Physcial and mental health problems of the elderly in nursing homes in Kuantan, Pahang

Aim of study: To describe the residents of nursing home for the elderly in relation to their socio-demographic, physical and mental profiles. Method: A cross-sectional study design was carried out. The elderly in two selected nursing homes in Kuantan, Pahang were interviewed. The respondents were interviewed using a structured questionnaire which included the biodata, social background, medical illness, presence of cognition, depression and ability to perform basic activities of daily living (ADL). Results: Results are available for 36 respondents out of 41 residents, giving a response rate of 87.8%. Chinese (77.8%), male (63.9%), single or divorced (50%), and low income (69.4%) was consisted the majority. Most respondents (86.1%) suffered from chronic illness, 61.1% were functional dependent (according to Barthel index), 33.3% have cognitive impairment (according ECAQ) and 22.2% have depression (according to GDS-14). The most common functional dependence was mobility on level surface (47.2%), followed by climbing stairs (38.9%). Conclusion: This study had identified chronic illness, cognitive impairment, depression, and functional decline as major health problems of the elderly in nursing homes that require greater attention and intervention

Study on characteristics of patients with repeated admissions for asthma in Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia

ABSTRACT (Perlu disediakan makluman di antara 100 - 200 perkataan di dalam Bahasa Malaysia dan Bahasa lnggeris. lni kemudiannya akan dimuatkan ke dalam Laporan Tahunan Sahagian Penyelidikan & Pembangunan sebagai satu cara untuk menyampaikan dapatan projek tuan/puan kepada pihak Universiti). Objective To determine the characteristics in patients with repeated admissions for asthma compared to patients with no repeated admission for asthma over the same period of one-year duration. Methods A cross-sectional comparative study among 30 patients with asthma who had repeated admissions and another 30 patients with asthma who had no repeated admission for exacerbation of asthma over the same period of one-year duration (2001 ). The socio-demographic, clinical characteristics and evaluation data were collected. The evaluation included measurement of peak expiratory flow (PEF), inhaler technique skills and questionnaires on knowledge of asthma. Results There was no significant difference in socio-demographic characteristics, measurement of PEF and inhaler technique skills in both groups. In clinical characteristics, there was significant difference noted in history of atopy, history of absenteeism, asthma symptoms and use of medications. There was significant difference in .the knowledge of asthma where the total mean scores was 14.8 in repeated admissions group and 17.7 in non - repeated admission group from the total sco~e of 31. Conclusions Patients with repeated admissions for asthma tend to have high past history of atopy, high history of absenteeism from work or school, more frequent nocturnal symptoms and more use of low dose inhaler corticosteroids. They also had poor inhaler techniques and less asthma knowledge. USM J

The prevalence of depression among elderly patients attending primary care clinics in Kuantan, Pahang, Malaysia

Identifying factors associated with depression among elderly population is important in order to improve their quality of life. A cross sectional study was conducted among elderly in three primary care clinics, Kuantan, Pahang in assessing the depression and its associated factors. The respondents were selected through convenient sampling and interviewed by using reconstruct standardized questionnaire which includes social-demographic background, medical illness, ability to perform basic activities of daily living (ADL), cognitive function and depression assessment. Out of 600 elderly that attended the clinics from 1st December 2006 to 31st January 2007, 182 (30.3%) respondents agreed to enroll in the study. The respondents comprised of Malay (93.4%), females (54.4%) and married (71.4%) elderly. Most of them were living with their family (92.3%), received formal education background (64.8%), had no past history of hospital admission (81.3%) and median income per capita of RM250 per month. Most respondents (90.7%) suffered from chronic illness, 19.8% were functional dependent (according to Barthel index), 15.4% had cognitive impairment (according ECAQ) and 17.0% had depression (according to GDS-14). The study revealed that depression were found significantly difference with increasing age, marital status, occupation, living arrangements, history of hospital admission and presence of cognitive impairment. These findings highlighted that high prevalence of elderly attended the primary care clinics have a depression that require greater in health intervention by healthcare professionals

Islamic perspective in Family Medicine

The Muslim physician, guided by the two primary sources of Islamic Law; the Quran and Sunnah, will possess the necessary traits of a good physician. Primary care Muslim physicians will deal with various types of patients and cases of different ages, races, religions, and social backgrounds. They need to have a good personality guided by sources of Islamic Law and upon reflecting on the life of Prophet Muhammad (PBUH). This chapter will discuss and relate most of the topics in this book on Islamic perspective and will provide simple guidelines to become a good Muslim physician

Prevalence of Diabetic Retinopathy (DR) and its associated factors among diabetes patients in Primary Care Clinics, Kuantan, Pahang

Introduction: Diabetic retinopathy (DR) is one of the commonest complications of diabetes mellitus. This study was to determine the prevalence of diabetic retinopathy and its association with chronic kidney disease (CKD), high HbA1c and dyslipidemia among diabetic patients in government primary care clinics. Methods: A cross sectional study was carried out. The respondents were selected from diabetic registry at two government primary care clinics in Kuantan, Pahang via stratified random sampling method during the study period from May 2010 to April 2011. The respondents were interviewed and assessed clinically using a structured questionnaire. Retinal examination was performed by accredited staff using non-mydratic retinal imaging and DR was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Results: Out of 400 respondents, 58.8% diagnosed diabetes less than 5 years and 51.0% had uncontrolled blood pressure (>130/80 mmHg). The prevalence of diabetic retinopathy and maculopathy were 33.5% and of 17.8% respectively. Most of these patients (22.3%) had mild non-proliferative diabetic retinopathy. DR-patients had higher percentages of chronic kidneys disease (17.9% vs. 6.8%; p<0.001) and a higher mean of HbA1C (8.69 vs. 8.11; p=0.015)compared to non-DR patients. The study revealed that DR was independently associated with chronic kidney disease {OR: 3.46, 95% CI (1.76, 6.80)} and high HbA1c {OR: 1.12, 95% CI (1.02, 1.23)}. Those with dyslipidemia however, has 39% less risk of diabetic retinopathy {OR: 0.61, 95% CI (0.39, 0.94)}. Conclusion: This study shows that diabetic patients with CKD and high HbA1c have greater risks to develop diabetic retinopathy but has protective risk with dyslipidemia

Common morbidity and utilization rate of the University Health Centre, International Islamic University Malaysia (Kuantan Campus) in 2010

Introduction: University Health Centre, International Islamic University, Malaysia, Kuantan campus, (UHC-IIUM), is a primary care clinic for its community, students, staff and their dependents. Common morbidity and utilization rate of the clinic need to be analyzed to know current practices environment for further planning to provide quality primary health care services in line with vision of the clinic. Aim : To scrutinize the common morbidity and utilization rate of University Health Centre , International Islamic University ( Kuantan Campus) Methods: A retrospective desktop study was done by using 2010 annual electronic medical record (EMR) data of UHC-IIUM (Kuantan-Campus) after getting approval from University authority. Background socio-demographic data and reason for encounter were extracted from the EMR and converted into the International Classification of Primary Care code for diseases under Reasons for Encounter (RFE) format. Utilization rate of UHC-IIUM (Kuantan Campus) was computed based on staff and students population of the University in 2010 which was analyzed in accordance with category of patients and faculty. Results: Total (9220) encounters of the University Health Centre were included in the study. Common morbidity of the health centre were respiratory diseases (24.4%), skin diseases (9.7%), gastrointestinal tract disorders (7.2%), general and unspecified (5.4%), locomotors-disorders (4.9%), eye and ear problems (3.6%), women health (3.2%), neurological disorders(2.2%), minor surgical cases( 1.8%) and endocrine disorders particularly Diabetes-Mellitus (1.9%). Minimum and maximum frequency of visit to the UHC were 1 and 30 respectively; 96% of patients visited 1 to 5 times per year. Utilization rate (visit per person per year) of UHC-IIUM (Kuantan) campus by staff was 2.31 and that of student was 1.72. Utilization rate in accordance with faculty were Office of Campus Director (12.96), followed by Security Department (5.65), Faculty of Dentistry (2.98), Faculty of Science (2.54), Faculty of Medicine (2.29%), Faculty of Pharmacy (1.85), Faculty of Nursing (1.33), Faculty of Allied Health Science (0.71) and others (0.95). Conclusion: This study illustrated common morbidity and current utilization rate of the UHC-IIUM (Kuantan-campus) by staff, students and faculty which is invaluable input to administrators and clinic health providers to plan further primary care activities in tailored to the need of community. Keywords : Utilization rate, common morbidity, University Health Centre, Electronic Medical Record

Ethics in primary care practice

Family physicians deal with various types of patients from different ages, races and social backgrounds. A family physician needs to be well equipped with a clear understanding of ethical principles to enable them to manage any kind of ethical issues raised. This chapter aims to discuss the four pillars of medical ethics namely ‘patient autonomy’, ‘beneficence’, ‘non-maleficence’ and ‘justice’. These four pillars will be discussed from the primary care perspective. Beyond that, this chapter will also discuss the extended medical ethics which are particularly relevant to primary care such as patient’s confidentiality, child’s rights

Introduction to family medicine

Primary care (also known as family medicine as a medical speciality in primary care) is the first point of contact that an individual has with health care provision. Primary care doctors are known as family doctors, general practitioners or family physicians. Family medicine is a medical speciality that provides comprehensive and continuous health care for the individual and the whole family. The practise encompasses the biological, clinical aspect and behavioural sciences, whereas the scope covers all ages from womb to tomb, all sexes, all aspects of the organ system and all diseases

Cardiovascular disease awareness among women with hypercholesterolemia and their health seeking behavior – a qualitative study

Cardiovascular diseases (CVD) are a group of disorders that affect the heart and blood vessels. It is an important cause of morbidity and mortality in Malaysian women. However, many women are not aware of it and have a misconception that CVD is a disease that only affects men. Therefore, the main objectives of this study are to explore CVD awareness among women who are at risk of developing the disease and evaluate their health seeking behaviour in regard to their hypercholesterolemia status. A series of in depth face-to-face interviews were conducted among 13 women who were found to have high cholesterol level detected in their blood during a routine medical screening at a primary health care clinic in the International Islamic University Malaysia, Kuantan, Pahang. All interviews were audio recorded and transcribed verbatim. NVIVO software Version 12 was used to code and manage all qualitative data. Results indicated that all participants had poor awareness of CVD. The majority of them did not perceive themselves as at high risk of developing CVD despite having high cholesterol levels in their blood. Poor CVD awareness, lack of knowledge and sociocultural aspect influenced their health seeking behaviour. This study provided an insight into the women’s awareness towards CVD. Health-care practitioners should elicit a patient’s awareness to facilitate the clinical management of CVD. Additionally, there is a clear need to increase CVD health awareness among women, especially those who are susceptible to CVD

A preliminary assessment on magnitude of oral health problems among five selected primary care clinics of Malaysia and Myanmar in 2012

Background: There is growing evidence that oral health is related to local and systemic diseases by sharing common risk factors. Although, oral health has long been overlooked in the medical community, electronic medical records study in 2011 found that 1.2% of all encounters of the University Primary Care Clinic were oral diseases. The first point of contact for patients with Primary Care Physicians (PCPs) can facilitate preventive dental care through timely referrals to dental profession4. Objectives: To assess the oral health concern of general/family medicine practices which may be used to set primary and emergency oral health care training for primary care physicians Methods: A uniform structured format was used to collect total number of patients and the patients with oral health problems (OHPs) who attended at the selected 3 primary care clinics of Kuantan, Malaysia (a private, a public and a University clinic) and two private clinics of Myanmar (one from Yangon (City) and one from Hninthada District within 1st April, 2012 to 31st July 2012. A cross-analysis was done between demographic data, reason for encounter (RFE) and the countries under study. Findings: In Malaysia, range of proportion of oral health problem (OHP) per month among the 3 primary care clinics was from 4.2 to 25.7 per 1000 patients/month. That of two Myanmar private clinics was from 3.6 to 11.6 per 1000 patients/month. Although, age group differences- the younger age group more in Malaysia and the older age group more in Myanmar was seen, there was no gender differences. Although the common OHP in both countries were more or less same -dental caries, periodontal diseases, oral ulcer, hand-foot mouth disease (HFMD); and co-morbidity with medical diseases were more in Myanmar than in Malaysia. Discussion and conclusion: This study confirms that Oral Health Problem is an important health issue in reason for encounter of primary care practices. It is recommend that all primary care physicians be more aware of oral health problems and if necessary be made part of the training as a primary care physician