Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.
Citation: Manderson L. Political economy and politics of gender: maternal and child health in colonial Malaya. In: Cohen P, Purcall J (editors). The Political Economy of Primary Health Care in Southeast Asia. Canberra: Australian Development Studies Network an ASEAN Training Centre for Primary Health Care Development; 1989, p79-100
This study aims to provide an overview of mental health problems of children and adolescents in Malaysia in general and the state of Terengganu in particular. It also highlights the challenges and the opportunities in the establishment of child and adolescent mental health services (CAMHS). CAMHS in Malaysia are developing slowly but have not reached the standards found in developed countries. Significant improvements are needed to ensure that the service can provide optimal help to children and adolescent as well as their families. Constraining factors such as a lack of trained workers, limited financial resources for training and inadequate facilities are among the challenges. Despite all these challenges, specific strategies are required to optimally utilise the potential existing resources. The Ministry of Health initiatives in creating and implementing the national mental health policy and increasing mental health awareness campaigns for children and adolescents are of paramount importance. To overcome the lack of resources in the implementation of CAMH services, in-service education and training, integration of mental health services with the existing primary health care facilities and cultivation of cooperative and communicative networks between primary care professionals, mental health workers and other relevant agencies are crucial steps.
Peritonsillar abscess, or quinsy, is a rare complication of acute tonsillitis. It usually presents with odynophagia, trismus, and muffled voice, reflecting the space-occupying lesion in the oral cavity. Examination reveals a unilateral swelling on either side of the soft palate, which drains thick pus after an incision is made. It is regarded as an emergency as an upper airway obstruction can develop. Bilateral peritonsillar abscess is a rare presentation and results in catastrophic sequelae. We present a case of bilateral peritonsillar abscess that was initially referred by a primary care centre facing a dilemma in diagnosis. Prompt diagnosis and fast drainage are warranted to avoid unwanted morbidity, and, also, mortality.
The incidence of road traffic injuries has increased over the last two decades. Of greater concern is the prediction that the problem is likely to increase further, given present trends in transportation. Injuries and not "accidents" need to be the focus of the health sector. Passive strategies, which are independent of human behaviour, are more likely to succeed in the prevention of injuries compared to "active" strategies. The health sector needs to play a bigger role in prevention through advocacy, research and education of target groups.
Aim: To explore primary care practitioners' experiences and feelings about treating their own family members. Methods: A qualitative study was carried out using focus group discussions. Five sessions were held among 22 primary care practitioners (five academic staff members and 17 medical officers). Results: Most participants treated their family members, especially their immediate families. They considered factors such as duration and severity of illness before seeking consultation with other doctors. Some participants felt satisfied knowing that they were able to treat their own families. However, most felt burdened and uncomfortable in doing so, mainly due to the fear of error in diagnosis and management. They were concerned that strong emotions may make them lose objectivity. Many were aware that negative outcomes resulting from their treatment may affect future relationships. Conclusions: While some doctors were comfortable about treating their own families, some faced significant conflict in doing so. Their decisions depended on the interplay of factors including the doctor, the family member and the relationship they share. A doctor needs to consider the potential conflict that may arise when carrying out one's professional role and at the same time being a concerned family member. Key words: doctors, family, Malaysia, primary care, self-treat.
Aim: To explore the help-seeking behavior of primary care doctors during illness. Methods: This qualitative study used focus group discussions to explore participants' help-seeking behavior during illness. It involved 22 primary care doctors (5 lecturers, 12 postgraduate trainees, 5 medical officers) working in a hospital-based primary care clinic. Result: Most primary care doctors in this study managed their illnesses without seeking help. Although most preferred to seek professional help for chronic illnesses and antenatal care, they tend to delay the consultations and were less likely to comply with treatment and follow-up. Explanations for their behavior include their ability to assess and treat themselves, difficulty to find suitable doctors, work commitment, easy access to drugs, and reluctance to assume a sick role. Conclusions: This study found that the help-seeking behavior of primary care doctors was similar to those in other studies. Due to their professional ability, heavy workload and expectations from peer and patients, primary care doctors were more likely to delay in seeking treatment especially for chronic and serious diseases. This highlights the need to enhance support services for doctors during illness. Key words: doctors, help-seeking behavior, illness
Aims: To evaluate the utilization of complementary and alternative medicine (CAM) in Kuching, Sarawak, Malaysia Methods: This was a cross-sectional study of patients who attended three randomly selected primary care clinics over 4 months from January to April 2004. Results: A total of 198 patients were recruited. One hundred and eighty-one (91.4%) patients agreed to participate by answering the anonymous questionnaire. Results: Ninety (51.4%) patients used CAM of which 43 (47.8%) patients used more than one type of CAM. Utilization rates of CAM were found to be associated with employment status but not with other socio-demographic factors. The common types of alternative medicine used were massage (n = 63; 36.2%) and herbal medicine (n = 44; 25.1%). Forty-two (46%) of the CAM users, used CAM for the problems that led to their current clinic visit. Thirty-four (37.8%) were using alternative and modern medicine at the same time. The reasons for CAM usage given by about half of the patients were that CAM was more effective and better for emotional or mental health problems. Conclusions: Usage of CAM was common in patients who visited primary care clinics. It is important to recognize this fact as combined use of CAM can create potentially dangerous interactions with pharmacotherapies Key words: complementary and alternative medicine (CAM), primary care
Background: A community-based general practice course has been developed in the Penang Medical College (PMC) (a joint Ireland-Malaysia venture) that simultaneously satisfies the medical regulatory authorities in Ireland and re-orients the current medical education to the health needs of the Malaysian community. Objectives: This paper describes the community-based general practice course in PMC, explores student evaluation of the various course objectives, student perception of general practice in Malaysia, and whether course experience has any influence on their choice of general practice specialty as a future career. Methods: Two consecutive classes of students (n = 78) were invited to complete anonymous, confidential pre-general practice rotation and post-general practice rotation course questionnaires. Results: Overall responses from both classes were 75/78 (96.1%) for pre-course and 73/78 (93.6%) for post-course questionnaire. Although students had minimal knowledge of Irish and Malaysian primary health care before the course, 60% were keen to learn about Irish primary healthcare and 54.7% expected to learn about the Malaysian healthcare system in the course. Overall, there was a slight reduction of 'No' response and increment of 'Maybe' response after the course with regard to working as a general practitioner in both countries but statistical tests show that there is no significance in the difference. Conclusions: An innovative community-based general practice course has been implemented in PMC but course experience of students does not seem to have any influence on their choice of general practice specialty as a future career. Key words: community, general practice course, Ireland, Malaysia, primary healthcare
Patients who are entering the last phase of their illness and for whom life expectancy is short, have health needs that require particular expertise and multidisciplinary care. A combination of a rapidly changing clinical situation and considerable psychosocial and spiritual demands pose challenges that can only be met with competence, commitment and human compassion. This article is concerned with the definition of suffering, recognition of the terminal phase and application of the biopsychosocial-spiritual model of care where family physicians play an important role in the community. Key words: biopsychosocial-spiritual care, dying, family medicine, good death, palliative care, suffering.
Aim: To evaluate the psychometric performance of the Malay version of the Medical Outcome Study (MOS) Social Support Survey among a sample of postpartum Malay women in Kedah, North West of Peninsular Malaysia.
Materials and methods: 354 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay versions of the MOS Social Support Survey, the Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the participants, who were bilingual, were also given the original English version of the instrument. A week later, these women were again asked to complete the Malay version of MOS Social Support Survey.
Results: The median number for item 1 (the single item measure of structural support) was 3 (inter-quartile range = 2 - 4). Extraction method of the remaining 19 items (item 2 to item 20) using principle component analyses with direct oblimin rotation converged into 3 dimensions of functional social support (informational support, affectionate support / positive social interaction and instrumental support) with reliability coefficients of 0.93, 0.74 and 0.72 respectively. Overall the scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). Its validity was confirmed by the negative correlations between the overall support index (total social support score) and all the three dimensions of functional support with the Malay versions of EPDS and BDI-II. The overall support index also displayed low but significant correlations with the single measure structural social support in the instrument (Spearman's rho = 0.14; p <0.01).
Conclusions: The MOS Social Support Survey demonstrated good psychometric properties in measuring social support among postpartum Malay women in Kedah, North West of Peninsular Malaysia and could potentially be used as a simple instrument in primary care settings.
It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not always present. This case describes an atypical presentation of aortic dissection, in which the patient walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein. Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for aortic dissection in the absence of classic features. The case is discussed with reference to the literature on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this frequently lethal condition.
In multiethnic countries such as Malaysia more than six different languages are spoken by patients in publicly-funded clinics. Sometimes doctors are unable to speak the patient's language and there are no professional interpreters. Research on doctor-patient communication has rarely included the language variable and its impact on information exchange and patient outcome in consultations where the doctor does not speak the patient's language. The few studies carried out in linguistically plural societies show that doctors and patients can face language barriers and trained interpreters are not always available. This paper illustrates some of the problems of using untrained interpreters in a primary care setting. Consultations were audiotaped and the transcripts were used to show how messages underwent distortion, condensation, and omission in interpreter-mediated consultations. Research needs to be carried out based on a model of doctor-patient communication which reflects the realities of the multilingual consultation.
We carried out a cross sectional study to detect emotional and behavioral problems among adolescents who smoke and their help-seeking behavior. This study was conducted in Sarawak, East Malaysia, between July and September 2006. Emotional and behavioral problems were measured using the Youth Self-Report (YSR/11-18) questionnaire; help seeking behavior was assessed using a help-seeking questionnaire. Three hundred ninety-nine students participated in the study; the smoking prevalence was 32.8%. The mean scores for emotional and behavioral problems were higher among smokers than non-smokers in all domains (internalizing, p = 0.028; externalizing, p = 0.001; other behavior, p = 0.001). The majority of students who smoked (94.7%) did not seek help from a primary health care provider for their emotional or behavioral problems. Common barriers to help-seeking were: the perception their problems were trivial (60.3%) and the preference to solve problems on their own (45.8%). Our findings suggest adolescent smokers in Sarawak, East Malaysia were more likely to break rules, exhibit aggressive behavior and have somatic complaints than non-smoking adolescents. Adolescent smokers preferred to seek help for their problems from informal sources. Physicians treating adolescents should inquire about smoking habits, emotional and behavioral problems and offer counseling if required.
Matched MeSH terms: Primary Health Care/organization & administration
Dengue fever is a major public health threat in Malaysia, especially in the highly urbanized states of Selangor and the Federal Territory of Kuala Lumpur. It is believed that many seek treatment at the primary care clinics and are not admitted. This study aims at establishing the fact that primary care practitioners, as the first point of patient contacts, play a crucial role in advising patients suspected of having dengue to take early preventive measures to break the chain of dengue transmission. A total of 236 patients admitted to two government hospitals for suspected dengue fever were interviewed using a structured questionnaire over a one week period in December 2008. It was found that 83.9% of the patients had sought treatment at a Primary Care (PC) facility before admission to the hospital, with 68.7% of them seeking treatment on two or more occasions. The mean time period for seeking treatment at primary care clinic was one and a half (1.4) days of fever, compared to almost five (4.9) days for admission. The majority of patients (96-98%) reported that primary care practitioners had not given them any advice on preventive measures to be taken even though 51.9% of the patients had been told they could be having dengue fever. This study showed the need for primary care providers to be more involved in the control and prevention of dengue in the community, as these patients were seen very early in their illness compared to when they were admitted.
In today's highly competitive health care environment, many private health care settings are now looking into customer service indicators to learn customers' perceptions and determine whether they are meeting customers' expectations in order to ensure that their customers are satisfied with the services. This research paper aims to investigate whether the human elements were more important than the nonhuman elements in private health care settings. We used the internationally renowned SERVQUAL five-dimension model plus three additional dimensions-courtesy, communication, and understanding of customers of the human element-when evaluating health care services. A total of 191 respondents from three private health care settings in the Klang Valley region of Malaysia were investigated. Descriptive statistics were calculated by the Statistical Package for Social Sciences (SPSS) computer program, version 15. Interestingly, the results suggested that customers nowadays have very high expectations especially when it comes to the treatment they are receiving. Overall, the research indicated that the human elements were more important than the nonhuman element in private health care settings. Hospital management should look further to improve on areas that have been highlighted. Implications for management practice and directions for future research are discussed.
Matched MeSH terms: Primary Health Care/standards*
Non-attendance results in administrative problems and disruption in patient care. Several interventions have been used to reduce non-attendance, with varying degree of success. A relatively new intervention, text messaging, has been shown to be as effective as telephone reminders in reducing non-attendance. However, no study has looked specifically at using text messaging reminders to reduce non-attendance in chronic disease care.
Matched MeSH terms: Primary Health Care/statistics & numerical data*
This study described the practice profile of an open access exercise stress test (EST) service to the primary care physicians at a teaching hospital in 2000. We performed a retrospective review of all ESTs ordered and conducted by the primary care physicians. A total of 145 ESTs were conducted, of which 80.7% were referred for assessment of chest pain. Proportions of positive, negative, uninterpretable and inconclusive ESTs were: 22.1%, 52.8%, 18.1% and 6.9%. Typical chest pain was independently associated with a positive EST in this study (p = 0.008, OR 5.50, 95% CI 1.56-19.37). Although referral to the open access EST service seemed appropriate, there is a need to reduce the number of uninterpretable and inconclusive results.