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Fulltext Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor-patient conversations in primary care consultations in Malaysia

Syed A, Mohd Don Z, Ng CJ, Lee YK, Khoo EM, Lee PY, et al.

BMJ Open, 2017 05 09;7(5):e014260.
PMID: 28490553 DOI: 10.1136/bmjopen-2016-014260

OBJECTIVE: To investigate whether the use of apatient decision aid (PDA) for insulin initiation fulfils its purpose of facilitating patient-centred decision-making through identifying how doctors and patients interact when using the PDA during primary care consultations.
DESIGN: Conversation analysis of seven single cases of audio-recorded/video-recorded consultations between doctors and patients with type 2 diabetes, using a PDA on starting insulin.
SETTING: Primary care in three healthcare settings: (1) one private clinic; (2) two public community clinics and (3) one primary care clinic in a public university hospital, in Negeri Sembilan and the Klang Valley in Malaysia.
PARTICIPANTS: Clinicians and seven patients with type 2 diabetes to whom insulin had been recommended. Purposive sampling was used to select a sample high in variance across healthcare settings, participant demographics and perspectives on insulin.
PRIMARY OUTCOME MEASURES: Interaction between doctors and patients in a clinical consultation involving the use of a PDA about starting insulin.
RESULTS: Doctors brought the PDA into the conversation mainly by asking information-focused 'yes/no' questions, and used the PDA for information exchange only if patients said they had not read it. While their contributions were limited by doctors' questions, some patients disclosed issues or concerns. Although doctors' PDA-related questions acted as a presequence to deliberation on starting insulin, their interactional practices raised questions on whether patients were informed and their preferences prioritised.
CONCLUSIONS: Interactional practices can hinder effective PDA implementation, with habits from ordinary conversation potentially influencing doctors' practices and complicating their implementation of patient-centred decision-making. Effective interaction should therefore be emphasised in the design and delivery of PDAs and in training clinicians to use them.

Matched MeSH terms: Private Facilities
Fulltext Non-compliance with inhaled corticosteroid (ICS) among asthma patients in Yazd City, Iran

Azam Rahim, Maimaiti, Namaitijiag, Abuduli, Maihebureti, Zafar Ahmed

Malaysian Journal of Public Health Medicine, 2013;13(2):77-87.
MyJurnal

Asthma is one of the most common chronic diseases in the world. It is estimated that around 300 million people in the world currently have asthma. The prevalence of asthma is increasing in most of countries, especially among children. The burden of severe asthma is considerable high in the Middle East courtiers including Iran. This study to investigate the effect of patients' knowledge about Inhaled Corticosteroids (ICS), attitude and health beliefs toward ICS, and behavioral intention to adhere to prescribed ICS in adult asthmatic patients in Yazd city, Iran. A cross sectional study was conducted from August 2008 to January 2009 in three private allergy and asthma clinics, located in Yazd city of Iran, using Structured face to face interviews using a questionnaire by the researcher. The results showed that the majority of patients (55.5%) were not adherent to their prescribed ICS. Patients’ knowledge toward ICS did not have effect on medication adherence behavior, while patients with positive attitude toward ICS were better adherent with their medication. Linear regression model identifies intention to comply with treatment and positive attitude toward ICS as predictors for adherence behavior. This study shows the relationship between medications beliefs, attitude, behavioral intention, and medication adherence. A better understanding of patient's medication beliefs, and attitude and their effect on compliance may help health care system to promote adherence.

Matched MeSH terms: Private Facilities
Fulltext The usefulness of osteocalcin measurements in Malaysian patients with rheumatoid arthritis

Wong TH, Das Gupta E, Radhakrishnan AK, Gun SC, Chembalingam G, Yeap SS

International e-Journal of Science, Medicine & Education, 2018;12(1):4-10.
MyJurnal

Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population. A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dualenergy x-ray absorptiometry (DXA) was used to assess BMD. Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.
Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, and Klinik Pakar Puchong, Kuala Lumpur, Malaysia

Matched MeSH terms: Private Facilities
Pharmacy students in private institutions of higher education: motivating factors when studying pharmacy and influences on university choice

Loo JSE, Lim SW, Ng YK, Tiong JJL

Int J Pharm Pract, 2017 Dec;25(6):429-437.
PMID: 28211115 DOI: 10.1111/ijpp.12352

OBJECTIVES: To identify factors influencing the decisions of Malaysian first-year pharmacy undergraduate students in private higher education when choosing to pursue a degree in pharmacy as well as their choice of private university.
METHODS: This cross-sectional study employed a validated, self-administered questionnaire which was administered to 543 first-year pharmacy students from nine different private universities. Factor analysis was utilised to extract key factors from the responses. Descriptive and inferential statistics were used to analyse the data.
KEY FINDINGS: Eight factors motivating students' decision to study pharmacy emerged from the responses, accounting for 63.8% of the variance observed. Students were primarily motivated by intrinsic interests, with work conditions and profession attributes also exerting significant influence. In terms of choice of private university, nine factors were identified, accounting for 73.8% of the variance observed. The image of the school and university were most influential factors in this context, followed by university safety, programme attributes and financial factors.
CONCLUSIONS: First-year pharmacy students in the private higher education sector are motivated by intrinsic interest when choosing to study pharmacy over other courses, while their choice of private university is influenced primarily by the image of the school and university.

Matched MeSH terms: Private Facilities/economics*
Fulltext Usefulness of newly acquired commercial dengue NSI antigen test kit for early detection of dengue in a general practice clinic in Batu Gajah, Perak

Chan, S.C., Teoh, L.C.

Asian Journal of Medicine and Health Sciences, 2018;1(1):1-8.
MyJurnal

The non-structural protein 1 (NS1) of the dengue viral genome has been found useful for diagnosis of acute dengue infections, being detected from one day and up to 18 days post onset of symptoms (1). Rapid Dengue NS1 antigen test was made available in commercial test kits for private clinics in Perak in 2014. This study aimed to determine the use usefulness of dengue NS1 test kits in suspected dengue cases in a general practice clinic in Perak and the period in which positive test results were obtained after the onset of symptoms. Clinic records of all suspected dengue cases seen in the ten months from October 2014 to July 2015 were traced. Patients’ demographic characteristics, presenting symptoms and the use of One Step Dengue NS1 Antigen test (Avo Diagnostics) were analyzed using SPSS version 17. Seventy one suspected dengue fever cases were seen in the study period, the highest number in July 2015 (25%). Majority were Chinese (80%), female (63%), and aged 40 years and above (51%). Most patients presented with fever (99%), body-ache (51%), gastrointestinal symptoms (51%) and headache (44%). Dengue NS1 antigen test was done in 94% of the suspected cases with 61% testing positive. The majority of the cases presenting one day to five days after onset of symptoms tested positive i.e. 59% (1 day), 90% (2 days), 54% (3-4 days) and 89% (5 days). Using dengue NS1 antigen test, positive results can be obtained as early as one day after the onset of symptoms. This test is a useful tool to aid primary care physicians detect dengue fever early.

Matched MeSH terms: Private Facilities
Fulltext Analysis of factors in response to rotavirus vaccination counselling in a private paediatric clinic

Kannan Kutty P, Pathmanathan G, Salleh NM

Med J Malaysia, 2010 Jun;65(2):127-32.
PMID: 23756797 MyJurnal

Rotavirus vaccine is available as an optional vaccine in Malaysia. The counselling of optional vaccines is considered an integral part of the health services offered in a private paediatric clinic. While ensuring that all babies are up-todate with their compulsory immunization, counselling of optional vaccines like the rotavirus vaccine could give parents the choice to make an informed decision on the acceptance of this vaccine. Over a period of two years, we counselled the parents regarding diarrhoea caused by rotavirus disease and the rotavirus vaccine. In this study, the factors that were significantly associated with the acceptance of the rotavirus vaccine were the gender of the baby, the mother's age, the mother's occupation, the mode of payment for the vaccine, the number of previous visits to the clinic by the parents, the number of counselling sessions given to the parents and the pre-counselling awareness or knowledge of rotavirus disease and rotavirus vaccine. It is hoped that these findings may assist busy clinicians in their continuous efforts to provide health education and vaccination counselling to the parents of their patients.

Matched MeSH terms: Private Facilities
Fulltext Professional training and roles of community pharmacists in Malaysia: views from general medical practitioners

Ahmad Hassali MA, Awaisu A, Shafie AA, Saeed MS

Malays Fam Physician, 2009;4(2-3):71-6.
PMID: 25606167 MyJurnal

AIM: This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists.
METHODS: A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners' level of agreement using a 5-point Likert-type scale.
RESULTS: Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists' recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients' pharmacotherapeutic outcomes (77.5%).
CONCLUSION: The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.
KEYWORDS: Community pharmacists; general practitioners; perceptions; roles; training

Matched MeSH terms: Private Facilities
Clinical and radiological profile of symptomatic knee osteoarthritis in Malaysia

Veerapen K, Asokan RN, Rathakrishnan V

APLAR Journal of Rheumatology, 2004;7(2):97-107.
DOI: 10.1111/j.1479-8077.2004.00069.x

Aims: To create a clinical and radiological profile of patients with symptomatic osteoarthritis of the knee in Malaysia.
Methods: One hundred consecutive patients presenting with symptomatic knee osteoarthritis at a private rheumatology clinic were profiled for demographic and clinical features. Anteroposterior weight-bearing, skyline and lateral knee X-rays were taken. Statistical Package for Social Sciences was used for data analysis.
Results: Women predominated (93%). Fifty-eight percent of the patients reported bilateral knee pain. Difficulty in walking, climbing and squatting was high (85%, 97% and 93% respectively). Patients with knee pain had a higher BMI than controls. Radiological abnormality, related to osteoarthritis was present in 97%. Osteophytes were generally tricompartmental while joint space narrowing was less evident in the lateral tibiofemoral joint than in the medial tibiofemoral joint and the patellofemoral joint. Almost half (49%) the patients manifested radiological varus deformity The severity of radiological abnormality increased with age. Although patients with unilateral pain had milder radiological abnormality, it tended to be bilateral. Clinically detectable hip abnormality and nodal osteoarthritis were uncommon, as was radiological chondrocalcinosis.
Conclusions: Patients presenting with symptomatic knee osteoarthritis to a rheumatology service had a high degree of disability, radiological abnormality and varus deformity. Radiological abnormalities were essentially bilateral and tricompartmental. © Asia Pacific League of Associations for Rheumatology.

Matched MeSH terms: Private Facilities
Fulltext A pilot study of the primary care management of knee osteoarthritis in the Northern States of Malaysia.

Arshad, A., Rashid, R.

International Medical Journal Malaysia, 2008;7(2):31-36.
MyJurnal

Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.

Matched MeSH terms: Private Facilities
Fulltext Intra-articular sodium hyaluronate for the treatment of osteoarthritis of the knee. A retrospective review of 45 patients.

Yoga R, Mukaram M, Ramachandran

Malays Orthop J, 2009;3(2):4-7.
MyJurnal

Intrarticular Hyaluronic Acid was administered to 45 patients with various grades of osteoarthritis in the knee. Following 3 fortnightly injections, these patients were reviewed at 6 weeks and 3 months with regard to their knee pain. We found the most patients (84.4%) has decreased knee pain following these injections. Patients who had severe grade osteoarthritis based on knee radiographs before the injections were less likely to have pain reduction compared to those with milder grade osteoarthritis. Only 4 (8.9%) patients showed no improvement and were subsequently considered for surgery. Many patients did not require any further treatment (24.4%) and the remaining were given analgesia (64.4%) to aid in their pain. One patient required another course of this injection. there were no complications recorded in this study. We concluded that Intrarticular Hyaluronic acid is an easy and safe method to treat osteoarthritis. The short-term outcome with regard to knee pain is good in patients with milder grades of osteoarthritis.
Study site: Private orthopaedic clinic, Johor, Malaysia

Matched MeSH terms: Private Facilities
Fulltext Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia

Lim HM, Sivasampu S, Khoo EM, Mohamad Noh K

PLoS One, 2017;12(2):e0172229.
PMID: 28196113 DOI: 10.1371/journal.pone.0172229

BACKGROUND: Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation.

METHODS: We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates.

RESULTS: Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71-0.96).

CONCLUSIONS: Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare resources. Nonetheless, geographic expansion alone is inadequate to achieve effective coverage in a dichotomous primary care system, and the role of the private sector in primary care delivery should not be overlooked.

Matched MeSH terms: Private Facilities
Fulltext Optimal cut-off levels to define obesity: body mass index and waist circumference, and their relationship to cardiovascular disease, dyslipidaemia, hypertension and diabetes in Malaysia

Mohd Zaher ZM, Zambari R, Chan SP, Muruga V, Ng B, Appannah G, et al.

Asia Pac J Clin Nutr, 2009;18(2):209-16.
PMID: 19713180

Many studies in Asia have demonstrated that Asian populations may require lower cut-off levels for body mass index (BMI) and waist circumference to define obesity and abdominal obesity respectively, compared to western populations. Optimal cut-off levels for body mass index and waist circumference were determined to assess the relationship between the two anthropometric- and cardiovascular indices. Receiver operating characteristics analysis was used to determine the optimal cut-off levels. The study sample included 1833 subjects (mean age of 44+/-14 years) from 93 primary care clinics in Malaysia. Eight hundred and seventy two of the subjects were men and 960 were women. The optimal body mass index cut-off values predicting dyslipidaemia, hypertension, diabetes mellitus, or at least one cardiovascular risk factor varied from 23.5 to 25.5 kg/m2 in men and 24.9 to 27.4 kg/m2 in women. As for waist circumference, the optimal cut-off values varied from 83 to 92 cm in men and from 83 to 88 cm in women. The optimal cut-off values from our study showed that body mass index of 23.5 kg/m2 in men and 24.9 kg/m2 in women and waist circumference of 83 cm in men and women may be more suitable for defining the criteria for overweight or obesity among adults in Malaysia. Waist circumference may be a better indicator for the prediction of obesity-related cardiovascular risk factors in men and women compared to BMI. Further investigation using a bigger sample size in Asia needs to be done to confirm our findings.
Study site: 93 primary care clinics (klinik kesihatan and general practice clinics) in Malaysia

Matched MeSH terms: Private Facilities
Fulltext Single-dose oral treatment with cefaclor for men with uncomplicated gonococcal urethritis

Lim HB

Med J Malaysia, 1984 Dec;39(4):272-4.
PMID: 6400040

Sixty patients with uncomplicated gonococcal urethritis were treated with a single dose oral regime comprising 3 g of cefaclor and 1 g of probenecid. Forty-eight patients (80%) returned for follow-up and the overall cure rate among them was 91.6%. Among the isolates, 25 (41.7%) showed penicillinase producing Neisseria gonorrhoeae (PPNG) strains. The cure rate for patients infected with PPNG was 85% while the cure rate for non-PPNG was 96.4%. Further work is required to establish the optimum dosage for this particular regimen.

Matched MeSH terms: Private Facilities
Fulltext Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore

Pan DS, Huang JH, Lee MH, Yu Y, Chen MI, Goh EH, et al.

BMC Fam Pract, 2016 11 03;17(1):148.
PMID: 27809770 DOI: 10.1186/s12875-016-0547-3

BACKGROUND: Patients' expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore.

METHODS: Data was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients' expectations for antibiotics.

RESULTS: Nine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed "antibiotics are effective against viruses" (715/914, 78 %) and that "antibiotics cure URTI faster" (594/912, 65 %). Inappropriate antibiotic practices include "keeping antibiotics stock at home" (125/913, 12 %), "taking leftover antibiotics" (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00-2.79), living in private housing (1.69; 1.13-2.51), presence of sore throat (1.50; 1.07-2.10) or fever (1.46; 1.01-2.12), perception that illness is serious (1.70; 1.27-2.27), belief that antibiotics cure URTI faster (5.35; 3.76-7.62) and not knowing URTI resolves on its own (2.18; 1.08-2.06), while post-secondary education (0.67; 0.48-0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics.

CONCLUSION: Majority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge.

Matched MeSH terms: Private Facilities
Do patients' perceptions exceed their expectations in private healthcare settings?

Suki NM, Lian JC, Suki NM

Int J Health Care Qual Assur, 2011;24(1):42-56.
PMID: 21456497 DOI: 10.1108/09526861111098238

PURPOSE: The purpose of this paper is to investigate whether patients' perceptions exceed expectations when seeking treatment in private healthcare settings in the Klang Valley Region of Malaysia.
DESIGN/METHODOLOGY/APPROACH: A survey was conducted among 191 patients in the Klang Valley Region of Malaysia to measure service quality of the private healthcare setting in Malaysia using SERVQUAL 5 dimensions model by Parasuraman et al. and three additional dimensions of the human element, when it comes to rendering good healthcare services, i.e. courtesy, communication and understanding of customers.
FINDINGS: The results revealed that the customers' perceptions did not exceed their expectations, as they were dissatisfied with the level of healthcare services rendered by private healthcare settings in that they felt that the waiting time of more than an hour to receive the service was excessive and, when there was a problem, the healthcare provider did not provide a response fast enough.
RESEARCH LIMITATIONS/IMPLICATIONS: Only eight service quality dimensions were studied. The sample investigated is relatively small, where three private healthcare settings were selected.
PRACTICAL IMPLICATIONS: It is recommended that hospital management should look into highlighted areas for which patients have high expectations.
ORIGINALITY/VALUE: The paper adds to the existing body of research on healthcare service quality, particularly on patients' perceptions and expectations. Survey results should be useful for continuous quality improvement.

Matched MeSH terms: Private Facilities
Infectious agents causing diarrhoea in Malaysian children

Koe, S.L., Puthucheary, S.D., Lam, S.K.

Malaysian Journal of Child Health, 1991;3(1):29-33.
MyJurnal

The stools of 97 children with acute gastroenteritis, attending a private paediatric clinic, were studied for infectious agents. Putative pathogenic microorganisms were identified in 47 cases (48.5%). Food poisoning Salmonella was the most common bacteria detected, 25 cases (25.8%). Rotavirus was present in 9 cases (9.2%). Interview of the parents and care-persons revealed a general lack of knowledge in the proper cleaning and sterilisation of milk bottles, rubber teats and pacifiers. In 44 households there were at least one animal kept and there were positive bacterial isolates from 47% of such households. However, positive isolates were found in only 26% of households with no kept animals. The implications of these findings are discussed. (Copied from article).

Matched MeSH terms: Private Facilities
Fulltext X-ray examinations in private hospitals and clinics

Lam ES

Family Practitioner, 1978;3(4):31-34.

Matched MeSH terms: Private Facilities
Fulltext Natural history of asymptomatic gallstones: differential behaviour in male and female subjects

Sood S, Winn T, Ibrahim S, Gobindram A, Arumugam AA, Razali NC, et al.

Med J Malaysia, 2015 Dec;70(6):341-5.
PMID: 26988206 MyJurnal

OBJECTIVE: The natural history of asymptomatic (silent) gallstones has been inadequately studied. Existing information derives from studies based on oral cholecystography or relatively small sample sizes. We planned a retrospective cohort study in subjects with gallstones to determine conversion rates from asymptomatic to symptomatic.
METHODS: We extracted data from computerised databases of one government hospital and two private clinics in Malaysia. Files were scrutinised to ensure that criteria for asymptomatic gallstones were fulfilled. Patients were called on telephone, further questioned to confirm that the gallstones at detection were truly asymptomatic, and asked about symptoms that were consistent with previously defined criteria for biliary colic. Appropriate ethical clearances were taken.
RESULTS: 213 (112 males) patients fulfilled the criteria for asymptomatic gallstones and could be contacted. 23 (10.8%) developed pain after an average follow up interval of 4.02 years (range 0.1-11 years). Conversion rates from asymptomatic to symptomatic gallstones were high in the first two years of follow up, averaging 4.03±0.965 per year. Over time the conversion rates slowed, and by year 10 the annual conversion rate averaged only 1.38±0.29. Conversion rates were much higher for females compared to males (F:M hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for conversion approached 6.15% for males, and 22.1% for females.
CONCLUSION: In conclusion, asymptomatic gallstones are much more likely to convert to symptomatic in females than in males. Males in whom asymptomatic stones are discovered should be advised conservative treatment. Surgery may be preferable to conservative management if the subject is a young female.
m radiology records of Hospital
Study site: Computerised database, Hospital Selayang, Selangor; private clinics, Kuala Lumpur, Malaysia

Matched MeSH terms: Private Facilities
Fulltext Zika outbreak emergency preparedness and response of Malaysian private healthcare professionals: are they ready?

Rajiah K, Maharajan MK, Yin PY, Yee YW, Lin WW, Kean CH

Microorganisms, 2019;7.
DOI: 10.3390/microorganisms7030087

Zika virus has been declared as a public health emergency of international concern. The Center for Disease Control and Prevention has issued guidelines reminding healthcare workers about the importance of taking steps to prevent the spread of Zika virus, how to test and isolate patients suspected of carrying the Zika virus, and how to protect themselves from infection. Therefore, it is of utmost importance for healthcare professionals to be fully aware of Zika virus preparedness, and response measures should an outbreak occur in Malaysia in order to quickly and efficiently contain the outbreak, ensure the safety of individual or healthcare personnel safety, as well as to prevent further spreading of the disease. This research aims to show how prepared Malaysian healthcare professionals are against Zika virus and how well can they respond during an outbreak. In total, 504 healthcare professionals (128 general practitioners, 215 community pharmacists, 161 nurses) from private health clinics were the target population of the four states of Malaysia where Zika cases suspected. The sample size of each category was calculated by using a formula for estimating the population proportion. An additional 10% of the calculated sample size was added to compensate the non-response rate. The Center For Disease Control and Prevention and World Health Organisation provided a checklist to assess how prepared healthcare professionals are for an Zika outbreak. This checklist was modified to a questionnaire in order to assess health care professionals' preparedness and response to the Zika outbreak. Community pharmacists are still lacking in their preparedness and perceived response to the Zika outbreak compared to the general practitioners in the private sector. Hence community pharmacists should attend training given by the Ministry of Health Malaysia as a continuing education, which may help them to respond during a Zika outbreak.

Matched MeSH terms: Private Facilities
Fulltext A study of hand, food and moth epidemic in Hulu Langat district, 2000. [Tinjauan wabak penyakit tangan, kaki dan mulut (HFMD) di daerah Hulu Langat, 2000]

Meftahuddin Tarip, Jamsiah Mustafa

Malaysian Journal of Public Health Medicine, 2003;3(1):16-22.
MyJurnal

The aim of this study is to describe the epidemiological features of HFMD outbreak in the Hulu Langat District in 2000. Until November 2000, a total of 60 cases were reported and the worst ever reported to the previous years. The mean age of patients was 3.9; 5.8 years with majority of the cases aged between 1 to 4 years old (53.8 per 100,000 of population), male gender (8.3 per 100,000 of populations), and were of Chinese (12.2 per 11 100,000 of populations) and Malay ethnicity (7.2 per 100.000 of populations). All cases were uncomplicated cases and were diagnosed clinically. Most of the notified cases were front the government facilities, which are 44 cases (73.3%). Thirty-five (35) cases (58.4%) were treated as outpatient and 25 cases (41.6%) as in patients (p>0,05). Only 7 cases (11.7%) have history of contact with HFMD patients. The notified cases were mainly from the densely populated areas which were Cheras, Kajang and Ampang. No differences were noted between HFMD cases which have been breasfed for less than 6 month or more, and twenty nine (29) cases (48.3 %) had completed the immunization schedule. In conclusion, the recent emergence of HFMD brings a new challenge, which have to be faced in the prevention and surveillance activities of public health problems in the district.
Study site: Notified cases from Klinik Kesihatan, hospital, private clinics, Ulu Langat, Selangor, Malaysia

Matched MeSH terms: Private Facilities

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