Inquiring conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. Furthermore, the subject matter is culturally sensitive to most ...Malaysian women. Hence, the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness.
The Menopause Quick 6 (MQ6) questionnaire was translated into the Malay language with an addition of an item, henceforth termed MQ6 (M). Forward and backward translation was performed. Face and content validity were conducted. MQ6 (M) was self-administered to 400 women aged between 40 and 60 attending six primary healthcare clinics in Malaysia. To ascertain the reliability for MQ6 (M), corrected Item-Total Correlation, Squared Multiple Correlation, Cronbach's Alpha if the Item is Deleted, and Kuder-Richardson Reliability Coefficients (KR20). Exploratory factor analysis was done to determine its' construct validity.
The outcome of the validation was satisfactory. By the Lawshe method, the content validity ratios ranged from 0.6 to 1.0 and the content validity index was 0.914. The Internal consistency for MQ6(M) Cronbach's alpha was 0.711 while Kuder-Richardson Reliability Coefficients KR20 was 0.676. Factor loading of all four items is above 0.70, indicating a well-defined structure. Whereas factor loading for three items fell within the range of 0.50-0.69 indicating a practically significant threshold for a new questionnaire.
MQ6 (M) has acceptable reliability and construct validity to be considered as a self-administered screening tool in primary care clinics in Malaysia.
...the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness. i. Background Inquiring ...conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. ...the translation of the MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness. ii. ...the proposed MQ6 when translated into Malay language MQ6(M), the tool had an acceptable psychometric property such as reliability, content and construct validity. ...the MQ6(M) tool, translated into Malay language, had an acceptable psychometric property such as reliability, content and construct validity.
Background: Immune checkpoint inhibitors (ICIs) are approved as cancer immunotherapeutic agents for advanced malignant melanoma (MM) in recent years, and nivolumab and ipilimumab are the most widely ...used ICIs either alone or in combination. However, their efficacy and safety between single and combined ICIs are not clear. This meta-analysis (MA) is aimed to update the efficacy and safety of ICIs by comparing monotherapy and combination therapy in the treatment of advanced MM.Method: We searched PubMed, Embase, EbscoHost and ClinicalTrials.gov for the eligible randomized controlled trials (RCTs) which compared the efficacy and safety of ICIs between a single ICI and combined ICIs. The outcomes analyzed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (AEs). A fixed-effect or random-effects model was adopted depending on the study heterogeneity.Results: A total of nine RCTs were included in this MA. Regarding the efficacy, combined nivolumab and ipilimumab therapy showed statistically significant prolonged OS and PFS with HR 0.65, 95% CI 0.53, 0.79, p < 0.0001 and HR 0.48, 95% CI 0.38, 0.60, p< 0.0001 respectively. Combination therapy with nivolumab and ipilimumab also showed statistically significant longer ORR than monotherapy; with RR 2.15, 95% CI 1.63, 2.84, p < 0.00001. In terms of safety, the incidence of all AEs which include any AEs, high-grade, haematological, gastrointestinal, dermatological, pulmonary, liver and endocrine AEs were significantly lower with monotherapy (either nivolumab or ipilimumab) of ICI compared to combination ICI therapy with a p-value < 0.00001 to 0.03.Conclusion: Efficacy of the combined nivolumab and ipilimumab was better than a single ICI, especially in the treatment of advanced MM. Although combination therapy showed better efficacy than monotherapy, monotherapy (either nivolumab or ipilimumab) was safer than combination therapy as it tended to decrease the incidence of most of the treatment-related AEs.
College students are vulnerable to tobacco addiction. Tobacco industries often target college students for marketing. Studies about prevalence of tobacco use and its correlates among college students ...in Nepal are lacking.
A cross-sectional survey was carried out in two cities of western Nepal during January-March, 2007. A pre-tested, anonymous, self-administered questionnaire (in Nepali) adapted from Global Youth Tobacco Survey (GYTS) and a World Bank study was administered to a representative sample of 1600 students selected from 13 junior colleges by two-stage stratified random sampling.
Overall prevalence of 'ever users' of tobacco products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9% respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%, smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per day. Most (67.8%) 'Current users' purchased tobacco products by themselves from stores or got them from friends. Most of them (66.7%) smoked in tea stalls or restaurants followed by other public places (13.2%). The average daily expenditure was 20 Nepalese rupees (approximately 0.3 USD) and most (59%) students reported of having adequate money to buy tobacco products. Majority (82%) of the students were exposed to tobacco advertisements through magazines/newspapers, and advertising hoardings during a period of 30 days prior to survey. The correlates of tobacco use were: age, gender, household asset score and knowledge about health risks, family members, teachers and friends using tobacco products, and purchasing tobacco products for family members.
School/college-based interventions like counseling to promote cessation among current users and tobacco education to prevent initiation are necessary. Enforcement of legislations to decrease availability, accessibility and affordability of tobacco products and policies to change social norms of tobacco use among parents and teachers are necessary to curb the tobacco use among college students.
Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and ...country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries.
We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys.
Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%.
Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
About 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for ...delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers.
A cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home.
A total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3%) and 100 (41.7%) were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8%) mothers gave birth alone. Only 46 (16.2%) women had used a clean home delivery kit and only 92 (38.3%) birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2%) deliveries and cord was cut using a new/boiled blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1%) deliveries. Birth place was heated throughout the delivery in 88 (64.2%) deliveries. Only 100 (45.8%) newborns were wrapped within 10 minutes and 233 (97.1%) were wrapped within 30 minutes. Majority (93.8%) of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%). Sixteen (10.8%) mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2%) newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%), 'ease and convenience' (21.4%) for planned deliveries while 'precipitate labor' (51%), 'lack of transportation' (18%) and 'lack of escort' during labor (11%) were cited for the unplanned ones.
High-risk home delivery and newborn care practices are common in urban population also. In-depth qualitative studies are needed to explore the reasons for delivering at home. Community-based interventions are required to improve the number of families engaging a skilled attendant and hygiene during delivery. The high-risk traditional newborn care practices like delayed wrapping, bathing, mustard oil massage, prelacteal feeding and discarding colostrum need to be addressed by culturally acceptable community-based health education programmes.
We assessed knowledge about the health effects of smoking, attitude, and intention to practice smoking cessation advice.
A cross-sectional online survey was done among 524 healthcare providers in 30 ...primary care clinics in Selangor State, Malaysia. Association of HCPs’ smoking cessation practices with demographics, service-related and smoking-related factors were tested by Poisson regression.
Overall current smoking prevalence was 3.1 (95%CI 1.6, 4.5), significantly higher among males (14.4 vs 0.2, p < 0.001). Knowledge score was higher (mean 10.8, SD 1.5, maximum 13) than attitude (mean 43.5, SD 13.2, maximum 65) and practice (mean 33.0, SD 9.2, maximum 45) towards smoking cessation. Practice score was associated with female sex Incidence Rate Ratio (IRR) 1.1, 95%CI 1.09, 1.2, being a nurse (IRR 1.08, 95%Cl 1.04, 1.12), knowledge (IRR 1.02, 95%CI 1.01,1.03), attitude (IRR 0.997, 95%Cl 0.99–1.00) and smoke-free homes (IRR 0.89, 95%CI 0.85,0.94).
Involvement of female HCPs (nurses) could improve cessation practices in primary care.
This study aimed to assess menopause symptoms, treatment-seeking behaviors, treatments received, and factors associated with seeking consultation from healthcare providers (HCPs).
Using a ...self-administered Menopause Quick-6 in the Malay language (MQ6M) questionnaire, we surveyed 349 women aged 40-60 years attending primary healthcare clinics in four states in Malaysia for their menopause symptoms. Health-seeking behaviors for menopause symptoms were assessed using questions regarding HCPs consulted and treatments prescribed. Binary logistic regression was employed on factors associated with seeking consultation for menopause symptoms.
Using MQ6(M), we observed that 125 (31.3%) women reported at least one menopause symptom, with joint pains (42.8%), menstrual changes (39.5%), and hot flashes (29.3%) being the most frequent symptoms. Furthermore, 60% of the women were prescribed vitamins, and only 13% were administered Hormone Replacement Therapy (HRT). Medical comorbidities, the presence of at least one gynecological condition, menopause status, and MQ6(M) score were associated with seeking consultation with an HCP. For women with medical conditions, the odds of seeking consultation increased by a factor of 1.34 (adjusted odds ratio AOR, 1.34; 95% confidence interval CI, 1.11-1.76) for every additional comorbidity. The odds of seeking consultation from an HCP increased by a factor of 1.26 (AOR, 1.26; 95% CI, 1.04-1.47) with a unit increase in MQ6(M) score.
Most women had menopause symptoms but favored the use of complementary and alternative medicine over HRT. Screening and awareness of menopause treatments need to be improved at primary healthcare clinics.
To systematically review Indian literature on delays in tuberculosis (TB) diagnosis and treatment.
We searched multiple sources for studies on delays in patients with pulmonary TB and those with ...chest symptoms. Studies were included if numeric data on any delay were reported. Patient delay was defined as the interval between onset of symptoms and the patient's first contact with a health care provider. Diagnostic delay was defined as the interval between the first consultation with a health care provider and diagnosis. Treatment delay was defined as the interval between diagnosis and initiation of anti-tuberculosis treatment. Total delay was defined as time interval from the onset of symptoms until treatment initiation.
Among 541 potential citations identified, 23 studies met the inclusion criteria. Included studies used a variety of definitions for onset of symptoms and delays. Median estimates of patient, diagnostic and treatment delay were respectively 18.4 (IQR 14.3-27.0), 31.0 (IQR 24.5-35.4) and 2.5 days (IQR 1.9-3.6) for patients with TB and those with chest symptoms combined. The median total delay was 55.3 days (IQR 46.5-61.5). About 48% of all patients first consulted private providers; an average of 2.7 health care providers were consulted before diagnosis. Number and type of provider first consulted were the most important risk factors for delay.
These findings underscore the need to develop novel strategies for reducing patient and diagnostic delays and engaging first-contact health care providers.
Background: The last decade has seen the emergence of the internet as the prime communication medium changing the way people live and interact. Studies from various countries have reported on ...internet addiction and its association with mental health, but none have come from Malaysia. Objectives: We aimed at assessing the frequency of the use of various internet applications and exploring the association of compulsive internet use with mental health and socio-demographic factors. Materials and Methods: A cross-sectional online survey was carried out among participants registered for the monthly opinion poll survey of University Tunku Abdul Rahman, Malaysia. The questionnaire contained socio-demographic information, the use of various internet applications on a five-point Likert scale, compulsive internet use scale (CIUS) and 12 item general health questionnaire (GHQ-12). Correlations and linear regression analyzes were carried out. Results: Of the 330 respondents, 182 were females and 148 were males. The mean age was 23.17 (SD = 3.84). Mean CIUS score was 19.85 (SD = 10.57) and mean GHQ score was 15.47 (SD = 6.29). Correlation coefficients of CIUS score with age, years of use and daily hours of internet use were −0.118 (P = 0.03), −0.014 (P = 0.81) and 0.242 (P < 0.001) respectively. Multiple linear regression analysis showed that age (β = −0.111, P = 0.033) and marital status (β = −0.124, P = 0.018) were negatively associated with CIUS scores whereas daily hours of internet use (β = 0.269, P = 0.001) and GHQ score (β = 0.259, P = 0.001) were positively associated with the CIUS score. Conclusions: Compulsive internet use was correlated with GHQ score. More research is needed to confirm our results. Psychologists may consider assessing internet addiction when evaluating young psychiatric patients.
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