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Teng CL, Lee VKM, Malanashita G, Sulaiman LH, Bujang MA. Gender and Ethnic Differences in Diabetes Self Care in Malaysia: An Individual Participant Meta-Analysis of Summary of Diabetes Self Care Activities Studies. Malays J Med Sci 2023; 30:162-171. [PMID: 36875195 PMCID: PMC9984106 DOI: 10.21315/mjms2023.30.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/03/2022] [Indexed: 03/05/2023] Open
Abstract
Background Many published studies in Malaysia have examined and assessed self care among type 2 diabetes mellitus (T2DM) patients using the Summary of Diabetes Self Care Activities (SDSCA) scale. The current paper is a meta-analysis of related studies that also examines how gender and ethnicity influence and shape T2DM self care practices in Malaysia. Methods We undertook a bibliographic search for studies conducted and published in Malaysia on T2DM adults using the SDSCA scale. This is a two-stage individual participant meta-analysis of SDSCA which synthesised the overall and subscale score based on gender and ethnic groups as well as the correlation between SDSCA and HbA1c. Results We examined 11 studies that utilised SDSCA to analyse 3,720 T2DM patients. The overall SDSCA score was 33.46 (47.8% of the 7-day week). The subscale score for general diet, specific diet, exercise, blood glucose self-monitoring and foot care were 4.80, 4.09, 2.87, 1.80 and 3.21, respectively. A small but statistically significant better self care in some gender or ethnic groups was noted. The SDSCA diet subscale and HbA1c showed statistically significant correlation. Conclusion The finding suggested Malaysian T2DM patients were deficient in exercise and blood glucose self-monitoring. In fact, overall self care among Malaysian adult T2DM patients appears to be suboptimal across gender and the three main ethnic groups. Greater efforts are therefore needed to educate Malaysian adult T2DM patients to improve their self care practices.
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Affiliation(s)
- Cheong Lieng Teng
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Ganeson Malanashita
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Lokman Hakim Sulaiman
- Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
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Yeap SS, Abu Amin SR, Baharuddin H, Koh KC, Lee JK, Lee VKM, Mohamad Yahaya NH, Tai CC, Tan MP. A Malaysian Delphi consensus on managing knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:514. [PMID: 34088302 PMCID: PMC8178929 DOI: 10.1186/s12891-021-04381-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA. METHODS A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus' core messages. RESULTS A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers. CONCLUSIONS This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, No. 1, Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia.
| | | | - Hazlyna Baharuddin
- Department of Internal Medicine, Universiti Teknologi MARA, Kampus Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Kar Chai Koh
- Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, 52100, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Joon Kiong Lee
- Department of Orthopaedic Surgery, Beacon Hospital, Jalan Templer, Section 51, 46050, Petaling Jaya, Selangor, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Hamdan Mohamad Yahaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Cheh Chin Tai
- Department of Orthopaedic Surgery, Ara Damansara Medical Centre, Jalan Lapangan Terbang Subang, Seksyen U2, 40150, Shah Alam, Selangor, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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Gilcharan Singh HK, Chee WSS, Hamdy O, Mechanick JI, Lee VKM, Barua A, Mohd Ali SZ, Hussein Z. Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial. PLoS One 2020; 15:e0242487. [PMID: 33253259 PMCID: PMC7703935 DOI: 10.1371/journal.pone.0242487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). METHODS Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months' post-intervention. RESULTS There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months' follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups. CONCLUSION Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. CLINICAL TRIAL This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.
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Affiliation(s)
- Harvinder Kaur Gilcharan Singh
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Winnie Siew Swee Chee
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Osama Hamdy
- Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, United States of America
| | - Jeffrey Ian Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Ankur Barua
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Siti Zubaidah Mohd Ali
- Department of Non-Communicable Diseases, Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
| | - Zanariah Hussein
- Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia
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Voon PT, Lee ST, Ng TKW, Ng YT, Yong XS, Lee VKM, Ong ASH. Intake of Palm Olein and Lipid Status in Healthy Adults: A Meta-Analysis. Adv Nutr 2019; 10:647-659. [PMID: 31095284 PMCID: PMC6628844 DOI: 10.1093/advances/nmy122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 12/11/2022] Open
Abstract
It is not clear whether a saturated fatty acid-rich palm olein diet has any significant adverse effect on established surrogate lipid markers of cardiovascular disease (CVD) risk. We reviewed the effect of palm olein with other oils on serum lipid in healthy adults. We searched in MEDLINE and CENTRAL: Central Register of Controlled Trials from 1975 to January 2018 for randomized controlled trials of ≥2 wk intervention that compared the effects of palm olein (the liquid fraction of palm oil) with other oils such as coconut oil, lard, canola oil, high-oleic sunflower oil, olive oil, peanut oil, and soybean oil on changes in serum lipids. Nine studies were eligible and were included, with a total of 533 and 542 subjects on palm olein and other dietary oil diets, respectively. We extracted and compared all the data for serum lipids, such as total cholesterol (TC), LDL cholesterol, HDL cholesterol, triglyceride, and TC/HDL cholesterol ratio. When comparing palm olein with other dietary oils, the overall weighted mean differences for TC, LDL cholesterol, HDL cholesterol, triglycerides, and the TC/HDL cholesterol ratio were -0.10 (95% CI: -0.30, 0.10; P = 0.34), -0.06 (95% CI: -0.29,0.16; P = 0.59), 0.02 (95% CI: -0.01, 0.04; P = 0.20), 0.01 (95% CI: -0.05, 0.06; P = 0.85), and -0.15 (95% CI: -0.43, 0.14; P = 0.32), respectively. Overall, there are no significant differences in the effects of palm olein intake on lipoprotein biomarkers (P > 0.05) compared with other dietary oils. However, dietary palm olein was found to have effects comparable to those of other unsaturated dietary oils (monounsaturated fatty acid- and polyunsaturated fatty acid-rich oils) but differed from that of saturated fatty acid-rich oils with respect to the serum lipid profile in healthy adults.
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Affiliation(s)
- Phooi Tee Voon
- Nutrition Unit, Malaysian Palm Oil Board (MPOB), Selangor, Malaysia,Address correspondence to PTV (e-mail: )
| | - Sin Tien Lee
- Nutrition Unit, Malaysian Palm Oil Board (MPOB), Selangor, Malaysia,Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University Putra Malaysia (UPM), Serdang, Malaysia
| | - Tony Kock Wai Ng
- Department of Biomedical Sciences, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Perak, Malaysia
| | - Yen Teng Ng
- Nutrition Unit, Malaysian Palm Oil Board (MPOB), Selangor, Malaysia
| | - Xiou Shuang Yong
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia (UPM), Serdang, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University (IMU), Seremban, Negeri Sembilan, Malaysia
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Ng YT, Voon PT, Ng TKW, Lee VKM, Mat Sahri M, Mohd Esa N, Ong SH, Ong ASH. Interesterified Palm Olein (IEPalm) and Interesterified Stearic Acid-Rich Fat Blend (IEStear) Have No Adverse Effects on Insulin Resistance: A Randomized Control Trial. Nutrients 2018; 10:nu10081112. [PMID: 30126103 PMCID: PMC6115919 DOI: 10.3390/nu10081112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022] Open
Abstract
Chemically-interesterified (CIE) fats are trans-fat free and are increasingly being used as an alternative to hydrogenated oils for food manufacturing industries to optimize their products' characteristics and nutrient compositions. The metabolic effects of CIE fats on insulin activity, lipids, and adiposity in humans are not well established. We investigated the effects of CIE fats rich in palmitic (C16:0, IEPalm) and stearic (C18:0, IEStear) acids on insulin resistance, serum lipids, apolipoprotein concentrations, and adiposity, using C16:0-rich natural palm olein (NatPO) as the control. We designed a parallel, double-blind clinical trial. Three test fats were used to prepare daily snacks for consumption with a standard background diet over a period of 8 weeks by three groups of a total of 85 healthy, overweight adult volunteers. We measured the outcome variables at weeks 0, 6, and at the endpoint of 8. After 8 weeks, there was no significant difference in surrogate biomarkers of insulin resistance in any of the IE fat diets (IEPalm and IEStear) compared to the NatPO diet. The change in serum triacylglycerol concentrations was significantly lower with the IEStear diet, and the changes in serum leptin and body fat percentages were significantly lower in the NatPO-diet compared to the IEPalm diet. We conclude that diets containing C16:0 and C18:0-rich CIE fats do not affect markers of insulin resistance compared to a natural C16:0-rich fat (NatPO) diet. Higher amounts of saturated fatty acids (SFAs) and longer chain SFAs situated at the sn-1,3 position of the triacylglycerol (TAG) backbones resulted in less weight gain and lower changes in body fat percentage and leptin concentration to those observed in NatPO and IEStear.
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Affiliation(s)
- Yen Teng Ng
- Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
- Nutrition Unit, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia.
| | - Phooi Tee Voon
- Nutrition Unit, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia.
| | - Tony Kock Wai Ng
- Department of Biomedical Sciences, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia.
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Clinical Campus, 70300 Seremban, Negeri Sembilan, Malaysia.
| | - Miskandar Mat Sahri
- Protein and Food Technology Unit, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia.
| | - Norhaizan Mohd Esa
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Seng Huat Ong
- Department of Actuarial Science and Applied Statistics, UCSI University, 56000 Kuala Lumpur, Malaysia.
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Tong SF, Ng CJ, Lee VKM, Lee PY, Ismail IZ, Khoo EM, Tahir NA, Idris I, Ismail M, Abdullah A. Decision making process and factors contributing to research participation among general practitioners: A grounded theory study. PLoS One 2018; 13:e0196379. [PMID: 29694439 PMCID: PMC5919004 DOI: 10.1371/journal.pone.0196379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The participation of general practitioners (GPs) in primary care research is variable and often poor. We aimed to develop a substantive and empirical theoretical framework to explain GPs' decision-making process to participate in research. METHODS We used the grounded theory approach to construct a substantive theory to explain the decision-making process of GPs to participate in research activities. Five in-depth interviews and four focus group discussions were conducted among 21 GPs. Purposeful sampling followed by theoretical sampling were used to attempt saturation of the core category. Data were collected using semi-structured open-ended questions. Interviews were recorded, transcribed verbatim and checked prior to analysis. Open line-by-line coding followed by focus coding were used to arrive at a substantive theory. Memoing was used to help bring concepts to higher abstract levels. RESULTS The GPs' decision to participate in research was attributed to their inner drive and appreciation for primary care research and their confidence in managing their social and research environments. The drive and appreciation for research motivated the GPs to undergo research training to enhance their research knowledge, skills and confidence. However, the critical step in the GPs' decision to participate in research was their ability to align their research agenda with priorities in their social environment, which included personal life goals, clinical practice and organisational culture. Perceived support for research, such as funding and technical expertise, facilitated the GPs' participation in research. In addition, prior experiences participating in research also influenced the GPs' confidence in taking part in future research. CONCLUSIONS The key to GPs deciding to participate in research is whether the research agenda aligns with the priorities in their social environment. Therefore, research training is important, but should be included in further measures and should comply with GPs' social environments and research support.
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Affiliation(s)
- Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Seremban, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Irmi Zarina Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azizah Tahir
- Cyberjaya University College of Medical Science, Cyberjaya, Malaysia
| | - Iliza Idris
- Klinik Kesihatan Ampangan, Seremban, Malaysia
| | | | - Adina Abdullah
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Pau A, Chen YS, Lee VKM, Sow CF, De Alwis R. What does the multiple mini interview have to offer over the panel interview? Med Educ Online 2016; 21:29874. [PMID: 26873337 PMCID: PMC4752591 DOI: 10.3402/meo.v21.29874] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 05/23/2023]
Abstract
INTRODUCTION This paper compares the panel interview (PI) performance with the multiple mini interview (MMI) performance and indication of behavioural concerns of a sample of medical school applicants. The acceptability of the MMI was also assessed. MATERIALS AND METHODS All applicants shortlisted for a PI were invited to an MMI. Applicants attended a 30-min PI with two faculty interviewers followed by an MMI consisting of ten 8-min stations. Applicants were assessed on their performance at each MMI station by one faculty. The interviewer also indicated if they perceived the applicant to be a concern. Finally, applicants completed an acceptability questionnaire. RESULTS From the analysis of 133 (75.1%) completed MMI scoresheets, the MMI scores correlated statistically significantly with the PI scores (r=0.438, p=0.001). Both were not statistically associated with sex, age, race, or pre-university academic ability to any significance. Applicants assessed as a concern at two or more stations performed statistically significantly less well at the MMI when compared with those who were assessed as a concern at one station or none at all. However, there was no association with PI performance. Acceptability scores were generally high, and comparison of mean scores for each of the acceptability questionnaire items did not show statistically significant differences between sex and race categories. CONCLUSIONS Although PI and MMI performances are correlated, the MMI may have the added advantage of more objectively generating multiple impressions of the applicant's interpersonal skill, thoughtfulness, and general demeanour. Results of the present study indicated that the MMI is acceptable in a multicultural context.
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Affiliation(s)
- Allan Pau
- Division of Community and Child Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia;
| | - Yu Sui Chen
- Division of Human Biology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Chew Fei Sow
- Clinical Skills and Simulation Centre, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Ranjit De Alwis
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Low WHH, Seet W, A S R, Ng KK, H J, Dan SP, Teng CL, Lee VKM, Chua SS, M Y FA, T K, Chee WSS, Goh PP, M Z, Lim TO. Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial. Med J Malaysia 2013; 68:129-135. [PMID: 23629558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
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Affiliation(s)
- W H H Low
- Clinical Research Center, Clinical Epidemiology Unit, 1st Floor MMA House, 124, Jalan Pahang, Kuala Lumpur 53000 Malaysia.
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Tee Voon P, Wai Ng TK, Mun Lee VK, Nesaretnam K. Reply to P Khosla and KC Hayes. Am J Clin Nutr 2012. [DOI: 10.3945/ajcn.112.037705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Voon PT, Ng TKW, Lee VKM, Nesaretnam K. Reply to T Karupaiah and ZAM Daud. Am J Clin Nutr 2012. [DOI: 10.3945/ajcn.111.033357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Voon PT, Ng TKW, Lee VKM, Nesaretnam K. Diets high in palmitic acid (16:0), lauric and myristic acids (12:0 + 14:0), or oleic acid (18:1) do not alter postprandial or fasting plasma homocysteine and inflammatory markers in healthy Malaysian adults. Am J Clin Nutr 2011; 94:1451-7. [PMID: 22030224 DOI: 10.3945/ajcn.111.020107] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary fat type is known to modulate the plasma lipid profile, but its effects on plasma homocysteine and inflammatory markers are unclear. OBJECTIVE We investigated the effects of high-protein Malaysian diets prepared with palm olein, coconut oil (CO), or virgin olive oil on plasma homocysteine and selected markers of inflammation and cardiovascular disease (CVD) in healthy adults. DESIGN A randomized-crossover intervention with 3 dietary sequences of 5 wk each was conducted in 45 healthy subjects. The 3 test fats, namely palmitic acid (16:0)-rich palm olein (PO), lauric and myristic acid (12:0 + 14:0)-rich CO, and oleic acid (18:1)-rich virgin olive oil (OO), were incorporated at two-thirds of 30% fat calories into high-protein Malaysian diets. RESULTS No significant differences were observed in the effects of the 3 diets on plasma total homocysteine (tHcy) and the inflammatory markers TNF-α, IL-1β, IL-6, and IL-8, high-sensitivity C-reactive protein, and interferon-γ. Diets prepared with PO and OO had comparable nonhypercholesterolemic effects; the postprandial total cholesterol for both diets and all fasting lipid indexes for the OO diet were significantly lower (P < 0.05) than for the CO diet. Unlike the PO and OO diets, the CO diet was shown to decrease postprandial lipoprotein(a). CONCLUSION Diets that were rich in saturated fatty acids prepared with either PO or CO, and an OO diet that was high in oleic acid, did not alter postprandial or fasting plasma concentrations of tHcy and selected inflammatory markers. This trial was registered at clinicaltrials.gov as NCT00941837.
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Affiliation(s)
- Phooi Tee Voon
- Department of Nutrition and Dietetics, International Medical University, Kuala Lumpur, Malaysia.
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Tong SF, Khoo EM, Nordin S, Teng CL, Lee VKM, Zailinawati AH, Chen WS, Mimi O. Process of care and prescribing practices for hypertension in public and private primary care clinics in Malaysia. Asia Pac J Public Health 2011; 24:764-75. [PMID: 21659332 DOI: 10.1177/1010539511402190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to compare the process of care and the choice of antihypertensive medications used in both public and private primary care clinics in Malaysia. A cross-sectional survey was completed in 2008 on randomly selected 100 public health clinics and 114 private primary care clinics in Malaysia. A total of 4076 patient records, 3753 (92.1%) from public clinics and 323 (7.9%) from private clinics were analyzed. Less than 80% of the records documented the recommended clinical and laboratory assessments. The rates of documentation for smoking status, family history of premature death, retinal assessment, and urine albumin tests were lower in public clinics. Overall, 21% of the prescription practices were less than optimal. The process of care and the use of antihypertensive medications were not satisfactory in both settings.
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Affiliation(s)
- Seng Fah Tong
- Univerisiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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13
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Loh AHP, Ong LY, Liew WK, Arkachaisri T, Lee VKM, Narasimhan KL, Jacobsen AS. Multiple indomethacin-induced colonic perforations in an adolescent. Singapore Med J 2011; 52:e82-e84. [PMID: 21552780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Colonic perforation is an uncommon cause of acute abdomen in paediatric patients, and can present a diagnostic enigma as well as management challenge to the paediatric surgeon. An adolescent developed multiple colonic perforations following a short course of oral indomethacin, requiring emergency hemicolectomy. This is the youngest known case of enteral non-steroidal anti-inflammatory drug (NSAID)-mediated large bowel injury. We review current evidence on NSAID-related enteropathy, and postulate potentiating mechanisms that may have accounted for the unusually rapid clinical course of our patient.
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Affiliation(s)
- A H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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Tan HM, Tong SF, Khoo EM, Low WY, Lee BC, Lee VKM, Ng CJ. 1634 THE PREVALENCE OF UNREPORTED LOWER URINARY TRACT SYMPTOMS AND ITS IMPACT ON QUALITY OF LIFE. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Khin YT, Peh WCG, Lee VKM, Teo HEL, Ng SB, Nathan SS. Aggressive osteoblastoma of the proximal humerus. Singapore Med J 2009; 50:e1-e4. [PMID: 19224061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A nine-year-old boy presented with increasingly worsening right shoulder pain of 18 months' duration. On physical examination, there was a tender firm swelling over the right upper arm. Radiographs showed a large osteolytic lesion in the proximal humeral diaphysis, with prominent mixed acute-on-chronic periosteal reaction in a lamellar fashion. There was a pathological fracture. The lesion appeared to be radiographically aggressive in nature. Bone scintiscan showed solitary marked uptake. On-table frozen section histopathological examination of the lesion showed an osteoblastic lesion with aggressive features. Completion curettage and high speed burring of the cavity was performed. In view of the patient's young age, which required a biological solution, and potential for local recurrence, that necessitated a radiopaque filler, the lesion was packed with a calcium phosphate cement paste. The final diagnosis was osteoblastoma with aggressive features. The patient remained well on follow-up to date. The filler continues to be remodelled to native tissue and there is no evidence of local recurrence. Osteoblastoma is a relatively rare benign tumour that typically occurs in the posterior elements of the vertebral column. The humerus is a very rare site of disease in the appendicular skeleton, and poses a diagnostic dilemma which implicates the possibility of osteogenic sarcoma.
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Affiliation(s)
- Y T Khin
- Department of Diagnostic Radiology, KK Women's and Children's Hospital, Singapore.
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Ng SB, Yong MH, Knight LA, Lee VKM, Nadarajah S, Stoop H, Looijenga LHJ. Gonadoblastoma-associated mixed germ cell tumour in 46,XY complete gonadal dysgenesis (Swyer syndrome): analysis of Y chromosomal genotype and OCT3/4 and TSPY expression profile. Histopathology 2008; 52:644-6. [DOI: 10.1111/j.1365-2559.2008.02988.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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