Conference 2009

Mazapuspavina Md Yasin¹, Ng Kien Keat¹, Anis Safura Ramli¹, Ambigga Devi¹, Nafiza Mat Nasir¹, Maizatullifah Miskan¹, Siti Radhiah Ahmad¹, Norhanniza Kamaludin¹, Siti Nordalila Saad¹, Nohafizah Anuar¹, Jemah Sajari² and Rozlan Ishak³.

ABSTRACT
Background:  In the NHMS III 2006 (National Health and Morbidity Survey), adult asthma prevalence was 4.53%. This survey quoted 68.1% had  exarcerbations  in past 12 months. These showed that despite the presence of well-developed clinical practice guidelines for asthma monitoring and management {Global Initiative for Asthma 2006 (GINA)}, asthma control is challenging.
Objective: To evaluate the effectiveness of adult asthma management in two public health clinics in Selangor specifically looking at asthma control and monitoring practices with reference to the standard care by GINA 2006.
Materials and Method: It is a clinical audit of adult asthma management (age ? 18 years old). Data obtained from 113 patients and their medical records using a modified questionnaire, based on Ministry of Health QAP (Quality Assurance Program) for Asthma Management. Statistical Package for the Social Sciences (SPSS) version 16.0 was used to analyze the data.
Results: The mean age was 50.4 years (SD±15.1) with male:female ratio of 1:1.33 (49:64). In asthma control: a) Objectively by predicted PEFR, percentage < 60%, 60-79% and >80% were 60.2% (68), 27.4% (31) and 12.4% (14). b) Subjectively by ACT (Asthma Control Test) score for uncontrolled (<20 score), well controlled (20-24 score) and total controlled (25 score) were 52.2% (59), 44.3% (50) and 3.5% (4). In asthma monitoring, there were 93.8% (106) had not been measured PEFR in their follow-up clinics and 96.3% (110) not using home asthma diary. Nonetheless, 62.7% (69/110) demonstrated correct inhalation technique, 59.4% (38/64) adhered to their prescribed inhaled prophylaxis (corticosteroid) and 66.3% (75) knew about action plan if asthmatic attack occured at home.
Conclusion: Majority of studied adult asthmatics, were uncontrolled, and only minority has  appropriate monitoring practices. Rigorous effort  needed, to standardized and strengthtened the practice of asthma management among healthcare professionals, according to the recommended clinical practice guidelines.

Syed Alwi SAR1
1 Department of Family Medicine,Faculty of Medicine and Health Sciences, Universiti  Malaysia Sarawak

Objective: The objective of the study was to estimate the prevalence of metabolic syndrome among healthy Sarawakian adults attending primary health care centers in Kuching,Sarawak
Methods: 312 Sarawakian aged from 20-45 years who were healthy and attending the health centers for routine checkup were invited for the study. The National Cholesterol Education Program - Adult Treatment Panel III criteria of metabolic syndrome were used. Body mass index, waist circumference, fasting blood glucose and fasting plasma lipids and blood pressure were measured.
Results: Total number of metabolic syndrome was 78 (18.9%); 57.8% were males. The prevalence of overweight and obesity were 31% and 38.3%. Low HDL-C was found in 50.7% (49.4% of males and 52.1% of females), central obesity was prevalent among 37.7% and was significantly more common among females than males (41.7% vs 26.9% respectively). High TG was prevalent among 21% where males rated significantly higher, double that of females (29.8% vs 15.1% respectively). About 21% of the sample was suffering from either high blood pressure (197.0% of males and 17.8% of females) and/or impaired fasting blood glucose (19.9% of males and 16.0 of females).
Conclusion: The prevalence of metabolic syndrome is high among healthy adults attending primary health care centers in Kuching,Sarawak.

Shelima Begum1, Elizabeth A Grunfeld1, Mark Ho-Asjoe2, Jian Farhadi 2
1Psychology Department, Institute of Psychiatry, King’s College London, 5th Floor Bermondsey Wing, Guy’s Hospital, London SE1 9RT
2 Department of Plastic Surgery, St Thomas’ Hospital, London, Se1 7EH

Objective: The aim of this study was to examine patients’ experiences of the decision to undergo breast reconstructive surgery following mastectomy.
Method: 21 women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants’ experience of the decision-making process.
Results: The immediate and delayed groups had different reasons for the decision to undergo breast reconstructive surgery and also differed in their reasons, whether to undergo immediate or delayed breast reconstruction. However both groups shared similar influential factors and received and used similar informational content and informational sources in order to make their decision.
Conclusion: This study has highlighted the important role of a credible information sources, the need for clear information about the outcomes of reconstructive surgery and also the need for novel methods of presenting information to patients.
Practice Implications: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos.

Authors: Ali, Fatima M H1; Ali, Muttib H2; 1Medical Student, King’s College London, UK, 2 Consultant Paediatrician, Princess Alexandra Hospital, Harlow, UK

Background: Ischaemic heart disease (IHD) is the top cause of mortality in Malaysia; it is widely understood that one can reduce the risk of IHD through modifiable risk factors: diet, exercise and smoking. Patients can control these factors and family medicine practitioners are vital for health promotion and education. Most patients present when they become symptomatic, yet healthy behaviour, such as a balanced diet, are lifelong habits best formed in childhood.

The Scheme: The King’s College London Cardiology Society with support from the British Heart Foundation developed a “Heart Health in Schools” community programme to address health promotion in school aged children. Over 3 months, 8 interactive sessions were delivered in schools for children aged 9-11 years old. The sessions lasted 2 hours each. Children were taught basic science about the heart and the circulatory system. They were also taught good “heart health” through: a mini-presentation, a group game about the heart and 4 small group activities. Medical and nursing students volunteering for the programme underwent a training session.

Feedback: Feedback from schools was encouraging with many schools wishing to sign up for future sessions. Medical students who participated in the programme enjoyed it and aided understanding health promotion in the community. Children who participated gave positive feedback to the volunteers; teachers felt the programme was educational as well as enjoyable.

Conclusion: Health promotion in childhood has a role in future adult behaviours; programs like this could potentially be run by family medicine practitioners as they have excellent links in the community and would be complementary to current health promotional activities in Malaysia.

A M Faudzi, MD, Norsiah M N, MD, Siti Zubaidah M A, MD, Norizzati B I B, MD, Azlin A, MD, Lydia A Latif, MD, Nazirah H, MD, Zaliha Omar, MD

Objective: The objective is to study the content validity of the Comprehensive ICF Core Set for DM from the Malaysian perspective. Methods: Design: This is a multicentre, cross-sectional study involving 5 Health Clinics conducted by Family Medicine Specialists in Malaysia. Subjects: Convenience sampling of 100 respondents with DM. The ICF based measures were collected using the Comprehensive Core Set for DM. SF 36 and SCQ were also used. Results: 97% had Type 2 DM and 3% had Type 1 DM. The mean years of having DM was 6 years. Body functions related to physical health including exercise tolerance (b455), general physical endurance (b4550), aerobic capacity (b4551) and fatiguability (b4552) were the most affected). For body structures, the structure of pancreas (s550) was the most affected. In the ICF component of activities and participation, limitation in sports (d9201) was the highest most affected followed by driving (d475), intimate relationships (d770), handling stress and other psychological demands (d240) and moving around (d455). Only 7% (e355 and e450) in the environmental category were documented as being a relevant factor by more than 90% of the patients. Conclusion: The content validity of the comprehensive ICF Core set DM for Malaysian population were identified and the results show that Physical and Mental functioning were impaired in contrast to what the respondents perceived as leading a healthy lifestyles.