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.

Purpose: This study aimed to identify factors influencing quality of life in post-menopausal women. Methods: The participants were 194 post-menopausal women who visited a women’s clinic in Changwon, Korea from July 1 to August 31, 2018, and completed questionnaires containing items on menopausal symptoms, marital intimacy, current menopausal hormone therapy (MHT), and quality of life. Collected data were analyzed by descriptive statistics, the independent t-test, Pearson correlation coefficients, and multiple regression using SPSS for Windows version 23.0. Results: Quality of life had a significant negative correlation with menopausal symptoms (r=–.40, p<.001), and a significant positive correlation with marital intimacy (r=.54, p<.001). The factors influencing the quality of life of post-menopausal women were current MHT (t=6.32, p<.001), marital intimacy (t=4.94, p<.001), monthly family income (t=4.78, p<.001), menopausal symptoms (t=–4.37, p<.001), and education level (t=3.66, p<.001). These variables had an explanatory power of 59.2% for quality of life in post-menopausal women. Conclusion In order to improve the quality of life of post-menopausal women, nursing interventions are needed to help menopausal women choose appropriate MHT, alleviate menopausal symptoms, and increase marital intimacy. Interventions should also be prioritized for women of a low educational level and with a low income in consideration of their health problems.

Purpose: This study aimed to identify factors influencing quality of life in post-menopausal women. Methods: The participants were 194 post-menopausal women who visited a women’s clinic in Changwon, Korea from July 1 to August 31, 2018, and completed questionnaires containing items on menopausal symptoms, marital intimacy, current menopausal hormone therapy (MHT), and quality of life. Collected data were analyzed by descriptive statistics, the independent t-test, Pearson correlation coefficients, and multiple regression using SPSS for Windows version 23.0. Results: Quality of life had a significant negative correlation with menopausal symptoms (r=–.40, p<.001), and a significant positive correlation with marital intimacy (r=.54, p<.001). The factors influencing the quality of life of post-menopausal women were current MHT (t=6.32, p<.001), marital intimacy (t=4.94, p<.001), monthly family income (t=4.78, p<.001), menopausal symptoms (t=–4.37, p<.001), and education level (t=3.66, p<.001). These variables had an explanatory power of 59.2% for quality of life in post-menopausal women. Conclusion In order to improve the quality of life of post-menopausal women, nursing interventions are needed to help menopausal women choose appropriate MHT, alleviate menopausal symptoms, and increase marital intimacy. Interventions should also be prioritized for women of a low educational level and with a low income in consideration of their health problems.

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.

Purpose: The goal of this study was to see how flipped learning affected nursing students in South Korea who were enrolled in a quit smoking intervention education program. The flipped learning-based quit smoking intervention education program was developed to help nursing students implement the intervention. Methods: This quasi-experimental study was conducted using a pretest-posttest design. A total of 52 nursing students, divided into experimental and control groups of 26 each, participated between November and December 2021. The experimental group was instructed in the flipped learning-based quit smoking intervention education program over six sessions. In accordance with flipped learning, each session was composed of pre-class, in-class, and post-class sections. Results: Compared to the control group, the experimental group showed improved beliefs about the health benefits of quitting smoking, as well as positive attitudes and self-efficacy from the quit smoking intervention. The experimental group experienced the greatest increase in student-centered activities and student participation through flipped learning. Conclusion These results indicate that the flipped learning method was effective in quit smoking intervention education for nursing students. Therefore, it is worthwhile to consider that a quit smoking intervention education program based on flipped learning be included in the regular nursing curriculum.

OBJECTIVES: A group therapy includes various types: group psychotherapy, psychodrama, activity therapy including occupational therapy as well as recreation therapy, art therapy of drawing, music, dancing and drama. It has long been in use for in-patients, and became more trendy at day hospitals and community mental health centers after the enactment of a mental health law. It was surprising that a few researches have been made in the field, including a basic fact finding and that a few Korean psychiatrists have been inclined toward it. Meanwhile, we finished a research work on: how a group therapy has been conducted so far, its current status across the country, possibly the best way to heal, and deal with, psychiatric patients. METHODS: The 1997 annual report by Korean Neuropsychiatric Association, has been available for random sampling in the following categories: training hospital, general hospital, psychiatric hospital, clinic with admissions, clinic without admissions, day hospital, community mental health center. Telephone polls were conducted on contents of frequency and status of a group therapy available with psychodrama, main therapists, co-therapists, duration & times of therapy, size of group therapy recipients etc. RESULTS: The group therapy is broken down into the order of percentage; Art therapy(30.9%), Activity therapy(28.4%), Group psychotherapy(27.2%), Others(24.1%), Large group therapy(23.2%), with the psychodrama(10.9) least of all. Against in-patients(61.6%), the group psychotherapy shows its greatest diagnosis for a combined gorup(51.4%), and finds its biggest type in a general group(83.2%), Against in-patients(65.3%), the psychodrama diagnosis is mostly conducted for a combined group (69.4%). For a main therapist, the group psychotherapy is taken care of by boardmen(31.1%), and social workers(29.5%), while psychodrama by psychiatric boardmen(36.1%), and social workers(36.1%). On the other hand, for a co-therapist, the group psychotherapy is done by nurse(40.8%), while psychodrama by social workers(25.9%), and volunteers(23.5%). At a time most group psychotherapies takes some 60 minutes, psychodrama 120 minutes. Group therapies take place each once a week. Its participation amounts to 26.0(+/-17.8) for a psychodrama, and to 11.0(+/-5.8) for a group psychotherapy. Clinics with admission rooms(83.6%), exceedingly enjoy more group therapy than ones without (2.2%). CONCLUSION: The group therapy is run at most hospitals as the main part of a psychiatric treatment. However, the job has been undertaken on a small scale by outpatient clinics as well as psychiatric boardmen. Therefore, more attention is urged toward a group therapy, its professional training, plus its more brisk business at outpatient clinics.
Ambulatory Care Facilities ; Art Therapy ; Commerce ; Community Mental Health Centers ; Dancing ; Diagnosis ; Drama ; Hand ; Hospitals, Community ; Hospitals, General ; Hospitals, Psychiatric ; Humans ; Jurisprudence ; Korea* ; Mental Health ; Music ; Occupational Therapy ; Psychiatry ; Psychodrama ; Psychotherapy ; Psychotherapy, Group* ; Recreation Therapy ; Telephone

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.