantes nunca 'había visitado una farmacia comunitaria. Finalmente, el 67% de los participantes estaba dispuesto a pagar por el servicio de dispensación farmacéutica; y la mediana que los participantes estaban dispuestos a pagar era de 10MYR (2,86USD). La VDP estaba ligeramente correlacionada con su conocimiento de los servicios de dispensación farmacéutica (r=0,377, p=0,02). Conclusión: En general, el público valorizó el servicio de dispensación farmacéutica. Su aceptación puede mejorarse educando al público sobre el papel del farmacéutico (AU)

Measurement of nicotine withdrawal symptoms: linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS) in Malay.

BACKGROUND: The purpose of the linguistic validation of the Wisconsin Smoking Withdrawal Scale (WSWS) was to produce a translated version in Malay language which was "conceptually equivalent" to the original U.S. English version for use in clinical practice and research. METHODS: A seven-member translation committee conducted the translation process using the following methodology: production of two independent forward translations; comparison and reconciliation of the translations; backward translation of the first reconciled version; comparison of the original WSWS and the backward version leading to the production of the second reconciled version; pilot testing and review of the translation, and finalization. RESULTS: Linguistic and conceptual issues arose during the process of translating the instrument, particularly pertaining to the title, instructions, and some of the items of the scale. In addition, the researchers had to find culturally acceptable equivalents for some terms and idiomatic phrases. Notable among these include expressions such as "irritability", "feeling upbeat", and "nibbling on snacks", which had to be replaced by culturally acceptable expressions. During cognitive debriefing and clinician's review processes, the Malay translated version of WSWS was found to be easily comprehensible, clear, and appropriate for the smoking withdrawal symptoms intended to be measured. CONCLUSIONS: We applied a rigorous translation method to ensure conceptual equivalence and acceptability of WSWS in Malay prior to its utilization in research and clinical practice. However, to complete the cultural adaptation process, future psychometric validation is planned to be conducted among Malay speakers.

Evaluation of breast cancer awareness among female university students in Malaysia / Evaluación del conocimiento sobre cáncer de mama entre estudiantes universitarias en Malasia

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia. Objective: The objectives of this study were to evaluate the knowledge of breast cancer risk factors, symptoms and methods of screening among female university students and their perception towards the disease treatment outcomes. Methods: A cross-sectional survey was conducted from February to March 2008 at University Sains Malaysia. Two hundred participants from 10 randomly selected faculties were interviewed face to face by a trained pharmacist using a validated questionnaire. In addition to their demographic characteristics, participants were required to answer 22 questions concerning knowledge of breast cancer and five questions related to their perception of breast cancer management and treatment outcomes. Data were analyzed using SPSS version 15. Results: The mean age of the respondents was 26.7 (SD=1.9) years. The results showed that the vast majority of the female university students had inadequate knowledge of breast cancer. The mean total knowledge score of the students was 60.7%. Indian students had significantly less knowledge of breast cancer compared to their Chinese and Malay counterparts (p<0.05). However, more than two third of the students were aware of breast self examination (BSE) and clinical breast examination (CBE) recommendations. Furthermore, the students had positive perceptions towards the treatment outcomes of breast cancer. Conclusion: This study has highlighted the need of a breast cancer awareness campaign, which should also stress the importance of early detection and reporting of breast cancer (AU)

El cáncer de mama es el cáncer más común y la mayor causa de muerte entre jóvenes de todos los grupos étnicos y edad en Malasia. Objetivo: Los objetivos de este estudio fueron evaluar el conocimiento sobre los factores de riesgo de cáncer de mama, los síntomas y los métodos de rastreo entre estudiantes universitarias y su percepción hacia los resultados del tratamiento de la enfermedad. Métodos: Se realizó un estudio transversal de febrero a marzo e 2008 en la Universidad Sains Malaysia. Un farmacéutico entrenado entrevistó cara a cara a 200 participantes entre las 10 facultades aleatoriamente seleccionadas utilizando un cuestionario validado. Además, de sus características demográficas e les pidió que respondiesen 22 preguntas relativas al conocimiento del cáncer de mama y 5 relativas a su percepción sobre los resultados de su gestión y tratamiento. Los datos se analizaron utilizando el SPSS versión 15. Resultados: La media de edad de los respondentes era de 26,7 (DE=1,9) años. Los resultados mostraron que la gran mayoría de las estudiantes universitarias tenían conocimientos inadecuados sobre el cáncer de mama. La media de puntuación total fue del 60,7%. Las estudiantes indias tenían significativamente menos conocimiento que sus colegas chinas y malayas (p<0,05). Sin embargo, más de dos tercios de las estudiantes conocían las recomendaciones de auto-exámenes de cáncer de mama y de exámenes clínicos de mama. Incluso, las estudiantes tenían una percepción positiva sobre los resultados del tratamiento del cáncer de mama. Conclusión: Este estudio indicó la necesidad de una campaña de concienciación sobre el cáncer de mama, que también debería remarcar la importancia de la detección temprana y la comunicación del cáncer de mama (AU)

Willingness to pay for a pharmacist's dispensing service: a cross-sectional pilot study in the state of Penang, Malaysia.

OBJECTIVE: The aim of this pilot study was to assess the value of the dispensing service of pharmacists from the general public's perspective using the contingent valuation technique in the State of Penang, Malaysia. METHODS: Participants were conveniently sampled from malls and were given a self-completed questionnaire that collected the patient's demographic information and their knowledge about the pharmacist's dispensing service. They were then presented with a description of the pharmacist's dispensing service, the risk of medication errors in prescriptions and their consequences, and the risk reduction of medication errors associated with pharmacist intervention. The willingness to pay (WTP) of the participants was later assessed using a contingent valuation interview that asked the likelihood and maximum amount they were willing to pay. RESULTS: In the study, 100 people participated, and 57% were aged between 18 and 35 years. Of these participants, 51% were women, and 46% of them earned more than 1000 MYR (285.71USD) per month. In addition, 8% of the participants had never visited a community pharmacy. Finally, 67% of the participants were willing to pay for the pharmacists' dispensing service, and the median amount that the participants were willing to pay was 10 MYR (2.86USD). The WTP amount was moderately correlated with their knowledge of the community pharmacist's dispensing services (r=0.377, p=0.02). CONCLUSION: Generally, the public valued the pharmacist's dispensing service. Their acceptance can be further improved by educating the public on the role of the pharmacist.