Malaysian Family Physician最新文献

Introduction: A healthy lifestyle influences hypertension control. However, studies investigating the effects of lifestyle on hypertension remain elusive. This study aimed to analyse the association between lifestyle factors and hypertension control among patients with hypertension.

Methods: This cross-sectional exploratory study was conducted from June to December 2022 among 265 patients with hypertension from the Pusat Kesehatan Masyarakat. The status of hypertension control was assessed by checking the serial blood pressure. The physical activity (PA) level, sleep quality, stress level and eating pattern were measured using the Global Physical Activity Questionnaire; Pittsburgh Sleep Quality Index; Depression Anxiety Stress Scale-21; and 24-Hour Food Recall Questionnaire, Adolescent Food Habits Checklist and Emotional Eating Scale, respectively. Stepwise binary logistic regression and a generalised linear model were used for the statistical analysis.

Results: Approximately 72.2% of the participants had uncontrolled hypertension. The majority showed a low PA level (46%), normal stress level (94.7%), good sleep quality (80%), low caloric intake (95.5%), neutral food habit (55.5%) and low emotional eating (93.2%). Sex (P=0.030), age (P=0.018), PA level (P=0.011), sleep quality (P=0.032) and stress level (P=0.030) significantly influenced hypertension control. Specifically, moderate (odds ratio [OR]=5.868, 95% confidence interval [CI]=3.024-11.798, P=0.000) and vigorous PA levels (OR=2.188, 95% CI=1.026-4.678, P=0.042) were significantly associated with hypertension control.

Conclusion: Moderate and vigorous PA levels are lifestyle factors that may play a role in controlling hypertension.

Introduction: Undesirable working conditions, insufficient professional development and other labour market pressures have significantly impacted the status of general practitioners (GPs). This study aimed to conduct a situational analysis of GPs in Iran using a forecasting approach until 2025.

Methods: Data were collected concurrently through direct contact, data matching among databases and tracking among graduates from four clusters of medical science universities over the past decade. This retrospective longitudinal study determined the status of GPs over consecutive years. Multi-state Markov and binary logistic regression analyses were performed using R and Stata 14.

Results: Of 430 graduates over the past decade, 94% were successfully identified. Only 20% of the graduates remained active as GPs. The greatest fluctuations in transfer occurred in the third year after graduation, with the remaining proportion of GPs dropping to less than 50%. The probability of remaining as GPs was 0.76 per year, while the highest transition was observed towards specialisation (0.12). Additionally, 2% of the GPs chose not to work, and less than 1% transitioned to a different specialty. Based on the transfer matrix for 2025, only 19% of the GPs were projected to remain, with the majority (59%) transitioning to specialisation.

Conclusion: The transfer probability varies across different years, indicating higher flow rates among GPs. However, only a limited number of GPs are projected to remain until 2025. A comprehensive set of interventions should be considered, spanning the pre-medical stage, during education and after graduation, to mitigate the factors contributing to GPs leaving their profession.

Introduction: The prevalence of visual impairment and ocular diseases changes over time. This measure can help general practitioners in anticipating common eye disorders that may require ophthalmological referrals to government hospitals. This study aimed to evaluate the prevalence of visual impairment and ocular diseases in an outpatient ophthalmology clinic in a public hospital and the types of investigations frequently conducted to diagnose these diseases.

Methods: A cross-sectional prospective study was conducted over three weeks in the eye clinic of the University of Malaya Medical Centre. The electronic medical records of all patients who attended the outpatient clinic were assessed to collect data on sex, age, type of visit, visual acuity, ocular presentation, investigations conducted and diagnosis of eye diseases. Visual impairment and blindness were categorised as per the World Health Organization criteria.

Results: Among 1002 patients, 327 had visual impairments (32.63%), and nine had blindness (0.9%). Cataracts were the most common ocular disease diagnosed (n=294, 29.74%), followed by glaucoma (n=123, 12.28%) and diabetic retinopathy (n=84, 8.38%). Optical coherence tomography was the most common investigation performed (n=272, 64.9%), followed by Humphrey visual field testing (n=53,12.6%).

Conclusion: Untreated refractive error is the leading cause of visual impairment in children, while cataract, glaucoma and diabetic retinopathy are the main contributors to visual impairment and blindness in elderly individuals. Our study highlights the urgent need for general practitioners to recognise avoidable visual impairment in all age groups to help prevent blindness.

Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well.

Introduction: Tuberculosis (TB) contacts in Malaysia undergo follow-up screening to reduce their risk of active or latent TB. However, adherence to this screening is low. Limited studies have explored the factors contributing to non-adherence to follow-up screening. This study aimed to determine the non-adherence rate and reasons in a government health clinic.

Methods: Participants were TB contacts due for their 2nd contact screening (including those who attended their first contact screening at Petra Jaya Health Clinic from November 2018 to March 2019), were aged at least 18 years and were able to understand English or Malay. Data were collected during the second contact screening from August 2019 to January 2020.

Results: A total of 383 TB contacts were included. Of them, 56.6% (n=217) were aged 20-39 years, and the sex distribution was equal (men: 44.1%, n=169). The majority were non-household contacts (82.2%, n=315). The rate of non-adherence to follow-up screening was 19.1% (n=73). Approximately 52.1% (n=36) reported forgetting their scheduled appointment date as the primary reason for non-adherence. The influencing factors included employment and ethnicity. Only 39.1% (n=27) were aware of their risk for active TB, while 49.5% (n=189) were unsure whether TB can be cured with proper treatment.

Conclusion: The findings highlight the need to improve the reminder system for TB contacts. Although direct association between knowledge and adherence could not be established, the low percentage of correct answers to most basic knowledge questions associated with TB indicates a need to improve health education for TB contacts.

Introduction: Optimal self-care promotes glycaemic control and prevents diabetes complications. Its performance is facilitated by an adequate level of diabetes knowledge. This review aimed to evaluate diabetes knowledge among Malaysians by assessing diabetes knowledge scores and their associated factors.

Methods: A comprehensive bibliographic search for Malaysian studies on diabetes knowledge was conducted in PubMed, Scopus and Google Scholar. Relevant literature was systematically selected and described; pertinent data were extracted; and data on diabetes knowledge levels and their associated factors were synthesised. The quality of the identified studies was assessed using a Joanna Briggs Institute critical appraisal tool.

Results: Thirty Malaysian cross-sectional studies that measured diabetes knowledge levels were retrieved. Nineteen of them used a named diabetes knowledge measurement tool, with 14 using the 14-item Michigan Diabetes Knowledge Test. A low knowledge level was prevalent among patients with diabetes mellitus (pooled mean knowledge score=6.92, proportion of patients with a low knowledge level=47.97%). The knowledge score was associated with some sociodemographic variables, health literacy, self-care and glycaemic control.

Conclusion: The association of diabetes knowledge with diabetes outcomes (e.g. self-care and glycaemic control) reflects the potential of the former as a target of intervention. Periodic measurement of diabetes knowledge in healthcare settings and among populations can help in assessing the effectiveness of diabetes educational interventions. Concerted efforts to improve diabetes knowledge among Malaysians have the potential to fill knowledge-practice gaps.