Managing COVID-19 Pandemic in the Community: A Primary Health Clinic Experience / 가정의학회지

The coronavirus disease 2019 (COVID-19) pandemic has affected several countries worldwide, including Malaysia, with the first reported case occurring in January 2020. Terengganu, a state on the east coast of Malaysia, is finding it challenging to contain the disease by aggressively instituting all public health measures to reduce the number of COVID-19 cases and community transmission. Our primary health clinic, which is situated in a semi-rural district in Terengganu, is also involved in the implementation of containment measures, community risk measurement, and the initial management of COVID-19 cases. The health clinic changed the clinic system for the delivery of healthcare services to avoid overcrowding of patients and adapted innovative ways of providing medical services, such as telemedicine and “drive-through” pharmacy. It also provided continuous health education and awareness regarding COVID-19 to both patients and clinic attendees. The essential element of combating the infection is the effective control of infection in a small, isolated clinic in which space and adequate facilities are known challenges. This study aimed to highlight the flow of COVID-19 management starting from screening, triaging, and management based on protocol, implementation of infection control measures, and training of healthcare workers in our health clinic. The mental health of these workers was managed by the Mental Health and Psychosocial Support Unit, as recommended by the Ministry of Health Malaysia. The role of primary care clinics in the ongoing pandemic is currently increasing. Hence, higher authority and the government must increase the number of facilities, human resources, and financial budget to ensure that all initiatives can be implemented effectively.

Pelvic Floor Muscle Exercise Education and Factors Associated with Implementation among Antenatal Women in Hospital Universiti Sains Malaysia / 가정의학회지

BACKGROUND: Pelvic floor muscle exercise is effective for pelvic floor muscle dysfunction. Despite the high prevalence of pelvic floor muscle dysfunction in women in the community, pelvic floor muscle exercise recognition is low in Malaysian society; thus, this intervention is not frequently used . This study assessed the knowledge of, attitudes towards, and use of pelvic floor muscle exercise among antenatal women before and after educational classes. The study also determined factors associated with exercise practice. METHODS: An interventional study was conducted in 121 antenatal women selected through systematic random sampling between June and December 2010. Baseline knowledge of, attitude towards, and practice of pelvic floor muscle exercise were assessed using self-administered validated questionnaires at first visit and at 2 months postpartum. All participants attended two exercise education classes on their next two visits before delivery. A paired t-test and multivariate analysis were used for data evaluation. RESULTS: The mean pre-intervention scores for knowledge, attitudes, and practice were 24.98, 24.25, and 3.51, respectively, with statistically significant mean score increments after intervention (P < 0.001). The mean differences were 4.67 (95% confidence interval [CI], 3.86–5.49), 3.77 (95% CI, 3.05–4.50) and 3.45 (95% CI, 2.90–4.00) for knowledge, attitudes, and practice, respectively. Lack of baseline information on pelvic floor muscle exercise was significantly associated with practice change following an educational class. CONCLUSION: Education is effective in improving knowledge of, attitude towards, and practice of pelvic floor muscle exercise. There is a need for greater effort to increase exercise awareness in our community, especially during antenatal class.

Body Weight Perception and Weight Loss Practices among Private College Students in Kelantan State, Malaysia / 가정의학회지

BACKGROUND: Body image is associated with the perception of people on themselves. Influencing factors are generated internally and/or externally. The most common issue pertaining to body image is body weight and weight loss. This study aimed to determine the association between body weight perception and weight loss practices among college students. METHODS: A cross-sectional study was conducted involving 297 college students from private nursing colleges in the state of Kelantan, Malaysia. A self-administered questionnaire was used to assess sociodemographic characteristics, body weight perception, and weight loss methods. Weight and height were measured, and body mass index (BMI) was calculated based on weight and height measurement. The World Health Organization BMI cutoffs were applied in the study. RESULTS: More than half (54.2%) of college students perceived their weight correctly as per actual measured BMI. A total of 51.5% of participants had tried various methods to reduce their weight. Body weight perception is associated with weight loss practices (odds ratio, 0.31; 95% confidence interval, 0.19–0.50; P < 0.001) adjusted for sex, marital status, and status of having obese family members. Those who had correct body weight perception were less likely to engage in weight loss practice. Food intake restriction (42.4%) is the most popular weight reduction method among students in nursing colleges. Over a quarter of the participants chose physical exercise (25.3%) to reduce their weight, and a small number engaged in unhealthy weight loss practices. CONCLUSION: Body weight perception is an important factor that influences the practice to reduce weight especially among young adult group and college students.

Patients’ blood pressure control and doctors’ adherence to hypertension clinical practice guideline in managing patients at health clinics in Kuala Muda district, Kedah

background: blood pressure (bP) control among Malaysian is poor and doctor’s adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients’ bP control, doctors’ adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined. Methods: A cross-sectional study was conducted in Kuala Muda district’s health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables. results: A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients’ age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor’s good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians’ treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence. conclusion: Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.

Cardiovascular Lifestyle Risks And Cardiovascular Screening Activities Among Healthy Government Servants In Kuala Terengganu, Malaysia

Lifestyles such as unhealthy dietary habits, physical inactivity and smoking are considered fundamental risk factors for cardiovascular disease. Preventive activities have been shown to reduce mortality and morbidity from cardiovascular disease. This study aimed to determine the prevalence of cardiovascular lifestyle risks and cardiovascular preventive activities among healthy government servants in Kuala Terengganu, Malaysia. A cross-sectional study was done from June to September 2013 among 121 government servants working at the Federal Complex, Kuala Terengganu. A questionnaire which consists of socio-demographic data, International Physical Activity Questionnaire (IPAQ), the dietary component of WHO STEPS and cardiovascular screening activities were used as tools. Clustering of cardiovascular lifestyle risks was defined as the presence of two or more of smoking, physical inactivity and unhealthy diet. Optimal cardiovascular screening is defined as having done the required screening for hypertension, diabetes, dyslipideamia and obesity. The study response rate was 90.9% (110 of 121). Prevalence of smoking, physical inactivity and unhealthy diet were 20%, 50% and 87% respectively. The prevalence of clustering of cardiovascular lifestyle risks was 57%. The prevalence of optimal cardiovascular screening for age was 49%. The prevalence of cardiovascular lifestyle risks among government servants in Kuala Terengganu is still high. About half of them did not have the optimal screening for cardiovascular disease. Measures need to be done to promote healthy lifestyle behaviors in the community. Effort should be made at the primary care level and public health to screen those with multiple cardiovascular lifestyle risks in order to optimize cardiovascular disease prevention.