Malaysian Family Physician最新文献

Introduction: Telemedicine is the provision of healthcare remotely via information and communications technology (ICT). This study aimed to assess the familiarity and factors related to the perception towards telemedicine and the willingness to practise telemedicine among primary care doctors.

Methods: A multi-centre cross-sectional study was conducted prospectively at all public healthcare clinics across Kuching, Sarawak. A questionnaire was adapted and modified from an overseas validated questionnaire, consisting of four parts: demographic data, familiarity towards telemedicine, factors related to the perception of telemedicine and willingness to implement telemedicine.

Results: A total of 131 doctors were recruited. Of them, 43.5% had never interacted with patients via email, WhatsApp or Telegram, while 68.7% had never attended any conferences, speeches or meetings regarding telemedicine. The doctors had low familiarity towards guidelines, technology and medical applications of telemedicine. The majority agreed on the ability of telemedicine to save patients' time and money, the potential of ICT in healthcare and the necessity during a pandemic but perceived the possibility of technical difficulties. The doctors who had experience in interacting with patients via email, WhatsApp or Telegram (P=0.001) and those who had ≤8 years of working experience (P=0.04) had a significantly better perception towards telemedicine.

Conclusion: Although the familiarity towards telemedicine among public primary care doctors is low, their perception is good in a majority of areas. Adequate technological support and continuous education on telemedicine and its guidelines, especially medicolegal issues, are imperative to adopt and propagate telemedicine in primary care.

Introduction: Syphilis and human immunodeficiency virus (HIV) coinfection is a common clinical problem with a significant rising trend worldwide. In Malaysia, the burden of care is shared between hospitals and primary care clinics. This study aimed to determine the prevalence of syphilis among people living with HIV (PLHIV) at primary care clinics in Malaysia and assess its association with sociodemographic characteristics, risk factors and treatment outcomes.

Methods: This retrospective study included 750 PLHIV aged ≥18 years who attended primary care clinics in three different locations in Malaysia from 1 January 2017 to 31 December 2019. Data were obtained from the patients' clinical notes using a structured questionnaire evaluating the sociodemographic characteristics, history of sexual and lifestyle behaviours, diagnosis and management.

Results: The patients' age ranged from 18 to 78 years (mean=34.7, standard deviation=10.2). The prevalence of syphilis among the PLHIV at the three primary care clinics was 33.8% (n=254). Syphilis was significantly associated with gender (P=0.038) as well as sexual activity (P<0.001), substance use (P=0.038), history of chemsex (P=0.001) and history of sexually transmitted infections (STIs) (P<0.001) within the past 12 months. The majority of the PLHIV with syphilis received treatment at the primary care clinics (n=248, 97.3%), and up to 96.1% (n=245) had completed such treatment.

Conclusion: Syphilis is prevalent among PLHIV at primary care clinics, and most patients receive standard treatment. Therefore, primary care doctors must enhance their knowledge to effectively manage STIs, especially syphilis.

Introduction: Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions.

Methods: A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted.

Results: Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56-0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02-2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI= 1.01-1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84-0.98, P=0.015) had a lower risk of anxiety than their counterparts.

Conclusion: Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.

Introduction: Autism spectrum disorder (ASD) is a developmental disability that causes significant social, communication and behavioural challenges. The Modified Checklist for Autism in Toddlers (M-CHAT) is a parent-administered screening questionnaire for ASD used at 18 and 36 months of age. This study aimed to determine the outcomes of children who failed M-CHAT screening during routine health screening at maternal and child health clinics in northeast district, Penang and the prevalence of ASD among those with a final diagnosis.

Methods: This retrospective cohort study was conducted at 12 maternal and child health clinics. All children who failed M-CHAT screening at 18 and 36 months from January 2017 to December 2021 and received a final diagnosis before 31 March 2022 were recruited. All information required was recorded in a data collection form and analysed using SPSS. Multiple logistic regression was performed to assess the association between the factors and ASD status.

Results: Eighty-two children failed M-CHAT screening. Fifty children did not receive a final diagnosis. Among 32 children who received a final diagnosis, 25 were diagnosed with ASD (78.1%). Among the children who underwent M-CHAT screening, the odds of having ASD increased by a factor of 1.2 for every 1-unit increase in age at final diagnosis.

Conclusion: In northeast district, Penang, more than half of children who fail M-CHAT screening have no final diagnosis. The specificity of the M-CHAT is 78.1% among children with a final diagnosis of ASD. The age at final diagnosis is positively associated with the diagnosis of ASD.

Introduction: Parents are key decision-makers in the immunisation practice and compliance of children. This study aimed to determine the knowledge and practice of immunisation among parents in Kelantan, Malaysia, and their associated factors.

Methods: A cross-sectional study was conducted using a validated online questionnaire from May to June 2021. An invitation was distributed to parents attending a university hospital and extended families of staff through online platforms. A total of 311 parents participated in the study. The questionnaire consisted of 10 questions each on knowledge and practice and three questions on vaccination status. Descriptive analysis was performed. The associations between the sociodemographic characteristics and knowledge and practice scores were determined using the chi-square test, and predictive factors were identified using logistic regression analysis.

Results: Most respondents were Malay (94.2%), Muslim (94.5%), women (79.7%) and married (96.1%). The median score for immunisation knowledge and practice was 8 (interquartile range [IQR]=2) and 7 (IQR=3), respectively. Multiple logistic regression revealed that parents who were unmarried or single, less educated, and had lower incomes were predicted to have poor knowledge of childhood vaccination (P<0.05). Conversely, those living outside Kota Bharu, less educated, and younger parents were predicted to have poor vaccination practice of childhood vaccination (P<0.05). Most respondents (97.8%) indicated completing their children's vaccination schedule.

Conclusion: Parental education and household income are associated with immunisation knowledge and practice. Improving access to information about childhood vaccination among targeted groups may further boost immunization coverage.

Orbital cellulitis is an extremely rare but potentially lethal condition in neonates. The clinical presentation of neonatal orbital cellulitis can be non-specific, and minimal signs of periorbital inflammation may go unrecognised by inexperienced parents or primary care medical personnel, leading to delayed treatment. Herein, we present a case series describing ophthalmia neonatorum complicated with neonatal orbital cellulitis owing to delayed treatment. The clinical presentation, management and outcomes are described. One neonate had orbital cellulitis, while the other had impending orbital cellulitis, with both cases resulting from delayed treatment of ophthalmia neonatorum. Both neonates were hospitalised for systemic antibiotic treatment and fully recovered with good outcomes. Timely identification and treatment of ophthalmia neonatorum are critical to mitigate potential severe sequelae, such as neonatal orbital cellulitis.

Introduction: During the coronavirus disease (COVID-19) pandemic, there was a widespread public misconception regarding ivermectin use in managing the disease. There is no approval of ivermectin as COVID-19 treatment by the Food and Drug Administration, and the adverse effects of the drug are alarming. This study aimed to evaluate the knowledge and attitude towards and prevalence of ivermectin use as COVID-19 treatment among the Malaysian population.

Methods: This cross-sectional study was conducted among 391 Malaysians aged ≥18 years. A validated online self-administered questionnaire disseminated via Google Forms was used to evaluate the knowledge and attitude towards and prevalence of ivermectin use as COVID-19 treatment. The socio-demographic characteristics and knowledge and attitude towards and prevalence of ivermectin use among the respondents were evaluated through descriptive analysis. The chi-square test was used to identify the association between the variables.

Results: The respondents had moderate levels of knowledge and attitude towards ivermectin use, while the prevalence of ivermectin use was 3.58%. The respondents' sex (P=0.014), age (P=0.012) and monthly income (P=0.049) were significantly associated with their level of knowledge. The respondents' sex (P=0.04) was significantly associated with their level of attitude. Conversely, no socio-demographic characteristics were significantly associated with the prevalence of ivermectin use as COVID-19 treatment.

Conclusion: The majority of Malaysians have moderate levels of knowledge and attitude towards ivermectin use as COVID-19 treatment, with a low prevalence of actual use.