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AIM: The objective of this study was to evaluate the effectiveness of the EMPOWER- participatory action research (PAR) intervention, a multifaceted strategy based on the chronic care model (CCM) on primary care providers (PCP)’ adherence to type 2 diabetes mellitus (T2DM) clinical practice guideline (CPG) in the Malaysian primary care setting. METHODS: This was a pragmatic cluster randomized controlled trial –PAR conducted in ten public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. The outcome measure was the absolute change in the proportion of PCP’s adherence to T2DM CPG captured using the “Indicators of Care Pro forma,” based on the recommendation by the Malaysian CPG on the Management of T2DM. Data were collected from the patients’ medical records, at baseline and at 1-year follow-up; and were analyzed using mixed method model. RESULTS: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 were in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the absolute change in the proportion of PCPs’ adherence to T2DM CPG in the intervention group compared to the control group at 1-year follow-up in several indicators of care. These included the recording of BMI (0.6% vs. −1.8%, p

Background: MLR and ANCOVA are common statistical techniques and are used for both experimental and non-experimental studies. However, both types of study designs may require different basis of sample size requirement. Therefore, this study aims to proposed sample size guidelines for MLR and ANCOVA for both experimental and non-experimental studies. Methods: We estimated the minimum sample sizes required for MLR and ANCOVA by using Power and Sample Size software (PASS) based on the pre-specified values of alpha, power and effect size (R2). In addition, we also performed validation of the estimates using a real clinical data to evaluate how close the approximations of selected statistics which were derived from the samples were to the actual parameters in the targeted populations. All the coefficients, effect sizes and r-squared obtained from the sample were then compared with their respective parameters in the population. Results: Small minimum sample sizes required for performing both MLR and ANCOVA when r-squared is used as the effect size. However, the validation results based on an evaluation from a real-life dataset suggest that a minimum sample size of 300 or more is necessary to generate a close approximation of estimates with the parameters in the population. Conclusions: We proposed sample size calculation when r-squared is used as an effect size is more suitable for experimental studies. However, taking a larger sample size such as 300 or more is necessary for clinical survey that is conducted in a non-experimental manner.

The repeatability of most questionnaires utilized in previous studies related to the consumption of dietary supplements (DS) among youth has not been well documented. Thus, a simple and easy-to-administer questionnaire to capture the habitual use of DS in the past one year known as the dietary supplement questionnaire (DiSQ) was developed and supported with external reliability evaluation. Analyses were done based on a convenience sample of 46 secondary school students. To elicit information regarding the intake of DS, the questionnaire was partitioned into two domains. The first domain was used to identify vitamin/mineral (VM) supplements, while the second domain was utilized to identify non-vitamin/non-mineral (NVNM) supplements. Cohen&rsquo, s kappa coefficient (k) was used to evaluate the test&ndash, retest reliability of the questionnaire. Questionnaire administration to the respondents was done twice whereby a retest was given two weeks after the first test. Between test and retest, the reliability of individual items ranged from moderate to almost perfect for the VM (k = 0.53&ndash, 1.00) and NVNM (k = 0.63&ndash, 1.00) domains. None of the items had &ldquo, fair&rdquo, or &rdquo, poor&rdquo, agreement. Various correlation coefficients can be obtained for the DiSQ but are generally reliable over time for assessing information on the consumption of supplements among the adolescent population.

Sexual dysfunction has been extensively studied in methadone maintenance treatment (MMT) patients. However, little data is available regarding sexual inactivity in the MMT patient population. The objectives of this study were to determine the prevalence and putative risk factors for sexual inactivity in the MMT patient population. This cross-sectional study involved 25&ndash, 71 year old MMT patients recruited from six methadone clinics. Two hundred and seventy-one patients were interviewed for demographic characteristics, comorbidities, concurrent medications used, and sexual activity. The prevalence of sexual inactivity in the MMT population was found to be 47.6%. Increasing age (p &lt, 0.01) and being single/divorced (p &lt, 0.01) were significantly associated with sexual inactivity. In subgroup analysis, increasing age was significantly associated with sexual inactivity in both single/divorced (p &lt, 0.05) and married (p &lt, 0.05) subgroups, while unemployment (p &lt, 0.05) was only significantly associated with sexual inactivity in the earlier subgroup. Our results suggest that sexual inactivity is common in the MMT patient population. The putative risk factors are related to biological and sociocultural factors. Having specific comorbidities or being on certain medications were not correlated with sexual inactivity in the MMT population. Routine assessment of sexual problems is essential, and proper management should be performed for MMT patients.

Background: MLR and ANCOVA are common statistical techniques and are used for both experimental and non-experimental studies. However, both types of study designs may require different basis of sample size requirement. Therefore, this study aims to proposed sample size guidelines for MLR and ANCOVA for both experimental and non-experimental studies. Methods: We estimated the minimum sample sizes required for MLR and ANCOVA by using Power and Sample Size software (PASS) based on the pre-specified values of alpha, power and effect size (R2). In addition, we also performed validation of the estimates using a real clinical data to evaluate how close the approximations of selected statistics which were derived from the samples were to the actual parameters in the targeted populations. All the coefficients, effect sizes and r-squared obtained from the sample were then compared with their respective parameters in the population. Results: Small minimum sample sizes required for performing both MLR and ANCOVA when r-squared is used as the effect size. However, the validation results based on an evaluation from a real-life dataset suggest that a minimum sample size of 300 or more is necessary to generate a close approximation of estimates with the parameters in the population. Conclusions: We proposed sample size calculation when r-squared is used as an effect size is more suitable for experimental studies. However, taking a larger sample size such as 300 or more is necessary for clinical survey that is conducted in a non-experimental manner.

Malaria is still of great public health concern, especially in Malaysian Borneo. The aim of this study was to determine the trends of P. knowlesi infection in Sarawak, Malaysia and to forecast the incidence of P. knowlesi until the year 2040. Data on P. knowlesi malaria cases from 1992 to the year 2014 were obtained from the Sarawak Health Department, Malaysia. ARIMA model was applied to forecast the future incidence of P. knowlesi infection. The data for the whole of Sarawak and subsequently the selected six districts which have high incidence rates of P. knowlesi infection were analyzed. Results of the analysis showed that there was an increasing trend of P. knowlesi cases from the year 1992-2014 (p

Background The chronic care model was proven effective in improving clinical outcomes of diabetes in developed countries. However, evidence in developing countries is scarce. The objective of this study was to evaluate the effectiveness of EMPOWER-PAR intervention (based on the chronic care model) in improving clinical outcomes for type 2 diabetes mellitus using readily available resources in the Malaysian public primary care setting. Methods This was a pragmatic, cluster-randomised, parallel, matched pair, controlled trial using participatory action research approach, conducted in 10 public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Patients who fulfilled the criteria were recruited over a 2-week period by each clinic. The obligatory intervention components were designed based on four elements of the chronic care model i.e. healthcare organisation, delivery system design, self-management support and decision support. The primary outcome was the change in the proportion of patients achieving HbA1c