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  1. Proportions of circulating T cells with a regulatory cell phenotype increase with HIV-associated immune activation and remain high on antiretroviral therapy
    Lim A, Tan D, Price P, Kamarulzaman A, Tan HY, James I, et al.
    AIDS, 2007 Jul 31;21(12):1525-34.
    PMID: 17630546
    To examine the relationships between blood CD4 natural regulatory T (Treg) cells, plasma HIV RNA level, CD4 T-cell count and immune activation in untreated HIV-infected patients and immunodeficient patients beginning antiretroviral therapy (ART), using a novel phenotype to define Treg cells (CD25CD127CD4). Data were compared with established Treg cell markers (FoxP3, CTLA-4 and GITR).
    Matched MeSH terms: Cross-Sectional Studies
  2. Fulltext Factors associated with reduced function and quality of life among adult people with HIV with depression and substance use in the Asia-Pacific region
    Rajasuriar R, Chong ML, Ross JL, Jiamsakul A, Avihingsanon A, Lee MP, et al.
    AIDS, 2023 Apr 01;37(5):823-835.
    PMID: 36728672 DOI: 10.1097/QAD.0000000000003474
    BACKGROUND: Depression and substance use (SU) disorders are prevalent among people with HIV (PWH) and impact health outcomes despite successful antiretroviral therapy (ART). We explored quality of life, functional ability and associated factors among PWH screened positive for depression and/or SU.

    METHODS: This cross-sectional study recruited adult PWH during routine follow-up at five HIV clinical sites in the Asia-Pacific region. Participants were screened for depression using Patient Health Questionnaire-9 and SU using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Quality of life (QoL) was assessed with WHOQOL-HIV BREF and functional ability with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Factors associated with mean QoL and disability scores were analysed using linear regression.

    RESULTS: Of 864 PWH enrolled, 753 screened positive for depression or SU. The median (interquartile range, IQR) age was 38 (31-47) years and 97% were on ART. Overall mean WHOQOL-HIV BREF and WHODAS scores indicated greater impairment with increasing depressive symptom severity and SU risk. In multivariate analysis, PWH reporting previous trauma/stress (difference = 2.7, 95% confidence interval [CI] 1.5-3.9, P  

    Matched MeSH terms: Cross-Sectional Studies
  3. Fulltext Stigma toward men who have sex with men among future healthcare providers in Malaysia: would more interpersonal contact reduce prejudice?
    Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, et al.
    AIDS Behav, 2016 Jan;20(1):98-106.
    PMID: 26324078 DOI: 10.1007/s10461-015-1168-x
    Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM.
    Matched MeSH terms: Cross-Sectional Studies
  4. Fulltext Evaluating Physicians' Intention to Discriminate Against Patients Living with HIV in Malaysia
    Tee YC, Earnshaw VA, Altice FL, Jin H, Kamarulzaman A, Wickersham JA
    AIDS Behav, 2019 Apr;23(4):1039-1047.
    PMID: 30560483 DOI: 10.1007/s10461-018-2362-4
    People with HIV (PWH) in Malaysia experience high levels of stigma, which may act as a barrier to accessing healthcare. Stigma against PWH in medical settings is understudied in Malaysia. In the present study, we examine factors associated with physicians' intention to discriminate against PWH in Malaysia. A cross-sectional online survey was emailed to all 1431 physicians at two major university hospitals in Malaysia; 568 (39.6%) participants completed the survey and were included in this analysis. Measures included intention to discriminate against PWH, stigma-related constructs, and socio-demographic characteristics. Multivariate linear regression was used to identify factors associated with intention to discriminate against PWH. Participants were comprised of women (53.5%), Malays (43.1%), and Chinese (35.0%) with nearly 10 years of clinical experience. Most participants were from non-surgical specialties (77.6%). The final multivariate linear regression showed that physicians who expressed greater discriminatory intent against PWH also expressed more negative feelings toward PWH, more HIV-related shame, were more fearful of HIV, and believed that PWH do not deserve good care. Physicians from surgical-based specialties were also significantly more likely to endorse discriminatory intent toward PWH. Stigma and intentions to discriminate against a class of patients, including PWH, can undermine engagement in care, which is central to international HIV prevention and treatment strategies. Interventions that reduce stigma toward PWH among physicians are crucial to ensuring equitable and stigma-free healthcare.
    Matched MeSH terms: Cross-Sectional Studies
  5. Fulltext Is forced migration a barrier to treatment success? Similar HIV treatment outcomes among refugees and a surrounding host community in Kuala Lumpur, Malaysia
    Mendelsohn JB, Schilperoord M, Spiegel P, Balasundaram S, Radhakrishnan A, Lee CK, et al.
    AIDS Behav, 2014 Feb;18(2):323-34.
    PMID: 23748862 DOI: 10.1007/s10461-013-0494-0
    In response to an absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (≥18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral loads. The primary outcome was unsuppressed viral load (≥40 copies/mL). Among a sample of 153 refugees and 148 host community clients, refugees were younger (median age 35 [interquartile range, IQR 31, 39] vs 40 years [IQR 35, 48], p 
    Matched MeSH terms: Cross-Sectional Studies
  6. Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety
    Culbert GJ, Waluyo A, Wang M, Putri TA, Bazazi AR, Altice FL
    AIDS Behav, 2019 Aug;23(8):2048-2058.
    PMID: 30465106 DOI: 10.1007/s10461-018-2344-6
    With adequate support, people with HIV (PWH) may achieve high levels of adherence to antiretroviral therapy (ART) during incarceration. We examined factors associated with ART utilization and adherence among incarcerated PWH (N = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2-24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2-12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7-6.2, p 
    Matched MeSH terms: Cross-Sectional Studies
  7. Fulltext Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region
    Ross JL, Jiamsakul A, Avihingsanon A, Lee MP, Ditangco R, Choi JY, et al.
    AIDS Behav, 2022 Dec;26(12):3862-3877.
    PMID: 35668223 DOI: 10.1007/s10461-022-03714-5
    Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and
    Matched MeSH terms: Cross-Sectional Studies
  8. HIV-related characteristics among female partners of injecting drug users in Kelantan, Malaysia: a descriptive study
    Mohd Nasarruddin A, Wan Mohammad WM, Nik Hussain NH, Ali SH, Zubir HM
    AIDS Care, 2015;27(3):301-6.
    PMID: 25471247 DOI: 10.1080/09540121.2014.985182
    Kelantan, a northeastern state in Peninsular Malaysia, is one of the states that has been acutely hit by injecting drug user (IDU)-driven HIV epidemic, in addition to having a high number of infected women in Malaysia. This cross-sectional study describes the socio-demographic characteristics, HIV risk factors, risk perception, and adoption of preventive behaviors among female partners of IDUs in Kelantan. Out of 101 women, the majority of them are from low socioeconomic background and have no other risk factors besides heterosexual HIV transmission from their male IDU partners. Although 45.5% have not been tested for HIV and more than half (53.5%) of them did not use condoms during sexual intercourse, only 44.6% of the women perceived themselves to be at risk of being infected with HIV. Most of the women (86.1%) were willing to undergo voluntary counseling and testing (VCT). Female partners of IDUs continue to be vulnerable to HIV due to having sexual contact with IDUs, and also due to their socioeconomic position in the community. To prevent HIV transmission among female partners of IDUs, consolidating HIV prevention efforts from multiple approaches is needed.
    Matched MeSH terms: Cross-Sectional Studies
  9. The relative risk of HIV among IDUs not in treatment in Malaysia
    Vicknasingam B, Narayanan S, Navaratnam V
    AIDS Care, 2009 Aug;21(8):984-91.
    PMID: 20024754 DOI: 10.1080/09540120802657530
    Despite the growing HIV threat among injecting drug users (IDUs) in Malaysia, there is a dearth of information on their HIV risk behaviour. This study focused on identifying specific risk behaviours that distinguished HIV positive IDUs from those who were not. For the first time, data on IDUs not in treatment were obtained through a cross-sectional survey of 526 subjects recruited from five selected cities across peninsular Malaysia. A structured questionnaire and face-to-face interviews were utilised to collect detailed information on their drug use practices and sexual behaviours. On-site serological testing determined their HIV and hepatitis C status. The findings indicated that ethnic Malays, who are also Muslims, form the majority of IDUs not in treatment. Bivariate analysis identified six risk factors associated with HIV seropositivity: being 44 years or younger; not holding a regular job; initiating drug use at age 23 or younger; being a morphine user; sharing injecting equipment and having multiple-sex partners. However, only the last two remained significant in multivariate analysis. That sharing contaminated injecting equipment is a significant risk factor strongly justifies the widening of the pilot needle and syringe exchange programme initiated hesitantly in late 2005 as a reaction to the worsening HIV/AIDS situation. Condom use, though not independently significant, remains important because consistent and wider use could neutralise the second risk factor--having multiple-sex partners. The finding that injecting drug use is increasingly occurring in groups underscores the need for outreach programmes that emphasise safe injecting practices in group settings. In addition, counsellors should endeavour to convince drug users to enter treatment since being in treatment appears to reduce risk behaviours. Finally, conservative Muslim unease about harm reduction must be assuaged quickly since Malay Muslims form the majority of IDUs not in treatment.
    Matched MeSH terms: Cross-Sectional Studies
  10. Fulltext Multi-ethnic perspective of uptake of HIV testing and HIV-related stigma: a cross-sectional population-based study
    Wong LP
    AIDS Care, 2013;25(11):1356-69.
    PMID: 23406514 DOI: 10.1080/09540121.2013.766302
    The objective of this study was to identify demographic characteristics and correlates of the uptake of HIV testing, willingness to be tested and perceived HIV-related stigma of Malaysian lay public. A cross-sectional computer-assisted telephone interview survey of a representative sample of multiracial Malaysians aged 18 years and above was conducted between December and July 2011. The survey collected information on demographics, knowledge about HIV transmission and religious beliefs on attitudes to HIV/AIDS. A total of 2271 households were successfully interviewed. The response rate was 48.65%. The HIV transmission knowledge score ranged from 0 to 15 (mean =10.56; SD±2.42). Three of the most common misconceptions about HIV transmission were mosquito bite (42.8%), eating in a restaurant where the cook is HIV positive (20.4%) and using a public toilet (20.1%). Only 20.6% reported ever having been tested for HIV, 49.1% reported a willingness to be tested for HIV and 30.3% had no intention of getting an HIV test. Low-risk perception (63.7%) constitutes a major barrier to HIV testing. Being Malay and Chinese (relative to Indian) were the strongest predictors of low-risk perception. Other significant predictors of low-risk perception were being male, being married and living in an urban locality. Perceived self-stigma if tested positive for HIV was prevalent (78.8%). Multivariate findings showed that being female, Malay, low income, living in rural localities and public stigma were significant correlates of self-stigma. These findings warrant interventions to reduce the disproportionate HIV transmission misconception, barriers to HIV testing and stigma and discriminative attitudes to involve considerations of sociocultural economic and demographic characteristics.
    Matched MeSH terms: Cross-Sectional Studies
  11. HIV infection among injecting drug users in north-east Malaysia, 1992
    Singh S, Crofts N
    AIDS Care, 1993;5(3):273-81.
    PMID: 8218462 DOI: 10.1080/09540129308258610
    Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)
    Matched MeSH terms: Cross-Sectional Studies
  12. Fulltext An assessment of health-care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency
    Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al.
    AIDS Care, 2014;26(10):1223-8.
    PMID: 24625279 DOI: 10.1080/09540121.2014.894616
    Stigma perpetuated by health-care providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWIDs), and men who have sex with men (MSM) in multiple clinical contexts and remains unexamined among professional health-care students in Malaysia. This cross-sectional, anonymous, and Internet-based survey assessed the attitudes of medical and dental students toward HIV-infected, PWID, and MSM patients. Survey invitation was emailed to 3191 students at 8 professional schools; 1296 (40.6%) responded and scored their attitudes toward these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0 (most negative) to 100 (most positive). Compared to general patients (mean = 76.50), the mean scores for HIV-infected (mean = 54.04; p < 0.001), PWID (mean = 37.50; p < 0.001), and MSM (mean = 32.13; p < 0.001) patients were significantly lower and significantly different between each group comparison. Within group differences, most notably religion, ethnicity, and personally knowing someone from these populations were associated with significant differences in attitudes. No differences were noted between pre-clinical and clinical year of training. Health-care students represent the next generation of clinicians who will be responsible for future HIV prevention and treatment efforts. Our findings suggest alarmingly negative attitudes toward these patients, especially MSM, necessitating prompt and effective interventions designed to ameliorate the negative attitudes of health-care students toward vulnerable populations, specifically HIV-infected, PWID, and MSM patients in Malaysia.
    Site site: online surveys at seven universities: University of Malaya, National University of Malaysia, International Islamic University Malaysia, Universiti Malaysia Sarawak, Penang International Dental College, Universiti Teknologi MARA Malaysia, and Universiti Sains Malaysia.
    Matched MeSH terms: Cross-Sectional Studies
  13. Fulltext Group sex, suicidality and online partners: implications for HIV and suicide prevention: a short report
    Kongjareon Y, Samoh N, Lim SH, Peerawaranun P, Jonas KJ, Guadamuz TE
    AIDS Care, 2020 08;32(8):954-958.
    PMID: 32160793 DOI: 10.1080/09540121.2020.1734174
    HIV-related factors and suicide-risk status were assessed among YMSM aged 18-24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17-2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09-2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05-2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26-2.21), and self-assessed as having "medium" or "high" HIV risk (AOR=2.53, 95% CI: 1.61-3.98 and AOR=3.35, 95% CI: 1.92-5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide.
    Matched MeSH terms: Cross-Sectional Studies
  14. Current HIV type 1 molecular epidemiology profile and identification of unique recombinant forms in Jakarta, Indonesia
    Sahbandar IN, Takahashi K, Djoerban Z, Firmansyah I, Naganawa S, Motomura K, et al.
    AIDS Res Hum Retroviruses, 2009 Jul;25(7):637-46.
    PMID: 19621986 DOI: 10.1089/aid.2008.0266
    HIV infection is a major problem in Indonesia. The number of people living with HIV has been increasing from year to year, especially among injecting drug users (IDUs). Since there were only limited data about molecular epidemiology profiles of HIV/AIDS in Indonesia, a cross-sectional study involving 208 HIV-1-seropositive individuals was conducted in 2007 in Jakarta. The majority of participants were 16-30 years of age (64.9%) and 74.5% were male. The most frequent risk factor was injecting drug use (IDU) (45.7%) followed by heterosexual transmission (34.1%). Phylogenetic analysis of gag (p17 and p6) and env C2V3 regions showed 200 (96.2%) of 208 DNA samples were CRF01_AE and only 3 (1.4%) were subtype B. Five samples (2.4%) indicated discordant subtypes between the three aforementioned regions: three of them showed unique CRF01_AE/B recombination patterns in 2.3-kbp nucleotide sequences (from p17 to part of RT), including one sample showing similarity to CRF33_01B, reported previously in Malaysia. This study shows the current predominant subtype is CRF01_AE in every risk group, with a decreasing number of pure subtype B, and the first identification of CRF01_AE/B recombinant forms among HIV-1-seropositive Indonesians.
    Matched MeSH terms: Cross-Sectional Studies
  15. Fulltext The relationship of socio-demographic characteristics and knowledge of breast cancer on stage of behavioral adoption of breast self-examination
    Moey SF, Mutalib AMA, Mohamed NC, Saidin N
    AIMS Public Health, 2020;7(3):620-633.
    PMID: 32968682 DOI: 10.3934/publichealth.2020049
    Background/aim: In Malaysia, breast cancer is the most common cancer among women. As such, early diagnosis and screening practices are important to increase the survival rate. Breast self-examination (BSE) is one of the main screening methods for breast cancer. Socio-demographic characteristics and knowledge of breast cancer are amongst the crucial roles in determining women's behavioral adoption in performing BSE. This study aims to assess the relationship of socio-demographic factors and knowledge of breast cancer on the stage of behavioral adoption of BSE among Malaysian women in Kuantan, Pahang.

    Materials and methods: A cross-sectional study was conducted on 520 women from three different government health clinics in Kuantan and IIUM Family Health Clinic from February to April 2018. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of breast cancer and its effect on the behavioral adoption of BSE.

    Results: Significant difference was found between socio-demographic characteristics and behavioral adoption of BSE. However, only breast screening and the best time for screening were found to be significant with the behavioral adoption of BSE and knowledge of breast cancer.

    Conclusion: It is found that most women in Kuantan, Pahang perform BSE but were still unaware of the importance of performing BSE for early breast cancer detection. This study was expected to enhance women's awareness of the benefits of performing BSE.

    Matched MeSH terms: Cross-Sectional Studies
  16. Antibiotic prophylaxis in elective colorectal surgery
    Gul YA, Lian LH, Jabar FM, Moissinac K
    ANZ J Surg, 2002 Apr;72(4):275-8.
    PMID: 11982514
    Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well-known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence-based medicine is employed in relation to this practice.
    Matched MeSH terms: Cross-Sectional Studies
  17. Pattern of psoriatic arthritis in an Asian population (Malaysia)
    Veerapen KK
    APLAR Journal of Rheumatology, 2007;10(4):287-294.
    DOI: 10.1111/j.1479-8077.2007.00308.x
    Objective: To profile the pattern of psoriatic arthritis (PsA) and its relationship to disease duration. Methods: Forty-six consecutive patients with PsA were entered into a cross-sectional study. Demographic data, disease duration and disability were recorded. Joint involvement was documented at 6 months from onset and at presentation. X-rays of the sacroiliac (SI) joints, thoracolumbar spine, and hands were taken. HLA B27 typing was done. Results: The male: Female ratio was 2.3: 1, mean age at onset of arthritis was 35.8 years and mean duration of PsA was 4.2 years. Oligoarticular involvement predominated (63%) at onset. Progression from oligoarthritis to polyarthritis occurred largely in the second year; 65.2% reported asymmetrical disease at onset while 50% had asymmetrical disease when disease duration was >.1 year. The frequency of involvement at onset was as follows: Sausage toes, metatarsophalangeals (MTPs) and interphalangeals (IPs) in 50% (each), proximal interphelangeals (PIPs) in 47.8%, sausage fingers 34.7% and knees 30%. With mean duration of 4.2 years it was: Sausage toe 71.1%, IP 69.5%, PIP and MTP 63%, knees 60.8%, distal interphalangeals (DIPs) 54.3%, sausage finger 52.1%, wrist 47.8%, followed by neck and back pain. Disability related to lower limb functions predominated and occurred early. Forty-one percent had radiological sacroiliatis/spondylitis and 46% had erosive arthritis in the hands; 10.2% were HLA B27 positive. Conclusion: PsA was progressive, starting predominantly as an asymmetrical oligoarthritis and becoming largely polyarticular within 2 years from onset. Lower limb disability was evident early and erosive changes in hand X-rays were seen in more than half the patients after 1 year. © 2007 Asia Pacific League of Associations for Rheumatology.
    Matched MeSH terms: Cross-Sectional Studies
  18. Use of complementary medicine in systemic lupus erythematosus patients in Malaysia
    Goh EML, Tan LC, Chow SK, Teh LK, Yeap SS
    APLAR Journal of Rheumatology, 2003;6(1):21-25.
    DOI: 10.1046/j.0219-0494.2003.00021.x
    Aim: To determine the prevalence of the use of complementary medicine in patients with systemic lupus erythematosus (SLE)., Method: A prospective survey was conducted of 132 patients using a standard questionnaire., Results: Of the 132 patients, 15.2% were on alternative therapy and 56.7% were taking food supplements. The common types of alternative therapy taken were oral traditional herbs (50%) and noni juice (20%). Vitamin C, calcium, vitamin E, vitamin B, Spirulina, evening primrose oil, fish oil and multivitamins were the commonest food supplements. There was no significant relationships between taking alternative treatment and educational level (P = 0.16), income (P = 0.05) or race (P = 0.42) of the patients. The majority of these patients took these therapies or supplements for up to 1 year. Up to 70% of the patients had not consulted a doctor before taking these therapies, with immediate family members and friends being the main sources of recommendation. The majority of patients spent RM50-RM500 (US$13-US$132) for 2 months' supply of medications. In conclusion, 15.2% of SLE patients in our study were on alternative therapy and 57.6% on food supplements., Conclusion: Physicians should be aware of these practices which should be taken into account during the history-taking and subsequent management of the patients.
    Matched MeSH terms: Cross-Sectional Studies
  19. Knowledge of osteoporosis among primary care doctors in Malaysia. [Abstract]
    Das Gupta E, Goh EML, Gun SC, Hussein H, Shahril NS, Yeap SS
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A53.
    Background: In the ageing population, osteoporosis (OP) is becoming an increasingly common medical condition. Effective interventions are available that should enable clinicians to limit the magnitude of the burden but this will require the proper knowledge of OP and its management. Objective: To explore family physicians' perceptions of OP and to identify their educational needs in this area.
    Method: Self administered questionnaires about OP knowledge and management were distributed to attendees of Rheumatology Workshops for primary care physicians between March and November 2005, in Malaysia.
    Results: A total of 134 primary care physicians participated in this survey comprising 53% private practitioners, 44% government doctors, 2.2% from academic institutions and 0.7% not stated. The majority 73 (54.4%) had practiced for more than 10 years, 29 (21.6%) under 5 years and 32 (23.9%) between 5 and 10 years. 127 (94.4%) of them saw patients with osteoporosis. Those who had qualified for over 10 years were more likely to treat OP (p = 0.012). 82% felt that osteoporosis was under-diagnosed whereas 14.9% thought it was over diagnosed. This was not related to specialty or years qualified. Regarding the reasons for under-diagnosis of osteoporosis, 71% stated that they had no access to DXA screening, 74% had no access to heel ultrasound, 66% felt the disease was asymptomatic, 37% felt that investigations were costly and only 11% perceived the problem as a lack of referral for specialist opinion. Majority of respondents recognized the risk factors for OP such as increasing age (93%), post menopausal state (90%), positive family history (70%) and a previous low trauma fracture (65%). 7% were not sure how to further investigate a case of OP. For all categories of bone density, under 50% would advise changes in life-style measures. For osteopenia, 65.7% recommended calcium, 54.5% activated vitamin D products. For OP, 79.1% would use bisphosphonates, 50% calcium. In established OP, 80.6% would use bisphosphonates, 44% calcium. Usage of HRT and SERMs ranged between 20% and 30% in all categories. 63% were aware of the Malaysian Clinical Practice Guidelines on Osteoporosis. 22% would not refer to a specialist, whereas 50.4% would refer severe cases only. Almost all (98%) requested for further continuing medical education on OP.
    Conclusions: In this study, the majority of primary care physicians had a reasonable working knowledge of the management of OP. However, 71% had no access to DXA. Therefore, awareness needs to be supplemented by adequate facilities to further improve the management of OP in the community.
    Matched MeSH terms: Cross-Sectional Studies
  20. Disease of Kings - clinical characteristics at two tertiary referral centers in Malaysia. [Abstract]
    Eashwary M, Hussein H
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A89.
    DOI: 10.1111/j.1479-8077.2006.00199_15.x
    Introduction: Gout is a clinical syndrome resulting from the deposition of monosodium urate monohydrate crystals. Recent studies have shown gout to be a significant metabolic disorder. However, there has been insufficient information on the clinical spectrum in the Malaysian population.
    Objective: This study is conducted to review the clinical characteristics of patients with gout.
    Study methods: In this cross-sectional study 52 patients with gout were recruited. The records of 13 patients from National University of Malaysia Hospital and 39 patients from Putrajaya Hospital, attending the rheumatology clinic between October and December 2005 were reviewed. Results: Gout was found predominantly among ethnic Malays 83%, and Chinese 17% in these centers. The male to female ratio was 12 :1. The peak age of onset of the disease was less than 40 years in 46% of the subjects. Primary gout in females was seen after menopause. 37% cases had a definitive hereditary incidence. At the first presentation 83% had acute monoarthritis and 17% acute polyarticular arthritis. Podagra was seen in 62%. Peripheral joints involvement was seen in 81% patients. Tophaceous gout was seen in 42%. In 85% cases the disease had a chronic polyarticular course, whereas in 15% the disease remained only at a single joint. In 10% cases, there was associated sero-negative arthritis. Associated disorders included hypertension (65%), diabetes mellitus (33%), dyslipidemia (56%), ischemic heart disease (23%), urate nephropathy (39%), uric acid nephrolithiasis (2%). In 88% of cases, there was associated hyperuricaemia. Most of the patients were overweight with body mass index 25-29 (39%) and obese with body mass index 30-70 (36%). Conclusions: Gout is not an unusual disorder in our centre. The age of onset of gout occurred much earlier with forty-six per cent of patients having their first attack of gout before the age of 40. Primary gout in females was seen after menopause. Majority of patients first presented with acute monoarthritis, of which sixty-two per cent presented with podagra. The incidence of tophi was high. Patients with gout should be screened for other associated disorders like diabetes mellitus, hypertension, dyslipidemia and obesity.
    Matched MeSH terms: Cross-Sectional Studies
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