Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience

Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

Introduction: Flooding has become a major natural disaster in Malaysia in recent decades. There may be a gender difference in many aspects related to flood response and practice. This study aimed to examine the gender gap in knowledge, attitudes, and practice of flood preparedness in Malaysia. Method: This cross-sectional study was conducted among patients attending the primary care clinic at Universiti Sains Malaysia health campus, Kelantan. A validated questionnaire was used for data collection. Results: 328 subjects were recruited, 56.1% of them were females. The female respondents were younger than the males (36 vs. 41 years old). However, females have better knowledge, and practice on flood preparedness compared to male respondents. Among those, women were more aware of the local emergency plan than males (p=0.01). More female respondents kept their vaccination and personal medical records in a waterproof container or sealed plastic bag during past and future flood preparations (3-5 day supply of non-perishable food) than male respondents (p<0.05). In addition, with the practice of keeping a one-week supply of medication, and having their medical records in a waterproof container along with a first-aid kit (p=0.001). For future flood preparation, more women would filter the cloudy water through clean clothes for boiling (p=0.035). The determinants of good preparedness for future floods for female were older-age (p=0.001), blue-collar (p=0.043); whereas male were lower household income (p=0.014), being blue collar (0.014) and white collar (0.039) compared with student/retiree based on multivariate logistic regression. Conclusion: Our study reported that the determinants of good preparedness for future floods were older-age, blue-collar and having a lower-household income.

Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.

Introduction: The provision of a satisfactory service by community healthcare centres in China plays an important role in the prevention and control of communicable diseases, especially during the COVID-19 pandemic. However, there is a lack of study in this field. This study aimed to determine the level of patient satisfaction with primary healthcare services in China and its associated factors during the COVID-19 pandemic. Methods: This cross-sectional study was conducted at 10 primary healthcare clinics in Xi’an, China. The 18-Item Patient Satisfaction Questionnaire was used for data evaluation and SPSS version 23.0 for data analysis. Results: A total of 315 patients were recruited. The overall patient satisfaction score was 26.1±3.1. In the multiple linear regression analysis, the highly educated patients had a higher patient satisfaction score than the low-educated patients (β=1.138, 95% confidence interval=0.135–2.141, P=0.026). Conclusion The overall patient satisfaction level of the patients who attended community healthcare centres in Xi’an was high. The patients with a higher educational level showed a higher patient satisfaction level than did those with a lower educational level.
Community Health Services ; Patient Satisfaction ; China ; COVID-19

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

This case report illustrates how a primary care physician managed a 60-year-old woman with severe obesity, uncontrolled diabetes mellitus, and low self-esteem for many years. Through a primary care physician, bariatric surgery is recommended for patients with severe obesity, which is then co-managed in a tertiary hospital through a multidisciplinary team. Primary care physicians are on the front lines when treating patients with severe obesity. A number of studies have shown that primary care physicians have low success rates in counselling and managing patients with severe obesity.(1,2) There is also a debate about bariatric surgery being unsuitable for the elderly age. It is crucial to intervene early to prevent obesity progression and its complications. Clinical inertia is one factor that hinders patients with severe obesity. Therefore, it is essential to address the problem of severe obesity early and should not miss the opportunity to counsel the treatment options and refer these patients to bariatric surgery if indicated. Primary care physicians are also crucial in providing continuity of care after bariatric surgery.

Introduction: This study aimed to determine the prevalence and factors associated with female sexual dysfunction in an outpatient clinic in Malaysia. Methods: The study was conducted among female patients aged 50 years and older who attended the outpatient clinic of a public hospital in Malaysia. A self-administered questionnaire was used that was based on the Malay version of the Female Sexual Function Index questionnaire. The predictors of female sexual dysfunction were identified using multivariate logistic regression analysis. Results: A total of 263 females were recruited in this study, with a mean age of 60.6 ± 6.7 years. The distribution of the respondents’ ethnicities was mostly Malay (42.2%), followed by Chinese (41.8%) and Indian (16.0%). The prevalence of female sexual dysfunction among participants was 68.8%. The prevalence of the subscales of female sexual dysfunction was as follows: desire (85.2%), satisfaction (74.9%), arousal (71.1%), lubrication (66.9%), pain (61.2%), and orgasm (60.8%). According to multivariate logistic regression, patients of Indian ethnicity had an increased risk of female sexual dysfunction (OR=16.60, 95% CI=2.54–108.63), and a higher frequency of sexual intercourse was correlated with a lower risk of female sexual dysfunction (OR=0.13, 95% CI=0.08–0.24). Conclusion Seven-tenths of the middle-aged female patients attending the outpatient clinic suffered from female sexual dysfunction. Indian ethnicity and having a lower frequency of sexual intercourse were predictors of female sexual dysfunction. Future intervention studies are needed to address this problem.
Prevalence ; Sexual Dysfunction, Physiological ; Women ; Ambulatory Care Facilities ; Middle Aged

Introduction: Psychological distress worsens the control of hypertension. This study aims to fill the knowledge gap and evaluate the prevalence and factors associated with depression, anxiety, and stress among patients with hypertension in a primary care clinic. Methods: A cross-sectional study was conducted at Klinik Kesihatan Bandar Jerantut on hypertensive patients using a systematic random sampling method. Data were collected from 391 hypertensive patients using a self-administered questionnaire. Multiple logistic regression analysis was performed to identify the associated factors. Results: The response rate was 99.5% (389/391). The mean age of respondents was 60.1 years and 44.7% were male. The prevalence of psychological distress was the highest at 28.8%, followed by anxiety (21.3%), depressive (16.2%), and stress symptoms (13.9%). Uncontrolled blood pressure was significantly associated with depressive (OR: 6.4; 95% CI: 3.32–12.28), anxiety (OR: 4.9; 95% CI: 2.75–8.82), and stress symptoms (OR: 6.3; 95% CI: 3.06–12.98). Worry about the complications of hypertension was significantly associated with depressive (OR: 4.5; 95% CI: 2.08–9.94), anxiety (OR: 10.8; 95% CI: 4.15–28.17), and stress symptoms (OR: 5.3; 95% CI: 2.14–13.22). Other associated factors were physical inactivity, employment, lack of formal education, and low household income. Conclusion A quarter of hypertensive patients experienced psychological distress in terms of depressive, anxiety, or stress symptoms. We recommend screening for psychological distress among high-risk hypertensive patients, especially those cannot achieve adequate blood pressure control or those who are worried about the complications of hypertension.
Anxiety ; Depression ; Hypertension ; Prevalence ; Primary Health Care

Introduction: Non-adherence to antihypertensive medications is a leading cause of uncontrolled hypertension and its complications. However, data on the factors associated with non-adherence to antihypertensive medications in the communities of Sarawak, Malaysia, are limited. This study aimed to examine the prevalence and determinants of medication non-adherence among patients with uncontrolled hypertension. Methods: A cross-sectional study was conducted using the systematic sampling method in four government primary healthcare clinics in Sarawak. A self-administered questionnaire was used to obtain socio-demographic data and evaluate non-adherence. Blood pressure was measured, and relevant clinical variables were collected from medical records. Multivariate logistic regression was used to determine the determinants of medication non-adherence. Results: A total of 488 patients with uncontrolled hypertension were enrolled in this study. The prevalence of medication non-adherence was 39.3%. There were four predictors of medication non-adherence among the patients with uncontrolled hypertension: tertiary educational level (odds ratio [OR]=4.21, 95% confidence interval [CI]=1.67–10.61, P=0.010), complementary alternative medication (OR=2.03, 95% CI=1.12–3.69, P=0.020), non-usage of calcium channel blockers (OR=1.57, 95% CI=1.02–2.41, P=0.039) and 1 mmHg increase in the systolic blood pressure (OR=1.03, 95% CI=1.00–1.05, P=0.006). Conclusion Because of the high prevalence of medication non-adherence among patients with uncontrolled hypertension, primary care physicians should be more vigilant in identifying those at risk of being non-adherent. Early intervention should be conducted to address non-adherence for blood pressure control.
Patient Compliance ; Hypertension ; Primary Health Care ; Malaysia