Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

INTRODUCTION: Diabetic patients generally have a good idea about healthy diet however their awareness regarding specific dietary recommendations is questionable. Thus, this paper aims to examine the awareness regarding specific dietary components among diabetic patients at a primary care clinic and its influence on self-reported dietary practice. MATERIALS AND METHODS: The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English-Malay version) was used. It was adapted with additional questions to assess respondents' awareness on: (1) healthful eating plan, (2) the quantity of one serving of fruits and vegetables, (3) choices and the allowed quantity of high fat food intake, (4) meaning of carbohydrate, and (5) carbohydrate spacing per day. RESULTS: From the 360 respondents, 85.0% knew about healthful eating plan. However, those who were unaware of the meaning of carbohydrate, carbohydrate spacing, the allowed high fat food intake, and the quantity of one serving of fruits and vegetables were 34.1%, 47.5%, 40.0%, and 30.8% respectively. Generally, the dietary practice reported by those who knew 'one serving of fruits and vegetables' (p<0.001), 'allowed quantity of high fat food intake' (p=0.001), 'meaning of carbohydrate' (p<0.001), or 'carbohydrate spacing' (p<0.001) was significantly different than those who were unaware of these terms. CONCLUSION: Although most respondents knew about healthful eating plan, majority of them were unaware of the specific dietary components, suggesting superficial dietary knowledge. Unfortunately, poor dietary awareness significantly influenced their self-reported dietary practice which could be considered as inaccurate. Thus, strategies to improve their dietary knowledge is necessary at the primary care setting.

Background: Many Type 2 Diabetes Mellitus (T2DM) patients refuse insulin therapy even when they require this modality of treatment. However, some eventually accept insulin. This study aimed to explore the T2DM patients' reasons for accepting insulin therapy and their initial barriers to use insulin. Methods: This qualitative study interviewed twenty-one T2DM patients at a primary care clinic who had been on insulin for more than a year through three in-depth interviews and three focus group discussions. A semi structured interview protocol was used and the sessions were audio-recorded. Subsequently, thematic analysis was conducted to identify major themes. Results: The participants' acceptance of insulin was influenced by their concerns and beliefs about diabetes and insulin. Concerns about complications of poorly controlled diabetes and side effects of other treatment regime had resulted in insulin acceptance among the participants. They also had a strong belief in insulin benefits and effectiveness. These concerns and beliefs were the results of having good knowledge about the diabetes and insulin, experiential learning, as well as doctors' practical and emotional support that helped them to accept insulin therapy and become efficient in self-care management. These factors also allayed their negative concerns and beliefs towards diabetes and insulin, which were their barriers for insulin acceptance as it caused fear to use insulin. These negative concerns were related to injection (self-injection, needle phobia, injection pain), and insulin use (inconvenience, embarrassment, lifestyle restriction, negative social stigma, and poor self-efficacy), whereas the negative beliefs were 'insulin could cause organ damage', 'their diabetes was not serious enough', 'insulin is for life-long', and 'insulin is for more severe disease only'. Conclusions: Exploring patients' concerns and beliefs about diabetes and insulin is crucial to assist physicians in delivering patient-centered care. By understanding this, physicians could address their concerns with aim to modify their patients' misconceptions towards insulin therapy. In addition, continuous educations as well as practical and emotional support from others were found to be valuable for insulin acceptance.

Aim: To determine the prevalence of depression, anxiety and stress, and its associated sociodemographic and clinical factors among people living with HIV/AIDS (PLWHA). Background: The number of PLWHA with a near-normal life expectancy has been increasing. This has led them to face various challenges living with the disease, exposing them to multiple psychological problems. Materials and methods: This was a cross-sectional study conducted at an HIV clinic in a government hospital in Northern Peninsular Malaysia. A total of 206 PLWHA were recruited using systematic random sampling. Sociodemographic factors and presence of negative emotional states were recorded using a self-administered questionnaire comprising the Depression, Anxiety and Stress Scale 21 (DASS-21). Results: The prevalence of depression, anxiety and stress were 36.9%, 45.1% and 26.7% respectively. The majority had moderate to extremely severe symptoms of depression (71.1%), anxiety (88.2%), and stress (72.27%). After controlling for cofounders using multiple logistic regression, those with a co-morbidity had 3.02 times the odds of having depression compared to those without co-morbidity (p = 0.01). The non-Malays had 53% less chance to experience anxiety compared to Malays (p = 0.01). Those with lower monthly household income were more likely to experience stress than those with higher income, the worst was among participants with income of

Adolescents are aware of the health risks of cigarette smoking yet still they continue to smoke. This article reports on how Malaysian adolescents rationalised their smoking behaviour despite knowing its danger. In this qualitative study, 26 adolescents (23 smokers and 3 former smokers) were interviewed through 3 focus group interviews and 3 in-depth interviews. The interviews were guided by a semi-structured interview protocol and recorded using audio recorders. This study highlights that the adolescents continued to smoke despite knowing the risks of smoking. They rationalised their smoking by disengaging themselves from the risks through: (1) disregarding the immediate effects of smoking, (2) ignoring the risk information, (3) normalising the mortality risk of smoking, (4) emotionally detaching themselves from relating to the threat, (5) regarding smoking as the lesser evil than other risky behaviour, and (6) discounting the actual risks by citing the exceptional cases. In conclusion, the adolescents might have made a calculated decision after weighing the risks and benefits of smoking but they chose smoking over quitting. This study provides meaningful insights for clinicians and policy makers to understand adolescents' reasoning for smoking, which then may result in the development of better strategies for challenging the rationalisations of adolescents.