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@#This case report illustrates how a primary care physician managed a 60-year-old woman with severe obesity, uncontrolled diabetes mellitus, and low self-esteem for many years. Through a primary care physician, bariatric surgery is recommended for patients with severe obesity, which is then co-managed in a tertiary hospital through a multidisciplinary team. Primary care physicians are on the front lines when treating patients with severe obesity. A number of studies have shown that primary care physicians have low success rates in counselling and managing patients with severe obesity.(1,2) There is also a debate about bariatric surgery being unsuitable for the elderly age. It is crucial to intervene early to prevent obesity progression and its complications. Clinical inertia is one factor that hinders patients with severe obesity. Therefore, it is essential to address the problem of severe obesity early and should not miss the opportunity to counsel the treatment options and refer these patients to bariatric surgery if indicated. Primary care physicians are also crucial in providing continuity of care after bariatric surgery.
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@#Introduction: Since pharyngitis in adults is one of the most common infectious diseases seen in general practitioner consultations in Malaysia, data on pharyngitis among adults concerning to its prevalence, socio-demographic, risk factors and clinical manifestations is very much lacking. This study aims to determine the prevalence of pharyngitis among adults in Sepang, Selangor, Malaysia from 2016 to 2017 and its associated demographic and risk factors. Methods: We conducted a cross-sectional study on 215 adult patients with a sore throat as the main symptom and who did not receive any antibiotic treatment within two weeks at three Malaysian primary care clinics. The researchers assessed the participants’ clinical manifestations and collected throat swabs for culture to determine the presence of group A streptococcus (GAS). Data on demographic characteristics, clinical manifestation and throat swab culture results were analyzed using chi-square test and multivariate logistic regression. Results: Pharyngitis was diagnosed in 130/215 (65%) adults with a sore throat. Only six isolates (2.8%) were identified as GAS. The overall mean age ± S.D was 36.43 ± 15.7. The majority of the participants were in the age group of 18-28 years. There were 42.3% males and 57.7% females; most participants were Malay 62.8%, followed by 30.2% Indian, 5.1% Chinese, and 1.9% other ethnicities. The most common symptom among the participants was cough 196 (91.2%), followed by rhinorrhea 161 (74.8%), tonsillar swelling or exudates 68 (31.6%), inflamed or reddish of pharynx 62 (28.8%), swollen anterior cervical lymph nodes 50 (23.3%), and fever ≥37.5°C 28 (13.0%). Conclusion: Besides, there was no significant association between pharyngitis and the demographic variables; the current findings emphasized that inflamed or reddish pharynx, tonsillar swelling or exudates were among the factors associated with pharyngitis.
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@#Introduction: This cross-sectional study aimed to investigate relationships between diet quality assessed by Malaysian Healthy Eating Index (HEI) and cardiometabolic risk factors in adolescents aged 13 years. Methods: 336 adolescents from various public secondary schools provided information on sociodemography and their anthropometric measurements including height (cm), weight (kg) and waist circumference (cm) were measured. Body mass index (BMI) was estimated thereafter. Dietary intakes assessed using a validated adolescent food frequency questionnaire (FFQ) was used to estimate Malaysian HEI. Biomarker parameters including lipid profile, fasting glucose, insulin and insulin resistance were also assessed. Associations of diet quality indicators to cardiometabolic risk factors were examined using regression models. Results: The overall diet quality of the adolescents was rather poor (49%), with a greater percentage of males were found to have low dietary quality score compared to females (56% vs. 39%; p<0.05). While males were more obese, a higher number of females (46.7%) were found to have at least one risk factors for cardiometabolic health compared to males (37.7%). After adjusting for covariates, no significant associations were observed among adolescents in the lowest quartile compared to those in the highest quartile of HEI score for obesity and abdominal obesity, as well as other cardiometabolic risk factors, in both males and females. Conclusion: Despite of poor dietary quality, no significant associations were observed between dietary quality assessed by Malaysia HEI and cardiometabolic risk factors in adolescents. Prospective studies are needed to establish a causal link between dietary patterns and cardiometabolic risk factors during adolescence.
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@#Introduction: In first six months of life, breastfeeding is the recommended form of feeding by the World Health Organisation for the growing child. To enable the working mother to continue this noble practice, adequate workplace breastfeeding support and self- efficacy is needed.This study aims to determine the prevalence of breastfeeding among working mothers of children aged three months to two years and factors associated with breastfeeding practice including workplace support and mother’s self-efficacy. Method: This is a cross sectional questionnaire study carried out in a rural Health Clinic in Selangor using socio-demographic data, Workplace Breastfeeding Support Scale (WBSS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). This study was conducted for a period of three months from April to June 2015. The respondents were employed Malaysian mothers of healthy infants aged three months to two years. A total of 84 participants were involved in the study. Data analysis was done with SPSS 22.Results: The prevalence of breastfeeding among working mothers were high at 97.6%. We found significant association of breastfeeding practice with workplace breastfeeding support (p=0.005) and self-efficacy (p= 0.017). We also noted a significant correlation between breastfeeding workplace support and breast feeding self-efficacy (r= 0.40, p <0.01). Age, religion, ethnicity, educational level and place of employment were found to be not associated with breastfeeding practices.Conclusion: This study highlights the importance of workplace support and self-efficacy with workplace breastfeeding practices. Policymakers and stakeholders should provide a conducive and supportive environment to enhance breastfeeding among working mothers.
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Congenital malformations (CM) comprise a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin. It has contributed to a significant proportion of infant morbidity and mortality. The aims of this study were to determine the extent and investigate the relationship between CM and its associated demographic variables. Data was extracted from Ministry of Health (MOH) database compiled from the reports on Stillbirth & Under 5 Mortality from year 2013 to 2014. Out of 9,827 child death, 2,840 (28.9%) were classified under CM as defined under ICD-10 classification. Majority of those with CMs died at neonatal stage (62.7%) and among mothers aged between 20 to 35 years old (67.3%). The mean age of mothers among CM children was 30.8±6.5 years old. Approximately 5.8%, 6.7% and 3.3 % of total CM were neural tube defects, heart defects and hydrops fetalis respectively. The prevalence of CM in males was 15% higher than females. The difference were evident between CM and age of death of children under 5 years old (p<0.001) as well as between CM and maternal age groups (p<0.001). CM is responsible for 28.9% of total causes of child death with higher occurrence of malformation in males. A significantly higher risk of CMs among mother aged between 20 to 35 years old was observed. This emphasises the importance of raising awareness and the need to strengthen appropriate response for surveillance and prevention program of common CM in Malaysia.