Introduction: This study aimed to cross-culturally adapt a Malay version of Knee Injury and Osteoarthritis Outcome Score (KOOS) and to evaluate its psychometric properties in patients with knee osteoarthritis (OA). Materials and Methods: The English version KOOS was translated into a Malay version using forward and backward translation process, followed by face validity and content validity. Two hundred and twenty-six knee OA patients attending the Outpatient and Orthopaedic Clinics, Universiti Sains Malaysia Hospital, completed the Malay version KOOS. Construct validity using confirmatory factor analysis and internal reliability assessment were performed. Results: The results showed that the original five-factor model with 42 items failed to achieve acceptable values of the goodness of fit indices, indicating poor model fit. A new five-factor model of 26 items demonstrated acceptable level of goodness of fit (comparative fit index= 0.929, incremental fit index= 0.930, Tucker Lewis fit index= 0.920, root mean square error of approximation= 0.073 and Chisquared/degree of freedom= 2.183) indices to signify a model fit. The Cronbach’s alpha value for the new model ranged from 0.776 to 0.946. The composite reliability values of each construct ranged between 0.819 and 0.921, indicating satisfactory to high level of convergent validity. Conclusion: The five-factor model with 26 items in the Malay version of KOOS questionnaire demonstrated a good degree of goodness of fit and was found to be valid, reliable and simple as an assessment tool for symptoms, pain activity of daily living, sports and recreational activity and quality of life for Malaysian adults suffering from knee osteoarthritis.

Introduction: Erectile dysfunction (ED) is common in men with diabetes and is associated with coronary artery disease and psychological distress. However, discussion of ED in primary care consultations is uncommon. Interventions, such as audit and feedback, mandate of management, and workshop on men’s sexual health, have been proposed to improve ED screening in public health clinics. This study aimed to pilot test a multi-faceted intervention to increase ED screening among men with diabetes and to improve knowledge and confidence in ED screening among primary healthcare providers (PHPs). Methods: We conducted an interrupted time-series quasi-experimental study with PHPs at public health clinics in Perak, Malaysia from February 2019 to February 2020. Doctors, nurses, and assistant medical officers involved in diabetes care were recruited. The intervention was conducted between July and September 2019 and comprised two phases: audit and feedback, and mandate from management (phase 1), and an interactive face-to-face workshop (phase 2). The primary outcome measure was monthly ED screening rate, and the data were retrieved from health records and the clinical diabetes registry. The PHPs completed a questionnaire on ED knowledge and confidence in ED screening before and after the workshop. Results: The total number of attendances by patients with diabetes was 50,325 during the study period, of which 21,413 were by men. A total of 30 PHPs participated in the training workshop: 7 (23.3%) doctors, 12 (40%) medical assistants, and 11 (36.7%) nurses. The mean duration of employment at a health clinic was 7 ± 5 years. The majority of the participants were male (56.7%), Malay (80%), married (76.7%), and had no experience with working in a urology department (76.7%). There was a significant improvement in the mean knowledge score (39.0 ± 11.4 vs. 63.6 ± 6.2, p<0.001) and median confidence level in ED screening from 2 (IQR 2–3) to 4 (IQR 4–4) after the workshop (p<0.001). After phase 1, the rate of ED screening increased from a baseline of between 10.3% (February 2019) and 12.7% (June 2019) before intervention to between 15% (July 2019) and 18.9% (September 2019) and was maintained between 18% (October 2019) and 17.9% (December 2019) after phase 2. Subsequently, the ED screening rate declined from 14.6% (January 2020) to 10.9% (February 2020). Conclusion This study found that audit and feedback with mandate from management increased ED screening and detection rate. The workshop improved the participants’ knowledge and confidence in ED screening but did not further increased ED screening. The improved practice was sustained for 6 months after the intervention, while the detection rate of ED persisted. We propose regular audit and feedback with mandate from management to sustain the practice of ED screening in men with diabetes.
Malaysia

Optimal glycaemic control is crucial in patients with diabetes mellitus (DM) to avoid episodes of hypoglycaemia and both micro- and macrovascular complications. Diabetic control relies mainly on the evaluation of haemoglobin A1c (HbA1c), which is unfortunately unreliable in patients with haemoglobinopathies. This case report describes a patient with type 2 DM and haemoglobin J (HbJ) trait, which resulted in erratic HbA1c values throughout her follow-up. Other approaches, such as self-blood glucose monitoring, are needed to evaluate glycaemic control instead of relying on HbA1c alone to guide the management DM in these patients.
Glycated Hemoglobin ; Hemoglobinopathies

Migraine Disorders ; Students, Medical ; Headache

Introduction: Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah. Methods: A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents. Results: The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively. Conclusion The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.
Child ; Child, Preschool ; Prevalence ; Smartphone ; Screen time

Introduction: Migraine is the most common headache affecting young people that impairs their functional ability. This study aimed to determine the frequency of migraines among Malaysian medical students, the association between migraines, stress level, and functional disability among these students, and describe their self-management practices. Methods: A cross-sectional study was conducted among medical students in a private medical school in Penang state. All medical students in the study site were screened for the presence of headache symptoms and the diagnosis of migraine using a self-administered questionnaire comprising International Headache Society (IHS) diagnostic criteria. Other domains that were assessed were perceived stress level and functional disability, which were measured using the Perceived Stress Scale and the Headache Impact Test-6 (HIT-6), respectively. The students’ self-management practices for their headaches were determined using a descriptive survey. Results: A total of 374 medical students participated in this study and 157 (42%) students reported experiencing headaches. More than half (n=97, 61.8%) of those with headaches fulfilled the IHS criteria for migraines. Migraines were significantly associated with functional disability compared with non-migraine headaches (p<0.001); however, no significant difference in stress levels were reported between the two groups. During migraine attacks, sleep (n=73, 60.33%) and self-medication (n=56, 69.14%) were the most common self-management practices. Only 11.46% of the 157 students with headaches consulted a doctor. Conclusion A high proportion of medical students suffered from headaches and more than half of them had migraines. Migraine headaches were associated with significant functional disability. Very few students sought medical consultation and most students chose to self-manage their headaches.
Migraine Disorders ; Students ; Stress Disorders, Traumatic, Acute ; Headache

Evidence-based medicine is the foundation of current medical practice. Suitable evidence is needed to support the holistic approach in clinical practice. Quantitative research produces some evidence needed for disease treatment based on probabilities or averages. However, the practice of evidence-based medicine should be personalised to individual patients without relying solely on an average perspective. Beliefs, values and expectations are unique for each individual and may differ significantly from the average. Therefore, understanding individual differences requires evidence from qualitative research. This is particularly important in family medicine practice, which focuses on holistic care for the person, family and community. Findings from properly conducted qualitative research can offer in-depth and comprehensive accounts on healthcare issues from patient and practice perspectives. Qualitative research also provides explanatory power and analytical transferability, which can be applied into daily family medicine practice. In conclusion, evidence from qualitative research should be rightfully equally acknowledged in family medicine and healthcare.
Family Practice ; Evidence-Based Medicine ; Qualitative research

Introduction: Booster vaccination has been shown to reduce transmission and serious infection with COVID-19. This study examined the willingness to receive a COVID-19 booster vaccine and its associated factors among high-risk patients at Klinik Kesihatan Putrajaya Presint 9. Methods: A cross-sectional study was conducted among patients aged ≥18 years attending Klinik Kesihatan Putrajaya Presint 9 with a high risk of contracting COVID-19 recruited via systematic random sampling. Data were collected using a self-administered questionnaire. A multiple logistic regression analysis was performed to identify the associated factors. Results: The response rate for this study was 97.4% (N=489). The median patient age was 55 years. Approximately 51.7% were men, and 90.4% were Malays. Approximately 81.2% were willing to receive a COVID-19 booster vaccine. The patients who perceived COVID-19 as a serious illness (Adjusted Odd Ratio, AOR=2.414), those who perceived COVID-19 booster vaccines as beneficial (AOR=7.796), those who disagreed that COVID-19 booster vaccines have many side effects (AOR=3.266), those who had no doubt about the content of COVID-19 vaccines (AOR=2.649) and those who were employed (AOR=2.559) and retired (AOR=2.937) were more likely to be willing to receive a booster vaccine than those who were unemployed and those who did not have close friends or family members who contracted severe COVID-19 (AOR=2.006). Conclusion The majority of the participants were willing to receive a COVID-19 booster vaccine. Healthcare authorities should take initiatives to design targeted public intervention programmes to increase the willingness for COVID-19 booster vaccination.
COVID-19 ; Immunization, Secondary ; Vaccines ; Malaysia

Introduction: Smartphone addiction is becoming a global concern affecting every part of society, including healthcare professionals. This study aimed to identify the prevalence of risk of smartphone addiction and its associated factors among medical and dental students in a public university in Malaysia. Methods: This cross-sectional study was conducted among pre-clinical medical and dental students using convenience sampling. Questions regarding sociodemographic profile and responses to the Smartphone Addiction Scale Short Version (SAS-SV) and Depression, Anxiety and Stress Score questionnaire (DASS-21) were collected. Multiple logistic regression testing was used to analyse the factors associated with smartphone addiction. Results: We invited 409 pre-clinical medical and dental students to participate voluntarily, resulting in a response rate of 80.2%. The prevalence of high-risk smartphone addiction among the participants was 47.9%. Male participants, participants who used smartphones mainly for social media, and participants with depressive symptoms were more likely to have a high risk of smartphone addiction. Medical students, participants who spent less than 3 hours per day on a smartphone, and participants who used smartphones for education-related activities were less likely to have a high risk of smartphone addiction. Conclusion Smartphone addiction prevalence among pre-clinical medical and dental students was high. Therefore, the authorities should overcome this problem by implementing early measures.
Internet Addiction Disorder ; Students, Medical ; Students, Dental

Introduction: Human immunodeficiency virus (HIV)-related stigmatisation and discrimination adversely affect health outcomes in terms of timely diagnosis, treatment and care. Despite global efforts, they remain common among healthcare workers worldwide. In Malaysia, family medicine specialists are entrusted with the care of HIV patients at the primary care level. This study aimed to assess HIV-related knowledge, acts of discrimination, stigmatising attitudes and their associated factors among family medicine trainees in Malaysia. Methodology: This cross-sectional study was conducted among 397 family medicine trainees in Malaysia using a validated, self-administered questionnaire that assessed the participants’ sociodemographic information, HIV/AIDS knowledge, stigmatising attitudes (attitudes of blame, attitudes towards imposed measures, comfort in dealing with HIV patients) and acts of discrimination. Results: The most common stigmatisation was “attitudes of blame” (mean [SD] score: 3.0 (0.74); range score:1–5), and the most frequent discriminatory act was breaching patient confidentiality (54.9%). Around 82.1% had good knowledge of HIV/AIDS. Married participants and participants who had 7 years or less in service were more stigmatising in “attitudes of imposed measures” towards people living with HIV (p=0.006). Conclusion Family medicine trainees exhibited stigmatisation and discrimination towards HIV patients despite having good HIV knowledge. Hence, appropriate and concerted health education should be given to all family medicine trainees to eliminate stigmatisation and discrimination.
Discrimination, Psychological ; Social Discrimination ; HIV