INTRODUCTION: Earlier studies have identified a gap between guidelines and actual clinical diabetes care in Malaysia.
OBJECTIVE: We audited the quality of care for patients with type 2 diabetes mellitus (T2DM) attending our diabetes clinic at a public hospital.
METHODS: A structured review of the outpatient clinic cards, prescriptions and laboratory results was conducted for patients attending the diabetes clinic at Sibu Hospital in October and November 2014.
RESULTS: For the total of 233 patients who were audited, the levels of fasting blood sugar, blood pressure, body mass index and fasting lipid profile were satisfactory at 99.1%, 99.6%, 92.6% and 99.6% respectively. 79.7% of the subjects had had HbA1c performed at least once over the previous six months. Only 25.8% had annual foot screening, while the eye screening rate was 71.2% and the albuminuria screening rate was 93.6%. For outcome measures, the mean (SD) HbA1c level was 9.2% (1.91%), with 13 patients (6.7%) having HbA1c less than 6.5%; 36.4% of participants achieved BP < 130/80 mmHg; and 69.4% had LDL < 2.6 mmol/L. The majority of the patients were overweight or obese (91.4%).
CONCLUSIONS: Overall, the performance of diabetic care processes at our hospital was satisfactory, except for foot examination. The glycaemic and weight control among the subjects were suboptimal and warrant an optimised and comprehensive approach on the part of the management.
BACKGROUND: Statins are a class of potent drugs that can be used to reduce cholesterol, especially low-density lipoprotein cholesterol (LDL-C). However, their effectiveness is limited if adherence to treatment is poor. The objectives of the study are to estimate the proportion of diabetic patient who has achieved LDL-C goal and to determine the association of LDL-C achievement with socio demographic factors and statin therapy adherence.
METHODS: This is a cross-sectional study involving 234 patients with type 2 diabetes mellitus (T2DM) and dyslipidaemia attending an outpatient clinic in a hospital in Kelantan. Interviews and self-administered questionnaires were used to determine their sociodemographic and clinical characteristics. Adherence to therapy was assessed using the Medication Compliance Questionnaire (MCQ). The associations between the achievement of LDL targets and sociodemographic/clinical factors, including adherence, were analysed with simple logistic regression.
RESULTS: About 37.6% of patients achieved their LDL-C target. The percentage of patients who adhered to statin use was 98.3%, and 20.5% of these patients reported full adherence. There was no significant association between achievement of LDL-C targets with adherence or any other sociodemographic factors, such as age, gender and educational or economic status (all P-value < 0.05).
CONCLUSION: Despite a high level of adherence, the majority of patients failed to achieve LDL-C targets. More concerted efforts are needed to improve this.
Study site: primary
care clinic in Hospital Universiti Sains Malaysia,
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The out patient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from with in the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.
Study site: ENT clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The prevalence of asthma is increasing, especially among children in Malaysia, with environmental factors as one of the main preventable contributors. The aim of this study was to determine the association between environmental air pollutants and the occurrence of asthma among children seen in pediatric clinics in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur. An unmatched case control study among children who attended the pediatric clinic was carried out from May to August 2015. A total of 223 children who were diagnosed with asthma (105 cases) and who did not have asthma (118 controls) were included in this study. Their parents or caregivers were interviewed using questionnaires modified from the International Study of Asthma and Allergies in Childhood. Data obtained were analyzed using SPSS software version 20. There was a higher risk of asthma in those who had carpet at home (OR = 2.15 CI [1.25-3.68]), those who lived within 200 m of heavy traffic (OR = 1.72 CI [1.01-2.93]), and those who were exposed to lorry fumes (OR = 2.61. CI [1.38-4.93]). Environmental air pollutants increased the risk of asthma among children in Malaysia. Exposure to congested roads, lorry fumes, and indoor carpet were associated with asthma among children in this study. Parents or caretakers of children with asthma should be given adequate education on the prevention of asthmatic attack among these children.
Study site: Paediatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
OBJECTIVE: Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients' role preference in decision-making and the associated factors.
DESIGN: A cross-sectional study.
SETTING: Study was conducted at an urban primary care clinic in Malaysia in 2012.
PARTICIPANTS: Patients aged >21 years were chosen using systematic random sampling.
METHODS: Consenting patients answered a self-administered questionnaire, which included demographic data and their preferred and actual role before and after consultation. Doctors were asked to determine patients' role preference. The Control Preference Scale was used to assess patients' role preference.
PRIMARY OUTCOME: Prevalence of patients' preferred role in decision-making.
SECONDARY OUTCOMES: (1) Actual role played by the patient in decision-making. (2) Sociodemographic factors associated with patients' preferred role in decision-making. (3) Doctors' perception of patients' involvement in decision-making.
RESULTS: The response rate was 95.1% (470/494). Shared decision-making was preferred by 51.9% of patients, followed by passive (26.3%) and active (21.8%) roles in decision-making. Higher household income was significantly associated with autonomous role preference (p=0.018). Doctors' perception did not concur with patients' preferred role. Among patients whom doctors perceived to prefer a passive role, 73.5% preferred an autonomous role (p=0.900, κ=0.006).
CONCLUSIONS: The majority of patients attending the primary care clinic preferred and played an autonomous role in decision-making. Doctors underestimated patients' preference to play an autonomous role.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults.
Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.
Discussion: Previous studies evaluating multifactorial interventions in falls have reported variable outcomes.
Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that
individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community.
Trial registration: ISRCTN11674947
Study: Malaysian Falls Assessment and Intervention Trial; MyFAIT
The Reasons For Living Inventory has been shown to have good psychometric properties in Western populations for the past three decades. The present study examined the psychometric properties and factor structure of English and Malay version of the Reasons For Living (RFL) Inventory in a sample of clinical outpatients in Malaysia. The RFL is designed to assess an individual's various reasons for not committing suicide. A total of 483 participants (283 with psychiatric illnesses and 200 with non-psychiatric medical illnesses) completed the RFL and other self-report instruments. Results of the EFA (exploratory factor analysis) and CFA (confirmatory factor analysis) supported the fit for the six-factor oblique model as the best-fitting model. The internal consistency of the RFL was α=.94 and it was found to be high with good concurrent, criterion and discriminative validities. Thus, the RFL is a reliable and valid instrument to measure the various reasons for not committing suicide among psychiatry and medical outpatients in Malaysia.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
BACKGROUND: East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries.
METHODS: The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality.
RESULTS: One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality.
CONCLUSIONS: A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.
INTRODUCTION: Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).
METHODS: A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function.
RESULTS: The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P
INTRODUCTION: The present study investigated the relationship between psychological symptoms and psychosocial function and the role of relevant sociodemographic data and antipsychotic use in the prediction of psychosocial function among multiracial schizophrenia outpatients in Malaysia.
METHODS: A total of 223 participants were recruited in this cross-sectional study conducted from December 2010 to April 2011. Psychological symptoms were assessed using the Positive and Negative Syndrome Scale whilst the psychosocial function was assessed using the Personal and Social Performance scale. Sociodemographic and treatment variables were gathered through interview or review of the medical records.
RESULTS: All dimensions of psychosocial functions were inversely correlated with Positive and Negative Syndrome Scale sub-domains. Only the disorganization sub-domain significantly predicts all dimensions of psychosocial function. For social data, body mass index and employment status were significant predictors of all dimensions of psychosocial functions. Typical antipsychotics significantly predict social function negatively as compared to sulpiride (β = -0.152, P = 0.028).
DISCUSSION: We found that the relationship between psychological symptoms and psychosocial functions were relatively consistent with the findings from the Caucasian population. Additionally, disorganization was the only significant predictor of all dimensions of psychosocial functions. This further emphasized the importance of cognition in psychosocial function. The roles of sulpiride, body mass index and employment status as predictors of psychosocial function were also discussed.
KEYWORDS: antipsychotics; psychosocial function; schizophrenia; symptoms
Study site: Psychiatric clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
The aim of this study is to examine the effectiveness of transmeatal low-power laser stimulation (TLLS) in treating tinnitus. This is a prospective, double-blinded, randomized, placebo-controlled trial. Patients with persistent subjective tinnitus as their main symptom were recruited into the study from the outpatient clinics. The recruited patients were randomized into the experimental group or TLLS+ group (patients in this group were prescribed to use TLLS at 5 mW at 650 nM wavelength for 20 min daily and oral betahistine 24 mg twice per day for a total of 10 weeks) and the control group or TLLS- group (patients in this group were prescribed with a placebo device to use and oral betahistine 24 mg twice per day for 10 weeks). All patients were required to answer two sets of questionnaires: the Tinnitus handicap inventory (THI) and visual analogue scales (VAS) symptoms rating scales, before starting the treatment and at the end of the 10-week treatment period. The total score of the THI questionnaire was further graded into five grades, grade 1 being mild and grade 5 being catastrophic. Wilcoxon-signed ranks test and Mann-Whitney test were used to compare and analyze the THI and VAS scores before and after treatment for each group. Changes with p value of <0.05 were considered as statistically significant. Chi square test was used to analyze the change of parameters in categorical forms (to compare between TLLS+ and TLLS-). Changes with p value of <0.05 were considered as statistically significant. Forty-three patients successfully and diligently completed their treatment. It was noted that using any condition of the device, TLLS+ or TLLS-, patient's tinnitus symptoms improved in terms of THI scores (TLLS+, p value = 0.038; TLLS-, p value = 0.001) or VAS scores with a change of at least one grade (TLLS+, p value = 0.007; TLLS-, p value = 0.002) at p value <0.05 significant level. In contrast when TLLS+ group was compared with TLLS- group, no statistically significant result was obtained. In term of VAS scores, there seems to be no statistically significant improvement in patients' annoyance, sleep disruption, depression, concentration and tinnitus loudness and pitch heard between the two groups. Transmeatal low-power laser stimulation did not demonstrate significant efficacy as a therapeutic measure in treating tinnitus.
Study site: Otorhinolaryngology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
OBJECTIVES: The objectives of this study were 1) to obtain information regarding the prescribing pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting at a Malaysian university, 2) to determine the prevalence and types of potential NSAID prescription related problems (PRPs), and 3) to identify patient characteristics associated with exposure to these potential PRPs.
METHODS: We retrospectively collected data from 1 academic year using the electronic medical records of patients in the University Sains Malaysia (USM) primary care system. The defined daily dose (DDD) methodology and the anatomical therapeutic chemical (ATC) drug classification system were used in the analysis and comparison of the data. Statements representing potential NSAID PRPs were developed from authoritative drug information sources. Then, algorithms were developed to screen the databases for these potential PRPs. Descriptive and comparative statistics were used to characterize DRPs.
RESULTS: During the study period, 12,470 NSAID prescriptions were prescribed for 6,509 patients (mean ± SD = 1.92 ± 1.83). This represented a prevalence of 35,944 per 100,000 patients, or 36%. Based on their DDDs, mefenamic acid and diclofenac were the most prescribed NSAIDs. 573 potential NSAID-related PRPs were observed in a cohort of 432 patients, representing a prevalence of 6,640 per 100,000 NSAIDs users, or 6.6% of all NSAID users. Multivariate logistic regression analysis revealed that patients with a Malay ethnic background (p < 0.001), members of the staff (p < 0.001), having 4 or more prescribers (p < 0.001) or having 2 - 3 prescribers (p = 0.02), and representing 4 or more long-term therapeutic groups (LTTGs) (p < 0.001) or 2 - 3 LTTGs (p < 0.001) were significantly associated with an increased chance of exposure to potential NSAID related PRPs.
CONCLUSIONS: This is the first study in Malaysia that presents data on the prescribing pattern of NSAIDs and the characteristics of potential NSAID-related PRPs. The prevalence of potential NSAID-related PRPs is frequent in the primary care setting. Exposure to these PRPs is associated with specific sociodemographic and health status factors. These results should help to raise the awareness of clinicians and patients about serious NSAID PRPs.
Study site: University Sains Malaysia (USM) primary care system.
INTRODUCTION: Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use.
METHODS: This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants.
RESULTS: A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77).
CONCLUSION: About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.
Study site: Outpatient clinic, three hospitals; 8 health clinics, Malaysia
BACKGROUND: There are limited published studies on patient satisfaction towards endoscopy from Asian countries. Different methods of evaluation of patient satisfaction may yield different results and there is currently no study to compare results of on-site versus phone-back interviews.
METHOD: On-site followed by phone-back interviews were carried out on consecutive patients attending the outpatient gastroscopy service of University of Malaya Medical Centre between July 2010 and January 2011 using the modified Group Health Association of America-9 (mGHAA-9) questionnaire. The question on technical skill of endoscopist was replaced with a question on patient comfort during endoscopy.
RESULTS: Seven hundred patients were interviewed. Waiting times for appointment and on gastroscopy day, and discomfort during procedure accounted for over 90% of unfavorable responses. Favorable response diminished to undesirable level when waiting times for appointment and on gastroscopy day exceeded 1 month and 1 hour, respectively. Satisfaction scores were higher for waiting time for appointment but lower for personal manner of nurses/staff and explanation given during phone-back interview. There was no significant difference in satisfaction scores for other questions, including overall rating between the two methods.
CONCLUSION: Waiting times and discomfort during procedure were main causes for patient dissatisfaction. Phone-back interview may result in different scores for some items compared with on-site interview and should be taken into account when comparing results using the different methods.
Study site: University Malaya Medical Centre (UMMC), Lembah Pantai, Kuala Lumpur.
WHAT IS KNOWN AND OBJECTIVE: Drug-drug interactions (DDIs) cause considerable morbidity and mortality worldwide and may lead to hospital admission. Sophisticated computerized drug information and monitoring systems, more recently established in many of the emerging economies, including Malaysia, are capturing useful information on prescribing. Our aim is to report on an investigation of potentially serious DDIs, using a university primary care-based system capturing prescription records from its primary care services.
METHODS: We retrospectively collected data from two academic years over 20 months from computerized databases at the Universiti Sains Malaysia (USM) from users of the USM primary care services.
RESULTS AND DISCUSSION: Three hundred and eighty-six DDI events were observed in a cohort of 208 exposed patients from a total of 23,733 patients, representing a 2-year period prevalence of 876·4 per 100,000 patients. Of the 208 exposed patients, 138 (66·3%) were exposed to one DDI event, 29 (13·9%) to two DDI events, 15 (7·2%) to three DDI events, 6 (2·9%) to four DDI events and 20 (9·6%) to more than five DDI events. Overall, an increasing mean number of episodes of DDIs was noted among exposed patients within the age category ≥70 years (P=0·01), an increasing trend in the number of medications prescribed (P<0·001) and an increasing trend in the number of long-term therapeutic groups (P<0·001).
WHAT IS NEW AND CONCLUSION: We describe the prevalence of clinically important DDIs in an emerging economy setting and identify the more common potentially serious DDIs. In line with the observations in developed economies, a higher number of episodes of DDIs were seen in patients aged ≥70 years and with more medications prescribed. The easiest method to reduce the frequency of DDIs is to reduce the number of medications prescribed. Therapeutic alternatives should be selected cautiously.
INTRODUCTION: The purpose of this study is to examine the prevalence of social support and its association with glycemic control in patients with type 2 diabetes mellitus (T2D) in an urban primary care center within an academic institution. Social support is important in the management of chronic diseases. However, its association with glycemic control has been controversial.
METHODS: This was part of a study examining religiosity in T2D patients. Nonsmoking patients with T2D for at least 3 years and aged 30 years and above were recruited. Social support was measured using The Social Support Survey-Medical Outcomes Study (SS), a self-administered questionnaire; the scores range from 19 to 95, and a high score indicates better social support. Glycemic control was measured using the 3 most recent glycosylated hemoglobin (HbA1c) levels within the past 3 years.
RESULTS: A total of 175 participants completed the SS survey (response rate 79.0%). The mean age was 62.7 (standard deviation [SD] = 10.8) years, and the mean duration of diabetes was 11.74 (SD = 6.7) years. The mean HbA1c level was 8.15 (SD = 1.44). The mean SS score was 68.1. The prevalence of high and low social support were 29.7% and 24.0 %, respectively. A significant correlation was found between SS score and number of social supporters (n = 167). No significant correlation was found between the self-reported number of social supporters or the SS score and the mean HbA1c level.
CONCLUSIONS: Social support was not associated with glycemic control in adult patients with T2D in this primary care setting.
Study site: Primary care clinic, Universiti Malaya Medical Centre (UMMC)
BACKGROUND: The commencement of methadone maintenance therapy (MMT) in 2005 represents a quantum leap in the management of heroin dependence in Malaysia.
OBJECTIVE: To examine the 2-year outcomes of this modality in the treatment of heroin dependence with respect to the quality of life (QOL), heroin abstinence, and rate of employment among heroin dependants attending the Tengku Ampuan Afzan Hospital (HTAA) MMT clinic.
METHOD: This was an experimental study in which the second QOL assessment was conducted 2 years after treatment initiation.
RESULTS: A total of 172 patients enrolled at the point of entry to the MMT program. The authors examined 107 patients who remained in the program 2 years later (62.6% retention rate). A paired t test demonstrated significant improvements in all 4 domains of QOL (physical, psychological, social relationships, and environment; P < .001). The most marked improvement was noted in the psychological domain.
CONCLUSION: The MMT program at HTAA is effective in improving the QOL among heroin dependants.
Study site: MMT clinic, Tengku Ampuan Afzan Hospital (HTAA), Kuantan, Pahang, Malaysia
BACKGROUND: Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia.
METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan.
RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS.
CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.
INTRODUCTION: Premature ejaculation (PE) is common. However, it has been underreported and undertreated.
AIMS: To determine the prevalence of PE and to investigate possible associated factors of PE.
METHODS: This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18-70 years attending the clinic were recruited, and they completed self-administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT.
MAIN OUTCOME MEASURE: Prevalence of PE.
RESULTS: A total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ(2) = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE.
CONCLUSION: PE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation.
Study site: primary care clinic at the University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
A retrospective study was undertaken to determine the clinical features of cutaneous larva migrans (CLM) seen in the Department of Dermatology, Hospital Kuala Lumpur (Kuala Lumpur, Malaysia) and to assess the rate of correct diagnosis made by the referring primary care doctors. Clinical records of all 31 patients with CLM seen between January 2006 and June 2010 were retrieved. The majority of patients were male. The mean age was 32.2 years. Pruritus was reported in 83.9% of cases and serpiginous tracts in 100%. The mean lesion count was 4.4 and the mean duration of disease before presentation was 3.1 weeks. The majority of skin lesions were on the buttock and lower extremities. Only 45.2% of patients had the correct diagnosis made by the referring primary care doctors. Older age of patients and lower number of lesions were associated with a higher rate of correct diagnosis. The low rate of correct diagnosis made by the referring primary care doctors to the dermatologists in this study warrants the need for education of not only primary care doctors but also future primary care providers, consisting of medical students, house officers and junior medical officers.
Study site: Department of Dermatology, Hospital Kuala Lumpur