Ethnic groups difference in discriminatory attitude towards HIV/AIDS patients among medical students: a cross-sectional study

Medical students are future doctors who are trained to treat all kinds of diseases including people living with HIV/AIDS (PLWHA) without prejudice. Teaching basic scientific knowledge and technical skills is no longer adequate for today’s medical students. There is also a need for them to be provided with high personal and professional values. This study examined stigmatizing attitude towards people living with HIV/AIDS (PLWHA) among the medical students in a public medical school. The participants were stratified to preclinical-year (year 1 and year 2) and clinical-year (year 3 and year 4) medical students. Simple random sampling was carried out to select 170 participants from each category of students. Self-administered questionnaires captured socio-demographic data, HIV/AIDS knowledge and stigmatisation attitudes towards PLWHA. Multiple linear regressions was used to assess the relationship between ethnic groups and stigmatization attitude. Three hundred and forty participants were recruited. Malay medical students who did not have previous encounter with PLWHA were associated with stigmatizing attitude towards HIV/AIDS patients, whereas clinical-year medical students who had no clinical encounter with PLWHA were more likely to feel uncomfortable with PLWHA. Malay ethnicity and medical students in clinical years who had not encounter a PLWHA were more likely to have stigmatizing attitude towards PLWHA

Metabolic control and cardiovascular risks among type 2 diabetes in a primary care clinic

Background: Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through faceto- face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in metabolic control

Emotional intelligence and academic performance in first and final year medical students: a cross-sectional study

Background Research on emotional intelligence (EI) suggests that it is associated with more pro-social behavior, better academic performance and improved empathy towards patients. In medical education and clinical practice, EI has been related to higher academic achievement and improved doctor-patient relationships. This study examined the effect of EI on academic performance in first- and final-year medical students in Malaysia. Methods This was a cross-sectional study using an objectively-scored measure of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Academic performance of medical school students was measured using continuous assessment (CA) and final examination (FE) results. The first- and final-year students were invited to participate during their second semester. Students answered a paper-based demographic questionnaire and completed the online MSCEIT on their own. Relationships between the total MSCEIT score to academic performance were examined using multivariate analyses. Results A total of 163 (84 year one and 79 year five) medical students participated (response rate of 66.0%). The gender and ethnic distribution were representative of the student population. The total EI score was a predictor of good overall CA (OR 1.01), a negative predictor of poor result in overall CA (OR 0.97), a predictor of the good overall FE result (OR 1.07) and was significantly related to the final-year FE marks (adjusted R2 = 0.43). Conclusions Medical students who were more emotionally intelligent performed better in both the continuous assessments and the final professional examination. Therefore, it is possible that emotional skill development may enhance medical students’ academic performance

Psychological interventions for behavioral adjustments in diabetes care - a value-based approach to disease control

Psychological aspects of a person, such as the personal value and belief systems, cognition and emotion, form the basis of human health behaviors, which, in turn, influence self-management, self-efficacy, quality of life, disease control and clinical outcomes in people with chronic diseases such as diabetes mellitus. However, psychological, psychosocial and behavioral interventions aimed at these groups of patients have yielded inconsistent effects in terms of clinical outcomes in clinical trials. This might have been due to differing conceptualization of health behavioral theories and models in the interventions. Assimilating different theories of human behavior, this narrative review attempts to demonstrate the potential modulatory effects of intrinsic values on cognitive and affective health-directed interventions. Interventions that utilize modification of cognition alone via education or that focuses on both cognitive and emotional levels are hardly adequate to initiate health-seeking behavior and much less to sustain them. People who are aware of their own personal values and purpose in life would be more motivated to practice good health-related behavior and persevere in them

Quality of care for adult Type 2 diabetes mellitus at a University Primary Care Centre in Malaysia.

Background: Type 2 Diabetes Mellitus (T2D) with its concurrent cardiovascular risk factors such as hypertension and dyslipidaemia and its complications has now accounted for the majority of national and global morbidity and mortality. Aims & Objective: The study aimed to determine the prevalence of complications appearing in diabetic patients despite therapy, addressing to an urban academic primary care centre. Methods: This was a sub-analysis of a cross-sectional study on 212 patients with Type 2 diabetes mellitus (T2D) conducted from June to September 2006. Patients aged ≥ 30 years, non-smokers and under follow-up care of senior doctors were recruited. The average of the three most recent readings of fasting plasma sugar, HbA1c, systolic and diastolic blood pressure, and lipid profiles was taken as measures of respective disease control. Results: Two thirds of the patients were female. The mean age was 62.7 (SD± 10.8) years and the duration of T2D was 11.74 (SD± 6.7) years. A total of 23.6% achieved HbA1c ≤ 7.0%, 26.2% attained LDL-C ≤ 2.6 mmol/L and 24.5% achieved target blood pressure < 130/ 80 mmHg. The most prevalent co-morbid condition was hypertension (77.3%). A total of 27.2% patients had diabetic complications, out of which 86.5% had one complication. Proteinuria < 1gm/L and coronary artery disease were the two most common complications. There were only 16% on subcutaneous insulin and this was significantly associated with fasting plasma glucose (t = 5.38, df= 204, p < 0.0001) and HbA1c (t = 4.31, df= 206, p < 0.0001). Conclusions: Many T2D patients at this centre did not achieve treatment goals. Insulin and lipid-lowering drugs use should be optimized to improve control rates. More structured care processes are urgently needed in order to achieve good glycaemic control

Assessing HIV/AIDS knowledge and stigmatizing attitudes among medical students in Universiti Putra Malaysia

OBJECTIVE: Medical students are future doctors who are trained to treat all kind of diseases including people living with HIV/AIDS (PLWHA) without prejudice. This study was to determine the factors associated with knowledge on HIV/AIDS and stigma towards PLWHA among medical students. METHODS: This was a cross sectional study with stratified random sampling conducted in a public university, Malaysia. The participants were preclinical-year (year 1 and year 2) and clinical-year (year 3 and year 4) medical students. Simple randomisation was carried out after stratification of medical students into preclinical and clinical-year. The selfadministered questionnaires were consisted of sociodemographic data, items assessing HIV/AIDS knowledge and items assessing stigmatisation attitudes towards PLWHA. RESULTS: We had 100% response rate of 340 participants. Pre-clinical and clinical year medical students each contributed 170 (50%). Majority was female (64.1%). About two-thirds (60.6%) was Malay, followed by Chinese (31.2%) and Indian (7.1%). Pre-clinical students were significantly more stigmatizing in subscale of "attitudes towards imposed measures" (t=3.917, p<0.001), even with adjustment for previous encounter and ethnicity (B= 1.2, 95% CI 0.48 to 1.83, p=0.001). On the other hand, clinical students were found to be significantly less comfortable in handling HIV/AIDS cases (t=0.039, p=0.039), even after controlled for previous encounter and ethnicity (B=0.6, 95% CI 0.29 to 0.98, p< 0.001). CONCLUSION: Clinical encounter with PLWHA was associated with higher knowledge in HIV/AIDS. Medical students in preclinical years were having stigmatizing attitude towards imposed measures compared to the clinical years who had more stigmatizing attitude in being less comfortable with PLWHA

Diabetes-related distress and depressive symptoms are not merely negative over a 3-year period in Malaysian adults with type 2 diabetes mellitus receiving regular primary diabetes care

For people with type 2 diabetes mellitus (T2DM) the daily maintenance of physical and psychological health is challenging. However, the interrelatedness of these two health domains, and of diabetes-related distress (DRD) and depressive symptoms, in the Asian population is still poorly understood. DRD and depressive symptoms have important but distinct influences on diabetes self-care and disease control. Furthermore, the question of whether changes in DRD or depressive symptoms follow a more or less natural course or depend on disease and therapy-related factors is yet to be answered. The aim of this study was to identify the factors influencing changes in DRD or depressive symptoms, at a 3-year follow-up point, in Malaysian adults with T2DM who received regular primary diabetes care. Baseline data included age, sex, ethnicity, marital status, educational level, employment status, health-related quality of life (WHOQOL-BREF), insulin use, diabetes-related complications and HbA1c. DRD was assessed both at baseline and after 3 years using a 17-item Diabetes Distress Scale (DDS-17), while depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to examine the relationship between baseline variables and change scores in DDS-17 and PHQ-9. Almost half (336) of 700 participants completed both measurements. At follow-up, their mean (SD) age and diabetes duration were 60.6 (10.1) years and 9.8 (5.9) years, respectively, and 54.8% were women. More symptoms of depression at baseline was the only significant and independent predictor of improved DRD at 3 years (adjusted β = −0.06, p = 0.002). Similarly, worse DRD at baseline was the only significant and independent predictor of fewer depressive symptoms 3 years later (adjusted β = −0.98, p = 0.005). Thus, more “negative feelings” at baseline could be a manifestation of initial coping behaviors or a facilitator of a better psychological coaching by physicians or nurses that might be beneficial in the long term. We therefore conclude that initial negative feelings should not be seen as a necessarily adverse factor in diabetes care

A preliminary study of job satisfaction and motivation among the Malaysian primary healthcare professionals

Aim: This study aimed to examine the relationship between personal or work-based characteristics and job satisfaction and motivation in Malaysian primary healthcare professionals. Methods: This was a cross-sectional survey conducted during the 15th Family Medicine Scientific Conference in June 2011 using the Warr-Cook-Wall scales. The questionnaires included demography and work-related items and were self-distributed and returned at the end of the conference. Independent risk factors were identified using multiple linear regressions. Results: A total of 149 conference participants completed the survey, with a response rate of 33.1%. They were mainly females (85.2%), Malay (83.2%), and married (83.9%) in almost equal proportions of practice location (urban 57.8% and rural 42.2%). Majority of them were working at community-based health clinics (74.0%) and in public sectors (94.4%). The respondents were mainly doctors (91.4%). The mean age of the participants was 39.1 years (SD 8.0), with a mean duration of service of 9 years (SD 6.9). Family medicine specialty (FMSt) residents had lower job satisfaction (B = -8.0, 95% CI -14.61 to -1.40, p = 0.02). Family medicine specialists (FMSs) had higher satisfaction with working conditions (B = 1.95, 95% CI 0.50 to 3.41, p = 0.01). A male worker had on average 2.8 (95% CI -4.7 to -0.9, p = 0.005) lower points in the total intrinsic job motivation scale. There was a positive relationship between the duration of working and job motivation (B = 0.10, 95% CI 0.004 to 0.2, p = 0.04). Conclusion: FMSt residents might have the least job satisfaction, but FMSs were generally satisfied with their working conditions regardless of the location of their clinics. Men and those who were novice in primary healthcare may need more support for motivation

Gycaemic control and treatment profile amongst 20646 adult type 2 diabetes mellitus: a descriptive report

An audit of Diabetes Control and Management-Diabetes Registry Malaysia (ADCM-DRM) was started to monitor the provision of diabetes care in the country. A total of 20,646 patients were registered in the registry until 31st December 2008. This report set out to determine the Type 2 diabetes controls and treatment profiles of these cohorts of patients. This was a registry-based observational study conducted from May to December, 2008. An online standard case record form was available for site data providers to register their diabetic patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Data were analyzed using Data Analysis and Statistical Software (Stata) version 9. A total of 81 centres, 6 of which were hospitals, participated in this registry until 31st December 2008, contributing a total of 20646 patients. A majority of them (99.2%) had Type 2 diabetes mellitus. The mean HbA1c was 8.0% (SD 2.10), with 30.1% and 17.9% of the patients who attained HbA1c < 7% and HbA1c < 6.5%, respectively. Metformin was prescribed more than sulfonylurea while only 11% had insulin. A review of the diabetic care policy and strategies in the primary health care clinics is needed to implement a more effective treatment of diabetes in this country