Purpose: To describe the management of mild conduct problems in an adolescent at the primary care level. Case report: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. Conclusion: This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.

We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
*Accidents ; *Child Abuse ; Drowning/*etiology ; Nurseries/legislation & jurisprudence ; Singapore

A 7-year-old boy with a diagnosis of advanced medulloblastoma refractory to treatment was discharged from hospital for further palliative care at home. During this short and eventful period, the child developed spinal cord compression with progressive weakness of upper and lower limbs, neck pain, faecal and urinary incontinence. This case highlights the important roles of a primary care doctor in the provision of palliative care for a child in the community.

Background: Patients’ education and empowerment are essential parts of a disease management. Patients have to be educated on the disease as well as lifestyle changes that they need to practise for a holistic and consistent improvement in their disease status. This study examined patients’ knowledge on diabetes and nutrition as well as the role of dietician in the patient education. Methods: This was a cross-sectional study of patients aged more than 18 years, in a primary care centre in Kuala Lumpur. Patients responded to a pre-tested self-administered questionnaire which contains socio-demographic profiles of patients, knowledge on diabetes and nutrition. Patients were also asked on dietician consultation and the number of dietician visits. Patients were conveniently selected on the data collection days. Only consented patients and those who could understand Malay or English language were selected. Results: There were 110 patients who participated in the study. Overall the patients had good knowledge on diabetes and nutrition. The mean total knowledge score was 71.2% ± 9.34. Domains such as diabetes complications, exercise, meal practice, food sources and proportion need reinforcement. Only 60 (54.9%) patients had seen a dietician. Patients who had seen dietician showed significantly higher level of knowledge score (p=0.04). However frequent meeting with the dietician did not show any significant improvement in the knowledge (p=0.10). Factors such as patients’ gender, ethnicity, level of education, employment status, glycaemic level, duration of illness and body mass index did not show any significant association with the overall diabetic and nutrition knowledge. Conclusion: There is still a need to improve the overall diabetic education particularly in areas that patients were lacking such as diabetes complications, exercise, meal practice, food sources and proportion. It is equally necessary to encourage all diabetics to see a dietician since it helps to improve their level of knowledge as shown in this study.

The advantages of breastfeeding have been well established. The objective of this study was to determine the practice and knowledge of breastfeeding in an urban com-munity and identify the influencing factors. This is a cross-sectional study. All mothers attending the Maternal and Child Health Clinic during the study period, who fulfilled the selection criteria, were included in the study. The mothers were interviewed using a self administered questionnaire. A total of 162 mothers participated in the study. The prevalence of initiating breastfeeding during the first week after childbirth was 93.8%. Breastfeeding was found to be higher among Malay mothers (p value <0.001). Mother’s education level, employment status, husband’s occupation, family income and attending antenatal classes did not show significant association with breastfeeding practice. Influence from significant family members was found to be an important factor towards encouragement of breastfeeding. Overall, the mother’s knowledge on breastfeeding was fairly good. However, more than half (58.6%) did not know that they should continue breastfeeding even if the mother or the baby were sick. More than 20% of the mothers were still ignorant regarding ‘lactational amenorrhoea’, breast milk protection against allergy and that nipple soreness is common when breastfeeding. Approximately 15% of the mothers were not aware that breast milk is better than formula milk. In conclusion, although the mother’s knowledge on breast-feeding was fairly adequate, misconception in certain areas of breastfeeding needs correction.

Chronic disability in children imposes great strains on a family. The responsibility of mothering disabled children may be detrimental to the well-being of mothers. This study aims to assess the different types of coping styles of mothers with disabled children and its influencing factors. It is a cross-sectional study using Coping Inventory Stressful Situation (CISS) scale to determine the mothers' coping styles. A sample of 81 mothers with disabled children attending two rural Community Rehabilitation Centres, were included in the study. Overall, the mothers were using a mixture of coping strategies. However, they scored more in the task-oriented (mean T score = 52.88) and emotion-oriented (mean T score = 50.52) coping styles, while the other subscales of coping styles, namely avoidance, distraction and social diversion were below average (mean T score < 50). Divorced mothers (p=0.04) and those with low educational level (p=0.00) were more inclined to use emotion-oriented coping strategies while mothers with younger children (< 5 years old) used more avoidance coping strategies (p=0.01). There were no significant difference of coping styles in association with the mothers' age, ethnicity, duration of marriage, number of siblings, child's birth order or gender. By understanding the mothers' coping styles, health care workers would be able to educate the mothers with effective coping strategies and consequently reduce their psychological distress.
Coping Behavior ; Disabled Children ; Child coping with hospitalization ; lower case pea ; Upper case tea

Background: Adolescent pregnancy has emerged to be a significant public health and social issue in Malaysia as its prevalence is increasing in our population. Objectives: This study aimed to identify the common characteristics of pregnant adolescents residing in a government shelter home. Their reasons for pregnancy, sources of information on contraception, and views on abortion and future care of the baby were explored. Methods: A cross-sectional study was performed on 26 universally sampled pregnant adolescents in the centre. The adolescents responded to a set of self-administered questionnaire on their socio-demographic profiles, reasons of their pregnancy, contraception and future plans including abortion as well as care of the newborn. Results: Almost all (92%) of the adolescents were unmarried. Majority of them were in late adolescence, age between 16 to 19 years (73.1%), from urban areas (73.1%) and of low income families (53.8%). There were 69.3% of the adolescents who were school dropouts. The reasons for pregnancy were consensual sexual activity (63.0%), coercion by boyfriend (18.5%), and rape (11.5%). The main sources of information on contraception were friends (50%), partners (50%) and the internet or mass media (42.3%). 54% had considered abortion earlier, but majority (92.0%) disagreed that abortion should be legalised in Malaysia. Most of the adolescents planned to parent their child with or without help from significant others and only 42.3% planned to relinquish their child for adoption. Conclusion: To curb teenage pregnancy-related problems, efforts on educating the adolescents about sexual reproductive health and assertive communication skills should be implemented, especially to the late adolescents, school dropouts and those from poor urban families. Parenthood support may be necessary to the pregnant adolescents who opted to care for their own child.

Introduction: Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child’s weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. Methods: This crosssectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. Results: A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR:0.28, CI:0.13-0.62). Parents with overweight children were significantly older (OR:1.08, CI:1.01-1.15), concerned about their child’s weight (OR:2.77, CI:1.49-5.12) and controlled their child’s feeding by restricting food intake(OR:2.70, CI:1.30-5.60). They were less likely to pressure their children to eat (OR:0.32, CI:0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI:1.28-13.47). Conclusion: There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child’s weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis made when someone including children who experiences traumatic stressor. Those who are exposed to a more severe trauma have highest level of PTSD. The aim of this study was to measure the prevalence of PTSD and its associated factors among 219 children who were affected by a form of natural disaster which is the tsunami waves in a rural area in Malaysia. A cross sectional study was carried out among children aged 10-12 years 6 months after the traumatic event. Child Posttraumatic Stress Disorder –Reaction Index (CPTSD-RI) was used as a screening instrument which was answered by the affected children through a self-administered questionnaire. Forty six percent of these children had PTSD symptoms; 31.1% of these children had mild, 11.4% had moderate, 3.7% had severe PTSD and none had very severe PTSD. Result also showed that 91.8% had re-experiencing symptoms, 28.3% had numbing/avoidance symptoms and 49.3% had hyperarousal symptoms. Children with low social support (Adj OR = 2.3 (95% CI: = 1.3- 4.2)), and children who experienced deaths among someone close to them (Adj OR = 3.7 (95% CI =1.2 - 11.5)) were more likely to have symptoms of PTSD. This showed that children are at higher risk of developing PTSD as early as 6 months after the event and thus early intervention should be offered to them. Future longitudinal study can be carried out among affected children to assess whether these PTSD symptoms persist over time.