Volume 6, Issue 1

  • 2021, January

    original research

    Barriers to Community Integration for Older People in Malaysia: A Qualitative Study from Occupational Therapist PerspectivesOpen Access

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    Abstract [+]

    Introduction
    Existing research has addressed the importance of community integration (CI) and its benefits of dwelling in a community but has yet to address the methods and efficiency of improving these activities among older people. Thus, it is vital to understand how healthcare workers can integrate the benefits of CI among older people, especially with the use of occupational therapists (OTs). The latter are actively working to improve ageing individuals mobility within the community.
    Objective
    This study aims to identify Malaysian OTs’ perspectives on CI’s and its implication on older people.
    Method
    Occupational therapist from different states of Malaysia participated in a semi-structured interview, through a virtual medium (Zoom Cloud Meetings). The interview guide encapsulated the theory of critical incident technique (CIT).
    Results
    Thematic content analysis, over fourteen participants from 13 states of Malaysia, provided insights into CI’s barriers for older people in Malaysia. The findings revealed that multifaceted factors from an individual, organisational and socio-environmental perspective limit older people’s active CI engagement.
    Conclusion
    South-East Asia hierarchal and collectivist culture play a significant role in influencing all factors of CI. OTs must understand and incorporate appropriate cultural norms during CI practice development for the older population in Malaysia.
    Keywords
    Occupational therapist; Critical incident technique; Older people; Community integration; Qualitative study; Societal norms; Cultural norms.


  • 2021, April

    commentary

    A Physicians Commentary on Electronic Health Records in the United States Medical PracticeOpen Access

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    Abstract [+]

    This commentary presents a point of view on how the arrival of electronic health records (EHR) in the United States (U.S.) has changed physicians’ practice. EHR implementation has pros and cons. EHR systems have been a great asset during the
    pandemic and help with efficiency, safety, and cost reduction. Despite their benefits, healthcare providers and organizations still face challenges, including usability and interoperability across systems, contributing to physicians’ burnout. Can physicians adopt new technologies and adapt to current challenges? Is it the right time for physicians to stop being observers and become active
    participants in the process of healthcare innovation and implementation?
    Keywords
    Physician; EHR; Implementation; Physicians’ burnout.


  • 2021, April

    original research

    Towards Universal Health Coverage: Designing a Community Based Intervention to Scale Up Coverage with Health Insurance, in A-Duiem Administrative Unit, Sudan 2018-2019Open Access

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    Background: Community engagement has proved effective in increasing access to healthcare including health insurance, in developed and developing countries.
    Aim: The study aims at designing and testing the effectiveness of engaging the community in awareness-raising and increment of health insurance coverage.
    Methods: The study was a social interventional community-based study, conducted in A-Duiem Administrative Unit, A-Duiem Locality, Sudan. Baseline data on enrollment in health insurance was collected from 800 heads of households, whereas data on knowledge and attitudes about health insurance was collected from 420 heads of non-insured households using a standardized questionnaire. Strategies to scaleup health insurance through community engagement was collected from community leaders, local authorities, and health insurance policymakers through in-depth interviews and focus group discussions. The community promotion package of health insurance was implemented for one year and post-intervention data were collected from 420 heads of households. Quantitative data were analyzed using SPSS version 20. Statistical significance was set at p<0.05 when the confidence interval was 95%. Qualitative data was analyzed manually using the thematic approach. Results: The study showed significant improvement in the knowledge of the heads of the non-insured households about health insurance after the intervention; knowledge about the enrollment process and service’s package has increased from 34.4% to 61.8% and from 55.8% to 84.7% respectively (p-value 0.0001 in both). The health insurance coverage increased by 17.3% with a significant difference and p-value at 0.0001. Conclusion: The study concluded that community members have a considerable role in awareness-raising and scaling up of health insurance coverage if they are properly organized, trained, monitored, and supervised. The insufficient commitment of local officials in the unit was a challenge to address during further testing and expansion of the experience. Keywords Health insurance; Population coverage; Knowledge; Attitudes; Community engagement; Intervention; Sudan.


  • 2021, June

    observational study

    Prevalence and Risk Factors of Low High-Density Lipoproteins-Cholesterol: An Analysis of the United States of America National Health and Nutrition Examination Survey, 2015-2016Open Access

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    Abstract [+]

    Background
    Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, with cardiovascular diseases (CVDs) being the most predominant. This is a similar trend in the United States (U.S.). Modifiable and non-modifiable factors are important determinants of dyslipidaemia, a known cause of CVDs.
    Objective
    This study aimed to explore the pattern of high-density lipoprotein cholesterol (HDL-C) distribution and its associated risk factors.
    Methods
    The data was collected from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 database which is part of the yearly cross-sectional survey. The NHANES uses complex multistage probability sampling method in data collection. The target population was the noninstitutionalized civilian living across the U.S. The primary sampling units were individuals. Socio-demographic characteristics, body measurement (waist circumference) and blood samples (to determine HDL-C and total cholesterol levels) were recorded. In the database, 5000 respondents were randomly selected for analysis. Statistical analyses were performed using Stata version 14.0. The results are described as means and standard deviation (SD) for group and continuous variables. Regression analyses were used to identify risk factors of low HDL-C.
    Results
    Of the complete cases (3989), 49.03% were males. The mean age was 46.57±15.44-years. The mean HDL-C was 1.39±0.45 mmoL/L. The prevalence of low HDL-C was 32.8% in males and 12.5% in females. The results obtained from multiple linear regression indicated that male gender, age, ethnicity, country of birth, number of children aged 0-18-years per household, waist circumference, family income to poverty ratio and total cholesterol were significantly associated with HDL-C. Multivariable logistic regression revealed male gender, age 30 to 49-years, ethnicity, smoking, enlarged waist circumference (cm), low family income to poverty ratio and high total cholesterol were associated with low HDL-C.
    Conclusion
    The prevalence of low HDL-C of was 22.4 %. This was distributed into 32.8% in males and 12.5% in females. The associated risk factors show that lifestyle modification is important in the prevention of low HDL-C and consequently, CVDs.
    Keywords
    HDL-C; Risk factors; Cardiovascular diseases; NHANES.


  • 2021, August

    original research

    Hypertension Management in Primary Health Care Centres: Blood Pressure Control and Classes of Antihypertensive Medication, Khartoum State, 2018Open Access

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    Background
    In Sudan, the delivery of care based on the primary health care (PHC) level, which is the first contact with the health system. PHC is the level at which the modifiable risk factors for hypertension are addressed together with the treatment of known hypertensive patients.
    Objective
    To assess the management of hypertension in PHC in Khartoum State, 2018.
    Material and Methods
    The study was a descriptive cross-section, health centre’s based that covered six PHC centres in Khartoum State. The study interviewed all diagnosed Sudanese hypertensive patients more than 18-years of age who attended the selected PHC centres. The research team collected data using a structured questionnaire and measuring the blood pressure (BP) with a mercury sphygmomanometer. The study variables were demographic characteristics and disease features as independent variables and hypertension control as the dependent variable. The statistician analyzed the data using the statistical package for the Social Science version 21.0 and the Chi-square (χ) test to obtain the p value to test the association between the addressed variables. The study group adopt ethical considerations throughout the study.
    Results
    Of the 384 hypertensive patients interviewed in this study, 57% were females and 47.7% were more than 60-years of age. A large percent of the subjects were either primary educated or illiterate (32.6%, 19.8% respectively). More than half of the hypertensive patients (52.1%) were uncontrolled and 52.9% had no comorbidities. Diabetes was predominant (39.3%) among those who had comorbidities. The majority of the patients (92.7%) were adherent to the medication. Of the studied patients, 58.1% used monotherapy. The most controlled patients were the elderly and middle-aged patients and the highly educated patients (p=0.005). Patients with a duration less than five-years were more likely to be controlled (p=0.036). The majority of the patients who used combined treatment were found to be controlled.
    Conclusion
    This study concluded that the high prevalence of uncontrolled hypertensive patients attending PHC was mainly attributed to the use of monotherapy, presence of comorbidities and medication non-adherence. The latter is related to patients’ ignorance, financial constraints and dislike of using many drugs during the day. In addition, elder age and high education were factors for
    better control.
    Keywords
    Hypertension control; Antihypertensive medication; Hypertension management.