Malaysian Family Physician最新文献

Introduction: Type 2 diabetes mellitus (T2DM) is one of the most prevalent non-communicable diseases globally. This study aimed to determine the association between body mass index (BMI) and diabetes mellitus (DM) control among patients with T2DM.

Methods: A retrospective study was conducted from October 2023 to June 2024 using secondary data from the National Diabetes Registry (NDR) of Muar District Health Office, Johor. Patients with T2DM registered in the NDR and audited from 2021 to July 2023 were included. The association between BMI and DM control was analysed using hierarchical multinomial logistic regression.

Results: A total of 1955 patients were included in the study. The prevalence of good, intermediate and poor BMI control was 38.8% (95% Confident Interval (CI)=36.7, 41.0), 22.2% (95% CI=20.3, 24.0) and 39.0% (95% CI=36.7, 41.2), respectively. Most patients were older Malay women. There was an association between BMI and DM control unadjusted (P<0.001) and adjusted for several confounding factors using seven models (P=0.003-0.034). The R² value also improved from 0.008 to 0.293. Conclusion: Among patients with T2DM, a higher BMI, the creatinine level and medications such as glucose-lowering drugs, ticlopidine, acetylsalicylic acid and statins are associated with DM control. However, as the study design does not allow for the assessment of causality or progression over time, the findings should be interpreted as descriptive associations rather than as evidence of cause-and-effect relationships. Focus on medication compliance, healthcare providers' role during medication consultation and stakeholders' role in maintaining drug supplementation is needed.

Erectile dysfunction (ED) is a prevalent medical problem affecting men globally, particularly those with co-morbidities such as cardiovascular disease, hypertension, dyslipidaemia and diabetes. This case series aimed to evaluate the effects of avanafil as a treatment option for patients with ED and other co-morbidities. Eight male patients from a family medicine clinic received either 100 mg or 200 mg avanafil based on their clinical indication. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score. The outcomes included changes in the IIEF-5 score upon avanafil treatment. Our findings demonstrated a significant increase in the 200 mg avanafil treatment group, with the IIEF-5 score increasing from 14.83±9.4 to 24.17±2.6 (P<0.05). However, no significant difference was observed in the 100 mg avanafil treatment group (P=0.7903) and the overall avanafil treatment group (100 mg + 200 mg avanafil; P=0.0501). No adverse events were reported among the patients. Avanafil is considered a potentially safe and effective treatment option for ED, particularly in individuals with co-morbidities.

Macular hyperpigmentation of the nasal region, often referred to as the 'chik sign', constitutes a distinctive physical manifestation associated with chikungunya fever. Chikungunya, a mosquito-borne viral illness, presents with acute febrile symptoms, intense arthralgia and cutaneous eruptions. The chik sign serves as a valuable clinical marker for discerning chikungunya from other febrile illnesses with analogous presentations, such as dengue fever and malaria. This differentiation is particularly crucial in endemic regions. Recognition of the chik sign underscores the significance of clinical acumen in diagnosing chikungunya. In conjunction with confirmatory laboratory testing, identification of this sign can augment diagnostic accuracy and guide appropriate therapeutic strategies. Herein, we present the case of a 44-year-old woman with chikungunya virus infection who exhibited acute febrile symptoms, severe polyarthralgia and hyperpigmentation of the nasal region. In conclusion, the chik sign is a crucial clinical marker for identifying chikungunya fever. Its identification can improve diagnostic precision and enable timely care, particularly in places with limited access to laboratory testing. Healthcare professionals should thus be vigilant for this skin pigmentation in patients who exhibit joint pain and feverish symptoms that are indicative of chikungunya virus infection. To further understand the clinical spectrum of chikungunya, more research into the presentation of this pigmentation would be helpful.

Introduction: The estimated maternal mortality ratio in Indonesia from 2016 to 2020 was 249 maternal deaths per 100,000 live births. Currently, this ratio remains relatively high. One effort to reduce maternal mortality is to provide regular antenatal care during pregnancy. This study aimed to analyse the urban-rural differences in the incompleteness of antenatal care coverage in Indonesia.

Methods: This cross-sectional study used data from Indonesian Basic Health Research 2018. A total of 64,399 women aged 15-49 years, including 26,792 and 37,607 women from urban and rural areas, respectively, were included. Univariate (percentage), bivariate (chi-square statistics) and multivariate (logistic regression statistics) analyses were conducted.

Results: Approximately 18.2% and 26.4% of the urban and rural participants received incomplete antenatal care, respectively. Secondary and primary education, lack of health insurance, home-based antenatal care, parity greater than 2, travel time to health facilities exceeding 15 min, absence of abortion history, undesired pregnancy and absence of pregnancy complications were associated with incomplete antenatal care in rural areas. Secondary and primary education, home-based antenatal care, travel time to health facilities exceeding 15 min, parity greater than 2 and undesired pregnancy were associated with incomplete antenatal care in urban areas.

Conclusion: Incomplete antenatal care coverage is more prevalent in rural areas than in urban areas, influenced by distinct socio-demographic and healthcare access factors. Strengthening health insurance programmes, improving healthcare facility access and promoting antenatal care education are critical to reducing disparities and ensuring better maternal health outcomes in both urban and rural areas.

Introduction: Menopausal symptoms, such as vasomotor disturbances, mood changes and atrophic vaginitis, significantly affect women's quality of life. This study aimed to examine how primary care doctors (PCDs) manage these symptoms and the clinical conditions influencing their decision to offer menopause hormone therapy (MHT), bridging gaps between guidelines and real-world practices.

Methods: A cross-sectional study was conducted from June to October 2022 among PCDs in public health clinics in Selangor, Kuala Lumpur and Putrajaya. An online survey was distributed to 1301 PCDs, achieving a 42.9% response rate (559 respondents). Data were analysed descriptively.

Results: Lifestyle modifications were the most common recommendation (98.4%), while complementary treatments were widely recommended (54.8%). MHT was discussed by 83.5% of the PCDs but directly prescribed by only 0.9%, with 66.0% referring patients to tertiary care. MHT was primarily offered for vasomotor symptoms (80.5%) and mood disorders (56.7%) but less commonly for non-communicable diseases such as hypertension (14.1%) and diabetes mellitus (25.2%). It was withheld in cases of breast cancer (91.9%) or venous thromboembolism (86.0%), with breast cancer concerns being a major barrier (75.3%).

Conclusion: Lifestyle modifications and complementary treatments were common practice options. MHT discussions were frequent, but prescription was limited due to patient concerns and comorbidities. Targeted updates to guidelines and tools can support healthcare professionals in counselling, risk assessment and effective management of menopausal symptoms.

Introduction: The unprecedented rise in the prevalence of polycystic ovary syndrome (PCOS) among women of reproductive age has raised concerns regarding their well-being. This study aimed to assess the quality of life (QoL) of women with PCOS and its associated factors in a tertiary hospital in Kolkata, India.

Methods: A cross-sectional study was conducted from October 2020 to September 2022 at the outpatient clinic of a tertiary hospital in Kolkata. Quantitative data were collected from 189 women with PCOS using a pretested questionnaire and analysed using SPSS version 16.

Results: Around 27.5% of the participants had an overall poor QoL. The psychological domain was the most affected domain, with 42.3% showing a poor QoL. A significant negative correlation was found between the psychological domain score and time since PCOS diagnosis (P=0.001). Multivariable logistic regression analysis showed that being married (adjusted odds ratio [AOR]=2.92) and having an unhealthy waist-hip ratio (AO R= 1.97) were significantly associated with a poor psychological QoL, whereas having an age of ≤24 years (AOR=2.56) and being in below middle socioeconomic class (AOR=2.08) were significantly associated with poor social and environmental QoL, respectively.

Conclusion: PCOS affects all domains of quality of life. Psychological distress is an important comorbidity of PCOS as with any other reproductive and metabolic comorbidities, necessitating the need for mental health screening and treatment among affected women. Healthcare providers should focus on various lifestyle modifications along with drug therapy to prevent the emergence of PCOS as a public health problem.

Refusal of medical treatment in paediatric case presents significant ethical and legal challenges, particularly when parental decisions conflict with a child's welfare. We report a case of life- threatening congenital diarrhoea in a neonate where the parents initially refused hospital admission despite extensive counselling. Given the severity of the child's condition, legal intervention under the Malaysian Child Act 2001 was necessary to ensure prompt medical care. This case underscores the importance of healthcare providers being well-versed in ethical principles and legal frameworks to protect vulnerable patients. Additionally, it highlights the need for clear national guidelines on invoking the Child Act in primary care settings to provide structured decision-making pathways for healthcare professionals. Ultimately, balancing parental autonomy with a child's best interests is essential in life-threatening conditions, reinforcing the role of legal mechanisms in safeguarding paediatric patients.

Introduction: Non-communicable diseases (NCDs) are considered the leading causes of death globally, accounting for 60% of all deaths. Measures such as stopping tobacco use, increasing physical activity, reducing alcohol consumption and improving diet can extend longevity and enhance the Quality of Life (QoL). This study aimed to assess the overall health behaviours and QoL of adults with NCDs residing in the urban field practice area of a teaching hospital in Kolkata and determine the association of their sociodemographic characteristics and health behaviours with their overall QoL.

Methods: A cross-sectional study was conducted in the outpatient department of the Urban Primary Health Centre-81 among 106 adults recruited via consecutive sampling. Face-to-face interviews were conducted using a predesigned, pretested and structured schedule. Data were analysed using the Statistical Package for the Social Sciences version 25.0. Descriptive and inferential statistics were employed to interpret the data.

Results: Among the participants, 45.3% were consuming tobacco, while only 6% were consuming alcohol following the diagnosis of NCDs. The majority (81%) undertook brisk walking, and 37% reported additional salt intake with meals. The overall perceived QoL was poor in 54.7% of the participants. The participants aged 41-60 years and the male participants had lower odds of having a poor QoL than their counterparts.

Conclusion: More than half of adults with NCDs report a poor QoL. Extensive interventions are needed to raise awareness in the community regarding the potential benefits of lifestyle modifications following the diagnosis of any NCD and thereby improve the QoL of patients.

Introduction: This study aimed to explore various models of health coaching used for blood pressure control in patients visiting primary care settings, along with the underlying theories. Additionally, the study sought to identify individuals serving as health coaches and the effect of health coaching on blood pressure control and risk factors.

Methods: This scoping review followed the PRISMA-ScR guidelines and utilised several databases including PubMed, ScienceDirect, ProQuest, Scopus and Web of Science. The search focused on articles published from January 2012 to July 2024. Eligible articles were examined to identify the forms of health coaching, the backgrounds and roles of health coaches and the outcomes of health coaching.

Results: An initial search yielded 963 articles, of which 16 were selected for the review. Most studies (n=10) showed that health coaching was used in conjunction with other strategies (multicomponent). The most frequently applied approach was phone coaching (n=9). The majority of the interventions were completed within 6 months (n=4). Eight studies indicated that most health coaches came from health backgrounds including nurses, pharmacists and family doctors. Positive clinical outcomes, such as decreased systolic and diastolic blood pressures or systolic or diastolic blood pressure alone, were documented in all included investigations. The non-clinical outcomes varied.

Conclusion: Health coaching is a promising approach for controlling blood pressure in primary care settings. This study highlights the importance of designing the form, time and staff for conducting effective health coaching in primary care settings.

Abdominal wall endometriosis (AWE) is a rare type of endometriosis, with an incidence ranging from 0.1% to 0.4%. It requires a high index of suspicion to avoid delays in diagnosis and treatment. This case is rather special because AWE occurred without a history of abdominal surgery or pelvic endometriosis. Herein, we report the case of a 48-year-old para-3 woman with localised cyclical abdominal pain associated with abdominal distension. On assessment during menstruation, there were localised tenderness at the right suprapubic area and a non-tender suprapubic mass corresponding to a 14-week-sized gravid uterus. An ultrasound revealed the presence of a heterogeneous hypoechoic lesion at the subcutaneous layer of the right suprapubic region sized 1.8×3.2×4.4 cm with poor demarcation. There were also multiple uterine fibroids varying in size and location. She underwent exploratory laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and abdominal wall mass resection. Intraoperatively, the right abdominal wall mass measuring 6x5 cm and involving the subcutaneous layer was found to adhere to the rectus sheath with some chocolate-stained areas without connection to the peritoneal cavity. Additionally, multiple uterine fibroids were noted. There was no pelvic endometriosis, and the other pelvic organs were normal. The histopathological diagnosis of the abdominal wall mass was endometriosis. AWE should be one of the differential diagnoses even in the absence of previous surgery when encountering a patient with an abdominal wall mass especially when it is related to the menstrual cycle.