Malaysian Family Physician最新文献

Ergotism is a rare but potentially serious condition characterised by peripheral vasospasm. Its diagnosis is challenging because the presentation varies depending on the type and location of the affected blood vessels. Ergot alkaloids, including ergotamine, are metabolised by the cytochrome P450 isoenzyme CYP3A4. Concurrent use of ergotamine with CYP3A4 inhibitors can significantly increase the risk of ergotism. However, this potentially dangerous drug interaction is often underestimated in general practice. Herein, we report the case of a middle- aged woman with a history of migraine headaches, who was treated with Cafergot (ergotamine tartrate and caffeine). After the initiation of human immunodeficiency virus therapy with Kaletra (lopinavir/ritonavir), she experienced recurrent episodes of bluish discoloration, livedo reticularis and tingling sensation in her upper and lower extremities over several years. Despite multiple hospital visits and extensive diagnostic workups, including normal blood investigations and biopsy, the correct diagnosis of ergotism-induced vasospasm due to ritonavir-ergotamine interaction was delayed. This diagnosis was supported by CT angiography, which demonstrated vasospasm of the femoral arteries. The patient's symptoms significantly resolved following ergotamine discontinuation. Ergotism is a self-limiting condition that can be fatal if not recognised and treated promptly. This case highlights the importance of awareness, particularly in primary care settings, on the potential drug interaction, principally in patients receiving drugs that inhibit CYP3A4, such as protease inhibitors. Clinicians should have a low threshold for suspecting ergotism in patients with recurrent or unexplained limb pain, numbness and skin changes, especially if they have a history of ergot alkaloid use.

Introduction: The World Health Organization recommends incorporating asthma programmes into national school health services, although this recommendation is rarely implemented.

Methods: In Malaysia, we developed a multi-level primary school asthma programme incorporating educational sessions for children with asthma and their parents, raising awareness within the whole school community and training school staff to provide first-aid asthma management. The programme was adapted for delivery during the COVID-19 pandemic, and a mixed-method feasibility study was conducted in October 2020.

Results: We identified 34 children with asthma, who comprised 3.7% of the school population. Only 14/34 (41.2%) children with asthma and 4/14 (28.5%) of their parents attended the remote sessions. The in-person session for school staff was attended by 55/62 (88.7%), among whom 86.0% rated the session as good/excellent.

Conclusion: The school-based intervention was feasible and received good feedback, despite the COVID-19 pandemic forcing remote delivery. Stakeholder engagement is essential in the development and feasibility of a school-based asthma programme.

[This corrects the article DOI: 10.51866/cm.674.].

Introduction: Acne is a common chronic inflammatory disease. Misconceptions hinder effective management. This study aimed to explore disease perception, treatment-seeking behaviour and the psychosocial impact of acne.

Methods: A cross-sectional study was conducted in four universities. A self-administered questionnaire was developed and validated. During clinical examination, acne severity was determined using the Comprehensive Acne Severity Scale (CASS) and psychosocial impact using the Cardiff Acne Disability Index (CADI).

Results: Four hundred students with acne aged 20±1.62 years participated, among whom 62.5% were women. The self-perceived acne severity matched the CASS score in 54.4% of the participants but was worse in 37.5%. Approximately 80.5% correctly recognised acne as a disease, while beliefs about its chronicity varied. The aggravating factors were food (92.8%), genetic predisposition (92.8%), stress (91.3%), hygiene (86.3%) and menstruation (84.8%). The information sources were families (79.7%), online social media platforms (60.2%) and friends (58.5%). Doctor consultation was significantly associated with correct disease perception, severe disease and higher psychosocial impact. Cost was the commonest deterrent for seeking (63.8%) and discontinuing treatment (43.2%). The psychosocial impact was predominantly mild (71%). The CADI domains mostly affected were feelings and psychological state. The clinical (odd ratio [OR] =2.29, 95% confidence interval [CI] = 1.45, 3.61) and self-perceived acne severity (OR=4.83, 95% CI=2.79, 8.35) predicted a higher psychosocial impact.

Conclusion: Misconceptions about acne as a disease were not prevalent, and aggravating factors other than food were correctly identified. Common information sources may further perpetuate misconceptions. Financial treatment barriers should be addressed especially in patients with severe acne and psychosocial impacts.

Introduction: This study aimed to determine the effects of parental short message service (SMS) reminders on infant immunisation coverage, timeliness and barriers and evaluate the effects of sex on immunisation outcomes in Maiduguri, Borno State, Nigeria.

Methods: This two-arm quasi-experimental study was conducted in two primary healthcare facilities selected using simple random sampling with opaque envelopes. A total of 524 participants were enrolled using purposive sampling. Data were statistically analysed using the Statistical Package for the Social Sciences version 28 with repeated-measures logistic regression analysis, the Z test for Poisson rates and the Wilcoxon signed-rank test.

Results: The parental SMS reminders significantly improved the immunisation coverage, as reported by 69 (26.3%) (P=0.001, 95% confidence interval [CI] = 12.2-40.5), 117 (44.7%) (P=0.001, 95% CI=32.6-56.9) and 116 (44.3%) participants (P=0.001, 95% CI=34.2-54.4) for the 6th-, 10th- and 14th-week schedules, respectively. Compared to mothers' involvement, fathers' involvement did not significantly affect the immunisation coverage (B=0.158, P=0.311, 95% CI=-0.148-0.464). With regard to the immunisation timeliness, the parental SMS reminders yielded a significant effect for the 6th-, 10th- and 14th-week schedules (P=0.001, 95% CI=25.9-46.7; P=0.001, 95% CI=24.2-43.0; and P=0.001, 95% CI=21.1-36.9, respectively). Compared to mothers' involvement, fathers' involvement significantly influenced the immunisation timeliness (B=0.298, P=0.038, 95% CI=0.016-0.579). Lastly, the parental SMS reminders significantly reduced the barriers to immunisation, with a P-value of 0.001.

Conclusion: Parental SMS reminders can significantly improve immunisation outcomes in Nigeria.

Introduction: About one-third of Malaysian adolescents engage in sexual activities before the age of 14 years, putting them at risk for unplanned pregnancies and sexually transmitted diseases. However, implementing sex education in Malaysia remains controversial and challenging. Therefore, this study aimed to develop and validate a newly gamified sexual and reproductive health (SRH) education module (ReReki) tailored for Malaysian adolescent boys.

Methods: The ReReki module was developed using the analysis, design, development, implementation and evaluation model, based on the theory of planned behaviour. Content validation involved six adolescent health experts, using Russell's model validity approach and a content validity questionnaire. Games were then designed to complement the Sexual and Reproductive Health (SRH) materials. The gamified ReReki module was pre-tested with 20 adolescent boys from a selected school, and the language was refined by a linguistic expert.

Results: The module included five main topics, 29 subtopics and six games. The overall content validity score based on the survey method was 81.8%, while that based on Russell's model was 79.3%, indicating a high level of validity for the ReReki module. One new topic and two subtopics were added, while two subtopics scoring below 70% were flagged for further review. The adolescent boys expressed their acceptance of the gamified SRH content.

Conclusion: All five main topics, along with the 29 subtopics in the ReReki module, are suitable and ready for use by adolescent boys in the Malaysian context.

Introduction: The desire for no additional births may be used to estimate the demand for family planning. Couple education may influence contraceptive use. This study aimed to examine the relationship between education and contraceptive use among women who desire no more children in Indonesia.

Methods: A dataset from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. The sample consisted of 17,938 women aged 15-49 years who desired no more children. Binary logistic regression was conducted for data analyses.

Results: Of the total respondents, 73% used contraceptive methods. Contraceptive use was strongly associated with secondary education among couples (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.17-1.37) and the working status of the husband (OR=2.62; 95% CI=2.07-3.32). The respondents living in rural areas (OR=1.14; 95% CI= 1.06-1.23) and in the Java-Bali region (OR=1.36; 95% CI=1.27-1.46) were more likely to use contraceptive methods. However, the respondents aged more than 35 years were less likely to use contraceptives.

Conclusion: Among women who desire no more children, contraceptive use is associated with educational level, age and place of residence. Educated women tend to be empowered and have better access to contraceptive services, improving their chances of using contraception. Healthcare providers and policymakers need to promote the use of contraceptive services including counselling for couples with a low educational level, urban women and women who live in the outer Java-Bali region.

As dementia has been declared a global health crisis by the World Health Organization, this perspective paper aims to shed light on the cuerent stata of dementia care in Malaysia. The paper firsc outlinea eeveral barriers to dementia care in Malaysia. The shortage of geriatric specialists hampers the accessibility of dementia caee avd resceerces. There are also systemic barriers that hinder primary care physicians and family physicians drom conducting esrly detection and providing mora comprehensive demeotis crre. The lack of dementia-focused community services and public education further compounds issues for people living with dementia (PLWD) and their informal caregivers (ICs). Consequently, ICs suffer mentally from caregiving demands, yet evidence-based psychosocial services to support them are scarce in Malaysia. This paper wraps up with recommendations aligning with Malaysia's national plans and policies to prepare the nation for current and future dementia care needs.

Vulvodynia manifests as persistent vulvar pain, affecting both sexual well-being and overall quality of life. While the precise cause remains elusive, various multifaceted predisposing and precipitating factors have been identified. Neurobiological and psychosocial elements contribute to a better understanding of the management of this complex disorder. Initial evaluation with detailed history-taking and focused pelvic examination are essential to exclude organic diseases contributing to vulvar pain. Management strategies are based on clinical experience, including non-pharmacological approaches and cognitive behavioural therapy. Oral pain-blocking medications such as serotonin-norepinephrine reuptake inhibitors and gabapentin as well as topical treatments such as oestrogen, lidocaine and gabapentin may be considered. More robust evidence is required for pharmacological treatments. Referral to a multidisciplinary team may be required in a proportion of patients who do not respond to conventional treatment. This concise review highlights the contemporary understanding of vulvodynia and proposes a practical approach within primary care settings.