Adherence to antiretroviral therapy (ART) prevents disease progression, and the emergence of resistant mutations. It also reduces morbidity, and the necessity for more frequent, complicated regimens which are also relatively more expensive. Minimum adherence levels of 95% are required for treatment success. Poor adherence to treatment remains a stumbling block to the success of treatment programs. This generates major concerns about possible resistance of the human immunodeficiency virus (HIV) to the currently available ARVs. This paper aims to describe baseline results from a cohort of 242 Malaysian patients receiving ART within the context of an intervention aimed to improve adherence and treatment outcomes among patients initiating ART. A single-blinded Randomized Controlled Clinical Trial was conducted between January and December, 2014 in Hospital Sungai Buloh. Data on socio-demographic factors, clinical symptoms and adherence behavior of respondents was collected using modified, pre-validated Adult AIDS Clinical Trials Group (AACTG) adherence questionnaires. Baseline CD4 count, viral load, weight, full blood count, blood pressure, Liver function and renal profile tests were also conducted and recorded. Data was analyzed using SPSS version 22 and R software. Patients consisted of 215 (89%) males and 27 (11%) females. 117 (48%) were Malays, 98 (40%) were Chinese, 22 (9%) were Indians while 5 (2%) were of other ethnic minorities. The mean age for the intervention group was 32.1 ± 8.7 years while the mean age for the control group was 34.7 ± 9.5 years. Mean baseline adherence was 80.1 ± 19.6 and 85.1 ± 15.8 for the intervention and control groups respectively. Overall mean baseline CD4 count of patients was 222.97 ± 143.7 cells/mm³ while overall mean viral load was 255237.85 ± 470618.9. Patients had a mean weight of 61.55 ± 11.0 kg and 61.47 ± 12.3 kg in the intervention and control groups, respectively. Males account for about 90% of those initiating ART in the HIV clinic, at a relatively low CD4 count, high viral load and sub-optimal medication adherence levels at baseline.
Antiretroviral Therapy, Highly Active

Abstract Introduction: Second hand smoke exposure to cigarette smoke leads to many medical conditions including asthma and lung cancer. Women are the most vulnerable adults of passive smoking at home. Even though Malaysia had its own smoke- free policy, the smoke- free home is voluntary in nature. Thus, this study was aimed to explore the practice of voluntary smoke- free- home among women in Alor Gajah and its determinants. Methods: A cross-sectional study based on multistage sampling was conducted among 180 non- smoking women in areas implemented Community Intervention Program (KOSPEN), which emphasized on healthy lifestyle, in Alor Gajah, Melaka from April 2018 to May 2018. Data on sociodemographic characteristic, characteristic of second hand smoke (SHS) exposure at home, knowledge, attitude and avoidance behaviour from SHS were collected using questionnaires. The data were then analysed using IBM Statistical Package for Social Science (SPSS) version 24.0 involving descriptive and inferential statistics. Results: Majority of the respondents practised smoke- free home (72.8%). The predictors of smoke- free home were those who attained higher education (AOR= 11.939, 95% CI 1.175- 121.277), did not live with any children (AOR= 3.546, 95% CI 0.985- 12.765) and lived with smokers other than their husband (AOR= 3.793, 95% CI 1.192- 12.076). Conclusion: Education level and household factors were significant predictors of smoke- free home. Thus, few measures were suggested to increase tobacco bans at home among women including periodic health programs, community empowerment programs and creating smoke- free housing.

Poor diagnosis, treatment and prevention practices had characterised Patent Medicine Vendor (PMV) activities in malaria control despite expectations on their contributions to check the menace. Interventions reversing this situation reduces disease burden and legitimise PMV inclusion in basic healthcare delivery. This study seeks to identify and review studies addressing this priority problem. Steps outlined in PRISMA guidelines were adopted to search and conduct reviews via electronic databases. Randomized trials with intervention effects on PMVs were considered and thirteen articles were ultimately reviewed and narratively evaluated. Analysis of search outputs identified intervention types, methods used, sample sizes, intervention periods, knowledge, attitude and practice variables, other outcomes and listing of priority systematic review topics, using pre-determined criteria. All reviewed studies were found to be effective despite adopting different intervention approaches. Furthermore, identifying and prioritizing reviews greatly improves future malaria interventions and results thereof, thereby maximising opportunities to deliver appropriate and evidence-based healthcare.

Introduction: The increasing burden of Non-Communicable Diseases and their prevalence has led Ministry of Health (MOH) Malaysia to introduce a community empowerment program “Komuniti Sihat, Perkasa Negara” acronymed as KOSPEN in July 2013. Thirty thousand community health volunteers have been trained nationwide up to May 2015. Objective: To identify the factors associated with knowledge on KOSPEN and its implementation among community health volunteers in Kulim District. Methods: A cross-sectional study based on simple random sampling was conducted among community health volunteers Kulim District. Volunteers participated in this study were 194. Data collected using self-administered questionnaire. All data collected were analysed using IBM SPSS version 22 involving descriptive and inferential statistics with significance level set at 0.05. Results: The study found that level of knowledge on KOSPEN is associated with employment status (p=0.02) and awareness level (p<0.001) among the community health volunteers. The level of implementation is associated with age (p=0.025), education level (p=0.007) and employment status (p=0.017) of the community health volunteers. Employment status (aOR=2.133, 95% CI=1.056-4.306, p=0.035) and awareness level (aOR=6.119, 95% CI=2.701-13.867 p<0.001) were predictors of level of knowledge on KOSPEN. Level of implementation of KOSPEN by the community health volunteers could be predicted by education level (aOR=4.085, 95% CI=1.299-12.851 p=0.016). Conclusion: Generally the KOSPEN volunteers had good knowledge on KOSPEN and implementation of KOSPEN program. However, there are still misconceptions among the KOSPEN volunteers regarding their functions and role. Therefore it is important to empower the volunteers with awareness on their roles, functions and good knowledge.

For the last 30 years, tobacco smoking has continued to be the leading cause of premature deaths in Malaysia. Majority of the smokers in Malaysia are at the precontemplation and contemplation stages. Therefore, for the purpose of increasing smoking cessation among this group, the strategies that motivate them to quit smoking have to be reviewed.

HIV-related stigma will discourage the efforts in preventing new infections and engaging people to receive treatment, care and support programmes. Identifying the valuable interventions programmes to reduce HIV-related stigma in a healthcare setting is vital in order to deliver the best health services. A scoping systematic review was conducted. Articles were searched based on Pubmed and ScienceDirect search engines. The key words used were HIV stigma, intervention and healthcare. Published English articles in the past ten years involving HIV stigma intervention studies, and studies that involved healthcare workers in a healthcare setting were included. Reviewed articles, systematic review and meta-analysis articles were excluded. Primary screening of titles and abstract of 85 articles were done. Secondary screening of 19 articles resulted in 8 articles, included in this manuscript. Most of the reviewed articles showed, application of the Integrated Theoretical Model in the intervention programme as a guide and utilising combined intervention components are effective tools in delivering the intervention programme. The stigma reduction-intervention programme should focus on the intervention components as a whole including training of HCW, role plays, group discussions, games, sharing of information and contacts with PLHIV as well presentations and lectures. An integrative model of behavioural prophecy is perceived and it is particularly essential for interventions that focus on creating and fortifying the aim in conducting the chosen behaviour.

Introduction: Dermatophyte infections are superficial infections that affect the skin and are caused by fungi, namely dermatophytes. Objectives: This study aimed to determine the prevalence of dermatophyte infections among patients who attended the Dermatology Department in Setif public hospital, Algeria and to determine the associated risk factors to these infections. Methods: A cross-sectional study with a sample size of 400 respondents was designed to collect the data using a validated pre-tested questionnaire from February to June 2019. The collected data was then analyzed using IBM SPSS version 25. Results: The response rate was 98.4% (315 respondents) with an overall mean age (SD) of 38.81 (16.37) years old. The prevalence of dermatophyte infections among respondents was 33.7%, 26% of them have single infections. On the other hand, multiple logistic regression analysis showed an increased odd of having dermatophyte infections by three times among patients from low-income families (OR=3.23, 95% CI=1.09- 4.78, p=0.03). Similarly, the presence of chronic diseases led to a twofold increase in the odds of having dermatophyte infection among patients (OR=2.27, 95% CI=1.01-10.49, p=0.045). It was also found that poor attitudes towards preventing dermatophyte infections increased the odds of having dermatophyte infection by near to three times (OR=2.58, 95% CI=1.14-4.74, p=0.002). Conclusion: The high prevalence of dermatophyte infections presents a significant concern in Setif Province, Algeria. In this context, further efforts are needed to review the practiced control measures to optimize the effectiveness of these measures, which may reduce dermatophyte infections, especially among patients with chronic diseases.

Introduction: Shoulder problems have been a challenge among the aging population. Although reports surfaced on factors affecting shoulder dysfunction, however, such studies in relation to other factors like neck pain (NP) factor are limited especially among the elderly in the urban population. This study investigated the prevalence and factors associated with shoulder complex dysfunction among the outpatient elderly attending private physiotherapy clinics. Methods: A total of 75 elderly aged ≥ 60 years old from four private physiotherapy clinics were recruited by simple random sampling method. The elderly were evaluated using the QuickDASH questionnaire to assess shoulder complex dysfunctions and NP scale. Results: A total of 92% of participants have shoulder complex dysfunction. A positive correlation of NP to shoulder complex dysfunction ( r (75) = 0.83, p<.001) with significant associations of sex ( z= -2.549, p=0.011), smoking ( z= -2.388, p=0.017), lifestyle ( z= -5.780, p=0.000), hypertension ( z= -2.808, p=0.005), osteoarthritis ( z= -2.966, p=0.003), and NP scale ( z= -2.173, p=0.031). The predicting factor of shoulder complex dysfunction is sex (β = 0.156, t (74) = 2.240, p= 0.028) and NP scale (β = 0.704, t (74) = 7.853, p= 0.000). Conclusion: There is a high prevalence of shoulder complex dysfunction among the outpatient elderly attending private physiotherapy clinics with a predicting associating factor of sex and NP.

Introduction: Urinary incontinence (UI) is a condition which is common and is closely linked to vaginal delivery. Pelvic floor muscle exercise (PFME) are considered the first line management of UI and regular practice of PFME is a key factor in its effectiveness. This study was designed to investigate the effectiveness of theory-based intervention using social media to reduce UI among postpartum women. Methods: This is a randomized controlled trial with the final number of recruited participants of 104. The participants were assigned randomly either to control or intervention groups and were followed up at three and six months. The primary outcome of this study was severity of UI. Adherence to exercises was the secondary outcome. Results: After the intervention, at three months and six months follow-up, there were significant differences between the two groups regarding the practice of PFMEs (p≤ 0.05). Friedman’s analysis of variance showed that there was a significant difference in respect of the exercise adherence rating scale among the intervention group at baseline, at three months and post six months (p≤ 0.05). In the intervention group at baseline the mean (standard deviation, sd) of the International Consultation on Incontinence Questionnaire Short Form was 3.00 (1.94) whereas at three months it decreased to 1.96 (1.69), which decreased further to 1.04 (0.51) at six months. Conclusion: theory-based education delivered through social media is a feasible and effective way of increasing the practice of PFMEs, and can lead to decrease of severity UI.

Introduction: Diabetic foot ulcers (DFUs) remain one of the greatest significant problems of diabetes mellitus. It is a cause of main suffering and expenses for patient, and financial problem on health facilities and public. One of the strategies to overcome DFU is through health education to prevent foot ulcer, which focused in promoting foot self-care. To reach this aim, researchers had applied different educational approaches. This systematic review is to evaluate various types of educational programs in terms of its method of delivery and effectiveness. Methods: The search involved various databases; EBSCOHOST, MEDLINE, CINAHL, Cochrane library, ScienceDirect, PubMed, SAGE SringerLink, Web of Science and Wiley Online Library. It was limited to full text research articles that report intervention studies, and the writte up in English Language, the publication was from 2005 to 2021. The key words were “diabetes”, “diabetes foot”, “foot self-care”, health education and “interventions”. Results: Twenty studies were involved in this review. Nine studies were randomized controlled trials (RCTs), while eleven reported non-randomized controlled trials (NRCTs). Conclusion: There are evidences that foot care education improves foot care and diabetic foot problems. Various health education approaches, for instance foot assessment, discussion, counseling, homebased visitation and telephone calls have been shown to be effective in improving educational programs. Studies in the future should focus on RCTs in different sites and apply follow-up of long duration to provide better recommendations to healthcare practitioners on effective educational interventions to prevent DFUs.