Malaysian Family Physician最新文献

Introduction: Survivors of stroke frequently encounter difficulties with self-care and self-management, adversely affecting their long-term quality of life (QoL). Patient education is vital in enhancing their QoL, but its overall efficacy must be established. This scoping review aimed to elucidate the efficacy of patient education interventions in improving the QoL of community-dwelling survivors of stroke.

Methods: A scoping review was performed by querying four databases (PubMed, Scopus, Cochrane Library and PEDro) for papers that fulfilled the inclusion criteria. The search terms included ('stroke' OR 'CVA' OR 'cerebrovascular accident') AND ('patient education' OR 'self-care') AND 'quality of life'. Publications published in English, subjected to peer review and including human participants were included in the review. Research pertaining to alternative neurological disorders or lacking relevance to the specified subjects of interest was excluded. Two reviewers independently evaluated the full-text papers to determine which ones satisfied the qualifying requirements.

Results: Five studies were included. Patient education interventions demonstrated a consistent trend toward improved quality of life (QoL) among community-dwelling stroke survivors, particularly when programmes were structured, multi-component, and delivered over time. Benefits were observed across domains of functional independence, participation, self-efficacy, and emotional well-being. However, substantial heterogeneity in intervention design and outcome measures limited determination of definitive active components or optimal delivery models.

Conclusion: Patient education interventions hold potential in improving QoL after stroke, but effectiveness is highly dependent on programme design, duration and delivery. Comprehensive, personalised and longitudinally supported interventions are more effective than brief or one-off programmes. Future research should identify core active components, assess subgroup effects and develop adaptable models that can be integrated into routine community-based stroke rehabilitation.

Introduction: Substance use disorders (SUDs) represent a significant public health concern, with an estimated 36.3 million people affected worldwide and approximately 100,000 active drug users in Malaysia. As individuals with SUDs frequently disengage from treatment, the cultivation of non-judgemental attitudes among healthcare professionals is critical. This study aimed to assess the perceptions of primary care practitioners (PCPs) in Selangor towards patients with SUDs and identify the associated factors.

Methods: A cross-sectional study was conducted from June 2021 to November 2023 among 235 PCPs in Selangor, utilising convenience sampling. Data were collected via an online, self-administered questionnaire. Perceptions were measured using the Drug and Drug Problems Perception Questionnaire (DDPPQ) with lower scores indicated more positive perceptions. Multiple linear regression was employed to identify the associated factors.

Results: The participants were predominantly women (76.8%) and medical officers (46.8%), with a median experience of 8 years. While the majority (73.4%) reported clinical encounters with patients with SUDs, only 24% had received specific SUD training and 23.2% had experience in methadone maintenance therapy (MMT). The mean total DDPPQ score was 45.38±6.91 reflecting generally negative perceptions. The regression model (R²=0.268) showed that favourable perceptions were significantly associated with prior MMT experience (B=-4.91, P<0.001) and higher frequency of clinical interaction (e.g. never vs always interaction: B=12.53, P<0.001).

Conclusion: The PCPs in this study exhibited a predominantly negative perception towards patients with SUDs. More negative perceptions were significantly associated with a lack of experience in MMT and less frequent clinical contact with this patient population.

We describe the case of a 55-year-old man with underlying tophaceous gout who presented with a 6-month history of multiple joint pains and associated constitutional symptoms. Physical examination revealed firm and non-tender swelling measuring 3x4 cm adjacent to the left clavicular head. This swelling did not move with deglutition. Neck imaging showed bilateral heterogeneous soft tissue lesions at the sternoclavicular, first costochondral and acromioclavicular joints. Multiple lytic lesions with cortical destruction involving the upper manubrium and distal ends of both clavicles were seen. Fine needle aspiration of the sternoclavicular joint yielded a small amount of synovial fluid, and its histopathological analysis confirmed the presence of monosodium urate crystal deposition. This case demonstrates a rare manifestation of tophaceous gout at the sternoclavicular joint, underscoring its ability to mimic other pathologies and the consequent challenges in diagnosis.

This paper is the second paper on implementation research in primary care. This paper outlines key processes for conducting implementation research, emphasising the importance of selecting relevant theories, models, and frameworks to guide each stage. Three core steps common for implementation research were described: identifying determinants that influence implementation, mapping appropriate strategies to address these determinants, and evaluating implementation outcomes. Determinant frameworks such as the Consolidated Framework for Implementation Research and the Theoretical Domains Framework help researchers understand contextual barriers and facilitators, while resources like the ERIC taxonomy and Behaviour Change Technique Taxonomy support strategy selection. Evaluation frameworks, including Proctor's implementation outcomes and RE-AIM, enable systematic assessment of implementation success. This paper also highlights the essential role of stakeholder engagement throughout the research process. Together, these components offer a structured, theory-informed approach to support effective, scalable, and sustainable implementation efforts in primary care.

Implementation research plays a vital role in narrowing the "evidence-to-practice" gap in primary care by ensuring that evidence-based interventions are not only adopted but also embedded into routine clinical practice in a sustainable way. This is especially important in primary care, where clinicians care for diverse patient groups, work within evolving healthcare systems, and face rapid technological change. Implementation research is defined as "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, thereby improving the quality and effectiveness of health services." This commentary introduces the concept and significance of implementation research, outlines its place within the broader research translation continuum, and clarifies how it differs from quality improvement. It also provides examples of how implementation research is applied in primary care to support the adoption of new innovations.should be further verified.

Introduction: The rising prevalence of prediabetes poses a significant public health challenge worldwide. This descriptive study aimed to offer insights into the epidemiological characteristics and progression patterns of prediabetes, which are crucial for informing effective interventions and addressing the growing diabetes mellitus (DM) epidemic.

Methods: This retrospective cohort study involved 705 adults with prediabetes attending 28 health clinics in Terengganu, Malaysia, from January 2019 to June 2023. Data on sociodemographic characteristics, medical history and clinical measures during diagnosis and follow-up were collected from medical records and analysed using descriptive statistics. The progression trends to normoglycaemia, stable prediabetes and DM were determined based on glycated haemoglobin levels recorded over a 2-year follow-up period.

Results: Of the 705 participants, 25.0% (n=176) reverted to normoglycaemia; 59.1% (n=4l7) remained stable with prediabetes; and 15.9% (n=112) progressed to DM within the 2-year follow-up. Dyslipidaemia, with higher triglyceride levels and lower high-density lipoprotein levels at diagnosis, was more prevalent among the participants who progressed to DM. Additionally, the participants with DM had higher median weight, body mass index and fasting blood sugar level at diagnosis than the other participants.

Conclusion: This study underscores the critical need for targeted interventions to address the observed trends in the progression from prediabetes to DM in the Malaysian population. Comprehensive prediabetes programmes focusing on lifestyle modifications such as weight management, glycaemic control and lipid profile optimisation, along with regular monitoring, are essential in preventing progression to DM.

Introduction: Primary healthcare workers are in a strategic position to promote smoking cessation due to their accessibility. This study aimed to determine smoking cessation counselling (SCC) practice among primary healthcare workers and identify its associated factors.

Methods: A cross-sectional online survey was conducted among 363 primary healthcare workers in all government healthcare clinics in the districts of Hilir Perak, Kerian, Kinta, Larut, Matang and Selama, and Manjung from January to June 2023. Doctors, allied health professionals, pharmacists, medical assistants, and nurses were included. Knowledge, attitude, and practice ofSCC were assessed using a validated 22-items questionnaire that covered 5 As (ask, advise, assess, assist and, arrange) and 5 Rs (relevance, risks, rewards, roadblocks and, repetitions). Multiple logistic regression was used to analyse the factors associated with poor practice.

Results: Most participants were doctors (31.1% ), followed by allied health professionals (21.8%), pharmacists (19.3%), medical assistants (14.3%), and nurses (13.5%). The majority showed poor practice (93.7%), knowledge (94.8%), and attitude (51.5%). Only 16.8% were trained in SCC. Multivariate logistic regression analysis revealed that only the district was significantly associated with poor counselling practice. Hilir Perak district showed the highest odds of having poor practice (adjusted odds ratio (aOR) =17.80, 95% confidence interval (CI)= 2.02-156.97, P-value=0.01). However, the prevalence of poor practice among the other districts was also high (77.0%-97.8%). Conclusion: SCC practice, knowledge, and attitude are poor among Perak's government primary healthcare workers. The district-specific differences suggest that localized studies should be considered to determine the influential factors.

Introduction: Low dietary diversity is strongly associated with anaemia, stunting and underweight in young children. However, its determinants vary across populations. This study aimed to evaluate the association of dietary diversity with child and family characteristics among children aged 24-59 months in Karangkamulyan Village, Banten, Indonesia.

Methods: A cross-sectional study was conducted in 2020 involving 210 children selected through a total sampling method. Data were collected through structured interviews with children's mother or primary caregiver. SPSS was utilised for data analysis.

Results: The mean dietary diversity score among the children was 3.78. The majority of the children (78.6%) had a low minimum dietary diversity (<5 food groups per day). Family size (odds ratio [OR]=2.732, 95% confidence interval [CI] = 1.012-7.377) and maternal parity (OR=2.589, 95% CI=1.028-6.520) were significantly associated with the minimum dietary diversity (P<0.05). Conversely, electricity expenditure (r=-0.255, P<0.05) and mobile phone credit expenditure (r=-0.143, P<0.05) were negatively correlated with the dietary diversity score.

Conclusion: This study revealed that non-food expenditure and family characteristics were significantly associated with dietary diversity among children aged 24-59 months. These findings highlight the need for collaboration among various stakeholders to improve the dietary quality for young children.