PURPOSE: To describe the management of mild conduct problems in an adolescent at the primary care level.
CASE REPORT: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents.
CONCLUSION: This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.
KEYWORDS: Conduct problems; adolescents; anger management; parenting skills
Treatment refusal is a common encounter in clinical practice. The process of deciding to refuse treatment is often complex. It is our responsibility to try and understand this process of decision making and the underlying reasons for treatment refusal. Many of these reasons are often rational in the context where the decision is made. The patients could be making the best decision for themselves even if these decisions are not necessarily the best in our mind. We should at all times discuss our treatment options and assess their ability to make decisions in achieving common goals. These goals should balance our best treatment strategies and the patients' best interest. This article discusses the reasons underlying treatment refusal and how we can achieve a common goal with our patients.
Introduction : Selangor’s private clinic registry system had been introduced in 2006 following gazettment of The Private Healthcare Facilities and Services Act. Through the act, data’s from the private clinics can be obtained and its characteristics can be compared between the urban and rural private clinic. An overview of the services can be known and an appropriate action can be planned.
Methodology : A cross-sectional study was done on private clinics registered in state of Selangor. Using databased known as MedPCs (Medical Practice Control System), a purposive sampling was used to select four districts – two urban and two rural. All private clinics in the selected districts were studied and all details shall be collected online.
Result : District of Gombak and Klang were selected as urban and Sabak Bernam and Kuala Selangor represented rural area. Of a total 625 clinics selected, 90.0% (562) from urban and 10.0% (63) rural. Distributions of clinic were in line with the act. The most prominent services were general treatment (89.4%) and ability to serve more than eight hours daily (89.4%). Medical clinic still dominated at 84.0% compared to dentistry at 16.0%. About 70.6% were operated by male doctors. Though clinic services in rural were relatively as good as urban, the different were significantly observed to the ethnicity of the doctor. Indian doctors more in rural (46.03%), whilst in urban, Malay doctors were more dominant (39.50%). Followed closely by seniority, where rural doctors were much senior (51.02 years old), however, most of the doctors in rural private clinics experienced less exposure in government sectors, compared to those in urban areas.
Conclusion : There were obvious difference in terms of distribution, where more clinics were located in urban compared to rural, but all were still in line to the act and their services were comparable. Most noticeable differences were ethnicity, seniority and past experience working in the public sector. Indian doctors were dominant in rural and Malay in urban. Although rural doctors were more senior, relatively they were less experienced working in the government sector.
INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time.
MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis.
RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04).
CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.
KEYWORDS: depression; incidence; post-partum
Nondisclosure of traditional and complementary medicine (T&CM) use may cause individual to be at risk of undue harm. This study aimed to explore patient's experience and views on their decision to disclose the use of T&CM to the doctor. An exploratory qualitative study using in-depth interview involving 10 primary care clinics attendees in Kuching was conducted. The results indicated that disclosure of T&CM use will motivate them to get information, increase doctor's awareness, and get support from family and friends for disclosure. Fear of negative relationship and negative response from doctors was a barrier for disclosure. Doctor's interpersonal and communication skills of being involved, treating patients respectfully, listening attentively, respecting privacy, and taking time for the patient were a critical component for disclosure. Intrapersonal trust regarding doctor influences their satisfaction on healthcare. Women are more open and receptive to a health concern and expressing negative emotions and tend to share problems, whereas men always described themselves as healthy, tended to keep their own personal feeling to themselves, and tended to not share. The doctor should consider gender differences in disclosure, their attitude towards T&CM use, and gained patient's trust in the delivery of healthcare services. Good interpersonal and communication skills must be maintained between doctor and patients.
Study site: Klinik kesihatan, Kuching, Sarawak, Malaysia
Introduction: Clinical resolution of periodontitis (CRP) of type-2 diabetic patients with chronic periodontitis (T2DM-PD) after receiving non-surgical periodontal treatment (NSPT) has been reported in the previous studies. This study aimed to evaluate CRP of T2DM-PD under medicaldental coordinated care (M-DCC). Materials and Methods: A 6-months follow-up quasi-experimental study was conducted among 20 subjects who received M-DCC in 2016. M-DCC included standard diabetic care provided by medical professional from 3 health clinics and NSPT provided by periodontal specialists from two periodontal specialist clinics. Target glycemic control achievement (TGCA) HbA1c 6.5% was assessed at baseline and 6 months after NSPT. Clinical resolution of PD was measured in terms of BPE, BOP %, CAL(mm), PPD(mm), PPD 4mm, PPD =4 mm and PPD 6mm at baseline, 3 and 6 months. Paired simple t test and ANOVA F test were applied to infer clinical resolution of periodontitis and its relation to TGCA.
Results: Mean (SD) of average BPE at baseline, 3- and 6-months were 3.52(0.34), 3.12(0.33) and 3(0.45) with (p<0.05); average PPD(mm) were 3.33(0.5), 3.23(0.75) and 2.73(0.57) with (p<0.05); PPD(%) 4mm were 71.03(12.33), 82.77(9.9) and 85.85 (8.9) with (p<0.05); PPD(%) =4 mm were 27.94(11.9), 16.97(10.01) and 13.71(9.1) with (p<0.05); PPD(%) 6mm were 8.04(4.32), 2.66(2.3) and 1.87(2.32) with (p<0.05). Significant resolution of BPE, CAL(mm) and PPD(mm) was noticed among two subjects who has changed from uncontrolled TGCA to controlled TGCA.
Conclusion(s): CRP and TGCA results have verified the effectiveness of M-DCC. A further clinical control trial with adequate sample size needs to confirm the results of the present study.
KEYWORDS: clinical resolution, chronic periodontitis, periodontal therapy, target HbA1C%, Type-2 Diabetic Patients with chronic periodontitis
Cardiac myxoma is often discovered as an incidental finding and presents with various subtle symptoms and signs. Electrocardiographic findings are mostly non-specific. Atrial flutter or conduction abnormalities are known to be rare. We report a case of large left atrial myxoma that was diagnosed by transthoracic echocardiography at a primary care clinic. An asymptomatic, 71-year-old woman presented with serial abnormal electrocardiogram changes during a routine consultation. A diagnosis of left atrial myxoma was obtained through transthoracic echocardiography. We report this case with a review of literature on cardiac myxoma associated with arrhythmia.
Self-perception is found to be a central predictive factor in experiencing successful aging. The aim of this study was to explore the role of sex, socioeconomic status, and emotional support in elders' aging perception. A cross-sectional design was used with 300 older aged participants recruited from 23 clinics and health centers in Qazvin, Iran. Data were collected included questions to elicit demographic information and Barker's aging perception questionnaire. Exploratory multiple linear regression showed that the level of emotional support (β: -12.10; 95% CI: [-20.72, -3.48]), socioeconomic status (β: 2.84; 95% CI: [0.25, 5.43]), and women (β: -4.34; 95% CI: [-6.91, -1.77]) were associated with aging perception among elders. Educational level and marital status did not significantly contribute to the variance of AP. Findings revealed that aging perception was related to individual differences as well as social and emotional factors. Researchers, health-care professionals, and elders may benefit from thinking about old age as an inevitable life stage.
Khoo EM, Sararaks S, Lee WK, Liew SM, Abdul Samad A, Cheong AT, et al.
Citation: Khoo EM, Sararaks S, Lee WK, Liew SM, Abdul Samad A, Cheong AT, et al. Patient Safety in MOH Primary Care Clinics - A Community Trial. Kuala Lumpur: Institute for Health Systems Research; 2010
Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH
Citation: Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH. National Medical Care Statistics: Primary Care, 2012. Kuala Lumpur: National Clinical Research Centre, Ministry of Health, Malaysia; 2014
A full-year study of sickness absence was done on 148 workers in a bus company. 58.8% of the workers took one or more than one day of absence while 42.2% took no absence at all. Sickness absence rates were 1.64 spells per person, 2.26 days per person and mean length of spell was 1.38 days per spell. The figures were low compared with Western countries or Singapore. Indian had higher absence rates and bus drivers and conductors had less days and spells of absence than office staff and mechanics in the same company.
A study was undertaken to evaluate the efficiency of health services at two maternal and child health (MCH) clinics in Kuala Lumpur. The time spent for individual patient care by the clinic staff was used as an indicator for the evaluation. The main objective was to derive a model of ideal operation time for specific patient care activities at a MCH clinic. Primary data was collected through systematic random sampling of patients between 25/7/1985 and 31/7/1985. Secondary data was obtained from available clinic records for July, 1985. The time a patient spent at the clinic and the time she spent at each examination station and waiting between stations was recorded with digital watches. Results show tha patients spent 80% of their time at the clinics waiting. The actual time spent on each patient was found to be considerably less than the ideal time measured under ideal conditions. Various recommendation are presented in the paper to reduce waiting time and extend examination time. The ideal patient capacity for the two clinics was also calculated.
Citation: Md Gowdh NF, Sivasampu S, Lim TO, Abdullah NH. National healthcare establishments and workforce statistics (primary care) 2008-2009. Kuala Lumpur: Clinical Research Centre, Ministry of Health, Malaysia
This study was conducted to find out the psychiatric symptomatology in the patients and their families attending a primary health care facility. The most frequent symptoms found were of depression (13.2%), followed by hypochondriacal symptoms (8.2%), anxiety symptoms (6.1%) and psychotic symptoms. A large proportion (21.5%) of children had psychiatric symptoms. The common symptoms include enuresis, hostility, tantrums, problems of conduct and destructiveness. Surprisingly, concern for these symptoms was lacking in both the patient and their family members.
This study aimed to determine the prevalence of suicidal ideation and the associated factors with suicidal ideation among older people. This was a cross-sectional study. The present study was carried out from March 2018 to May 2018. In total, 200 older people aged 60 years and over were recruited from a medical outpatient clinic in Malaysia. The older people completed a self-administered questionnaire on sociodemographic background, depression, and suicidal ideation. The data analysis involved descriptive and inferential analysis using IBM SPSS Statistics version 23.0. The prevalence rate of suicidal ideation was 3%. There were significant associations between ethnicity (p<0.00), marital status (p=0.008), depression (p<0.00) and suicidal ideation. Risk factors for suicidal ideation in older people are ethnicity, marital status, and depression. Future studies should focus on these factors in any intervention aimed to reduce suicidal ideation among older people in Malaysia.