Children with musculoskeletal symptoms are commonly seen by general practitioners (GPs). Those that present with atraumatic limp pose a particular diagnostic challenge. Although uncommon, Perthes disease (PD) is an important cause of atraumatic limp in children and may result in debilitating consequences if missed. We put forward a case of delayed diagnosis of PD in a child, thus highlighting the need for a greater index of suspicion among GPs in approaching any child with a limp.

Background: Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity. Methods: This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak. Results: The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P < 0.001), and smoking and income (P = 0.050). Age-adjusted logistic regression showed that women were 0.246 times more likely to be obese, that older participants (> 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke. Conclusion: These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity.

Background: It is important to understand the prevalence of risk factors for cardiovascular disease, especially in a rural setting. Methods: A cross-sectional study was carried out in 238 rural households located in the Kuching and Samarahan divisions of Sarawak among individuals aged 16 years and above. Anthropometric measurements, blood levels of glucose and cholesterol, and blood pressure were collected. Results: Prevalence of blood pressure in the hypertensive range was 43.1%. The highest rates of blood pressure in the hypertensive range were found in individuals aged above 60 years (38.6%) and 50–59 years old (31.8%). Age was one factor found to be significantly associated with blood pressure in the hypertensive range (P < 0.001). Prevalence of obesity was 49.0%. The highest prevalence of obesity was found among those aged 40–49 years (41.9%) and 50–59 years (29.9%). Gender was significantly associated with obesity (P = 0.004). The prevalence of blood cholesterol at risk was 21.6%, and the highest rate was found in the 40–49 years age group (34.0%). Fifty percent of respondents were found to have hyperglycaemia, with the highest prevalence in the 50–59 years age group (37.5%). A significant association was found between obesity, blood pressure in the hypertensive range and blood glucose level. When compared with non-obese individuals, those who were obese were more likely to have blood pressure in the hypertensive range and hyperglycaemia. Conclusion: The risk of developing lifestyle-related diseases is no longer based on geographical or socio-economic factors.

Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.

Introduction: With increasing evidence of disease transmission through doctors’ white coats, many countries have discouraged doctors from wearing their white coats during consultations. However, there have been limited studies about patients’ preferences concerning doctors’ attire in Malaysia. This study, therefore, aimed to investigate patients’ perceptions of doctors’ attire before and after the disclosure of information about the infection risk associated with white coats. Method: This cross-sectional study was conducted from 1st June 2015 to 31st July 2015 at three different primary care settings (government, private, and university primary care clinics) using a self-administered questionnaire. A 1:5 systematic random sampling method was employed to select the participants. The respondents were shown photographs of male and female doctors in four different types of attire and asked to rate their level of confidence and trust in and ease with doctors in each type of attire. Subsequently, the respondents were informed of the risk of white coat-carried infections, and their responses were reevaluated. Data analysis was completed using SPSS Version 24.0. Associations of categorical data were assessed using the Chi-Square test, while the overall change in perceptions after the disclosure of additional information was examined using the McNemar test. Results with p-values < 0.05 were considered statistically significant. Results: A total of 299 respondents completed the questionnaire. Most of the respondents had more confidence and trust in the male (62.5%) and female (59.2%) doctors wearing white coats. A high proportion of the respondents from the government clinic (70.5%) felt more confidence in male doctors dressed in white coats (p-value = 0.018). In terms of ethnicity, male doctors in white coats were highly favored by Malays (61.0%), followed by the Chinese (41.2%) and Indians (38%) (p = 0.005). A similar preference was observed for the female doctors, whereby the highest number of Malays (60.3%), followed by the Chinese (41.2%) and Indians (40.0%) (p = 0.006), had a preference for female doctors wearing white coats. Only 21.9% of the initial 71.9% of patients who preferred white coats maintained their preference (p < 0.001) after learning of the risk of microbial contamination associated with white coats. Conclusion: Most patients preferred that primary care doctors wear white coats. Nevertheless, that perception changed after they were informed about the infection risk associated with white coats.

Background: Colorectal cancer (CRC) is the second most common cancer in Malaysia. Awareness of risk factors, symptoms and warning signs of CRC will help in early detection. This paper presents the level of CRC awareness among the urban population in Malaysia. Method: A cross-sectional study was conducted from November 2015 till December 2016 at three government clinics in the Klang Valley. The validated Bowel Cancer Awareness Measure questionnaire in both English and Malay was used. The mean knowledge scores for the warning signs and risk factors of CRC in different socio-demographic groups were compared using ANOVA in SPSS version 23. Statistical significance was set at p<0.05 and a 95% confidence level. Results: Of the 426 respondents, 29.1% were unable to recall the warning signs and symptoms of CRC. Average recall was less than two warning signs and symptoms (mean 1.62, SD 1.33). The mean total knowledge score for CRC was 9.91 (SD 4.78), with a mean knowledge scores for warning signs and risk factors at 5.27 (SD 2.74) and 4.64 (SD 2.78), respectively. Respondents with a higher level of education were found to have higher level of knowledge regarding the warning signs of CRC. There was a significant positive association between knowledge score for warning signs and level of confidence in detecting warning signs. Regarding the total knowledge score for CRC, 3.3% of respondents scored zero. For warning signs and risk factors, 8.2% and 8.5% of respondents had zero knowledge scores, respectively. Conclusions: Generally, awareness of CRC is poor among the urban population of Klang Valley. Greater education and more confidence in detecting warning signs are significantly associated with better knowledge of warning signs. CRC awareness programs should be increased to improve awareness.

Making healthcare decisions collaboratively between patients and doctors can be challenging in primary care, as clinical encounters are often short. Conflicts between patients and doctors during the decision-making process may affect both patient and doctor satisfaction and result in medicolegal consequences. With the increasing recognition of the importance of patient empowerment, shared decision making (SDM) can serve as a practical consultation model for primary care doctors (PCDs) to guide patients in making informed healthcare choices. Although more research is needed to find effective ways to implement SDM in the real world, the 6-step approach presented in this paper can guide PCDs to practise SDM in their daily practice. Implementation of SDM can be further enhanced by incorporating SDM training into undergraduate and postgraduate curricula and using evidence-based tools such as patient decision aids.

Introduction: The World Health Organization recommends evaluation of maternal satisfaction to improve quality of health care during childbirth. Dissatisfaction may lead to undesired outcomes such as unassisted homebirth and delay in seeking treatment. Determining the maternal satisfaction level and its associated factors may help to improve health care services and prevent negative implications to both mothers and infants. This study aimed to determine the maternal satisfaction towards intrapartum care of designated healthcare facilities and its associated factors among postnatal women. Methods: This was a cross-sectional study of postnatal women attended Klinik Kesihatan Salak from December 2017 to February 2018. Systematic random sampling with the ratio of 1:3 was applied to the eligible respondents. A self-administered questionnaire that include respondent’s socio-demographic characteristics and a validated 14-items Maternal Satisfaction with Hospital-based Intrapartum Care Scale was used. Data was analyzed using SPSS 23. Results: 274 respondents were recruited in this study. Overall, only 21.2% of respondents were satisfied with the intrapartum care given. The level of satisfaction was highest in interpersonal care domain (36.1%), followed by physical birth environment (34.3%) and the least satisfied was information and decision making domain (27.7%). Binary logistic regression showed that maternal satisfaction was significantly associated with place of birth (AOR (95% CI): 0.046 (0.183, 0.984)) and labour complications (AOR (95% CI): 3.387 (1.345, 8.528)). Conclusion: The overall maternal satisfaction towards intrapartum care was low and the information and decision-making domain appeared to be the least satisfied. Maternal satisfaction was associated with place of birth and labour complications. Therefore, health care providers should emphasize and improve the quality of services especially for this domain and to consider factor that contribute to dissatisfaction towards the intrapartum care.

Introduction: Metered-dose inhalers (MDI) are the most used inhalers worldwide. However, improper MDI techniques remain a significant problem and cause uncontrolled asthma. Studies worldwide have reported that the causes of inefficient inhaler technique are multifactorial. However, this topic has been less well studied in the Asian population. This study aimed to evaluate the MDI technique and associated factors among adults with asthma in a primary care setting in Malaysia. Method: This was a cross-sectional study with universal sampling conducted between July and October 2017. A total of 146 patients with asthma aged 18 years and older in a primary care clinic in Putrajaya, Malaysia were recruited. Logistic regressions were used for statistical analysis to examine the association between improper MDI techniques and their related factors. Results: The majority (83%) of respondents were female with a median age of 37 (IQR = 30.75–49.25) years, and the median duration of asthma of 20 (IQR = 10–30) years. An improper MDI technique was observed in 100 (71.9%) patients. The most frequently missed step was exhaling gently and fully before inhalation (51.4%). Respondents who were not on an MDI preventer (adjusted OR: 2.487, 95% CI: 1.121–5.519, p = 0 .025) or had used an MDI 5 years or fewer (adjusted OR: 3.369, 95% CI: 1.425–7.964, p = 0.006) were more likely to employ an improper MDI technique. Conclusion: There was a high proportion of improper MDI techniques among patients with asthma. Patients not using an MDI preventer or who had used an MDI less than 5 years were at higher risk of improper MDI technique.

Introduction: It is common, and many international and local studies confirm this, that women of reproductive age misperceive their body-weight status. This phenomenon can lead to their being less likely to adopt a healthy lifestyle which later exposes them to increased health problems and risks including those of a gynecological and obstetric nature. Generally, there have been inconsistent findings concerning the association between the self-perceived weight status and sociodemographic factors, physical activities, and previous weight loss attempts of women of reproductive age in an Asian population like Malaysia. Objective: This study aimed to determine the factors associated with body weight status misperception among reproductive-aged women at a primary care setting in Malaysia. Methods: This is a cross-sectional study conducted at Klinik Kesihatan Durian Tunggal in 2016-2017. The questionnaire included questions on the perception of weight status, sociodemographic factors, smoking status, level of physical activity, and weight loss attempts. Logistic regressions were used for statistical analysis to examine the association between body weight status misperception and related factors. Results: The study recruited 630 reproductive-aged women. The mean age and SD of the respondents was 32.7 + 8.9 years, and 84% of the respondents were Malays. More than three-quarters of the respondents (75.5%, n = 476) had received up to a secondary level of education. The majority of the respondents were in the overweight/obese group (59.4%, n = 374). The mean BMI of the respondents was 27.1 kg/m2 + 6.61. Approximately 65.4% (n = 412) of the respondents had an inactive lifestyle. However, 60% (n = 378) of the respondents reported that they had attempted to reduce their weight in the last year. A total of 141 respondents (22.4%) misperceived their weight status with 113 (80.1% ) of them underestimating their weight status. Women with primary-level education (OR: 3.545, 95% CI: 1.530-8.215, p = 0.003) and secondary-level education (OR: 1.933, 95% CI: 1.065-3.510, p = 0.030) had a greater likelihood of misperceiving their body weight status as compared to those who have a tertiary level of education. Women with no weight loss attempts were also at risk of body weight status misperception (OR: 1.850, 95% CI: 1.195, 2.865, p = 0.006). Conclusion: Bodyweight status misperception among reproductive-aged women was associated with a low level of education and with those who had made no weight loss attempts. Identifying women who are at risk of misperceiving their weight status would enable early counseling on weight management.