Malaysian Family Physician最新文献

Palliative care is a vital component of primary healthcare systems, especially in Asia, where the ageing population is expected to increase significantly in the coming years. Integrating palliative care into primary healthcare systems is a crucial strategy for achieving universal access to palliative care. It is necessary to take concurrent actions to achieve this integration, including integrating palliative care into public health policies, educating primary healthcare workers, establishing appropriate service structures and ensuring the availability of controlled medications. Healthcare professionals involved with primary care, often led by physicians, play a significant role in driving the implementation of primary palliative care in Asia, as evidenced by their involvement in community- and home-based palliative care in India and primary palliative care for patients with cancer in Indonesia. However, there are challenges associated with implementing these actions in each country. Therefore, it is crucial to examine the ongoing advocacy efforts, milestones, obstacles and strategies that shape this process in the Asian context.

Introduction: Despite the wide range of injuries sustained by adolescents during karate, limited studies have investigated the type and frequency of sports injuries among adolescent karate athletes. This study would be the first to examine the epidemiology of injuries among adolescent karate athletes. Its objective was to describe the incidence of injuries throughout the 2023 season and the pattern of injuries among Malaysian adolescent karate athletes.

Methods: From 1 January to 31 December 2023, this cross-sectional study examined 119 Malaysian adolescent karate athletes aged 13-19 years. Data on demographic characteristics and patterns of injuries were collected using a standardised form and analysed using SPSS version 26.

Results: The incidence of injuries was 22.3 injuries per 1000 athlete exposures. Specifically, the incidence of injuries during training was 15.34 injuries per 1000 athlete exposures, while that during competition was 106.6 injuries per 1000 athlete exposures. The majority of the injuries were mild (n=113, 87.6%), while the minority were severe (n=6, 4.7%). The injuries most commonly occurred in the head and neck (n=31, 24%), followed by the ankle (n=13, 10.1%) and foot (n=14, 10.9%).

Conclusion: There is a need to explore the extrinsic and intrinsic risk factors of injuries among adolescent karate athletes in Malaysia, as the incidence of injuries is high during competition. Additionally, it is important to educate athletes and supporting sports science members about injury prevention programmes.

Introduction: The study aimed to determine the prevalence and associated factors of internet addiction (IA) among early adolescents during the COVID-19 pandemic in Kota Bharu, Kelantan, Malaysia.

Methods: A cross-sectional online survey was conducted from February to April 2021 among adolescents in Kota Bharu, Kelantan. Participants completed the Malay Version of the Internet Addiction Test, the Depression, Anxiety and Stress Scale-21 and a sociodemographic information form. A multiple logistic regression analysis was performed to determine the associations between variables.

Results: A total of 535 adolescents participated in this study. Among them, 65.9% were girls. The prevalence of IA among the participants was 48.6%. Male sex [adjusted odds ratio (AOR)=2.15, 95% confidence interval (CI)=1.30-3.57], internet usage at home (AOR=6.17, 95% CI=1.94-19.58), internet usage to watch/download music (AOR=2.50, 95% CI= 1.52-4.12), internet usage to engage in social networking (AOR=2.29, 95% CI=1.19-4.40), inadequate parental/guardian bonding (AOR=2.19, 95% CI=1.31-3.65), depression (AOR=2.03, 95% CI=1.07-3.85), anxiety (AOR=2.79, 95% CI=1.64-4.76) and stress (AOR=4.67, 95% CI=2.00-10.91) were significantly associated with IA.

Conclusion: IA was prevalent among Malaysian adolescents during the COVID-19 pandemic. Sex, internet usage profile and psychological factors were significant predictors of IA.

Introduction: The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence.

Methods: This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28).

Results: A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05).

Conclusion: Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

Introduction: Using quick response (QR) codes to disseminate information has become increasingly popular since the declaration of COVID-19 as a pandemic. We aimed to investigate the feasibility of implementing QR-based quality improvement projects in our clinic to improve patients' medical knowledge, experience and access to care.

Methods: We utilised systematic random sampling by recruiting every 25th patient registered in our clinic during data collection. Participants answered a self-administered printed questionnaire regarding their smartphone usage and familiarity with QR code scanning at the patients' waiting area. Data were analysed using the Statistical Package for the Social Sciences version 26.

Results: A total of 323 patients participated (response rate=100%). The participants' median age was 57 years (interquartile range=4l-67). Most participants were women (63.1%). Approximately 90.4% (n=282) used smartphones, with 83.7% (n=261) reporting average or good usage proficiency. More than half (58.0%) accessed medical information via their smartphones, and 67.0% were familiar with QR codes. Multiple logistic regression analyses revealed that familiarity with QR codes was linked to age of <65 years [adjusted odds ratio (AOR)=4.593, 95% confidence interval (CI)=2.351-8.976, P<0.001], tertiary education (AOR=2.385, 95% CI=1.170-4.863, P=0.017), smartphone proficiency (A0R=4.703, 95% CI= 1.624-13.623, P=0.004) and prior smartphone usage to access medical information (AOR=5.472, 95% CI=2.790-10.732, P<0.001).

Conclusion: Since smartphones were accessible to most primary care patients, and more than half of the patients were familiar with QR code scanning, QR code-based quality improvement projects can be used to improve services in our setting.

Introduction: Tuberculosis (TB) remains a highly prevalent disease in Malaysia. Early identification using cost-effective methods such as chest radiography can reduce the health burden of a TB epidemic. However, normal chest radiographic findings are common. This study aimed to evaluate the characteristics of smear-positive pulmonary TB with normal chest radiographic findings during an outbreak.

Methods: A cross-sectional study was conducted by reviewing the medical records of 56 pulmonary TB cases registered at Kodiang Health Clinic from April to October 2022. Smear-negative and extrapulmonary TB cases were excluded. Relevant information was extracted from the medical records and recorded in a case report form for data management and analysis.

Results: Approximately 60.7% of the cases had symptoms lasting >2 weeks, and 89.3% showed abnormal findings upon clinical examination. Additionally, 73.2% had sputum acid-fast bacilli counts of ≥1+, and the sputum Mycobacterium tuberculosis culture and sensitivity test findings were positive in 82.1% of the cases. The proportion of smear-positive pulmonary TB with normal chest radiographic findings was 42.9%. The factors associated with smear-positive pulmonary TB with normal chest radiographic findings included being under 18 years old (P=0.021), being a student (P=0.010), being single (P=0.012) and being asymptomatic (P=0.04).

Conclusion: Normal chest radiographic findings may lead to a misdiagnosis of smear-positive pulmonary TB, especially during an outbreak. Therefore, active case detection among close contacts with risk factors for normal radiographic findings should consider additional supportive tests.

Injuries to the cervical spine following phlebotomy have not been reported in the literature. Herein, we report the case of a 27-year-old lady with major depressive disorder and trypanophobia who experienced a syncopal episode during a blood test, resulting in a C2 Hangman's fracture. After the application of a halo vest, she recovered without any long-term pain or neurological impairments. The concept of needle phobia is important for healthcare professionals to understand, since patients' fear of needles can lead to detrimental injuries during panic attacks. Greater attention should be paid to alleviate this fear, with the ultimate goals of improving health and preventing unwanted injuries following phlebotomy.

Introduction: Communication is a key element of palliative care. The concealment of advanced-stage diseases is a communication challenge. This study aimed to explore the patterns and difficulties in communication regarding the concealment of advanced-stage cancer between caregivers and patients. Methods: This qualitative study employed an interpretive phenomenological approach and was conducted at a district hospital in Thailand. Semi-structured in-depth interviews were performed to collect data from caregivers (i.e. family members) of patients regarding the concealment of advanced-stage cancer. The data analysis followed an inductive thematic approach.

Results: Ten in-depth interviews were conducted among the caregivers of patients aged 57-97 years. Four themes emerged: (i) reasons for concealing the diagnosis and prognosis (personality of patients and concerns about negative effects), (ii) communication patterns between caregivers and patients (communicating symptoms/signs instead of the diagnosis/prognosis and distorting information), (iii) difficulties and challenges in maintaining concealment (feelings of guilt, hesitation in sharing the information and suspicion of patients' awareness of their diagnosis/prognosis) and (iv) communication support from healthcare professionals (avoiding informing patients about their diagnosis/prognosis, supporting decision-making and disclosing the information).

Conclusion: The concealment of advanced-stage cancer is perceived as an appropriate communication approach among some caregivers. Communicating information about advanced-stage cancer is dynamic. Some caregivers and families consider disclosing the information in the future. Healthcare professionals can support communication throughout care. Future studies should focus on decision-making and communication processes for better handling of information concealment or the conspiracy of silence in palliative care.