Introduction: Depression is an important problem in primary care practice and is the commonest psychiatric disorder among the elderly.
Aim: To assess the prevalence of depression among the elderly patients attending a rural primary health care clinic in Malaysia and to identify its associated factors.
Method: The Geriatric Depression Scale (GDS) questionnaire was used as a screening instrument. Patients with positive GDS scores for depression were further assessed for Major Depression.
Results: 14% of the patients were found to have depression. The associated factors identified were gender, marital status, educational level, total family monthly income, living arrangement and if they had someone to confide in. Further clinical evaluation using the DSM IV Criteria for major depression revealed that two-thirds of the patients with depression were suffering from major depression.
Conclusion: The prevalence of depression among the elderly patients at a rural primary health care clinic was high. Primary health care doctors and staff should take extra care to detect depression when managing elderly patients.
Epilepsy is the most common neurological disorder in pregnancy. The effects of epilepsy include congenital abnormalities which are increased 2-3 fold. The babies born suffer from haemorrhagic disease of newborn. Preconception management and folic acid supplementation is important in optimizing outcome. With close monitoring and proper management, more than 90% of mothers have no complications throughout their pregnancy. Hormonal contraception dosage need to be increased due to the enzyme inducing nature of the anti epileptics drugs.
Caring for an elderly person is not an easy job and it requires understanding, patience, tolerance, full attention and dedication on the part of the caregiver. The effects on the caregiver in terms of his mental, emotional, physical and financial aspects are tremendous. Due to all these stresses, the caregiver's mental health would possibly be affected. This study explored the relationship between the mental and physical health of the elderly person and the caregiver, in forty-three elderly persons and their caregivers. Analyses of the results indicated that the caregivers' burden was related to their mental health status. In addition, the elderly persons' depressive symptoms, memory and behavior problems were the two main causes of these caregivers' burden.
The morbidity patterns of elderly patients presenting to a family physician clinic was studied by the attending physician completing a questionnaire on all elderly patients aged 60 and above attending the clinic between 1st January to 31st March 2000. 612 elderly patients registered during the study period. The most common presentations included upper respiratory tract infections (21.6%), hypertension and diabetes mellitus (18%), gastritis/dyspepsia (5.0%) and injuries (5.0%), Musculoskeletal complaints (backache, gout, osteoarthritis) and anxiety were also among the top 10 most common presenting complaints. Injuries were mainly soft tissue injuries and sprains sustained at home. Some were preventable.
1) A variety of surgical lesions can occur in infants and children. 2) The first step in the management is to arrive at an accurate diagnosis. Most lesions can be diagnosed or suspected through "pattern recognition" 3) Some lesions can be treated by the general practitioners / family physicians for e.g. umbilical granuloma. 4) Lesions that can be observed over time for spontaneous resolutions are umbilical hernia, congenital hydrocele and haemangioma. 5) Lesions or conditions that require prompt referral are undescended testis, inguinal hernia, neonatal jaundice and large cystic hygJ1Qmas 6) Thyroglossal cyst, hypospadias and small cystic hygromas can be referred to a specialist at a time convenient for the family. 7) Phimosis may require an expert consultation 8) Expert consultation should be sought when in doubt; for example when difficulty is encountered in differentiating a retractile testis from an undescended testis. 9) As a general rule, all skin and subcutaneous swellings, except a hemangioma should be referred to a specialist, as soft tissue malignancy is a possibility even in infants. 10) Family physicians should be aware of the potential long-term problems of some conditions such as undescended testis and biliary atresia.
Between 2/10/2000 and 30/1/2001, the organizational structure and management in 4 general practice (GP) clinics & 2 health centers (HC) in Kinta District were studied by 14 Level 4 medical students of Perak College of Medicine. Data collected from work process files and staff interviews / shadowing showed that GPs in the study had more working experience with postgraduate qualifications than HC doctors. All HC nurses but only one GP clinic nurse had formal training. HC organization was more complex with documentation. GP organization was simple and lacked documentation. HC management was by a group while GPs handled all management aspects. This study enhanced students' understanding of Malaysian primary care system.
Objectives: The objectives of this study were to screen for psychiatric symptomatology in Form 4 students in Ipoh, Perak and to determine demographic characteristics, contributing factors and the key person consulted for psychiatric / emotional problems. Methods: Between December 1997 and March 1998, 84 Form 4 students selected by random sampling from 2 Ipoh schools (one co-educational - S1 and one all boys - S2) were screened using the 30-item Malay version General Health Questionnaire (GHQ-30) and a demographic questionnaire. S1 students were interviewed by a psychiatrist (second author) to assess for anxiety / depression / somatization using DSM IIIR criteria. Results: Eighty three students (98.8%) completed their questionnaires. Twenty four students (28.9%) had high GHQ scores (8 and above). There was no significant association found between GHQ scores and gender, race, parental occupation and marital status / situation, number of siblings, frequency of illness and Penialian Menengah Rendah (PMR) results. A significant association was found between the GHQ scores and the students' birth order and perceived performance in the past 6 months as compared to PMR. Fifty percent consulted their friends for emotional problems, 29.2% their parents, 4.9% their siblings. None consulted their teacher / school counselor. Conclusion: Further studies are recommended to look into the prevalence of psychiatric symptomatology amongst our Malaysian secondary school students and into the possible use of the Malay version GHQ-30 as a screening tool in this age group.
1. Revised ARA criteria (1987) the diagnosis of RA requires presence of at least 4 of the following 7 features: 1) morning stiffness> 1 hour 2) swelling of 2 or more joints (of 6 weeks duration) 3) symmetrical joint involvement 4) arthritis of more than 1 hand joints (of at least 6 weeks duration) 5) positive rheumatoid factor, 6) presence of rheumatoid nodule 7) X-ray changes. 2. Use of DMARD should start early, along with pain control by non steroidal anti inflammatory drugs (NSAID) 3. Early referral to rheumatologists is the current recommendation 4. Indications for early referral include: i. Early morning stiffness (EMS) of 30 mins ;- ii. Metatarsophalangeal (MTP) / metacarpophalageal (Mep) involvement. iii. 2 or more swollen joints.
Musculoskeletal complaints are one of the most common presenting symptoms to primary care physicians. However, in Malaysia, there has been no prospective survey to look at this problem. This was a descriptive study to look at the prevalence of non-traumatic musculoskeletal complaints presenting to the primary care clinic at University Malaya Medical Center, Kuala Lumpur. Over a 3-week period, there were 408/4201 patients (9.7%) with non-traumatic musculoskeletal disorders. The most common regional problem was backache and the most commonly made diagnosis was non-specific musculoskeletal pain. In conclusion, musculoskeletal disorders form a significant proportion of primary care consultations and thus should be included in the curriculum for the primary care physician training. Keywords: musculoskeletal disorders, arthritis, primary care
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.
The morbidity patterns and demographics of patients presenting to two government health centers and four private general practice clinics were studied over one week. Results showed little difference in the morbidity patterns but a significant difference in the demographics of the patients. The commonest illnesses seen were minor ones like upper respiratory tract infection and chronic ones like hypertension and diabetes mellitus. A wide spectrum of illnesses was seen in all the clinics. Both places handled few emergencies and referred only occasionally. There was an equal percentage of patients from both sexes. Ages of the patients varied from place to place and the racial distribution was influenced by several factors, including the existing patient population and the race of the doctor.