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Introduction: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy. Objectives: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT. Design: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores. Results: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable. Conclusion: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to determine the factors and predictors of good glycaemic control among patients with Type 2 Diabetes Mellitus (T2DM) in two rural government health clinics in Kuala Selangor. Methods: This cross-sectional study involved 200 patients selected through systematic random sampling from a list of T2DM patients in two government health clinics in Kuala Selangor. Data was collected using a self-administered questionnaire while glycosylated haemoglobin (HbA1c) results were obtained from the patients' blood results record at the clinic. HbA1c of 6.5% and below was categorized as good glycaemic control. The factors studied were socio-demographic characteristics (age, gender, ethnicity, level of education, occupation and household income), T2DM medical history (T2DM duration and type of treatment), diabetes knowledge, health literacy, adherence to treatment, body mass index (BMI) and physical activity. Pearson's chi square test was used to test for associations and multiple logistic regressions were used to determine the predictors. Results: The response rate was 86.9%. The proportion of good glycaemic control was 34.0%. Level of glycaemic control was significantly associated with duration of being diagnosed with T2DM (p=0.006) and type of treatment (p=0.009). The probability of having good glycaemic control was 2.5 times more likely among respondents diagnosed with T2DM for less than 10 years (AOR=2.458, 95% of CI=1.504-14.282, p=0.037). Conclusion: Shorter duration of being diagnosed with T2DM has been found to be a predictor of good glycaemic control in this study population, thus warranting stricter monitoring among patients who have been diagnosed for a longer period. [ABSTRACT FROM AUTHOR]

Early identification of any vestibular dysfunction and balance problem in children is crucial for their general well-being. However the identification process, could be challenging and difficult as compared to adults. We conducted a preliminary study to review our initial experience with ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs), video head impulse test (vHIT) and Bruininks Oseretsky Test of Motor Proficiency II (BOT-2) on healthy children and also to determine the feasibility of these tests in this population. Twenty one normal healthy children (12 boys and 9 girls), aged between 6 and 15 years old (mean age, 11.15 ± 2.54 years) participated in the study. They underwent oVEMPs and cVEMPs elicited with bone conduction stimulus via minishaker and air conduction stimulus respectively. All six semicircular canals were assessed using the vHIT. Bilateral coordination, balance, running, speed and agility which are the three subsets of BOT-2 gross motor assessment were conducted for balance assessment. All subjects completed the vestibular and balance assessment except for 1 subject who did not complete the vHIT vertical component. The response rate was 100% for oVEMPs, cVEMPs, and BOT-2, and 95.24% for vHIT. The mean latency and mean amplitude for n10 oVEMPs were 8.88 ± 0.92 and 2.71 ± 1.29, respectively. The mean latency for cVEMPs p13, and n23 were 13.4 ± 1.35 and 21.76 ± 3.71, respectively with interamplitude mean of 97.57 ± 42.69. The vHIT mean for vestibular ocular reflex (VOR) gain were >0.85 for lateral canals and > 0.65 for vertical canals. The mean scale score for bilateral coordination, balance, running, speed, and agility for BOT-2 were 17.52 ± 3.40, 15.14 ± 3.65 and 13.9 ± 5.46, respectively. This study suggest that VEMPs, vHIT, and BOT-2 are feasible test for vestibular and balance assessment in children. Apart from the tests findings, it is hoped that the described experienced and adjustment made in assessing this young population could also be applied by other relevant professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia. Method: A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated. Results: Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016. Conclusions: Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program. [ABSTRACT FROM AUTHOR]

A compliment is one of the speech acts that has been identified as being able to enhance communication fluency. However, if the compliment is uttered in the context of cross-cultural communication, it is not only different in its application, but also different in its way of delivery, frequency and function. This study examines the complimentary speech act used in the Japanese language of Japanese-speaking Malaysian tour guides when used towards Japanese tourists throughout their guided tour sessions. This study is a qualitative study and the data were collected through audio, visual and observational notes on the interaction of four Malay tour guides when using the Japanese language while interacting with 12 Japanese tourists during four sets of guided tours, as part of a Free Independence Travel (FIT) package. The findings show that the complimentary speech in terms of the function, strategy, and topic choice by the tour guides is accurate for the target culture. However, the response patterns by the Japanese tourists towards the complimentary speech in this cultural encounter were beyond and did not conform to the supposed norms and social rules of Japanese culture. Although the complimentary speech that was applied in this cross-cultural context was contradictory to or beyond the cultural norms, it nevertheless did not lead to conflicts. This study provides exposure on the utterance of complementary speech used by tour guides during the course of the tour visits because this will enhance the smoothness in the flow of cross-cultural communication using the medium of the Japanese language. This research is hoped to act as a reference in Japanese language education for tourism as a guide to enhance the cross-cultural communication skills of Japanese-speaking tour guides in Malaysia. [ABSTRACT FROM AUTHOR]

Vestibular assessments in children are essential for the early identification of vestibular and balance dysfunctions. Vestibular evoked myogenic potentials, cervical (cVEMPs) and ocular (oVEMPs) have been reported to be feasible and effective when assessing otolith function in children. The main aim of the study was to obtain normative data for cVEMPs and oVEMPs from preschool and primary school-aged Malaysian children. A group of 33 healthy children, aged from 5 years 9 months–12 years 4 months (mean ± SD = 8.83 ± 1.92 years), was recruited. Their otolith saccular function was assessed using 750 Hz tone burst for cVEMPs (with ER3A insert phone), while their utricular function was assessed using Brüel & Kjaer Mini-shaker Type 4810 (Naerum, Denmark) for oVEMPs. For cVEMPs, the mean value of P13 latency, N23 latency, P13–N23 interamplitude and asymmetry ratio were 12.62 ± 1.38 ms, 19.85 ± 1.95 ms, 92.47 ± 50.35 μV and 14.03 ± 9.75%, respectively. For oVEMPs, the mean value of N10 latency, P15 latency, N10–P15 interamplitude and asymmetry ratio were 9.23 ± 1.07 ms, 14.41 ± 1.04 ms, 10.32 ± 5.65 μV and 15.84 ± 11.49%, respectively. Two-way ANOVA analysis found that ear laterality and gender had no significant effect on all cVEMPs and oVEMPs parameters. No significant correlation was found between age and all VEMPs parameters. The normative data for cVEMPs and oVEMPs obtained in this study can be used as a guide by health professionals to assess saccular and utricular functions among children age from 5 to 12 years of age. [ABSTRACT FROM AUTHOR]