Prevalence and sociodemographic predictors of high-risk vaginal human papillomavirus infection: findings from a public cervical cancer screening registry.

INTRODUCTION: High-risk human papillomavirus (HPV) screening is vital for early cervical cancer detection and treatment. With the introduction of the national cervical cancer screening programme and screening registry in Malaysia, there is a need to monitor population-based HPV screening uptake and high-risk HPV prevalence as part of cervical cancer surveillance. OBJECTIVE: To determine the prevalence and sociodemographic factors predicting high-risk HPV infection in Malaysia based on a public, community-based cervical cancer screening registry targeting women at risk of getting HPV infection. METHODS: The study used data from the Malaysian cervical cancer screening registry established by the Family Health Development Division from 2019 to 2021. The registry recorded sociodemographic data, HPV test details and results of eligible women who underwent HPV screening at public primary healthcare facilities. A vaginal sample (via self-sampling or assisted by a healthcare provider) was used for DNA extraction for HPV detection and genotyping. Registry data were extracted and analysed to determine prevalence estimates of high-risk HPV infection. Multifactorial logistic regression analysis was conducted to determine predictors of high-risk HPV infection. All analyses were performed using Stata version 14. RESULTS: The programme screened a total of 36,738 women during the study period. Women who attended the screening programme were mainly from urban areas, aged 30-39 years, and of Malay ethnicity. The prevalence of high-risk HPV infection was 4.53% among women screened, with the yearly prevalence ranging from 4.27 to 4.80%. A higher prevalence was observed among urban settling women, those aged 30-49 years, those of Indian ethnicity, and those without children. The results from logistic regression showed that women from urban areas, lower age groups, of Indian or Chinese ethnicity, and who are self-employed were more likely to be infected with high-risk HPV. CONCLUSION: Targeted and robust strategies to reach identified high-risk groups are needed in Malaysia. In addition, the registry has the potential to be expanded for an improved cervical cancer elimination plan. TRIAL REGISTRATION: Trial registration number: NMRR ID-22-00187-DJU.

Cognitive Frailty and Functional Disability Among Community-Dwelling Older Adults: A Systematic Review.

Background and Objectives: This review aimed to summarize the association between cognitive frailty (presence of frailty and cognitive impairment) and the risk of disabilities in activities of daily living (ADL), instrumental ADL (IADL), mobility, or other functional disabilities among older adults. Research Design and Methods: PubMed, Embase, CINAHL Plus, and PsycINFO were searched from January 2001 to May 14, 2022, for observational studies that reported cognitive frailty among community-dwelling individuals aged 60 years and above. Results were narratively synthesized. Results: Eleven studies encompassing 44 798 participants were included, with a prevalence of cognitive frailty ranging from 1.4% to 39.3%. Individuals with cognitive frailty were more likely to develop disabilities in ADL and IADL compared to robust (absence of frailty and cognitive impairment) individuals. Significant disability burden and elevated risk of combined ADL/IADL disability or physical limitation among participants with cognitive frailty were reported. There was limited evidence on the association between cognitive frailty and mobility disability. Discussion and Implications: Individuals with cognitive frailty were likely at higher risk of developing functional disability and incurring higher disability burden than robust individuals, but evidence remains limited for those with prefrailty with cognitive impairment. Further research on this gap and standardization of cognitive frailty assessments would facilitate comparisons across populations. PROSPERO Registration: CRD42021232222.

Diabetes, Ramadan, and driving - Ensuring patient safety while respecting religious autonomy: A qualitative study.

BACKGROUND AND AIMS: Hypoglycaemia due to fasting during Ramadan may affect the ability to perform complex activities among people with type 2 diabetes mellitus (T2D), but it is unclear how this affects one's ability to drive. This study aims to explore driving experiences and coping strategies to ensure safe driving among people with T2D who fast during Ramadan. METHODS: We conducted an exploratory qualitative study and purposefully selected people with T2D who drove and fasted during the past Ramadan period in 2019. In-depth face-to-face interviews were conducted and transcribed verbatim. Data were analysed thematically using a constant comparative method until saturation was achieved (n = 16). RESULTS: Two major themes were identified, namely: (1) knowing oneself and (2) voluntary self-restriction. Participants described the importance of understanding how Ramadan fasting affected them and their level of alertness. As such, participants often adjusted their daily activities and tested their blood glucose levels to prevent experiencing hypoglycaemia. Other coping strategies reported include adjusting their medications and driving restrictions or driving in the mornings when they were more alert. Findings from this study shed light on participants' experiences and coping mechanisms while driving during Ramadan. CONCLUSION: Given the risks and effects of hypoglycaemia among those who fast, there is a need to provide appropriate and focused patient education during Ramadan to people with T2D to ensure they can perform complex activities such as driving safely, especially in Muslim majority countries.

The prevalence of functional disability and its impact on older adults in the ASEAN region: a systematic review and meta-analysis.

OBJECTIVES: Functional disability is a common consequence of the ageing process and can lead to poor health outcomes due to the inability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) independently. However, the prevalence of functional disability among older adults in the Association of Southeast Asian Nations (ASEAN) region is poorly documented. This study aimed to assess the prevalence of functional disability and its impact on older adults in the ASEAN region. METHODS: A systematic literature search was performed on 4 databases from inception until March 2021 to identify studies examining individuals aged 60 years and above reporting functional disabilities in the ASEAN region. Information on the prevalence and impact of functional disability was extracted, assessed for bias, summarised, and analysed using a random-effects meta-analysis. RESULTS: Thirty-four studies with 59,944 participants were included. The pooled prevalence of ADL disability was 21.5% (95% confidence interval [CI], 16.2 to 27.3) and that of IADL disability was 46.8% (95% CI, 35.5 to 58.3). Subgroup analyses showed higher prevalence among those of advanced age and women. Adverse impacts included increased years of life with disability and poor health-related quality of life. CONCLUSIONS: Nearly a quarter of the older adult population in the ASEAN region experience functional disability. These findings highlight the need for further research on the burden and impact of functional disability within this region to allow decision-makers to gauge the severity of the issue, develop policies to reduce the risk of developing functional disabilities, and foster healthy ageing.

Applying Discrete Event Simulation to Reduce Patient Wait Times and Crowding: The Case of a Specialist Outpatient Clinic with Dual Practice System.

Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital's information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study's dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10-21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.

Research funding impact and priority setting - advancing universal access and quality healthcare research in Malaysia.

BACKGROUND: Health Research Priority Setting (HRPS) in the Ministry of Health (MOH) Malaysia was initiated more than a decade ago to drive effort toward research for informed decision and policy-making. This study assessed the impact of funded prioritised research and identified research gaps to inform future priority setting initiatives for universal access and quality healthcare in Malaysia. METHODS: Research impact of universal access and quality healthcare projects funded by the National Institutes of Health Malaysia were assessed based on the modified Payback Framework, addressing categories of informing policy, knowledge production, and benefits to health and health sector. For the HRPS process, the Child Health and Nutrition Research Initiative methodology was adapted and adopted, with the incorporation of stakeholder values using weights and monetary allocation survey. Workshop discussions and interviews with stakeholders and research groups were conducted to identify research gaps, with the use of conceptual frameworks to guide the search. RESULTS: Seventeen ongoing and 50 completed projects were identified for research funding impact analysis. Overall, research fund allocation differed from stakeholders' expectation. For research impact, 48 out of 50 completed projects (96.0%) contributed to some form of policy-making efforts. Almost all completed projects resulted in outputs that contributed to knowledge production and were expected to lead to health and health sector benefits. The HRPS process led to the identification of research priority areas that stemmed from ongoing and new issues identified for universal access and quality healthcare. CONCLUSION: The concerted efforts of evaluation of research funding impact, prioritisation, dissemination and policy-maker involvement were valuable for optimal health research resource utilisation in a resource constrained developing country. Embedding impact evaluation into a priority setting process and funding research based on national needs could facilitate health research investment to reach its potential.